Medicaid expansion on SD’s Nov. 8 election ballot

BROOKINGS — Expanding Medicaid in South Dakota is either a prudent use of tax dollars designed to enhance health care coverage or a disaster that will bust the state budget. Those are the arguments offered by backers and opponents of Amendment D, a measure that would expand access to Medicaid in the state.  

Funded by the state and the federal governments, Medicaid provides medical coverage for low-income people. Amendment D expands Medicaid benefits to any person age 18 or under 65 whose income is at or below 133% of the federal poverty level. Amendment D is on the Nov. 8 general election ballot. Early voting begins Friday, Sept. 23.  

Tax dollars South Dakotans already pay into the federal government would be funneled back to the state if the expansion is approved, according to Zach Marcus of South Dakotans Decide Healthcare, a group that is advocating for the passage of the amendment. 

“It’s important to keep in mind that this is about keeping our tax dollars here in South Dakota for use by working South Dakotans to access affordable care,” Marcus said. “That’s what this is about.” 

Medicaid expansion has been approved in 38 other states, and not always with the best results according to John Wiik who is leading the opposition to Amendment D. The Republican state senator from Big Stone City said states consistently fail to predict the usage of Medicaid expansion, leading to budget shortfalls.  

“Every one of our neighboring states, they underestimated utilization,” Wiik said, predicting that passage of Amendment D would lead to state budget cuts by fiscal year 2026 or 2027 just like the state had to do in 2010. “I don’t remember that being particularly popular with people.” 

Wiik’s also concerned about writing a federal program—Medicaid— into the state constitution.  

“If expanding Medicaid is really the goal,” Wiik said, “we can do it under law. I really don’t want it in the constitution. It’s not something that’s going to stand the test of time like our constitution has done.” 

Expanding Medicaid through a constitutional amendment rather than an initiated measure ensures that the Legislature won’t be able to tinker with the program once voters have approved it, Marcus said.  

“I think it’s always important to keep in mind that fundamentally things that are placed in state statute can change,” Marcus said. “The purpose of a constitutional amendment is to ensure that South Dakota voters get what they vote for.” 

South Dakota already has a good system, Wiik said, where Medicaid recipients get prompt, quality care. The state estimates an increase of 42,500 recipients if Medicaid is expanded.  

“I can’t guarantee that we have enough providers to keep up with the level and quality of service we are able to provide to those who desperately need it right now,” Wiik said.  

An expanded program, according to Wiik, would mean that people on the Affordable Care Act’s silver plan and others who use a Farm Bureau insurance plan could lose that coverage and be forced on to Medicaid. 

“We’re taking health care away from people that have coverage that they like and works for them,” Wiik said. “I don’t think that’s ever a good idea.” 

Marcus counters that any changes would result in savings for the state without a loss of coverage for individuals. “It would be more efficient and cheaper for the state in the long run, which is part of the savings, to have all those programs consolidate through Medicaid,” Marcus said. “There are certain programs that would change, but nobody is losing health care as a result.” 

In their “pro” argument in the Secretary of State’s 2022 Ballot Question brochure, Amendment D backers say Medicaid expansion would be good for the health of citizens as well as the state’s economy. They cite one economic study that forecasts $3.5 billion in new economic output by 2025 with $800 million of that generated in 2023. 

The amendment backers also make a case for expanded Medicaid coverage strengthening rural hospitals and clinics. Wiik doesn’t see it that way. 

“If you look at the statistics, the rural hospitals and smallest hospitals close faster once states have expanded Medicaid,” Wiik said. “It puts more of a burden on the hospitals because everything is a fixed rate from the government.” 

Marcus sees Medicaid expansion as a way for workers in rural areas to set their sights on better jobs without the fear of losing their health care coverage.  

“Folks being able to access health care while they’re working multiple jobs and trying to make ends meet gives them confidence to be able to go out and improve themselves,” Marcus said, “seek that promotion rather than worrying about whether you can afford to risk your health.”