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South Dakota Medicaid expansion will be on November 2022 ballot

South Dakotans will vote on expanding Medicaid eligibility on the November ballot but might face a taller hurdle to approve it.

Constitutional Amendment D was validated after an estimated 38,244 people signed petitions to put in on the ballot, the Secretary of State announced Monday.

That's more than the 33,922 signatures needed for initiated amendments to make it onto the ballot.

Medicaid is a federal-state health insurance program for low-income people. South Dakota is one of 12 states that has not accepted federal incentives to expand Medicaid eligibility, according to the Kaiser Family Foundation.

Medicaid expansion has only failed once when put before voters, according to Health Affairs. Voters in Maine, Idaho, Utah, Nebraska, Oklahoma and Missouri approved expansion. Montanans rejected expansion — which would have been covered through a tobacco tax increase — but lawmakers later approved it.

Kaiser Family Foundation

The South Dakota amendment would expand Medicaid to people between 18 and 65 who earn 133% or less of the federal poverty level. The program would be made available to 42,500 additional South Dakotans in its first year, according to the non-partisan Legislative Research Council.

Studies show Medicaid expansion improves healthcare outcomes while producing economic benefits for recipients, healthcare systems and the overall economy.

But expansion supporters might face a new obstacle this year.

Areferred amendment on the June ballot says any future ballot question that raises taxes or spends at least $10 million — such as the Medicaid expansion question — must be approved by 60%, not 50%, of the voters. The Legislature put the question on the ballot for the public to vote on.

State Sen. Lee Schoenbeck has said he supported the amendment in hopes of making it harder to pass Medicaid expansion. Schoenbeck, R-Watertown, acknowledged that he "was motivated by the Medicaid expansion campaign, but argued the vote threshold should apply to all ballot initiatives that levy taxes or spend significant state funds,” according to the Associated Press.

Expansion supporters are concerned about voter turnout in the June election since it's a primary election without a presidential race. Just 26% of South Dakota voters participated in the June 2018 election compared to 65% in November.

Medicaid expansion will be the only constitutional amendment question on the November ballot. Supporters of initiated measures — which create laws — have until May 3 to submit petitions.

Arielle Zionts, rural health care correspondent, is based in South Dakota. She primarily covers South Dakota and its neighboring states and tribal nations. Arielle previously worked at South Dakota Public Broadcasting, where she reported on business and economic development.
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