South Dakota health groups push Medicaid expansion as ‘deal’

SIOUX FALLS, S.D. (AP) — A campaign group backed by South Dakota’s major health care systems announced Wednesday that it will begin gathering petition signatures for a ballot measure to expand Medicaid to provide health coverage for low-income people.

Medicaid expansion is shaping up to be a major question facing voters next year with much of the debate so far centering around the financial costs and benefits of the program. Two separate groups are launching ballot-measure campaigns for the November 2022 election, while top Republican lawmakers are pushing voters to install into the state constitution a higher vote threshold for Medicaid expansion.

South Dakota is one of 12 states that have not expanded health care coverage to more low-income adults under a key provision of the Affordable Care Act, the health care law championed by former President Barack Obama. But even as the federal government has tried to entice those states with financial incentives, key Republican lawmakers have indicated they have no plans to give up resisting Medicaid expansion. In South Dakota, proponents for expansion are trying to circumvent the Legislature by passing a law through the ballot.

South Dakotans Decide Healthcare, a group backed by the state’s major health care organizations, said it has received a required fiscal analysis from the Legislative Research Council and will start collecting petition signatures. The group made it clear it will be making a financial argument to voters, touting in a statement that the state would receive $1.3 billion in federal funding over five years for expansion. The state’s share over that time would be $166.2 million, but would also result in $162.5 million in savings, according to the Legislature’s researchers.

“This is a good deal, plain and simple, and I have a lot of faith that the voters in this state will agree,” said Tim Rave, the head of the South Dakota Association of Healthcare Organizations, in a statement.

The proposal would make Medicaid available to people who live below 133% of the federal poverty level, which is currently about $17,000 annually for an individual or $35,000 for a family of four. About 42,500 South Dakota residents would qualify for Medicaid under the proposal.

Dakotans for Health, which has touted itself as a “grassroots” effort, has also been gathering signatures for a separate ballot measure that aims to do the same thing. The group is led by Rick Weiland, a former Democratic Senate candidate.

Both campaigns need to gather and certify nearly 17,000 signatures to get their proposals on the November 2022 ballot.

However, before that election, the campaigns will face a challenge in the June primary next year. Republicans in the Legislature have proposed an amendment to the state constitution that would place a 60% vote threshold on ballot initiatives that raise taxes or spend more than $10 million within five years of enactment, such as the Medicaid expansion proposals.

That constitutional amendment is subject to voter approval, but top Republican lawmakers, with an eye on Medicaid expansion, maneuvered to place it on the primary ballot, even though fewer voters will likely decide on it.

Two Republican legislative leaders — Sen. Lee Schoenbeck and Rep. Jon Hansen — are planning to financially back the push to pass the constitutional amendment. The two lawmakers last week filed paperwork to form a campaign committee called South Dakotans Against Higher Taxes, writing the purpose of the group is to “oppose higher taxes and big government spending and support measures that keep our taxes low.”

Stephen Groves
Stephen Groves
Stephen covers Congress in Washington.