Medicaid Expansion Wins In Red State South Dakota

Voters in Republican-leaning South Dakota Tuesday approved a ballot measure to extend Medicaid benefits to more than 40,000 low-income adults.

The vote by a wide margin of South Dakotans to expand Medicaid health insurance for low-income Americans under the Affordable Care Act is a political blow to Republican Gov. Kristi Noem, who opposed the ballot initiative. It’s also a setback for Republicans generally given their past unsuccessful efforts with Donald Trump to try to repeal the health law, also known as Obamacare.

The Medicaid expansion measure known in South Dakota as “Constitutional Amendment D” had 55% support compared to 45% opposed with more than 80% of precincts reporting by early Wednesday morning, media outlets and state figures showed.

“South Dakotans know their families and neighbors deserve health care without going into debt or avoiding check-ups, procedures, and medication they need,” Kelly Hall, the executive director of the Fairness Project, which worked with the ballot initiative’s supporters in South Dakota and has helped other states win Medicaid expansion.. “Citizens took matters into their own hands to pass Medicaid expansion via ballot measure — showing us once again that if politicians won’t do their job, their constituents will step up and do it for them.”

The passage of the ballot measure 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.

With the initiative’s passage in South Dakota, there will now be just 11 states yet to expand Medicaid under the Affordable Care Act, according to the latest tally from the Kaiser Family Foundation.

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. The Fairness Project estimates passage of the ballot measure in South Dakota alone would “keep $328 million of (federal) tax dollars in-state each year.”

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.

South Dakota’s now voter-approved Amendment D “will direct the state to expand Medicaid next year to any person aged 18 to 65 with an income up to 133% of the federal poverty level — about $19,000/year for an individual or $39,000/year for a family of four,” the Fairness Project said in a press release issued last week.

“Since day one, our partners at the Fairness Project have been deeply invested in the effort to finally expand Medicaid for South Dakotans, and this win would not have been possible without them,” said Zach Marcus from South Dakotans Decide Healthcare. “The Fairness Project’s ability to build unconventional coalitions, and their strategic advice, financial support, and dedication to expanding health care access to working people were critical to our success. Now, tens of thousands more families in South Dakota will have access to life-saving health care due to this crucial campaign and the work of the Fairness Project.”