Mel’s Musings: Amendment F gets an “F”

I’m sure people get tired of me reciting my background but be fair. I have no idea who is reading this and where they are. These “Mel’s Musings” are posted on Mitchell Now and available on the worldwide web. I don’t know if it is one of my lifelong friends reading this or if a stranger half a world away is stumbling across my ramblings for the first time, so that’s why….I was elected to the State Legislature in the fall of 1992 and served twelve years. I served four terms, eight years, in the State Senate (1993-2000) and two terms, four years, in the State House (sessions 2001-2004). During my Senate time, the voters of South Dakota passed an initiated measure to start school after Labor Day. You’re thinking, “I thought this was about Amendment F?”, bear with me…
The voters decided to start school after Labor Day because districts like Mitchell were starting in August. My first year in Mitchell (school year 1982-83) I was the Head Tennis Coach, and the first sanctioned day of practice was August 1st, in-service was early the next week, and we were in school with kids sweltering in their desks (no air conditioning in those days) by August 12th or so. The kids in 4H went up to the State Fair to show animals etc. and they missed nearly a week of school. In Mitchell, as well as in other school districts, that was an “unexcused” absence with academic consequences. Rural folks especially were outraged, hence the ballot measure to start school after Labor Day, once the State Fair was over.
Immediately after the initiative passed, the Legislature had bills to undo it. That’s not hyperbole, that’s a fact. Now, it took something like six solid years in a row to undo the will of the People, but their will was undone and now we’re back to starting school in the dog days of August. There are other examples of law makers trying to undo the will of the voters, just ask any pro-legalization of marijuana proponent.
In 2022, the people of South Dakota voted to expand Medicaid WITHOUT work requirements. That was a specific choice. It was a deliberate choice. It was not an oversight or a mistake. Medicaid eligibility was expanded to 133% of poverty. Folks in South Dakota did that for good and sound reasons.
First, we are a compassionate people and most of us recognize that poverty can be only one accident, serious disease or major mishap away for any of us.
Second, it’s awfully hard to work when you’re sick and Medicaid is about health insurance for the statutorily poor. The whole point of insurance is to provide care for when you’re sick so you can recover WITHOUT working.
Third, the voters of South Dakota recognize the work ethic in their fellow citizens. In the latest unemployment figures, South Dakota has the lowest unemployment rate in the country at 2%. That translates into about 9,800 people currently out of work statewide. Mitchell has an unemployment rate of 1.7%. The two biggest groups that use Medicaid are those under 18, who by and large can’t work anyway for obvious reasons, as well as the very old being supported in assisted living and nursing homes by Medicaid, once their private funds run out. Those elderly folks won’t be rejoining the workforce any time soon either.
Fourth, not everyone eligible for Medicaid even signs up for it. The proponents of Amendment F are slyly suggesting with this amendment that there are freeloaders coasting on the system. As I mentioned, our unemployment rate belies that assumption. When Medicaid was expanded in 2022, it made roughly another 60,000 South Dakotan’s eligible for the program. Two years later, only about half of those eligible have signed up. We’re a proud people and apparently, there are no freeloaders here. The assumption of the proponents that there are those of us who are just waiting for a chance to suck at the public teat at taxpayers’ expense is demeaning and insulting.
The proponents will say that other social programs in South Dakota have work requirements, food stamps (it’s got a fancier name these days) for example and they’d be right. However, Medicaid is a health program. To have a work requirement for a health program seems like a Catch-22. It’s like the old saw about banks, “Banks will loan you money when you can prove you don’t need to borrow it.” With Amendment F you can have health coverage as long as you’re working and don’t need it, right up to the point when you can’t work because you’re sick and that’s when you need health coverage but because you’re not working because now you’re sick…oops, sorry – no medical coverage for you.
How does a pregnant woman on bed rest, keep working to qualify for expanded Medicaid coverage? How does a person laid low with pneumonia continue working to keep their coverage? The vast majority of jobs in South Dakota have no paid sick leave. When you are off work, you’re not making money and now the proponents of Amendment F want to take away your health coverage at that very moment you need it most. God forbid you get cancer and need to have chemotherapy. The proponents of Amendment F say to that chemo patient, “Get up off your lazy ass and go to work or we’ll take your health coverage away!”
Amendment F offends me.
Amendment F offends me on so many levels.
First, it is a denial of the will of the voters. I get times change and so do the attitudes of the citizenry, but we decided this very issue just two years ago. The same arguments were brought up then and voters soundly rejected them. Why are we back on this same horse with the same tired assumption that people are lazy freeloaders? South Dakota’s unemployment figures show people want to and are working. The fact that not everyone who is eligible for Medicaid even signs up for it is another sign that the system is not being abused. The vast majority of people on Medicaid would not be eligible to work – again, seniors and children who are excluded from work requirements by federal law – so why are we pursuing a policy who’s only purpose can be to deliberately deny sick people coverage when they need it most?
Second, this has been tried in Arkansas. No other state in the country has work requirements for an expanded Medicaid program. Georgia has it for traditional Medicaid but since the major caseload is the elderly and children, with the rest of the Georgia Medicaid population already working by and large, it tends to be a moot point.
Arkansas’ program cost taxpayers an extra $26 million to administer. It set up burdensome requirements for those on Medicaid and the businesses that hired them to “prove” they were employed and continued to be employed. It threw 18,000 people off the Medicaid roles unjustly leading to medical bankruptcies and increased costs for counties for indigent care. A judge pulled the plug on Arkansas’ work requirements and ended their experiment forcing sick people to work so they could qualify for Medicaid.
Third, there’s no reason to think South Dakota work requirements would be any more successful than Arkansas’ were. What documentation would businesses have to provide to the State in order to prove someone is employed and how often? After all, the proponents of Amendment F don’t trust people to work now – despite all the evidence to the contrary – so how often would businesses have to report, weekly perhaps? Since Medicaid is a health program, would federal privacy requirements (HIPAA) apply meaning employers couldn’t know who was on Medicaid so, as a bureaucratic result, they would have to constantly provide employment data to the state for every person on their payroll in order to comply with Medicaid work requirements on the off chance that one of their employees was enrolled in the program? I don’t know and I suspect the proponents of Amendment F don’t know either. What would those bureaucratic requirements do to the incentive to hire people on the economic margins for jobs? Would these work requirements actually dissuade employers from hiring people who otherwise would be eligible for Medicaid due to the hassle of the compliance paperwork for employers? How would the self-employed prove they’re working? How many more state employees would be required? With only 2% unemployment, is the paperwork, bureaucracy, cost to the taxpayer etc. worth it?
Fourth, there is a case to be made that being unemployed in Sioux Falls is significantly different than being unemployed down in Pine Ridge or up in Buffalo in the western part of the state. What if you want to work but there is literally nothing available? South Dakota is vastly different, depending where in the state you actually live.
Fifth, there seems to be the assumption on the part of the proponents of Amendment F that denying people Medicaid coverage will “save” money. That’s patently not true. Counties have indigent health expenses. Hospitals and clinics routinely write off costs they can’t collect from the indigent and then pass it along to the rest of us in the form of higher fees with the resultant increased health insurance premiums for those who have insurance. People without Medicaid coverage will obtain medical care and the rest of us will end up paying for it in any case, one way or another.
Amendment F is offensive on so many levels. The voters spoke, loudly, decisively and they thought definitively two years ago. Amendment F should be defeated, as should anyone seeking office who is defiantly defying the will of the State’s voters by pushing for its passage.