PIERRE - Governor Daugaard has joined a number of other Republican governors in refusing certain elements of the Affordable Care Act, also known as Obamacare.

First, he opted not to set up a state healthcare exchange, which could result in lost cost savings, but is mostly harmless as eligible South Dakotans will simply be moved to the national exchange. Much more concerning is the decision to reject federal funds to expand Medicaid, as the ramifications will likely prove quite costly.

The US Supreme Court decision that upheld the general constitutionality of Obamacare, struck down the provision that required states to expand Medicaid provision to families earning up to 138% of the federal poverty level. By leaving the expansion of Medicaid to the states, the plan to ensure that everyone has health insurance is jeopardized.

The Governor’s decision effectively creates a donut hole in the coverage plan through which many low income earners will fall by making too much to qualify for existing Medicaid, but not enough to qualify for the exchange. This is estimated to impact about 48,000 South Dakotans, who are currently uninsured.

The reasoning cited by Governor Daugaard in rebuffing the plan is skepticism that promised federal funding to pay for the expansion will not materialize. As currently formulated, 100% of the cost of the expansion is paid for by the federal government until 2017, at which time it begins to step down until 2020. From that point forward 90% of the cost will be covered by federal funds.

Obviously anything can happen in politics, and these funding levels could be changed in either direction, but the potential that this might someday occur seems like scant reason to deny needy people healthcare today.

Turning down federal money to expand Medicaid will have serious consequences for South Dakota. Uninsured people who are ill and do not seek treatment are much more likely to have their health negatively impact their presence and performance at work, setting up personal catastrophes and lessening the state’s economic performance overall.
Furthermore, the uninsured, especially when they are also struggling financially, often delay getting routine and preventative medical care that results in them showing up at the emergency room when it might already be too late, and certainly will be more costly, to treat their conditions. If they survive, many of these bills will go unpaid, which results in health care providers pushing the cost onto other patients in order to recoup their losses, which is part of the reason why healthcare is so costly in the first place.

Governor Daugaard has punted the issue of the healthcare gap to the legislature. Hopefully, they will see the bigger picture and be motivated by a desire to enhance the quality of life and reduce healthcare costs to all South Dakotans.

For some of our neighbors this is really a matter of life and death, and they deserve better than to have their fates tied to a purely political effort to try to sabotage Obamacare for partisan gain.

The opinions expressed in this commentary are solely those of John Gossman and do not necessarily reflect the opinions of this radio station, Results Radio or Townsquare Media.