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Woster: Amendment C is head bender that should be voted on in November

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The interview posted above is from SDPB's daily public affairs show, In the Moment with Lori Walsh.

When June 7th gets here, I’m going to go vote against Amendment C.

Or maybe I’ll do it before June 7th, during the state’s early voting period. Even with the slowdown in COVID cases, the early voting option makes pretty good sense.

On that, my problem is that I really like to go to my local polling place, the old brick hospital-turned-apartments building a few blocks away, to fill out my ballot. I like to check in with the poll workers there, too, and get an “I voted” sticker.

But wherever and whenever I vote in the primary, it’ll be a “no” on C for me.

Amendment C, which was placed on the ballot by the Republican supermajorities in the South Dakota House and Senate, would require that certain ballot measures get at least 60-percent approval by voters to become law, instead of the now-required simple majority.

Those measures would include any that increase taxes or fees or appropriate $10 million in any of the first five years the law is in effect. The amendment is aimed at efforts to expand Medicaid in South Dakota, an issue that has already been placed on the November general election ballot through a petition drive by supporters.

In 2021, the state Legislature passed the joint resolution that became Amendment C. Typically, that would put the issue on the next general election ballot in November. This coming November.

But state Senate leader Lee Schoenbeck of Watertown had the resolution written so that it was on this year’s primary ballot instead.

That’s the first reason I’m voting “no” on Amendment C. It shouldn’t be on the primary ballot. It should be on the general-election ballot, as ballot measures usually are. There’s a good reason for that, too: turnout.

Voter turnout for general elections is two or three times what the turnout is for June primaries. In 2020, for example, voter turnout statewide for the June primary election was 28 percent, while the turnout for the general election the following November was 74 percent. In 2018 and 2016, the turnout was 27 percent and 22 percent for the primary elections and 65 percent and 70 percent for the general elections.

Especially on an issue this big, the decision should be made by as many South Dakotans as possible, in the general election.

Senate leader opposed to “more welfare” through Medicaid expansion

In addition to the turnout question, there is the issue of who turns out. The dominant Republican party often has important primary races between GOP candidates. The depleted Democratic Party seldom does. So there’s more motivation for Republican voters to turn out for the primary.

Also, independent voters are allowed to vote in Democratic primary races, but not in Republican primaries. So, with few Democratic primary races, there’s less motivation for independents to turn out.

That’s likely another edge for Republicans.

Opponents of Amendment C have charged Schoenbeck and other Republicans with putting the amendment on the June primary in order to to take advantage of those factors and lower voter turnout overall.

Beyond political parties, lower voter turnout in primaries likely gives the advantage to the most committed voters — the ones certain to turn out to vote — on a ballot issue. Those voters might or might not represent the feelings or beliefs of the larger state citizenry.

You can say, “Well, if those other people don’t show up in June, they get what they deserve, or don’t get it.”

That’s true, kind of. But people outside the feverish advocates on either side are busy. They’re distracted, with life. And they’re disconnected from politics much of the time. They tend to show up more often for the general because there are usually more issues and bigger candidates to choose from and because it’s the “Election Day” they know best.

That doesn’t mean they don’t have legitimate desires and needs. We should respect those desires and needs, and give them a chance to express them.

Schoenbeck denies that limiting turnout was his motivation. During a candidate forum in Watertown recently, Schoenbeck said — as reported on public radio by Lee Strubinger — that he had the proposed amendment placed on the June primary so that it would be in effect before citizens voted on Medicaid expansion this November.

That way, Medicaid expansion will need 60 percent to pass, rather than a simple majority.

“That’s why it’s on the primary ballot,” Schoenbeck said. ‘There’s no other reason.”

Schoenbeck said he doesn’t want “more welfare” through Medicaid expansion.

I’ve known Schoenbeck for quite a few years. We’ve hunted pheasants together many times and talk hunting and politics regularly. I like him. And I take him at his word on this. We just disagree.

The vote on Amendment C should still be in November, not next month. Opponents of Medicaid expansion had to know this ballot measure was coming. They had plenty of time to put this on the general-election ballot in previous years. The Medicaid expansion effort has been headed for the ballot for years, since back in the administration of Dennis Daugaard when he was being pushed to expand Medicaid.

Daugaard was cautiously open to Medicaid expansion, if ...

A conservative to his core, but one with a heart, Daugaard resisted the idea of Medicaid expansion. He feared that the windfall of federal dollars being offered through the Affordable Care Act (Obamacare) to states willing to expand Medicaid would eventually go away or be sharply reduced, leaving South Dakota government with a perpetual financial burden to carry.

But Daugaard was willing to consider expansion if in the process it could help or fix a vexing problem with Medicaid services to Native American people in the state. Native people who were qualified for Medicaid and used health-care services other than the Indian Health Service cost South Dakota millions of dollars a year, a cost that rightfully should have been a federal expense.

