South Dakota votes to expand Medicaid

South Dakota voters on Tuesday approved a measure to expand the state’s Medicaid program under the Affordable Care Act.

The program, which takes effect in July and is expected to cover more than 40,000 people, passed with about 56 percent support.

The Republican-controlled state, where lawmakers have long resisted Medicaid expansion, is the seventh in the last five years to do so at the ballot box — and likely the last to do so for some time.

“We are thrilled by this victory, which took years of work, coalition building, and organizing to achieve,” said Kelly Hall, executive director of the Fairness Project, which helped pass the ballot measure. “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.”

Opponents of Medicaid expansion tried to make passage of the ballot measure more difficult through a June initiative, Amendment C, that would have raised the voter approval threshold to 60 percent. That measure was overwhelmingly defeated.

Under the American Rescue Plan, the federal government encouraged states to expand Medicaid by covering an extra 5 percent of the costs of the program, in addition to the 90 percent it covers for newly eligible individuals under Obamacare.

The Kaiser Family Foundation estimates those incentives will send $110 million to South Dakota.

Opponents of Medicaid expansion, including Republican Gov. Kristi Noem, argued the measure would cost the state in the long run, force lawmakers to raise taxes, and discourage able-bodied adults from getting jobs. Proponents, meanwhile, pointed to the program’s success in the 38 other states that have implemented it over the last decade.

More than 17 million low-income Americans have gained coverage as a result of Medicaid expansion, a portion of the Affordable Care Act that was made optional as a result of a 2012 Supreme Court decision.

The South Dakota vote signals the end of an era for expanding Medicaid ballot box. Of the 11 states that still have yet to expand Medicaid, only three — Florida, Mississippi and Wyoming — have a voter-initiated ballot measure process, and none appear likely to take up the proposal in the short term.

In Florida, a 60 percent voter approval threshold makes passing ballot measures challenging. In Mississippi, the state Supreme Court effectively threw out the state’s ballot initiative process. And in Wyoming, proponents are pushing to expand Medicaid through the legislative process rather than at the ballot box.

Supporters of the measure included the South Dakota State Medical Association, the Greater Sioux Falls Chamber of Commerce and the South Dakota Farmers Union.