Despite pushing the federal government to provide 100 percent of the cost for health care for American Indians, what South Dakota Gov. Daugaard has characterized as a longstanding treaty obligation, on Feb. 29 Daugaard ruled out Medicaid expansion during this legislative session.

Last week, two states rejected Medicaid expansion, another is continuing negotiations with Washington and one is studying whether and how to continue expansion already in place and reduce the numbers of people eligible. Currently 31 states and the District of Columbia have expanded income eligibility for Medicaid as provided for by the Affordable Care Act. Sixteen states remain firmly in the non-expansion column.

On Tuesday, Jan. 12, John Bel Edwards signed his first executive order as Louisiana’s new governor to expand Medicaid eligibility to an estimated 300,000 individuals. The expansion is to be effective no later than July 1, 2016 according to the order.

Louisiana becomes the 31st state (plus DC) to expand Medicaid income eligibility as permitted by the Affordable Care Act.

South Dakota Gov. Dennis Daugaard may find that the third time is the charm as he negotiates with the federal government to live up to its treaty obligations to provide health services to the state’s Native Americans. Twice before in recent state history, governors have tried and failed to solve the longstanding problem, which results in a massive cost shift to state revenues to pay for health care for many Native Americans. In his Dec. 8, 2015, budget address in Pierre, S.D., Daugaard proposed that should the federal government fulfill its obligation to provide health services to Native Americans, the state would use the projected $67 million annual savings to the state to finance the cost of Medicaid expansion.

No state can ignore the challenge of controlling the cost of health care, estimated to reach one-fifth of GDP by 2020. Medicaid budget growth continues to strain states’ abilities to grow program priorities in other arenas. The uncertainty of federal commitment to current Medicaid matching formulas is exacerbated by the 2016 election. Promising state strategies to control costs of health care generally and Medicaid specifically were explored.  

No state can ignore the challenge of controlling the cost of health care, estimated to reach one-fifth of GDP by 2020. Medicaid budget growth continues to strain states’ abilities to grow program priorities in other arenas. The uncertainty of federal commitment to current Medicaid matching formulas is exacerbated by the 2016 election. Promising state strategies to control costs of health care generally and Medicaid specifically were explored.

Medicare pays between $16,500 and $33,000 for hip or knee replacements depending upon the hospital and geographic area of the country, but with a new payment program Medicare expects to save $343 over the next five years.

On Nov. 16, 2015, the Centers for Medicare & Medicaid Services announced they would begin to make bundled payments for these surgeries in 800 hospitals in 67 geographic areas under a model program over the next five years.

The Kaiser Family Foundation released a report Oct. 13 with state by state estimates of the uninsured. Nationally, 32.3 million non-elderly persons are uninsured, but one half of that number is missing out on Medicaid or CHIP eligibility in...

Two sources of contemporaneous data available from reputable national research institutions provide evidence that the Affordable Care Act has realized its principal goal of increasing the rate of health insurance coverage in the United States. The rates of uninsured Americans between late 2013 and early 2015 have dropped from 18 percent to 11.9 percent, according to Gallup, and from 17.4 to 10.1 percent, according to the Urban Institute. Further, the Gallup data which also provide state-by-state statistics show that the states with the greatest uptake in health insurance were more likely to have increased Medicaid eligibility and to operate state-based health insurance exchanges

While the same-sex marriage and Affordable Care Act cases are the most significant of the U.S. Supreme Court’s 2014–15 term in general and specifically affecting states, other cases will significantly impact states too. The court will decide three tax cases, a Medicaid reimbursement case, two redistricting cases and a Fair Housing disparate impact case.

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