South Dakota Voters Reject GOP Effort Aimed At Derailing Medicaid Expansion

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[MM Curator Summary]: Legislators tried to position a ballot measure to require more clear legislative support for funding Medicaid expansion; voters shot it down 2 to 1.


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South Dakota voters June 7, 2022 rejected a measure that would have required certain ballot … [+] initiatives like Medicaid expansion to pass with 60% support instead of a simple majority. In this July 5, 2018 photo, volunteer Allie Christianson of Omaha, sorts late-arriving signed petitions to be added to petitions in boxes, rear, in Lincoln, Neb. to get a ballot measure to expand Medicaid in Nebraska on the November general-election ballot. The measure passed that November. (AP Photo/Nati Harnik)


South Dakota voters Tuesday overwhelmingly rejected a measure that would have required certain ballot initiatives like Medicaid expansion to pass with 60% support instead of a simple majority.

The overwhelming defeat of “Constitutional Amendment C” by a 2 to 1 margin in South Dakota comes ahead of a November referendum on expanding Medicaid health insurance for the poor in the state. With 88% of precincts reporting, the measure initiated by Republicans in the South Dakota state legislature had only 32% support with nearly 68% of South Dakota voters, or more than 110,000 voting “no” compared to less than 53,000 who supported the measure.

“Today, the people of South Dakota have preserved their right to use direct democracy,” said Kelly Hall, executive director of The Fairness Project, which campaigned against Amendment C and has helped several states expand Medicaid via voter referendums since 2017.

The Fairness Project said Amendment C was merely designed to make passage of Medicaid expansion in South Dakota more difficult. This November, the Medicaid expansion question on the ballot in South Dakota can be passed with a simple majority of votes as has already happened in six other states.

“This victory will benefit tens of thousands of South Dakotans who will choose to use the ballot measure process to increase access to health care for their families and neighbors, raise wages, and more policies that improve lives,” Hall said. “We look forward to what’s next in South Dakota: an aggressive campaign to expand Medicaid in the state.”

The campaign in South Dakota is the latest momentum to expand Medicaid coverage for the poor under the Affordable Care Act. In 2020, voters in Missouri and Oklahoma approved ballot initiatives to expand Medicaid, following the lead of successful ballot initiatives in 2018 in Nebraska, Idaho and Utah. Those states, like Maine in 2017, bypassed Republican governors and legislatures to expand Medicaid by public referendum.

South Dakota remains just one of only 12 states that has yet to expand Medicaid under the Affordable Care Act.

The expansion of Medicaid benefits under the ACA has come a long way since the U.S. Supreme Court in 2012 gave states a choice in the matter. There were initially only about 20 states that sided with President Barack Obama’s effort to expand the health insurance program for poor Americans.

The 12 holdout states including South Dakota that have yet to expand Medicaid have already missed out on generous federal funding of the Medicaid expansion under the ACA. From 2014 through 2016, the ACA’s Medicaid expansion population was funded 100% with federal dollars. The federal government still picked up 90% or more of Medicaid expansion through 2020 and that was a better deal than before the ACA, when Medicaid programs were funded via a much less generous split between state and federal tax dollars.

Last year, the U.S. Congress and the Biden administration gave states a new incentive to expand Medicaid under the ACA as part of the Covid-19 relief legislation known as The American Rescue Plan Act, which President Biden signed into law.

“In addition to the 90% federal matching funds available under the ACA for the expansion population, states also can receive a 5 percentage point increase in their regular federal matching rate for 2 years after expansion takes effect,” the Kaiser Family Foundation says in a 2021 analysis. “The additional incentive applies whenever a state newly expands Medicaid and does not expire. The new incentive is available to the 12 states that have not yet adopted the expansion as well as Missouri and Oklahoma.”


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