Kristi Noem

So much relief’: South Dakota voters pass Medicaid expansion

On Tuesday, South Dakotans voted in favor of expanding Medicaid under the Affordable Health Care Act. This will provide healthcare access for tens of thousands of people who are poor and discredits any attempts by the state GOP to stop the effort.

The successful ballot initiative, which received 56% of the vote should ensure that the program is available to more than 40,000 people when it goes into effect in July. Many people wouldn’t have been able to access health care without it.

Sarah Houska is one of the most important residents of America. She had to quit her job, which provided health insurance, to care for her son, 5, who required intensive medical attention.

Houska, 29 years old, said that she still worries about her family’s stability if she gets sick.

Houska stated Wednesday that it was a great feeling and that there was so much relief. He also expressed pride in the state’s passing of this amendment. It wasn’t even close. “I wasn’t waiting with my nails for the vote to come in.

The ballot measure changed the state constitution to include Medicaid expansion to all adults earning up to 138% below the federal poverty level.

According to the Center on Budget and Policy Priorities (a progressive think tank), an adult with two children would have to earn less than $105,590 per year to be eligible for the public healthcare program. A family of three with a combined income of up to $31,780 is now eligible.

Eliot Fishman is the senior director for health policy at Families USA. He stated that Medicaid was not available in South Dakota for parents with almost any income. People who did not have income, such as those with severe health, mental, or substance abuse problems, were also not eligible.

Fishman stated that Medicaid coverage in a state such as South Dakota is crucial for those in manual labor, underpaid roles in the substantial agricultural sector, and the large uninsured population of Indian reservations.

Advocates formed a wide coalition, which included the state Chamber of Commerce and farming and ranching organizations, as well as first responders, to push for the passage of the measure. The process took more than two years because South Dakota advocates began the process in October 2020.

Zach Marcus, South Dakotans Decide Healthcare’s campaign manager, stated that while there were some nerves on Election Day, supporters were confident that voters would vote it through.

He said, “Fairly early in the night, it seemed quite probable that we would win, but it takes time for votes to be counted, and you never want to get ahead of yourself.”

For supporters, it was not an easy road. The opponents of expanding tried to stop the effort by pushing for their ballot measure that would have raised the voter approval threshold from 60% to 60%. The idea was rejected by South Dakotans in June.

Since 2012, when the Supreme Court ruled that the state’s participation in the Affordable Care Act was voluntary, Republican governors and legislatures have been resistant to expanding Medicaid. Progressive advocates from states such as Missouri, Oklahoma, and Nebraska used the ballot initiative process, to bypass partisan legislatures, and directly speak to voters.

The Fairness Project, a national organization that supports local activists in pushing for progressive policies through ballot initiatives, is called the Fairness Project. Kelly Hall, the executive director of the Fairness Project, stated that they began polling South Dakota over two years ago. The results were not as promising at first compared to efforts in Missouri and Oklahoma.

She said that South Dakota was the most difficult of the Medicaid expansion battles she’d taken on and that many things could have gone wrong.

Hall stated, however, there are still many things to do to make sure that the program is implemented by state leaders.

Despite the success of other measures, some Republican legislators have attempted to block funds from states that they don’t support. Missouri Republicans stopped funding last year after voters supported expanding. After an initiative was passed in Utah, Republicans in Utah cut expansion. Idaho GOP legislators tried to reverse the initiative vote.

Governor of South Dakota Kirsti Noem (a Republican who was overwhelmingly elected Tuesday to a fourth-year term) opposed expansion but said in a debate that she would not vote against the voters’ decision.

Noem’s office didn’t respond to my request for comment.

Houska stated that she hoped that Houska would enforce the law if it was what the people wanted.

Despite the success of the ballot measures to expand Medicaid nationally, South Dakota will likely be the last state where healthcare advocates can pursue such an initiative. Only Florida, Mississippi, and Wyoming are the only remaining states without a ballot initiative process to expand Medicaid.

There is some hope in Florida and Wyoming for expansion, but it is difficult in these states. In Mississippi, the Supreme Court has declared the state’s initiative process unconstitutional. The Legislature has yet to address it.

Hall stated that her organization will likely pursue other ballot measures to address issues related to health care, like the one passed in Arizona which set a ceiling on interest rates for medical debt. However, Medicaid expansion would not be the organization’s main focus.

Other states have the potential to approve expansion on their own. President Joe Biden made it more appealing by increasing federal matching funds through American Rescue Plan Act.

Robin Rudowitz is the Director of the Program on Medicaid & the Uninsured at Kaiser Family Foundation. He said that there are reasons to be optimistic.

“Wyoming was very close to passing their legislative session. The issue was also re-upped by the governors of Wisconsin and Kansas, who both continue to support expansion. She said that North Carolina is also experiencing ongoing debate over expansion. “So, there were some states that certainly restarted the discussions.”

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