South Dakota voters reject GOP effort to block Medicaid expansion

Voters in South Dakota on Tuesday overwhelmingly rejected a Republican-led attempt to make it more difficult to pass ballot initiatives in the state. In an effort to block an expansion of Medicaid coverage for low-income residents, Republican lawmakers had put an initiative on the ballot that, if approved, would have required that future ballot initiatives earn 60% of the vote to pass rather than a simple majority.

The measure came ahead of a November ballot initiative to expand Medicaid in South Dakota. Republican state Senate President Pro Tempore Lee Schoenbeck said in April that putting the measure on a primary ballot, an unusual approach to such initiatives, was intended to increase the vote threshold before the vote on the Medicaid expansion: “You know what, it doesn’t matter what ballot it’s on. It’s on the primary so we can get it in place as soon as possible, because those same people are pushing a welfare program on the November ballot. And you want this to apply to that vote as well.”

With more than 95% of precincts reporting, voters had rejected the GOP proposal by a margin of 67.4%-32.6%, according to the New York Times.

“Today, the people of South Dakota have preserved their right to use direct democracy,” Kelly Hall, the executive director of the Fairness Project, which campaigned against the measure, said in a statement. “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. We look forward to what’s next in South Dakota: an aggressive campaign to expand Medicaid in the state.”

South Dakota is one of 12 states that have not expanded Medicaid coverage under the Affordable Care Act more than a decade after the ACA became law.

The ACA offers states funding to expand health care coverage to those making 138% of the federal poverty level. In 2021 that was an income of $17,774 for an individual, according to the Kaiser Family Foundation.

Over the past few years, voters in a handful of Republican-run states overrode lawmakers by approving Medicaid expansion via ballot initiatives.

Voters in deep-red Utah, Idaho, and Oklahoma all expanded Medicaid coverage via ballot initiative. Voters in Missouri approved a ballot initiative to expand Medicaid in 2020, but the GOP-controlled legislature is now trying to reverse that expansion, which has provided health insurance coverage to more than 100,000 Missourians.

If voters in South Dakota approve the initiative on the ballot in November, 27,800 uninsured adults would gain health care coverage, according to Kaiser Health News. Many of those people are childless adults who are currently ineligible for Medicaid in South Dakota.

Democrats in the state celebrated the defeat of the ballot initiative on Tuesday.

“South Dakota voters know a bad deal when they see one. I’m glad common sense prevailed and this horrible measure was defeated,” tweeted state House Minority Leader Jamie Smith, who is running for governor against incumbent Republican Kristi Noem.

Federal lawmakers also hailed voters in the state for knocking down the GOP effort to make it more difficult to pass ballot initiatives.