Daugaard eventually came around to an expansion plan after he and people on his staff worked with federal officials to shift more medical costs for treating Native Americans covered by Medicaid from the state to the feds. But before he was willing to take an expansion plan to the state Legislature, he wanted some assurance that state lawmakers would be willing to approve it.

Working with the Indian Health Service, in-state health-care providers, and tribal leaders, Daugaard’s team found a solution that allowed Natives who are treated at non-IHS facilities to be more easily referred there by IHS. In some cases, that included referrals after the Native patient showed up at the non-IHS facility.

That workaround saved the state $10 million to $20 million a year in healthcare costs for Native people that went back to the feds. Daugaard had significant support for the next step, expanding Medicaid coverage, in the state Senate. But he was well short of the votes needed for approval in the South Dakota House — where many good ideas go to die.

That last comment about the House might give you an idea of where I stand on Medicaid expansion. Far from “more welfare,” in my mind, it’s an investment in our state, its economy, its health-care system, and, especially, in the working poor who don’t get affordable health insurance at work and can’t afford to buy it on their own.

This is how a state shows its heart. But also its head. Because expansion makes sense.

Low-income families to benefit from healthcare coverage

The South Dakota Legislative Research Council estimates that more than 42,000 South Dakotans who are not now eligible for Medicaid coverage would be covered under the proposed expansion. The coverage would extend to individuals living at or below 133 percent of the federal poverty level. That’s about $18,000 for one person and about $37,000 for a family of four.

The LRC also estimates that South Dakota state government would have to pay about $20 million of the $300 million a year in annual costs for the expansion.

And in the beginning, the state would likely pay nothing. A COVID-relief package approved last year would provide $60 million for South Dakota for the initial expansion of Medicaid, likely covering the state’s share entirely for the first three years.

The federal dollars will boost hospitals, especially those in rural areas, with an infusion of funding and compensation, finally, for much of the uncompensated or partly compensated health care they provide and have provided for many years.

The additional people covered will mean access to prescriptions they couldn’t previously afford. It will mean more regular physical health care and treatment sooner before health problems worsen and become more serious, more costly, and possibly life-threatening.

It will mean psychiatric care and counseling services for people who need them but can’t afford them, again preventing problems from worsening and possibly reducing suicides and suicide attempts.

It will mean a healthier citizenry across the state, including and perhaps especially the Native American population, through better access to better care.

A Kaiser Family Foundation review of studies on Medicaid expansion through the Affordable Care Act from 2014 to 2020 showed profoundly positive increases in healthcare coverage and boosts in access to and use of healthcare services. It showed an increase in health-care insurance coverage, healthcare provider capacity, positive health outcomes, and, yes, positive benefits to state economies.

Healthier people cost society less. They are more productive. More productive people are good for employers, society, and for state and local economies.

Thirty- eight states have taken the federal funding and expanded Medicaid coverage. They include North Dakota, Montana, Nebraska, Iowa, and Minnesota. Wyoming is the only state adjoining South Dakota that didn’t expand Medicaid.

So far, none of the states that expanded Medicaid seems to be rolling over financially because of it. If anything, the opposite seems to be true. They are benefiting.

So, yeah, I think expanding Medicaid is the right thing to do and the smart thing to do.

But if Amendment C passes in June, it’ll be a challenge getting 60 percent approval for Medicaid expansion in November.

So how about that 60 percent threshold? I have issues with that, too, as I expressed, and not just because the vote is in June.

Then there’s the issue of whether to trust citizens

On the issue itself, I guess it comes down to whether legislators and our governor believe in the state’s long history of promoting direct citizen involvement in governance through ballot issues. Those ballot issues involve initiated measures or proposed constitutional amendments placed on the statewide general-election ballot through citizen petition drives. They also involve using similar citizen petition drives to refer laws passed by the Legislature to a public vote.

The foundation of that process is a majority vote at the ballot box, not a super-majority vote, as is being proposed.

Do we really want to make that citizen’s process more difficult? For people like you and me? Even if it’s only for tax-and-spend measures?

It seems like most of the legislators we send to Pierre these days, and the current governor, are just fine with making the people’s process more difficult. Apparently, they question whether we as unelected citizens are capable of decision-making for ourselves on crucial issues.

Part of it is probably a power thing. Republicans are accustomed to having such total dominance over state government that they find it hard to cede even limited control to citizen votes they can’t control. That’s especially true when they don’t like or agree with some of the outcomes, recent votes on medical and recreational marijuana being examples.

Supporters of Amendment C point to the fact that it takes a two-thirds vote of support by both houses of the state Legislature to approve a tax or fee increase. And that makes pretty good sense to me. So the argument is that similar higher standards should be applied to proposals to increase taxes or fees brought to the ballot by citizens.

That’s an argument that we should debate individually, as a separate ballot issue with a vote in the general election.

The same goes for the provision in Amendment C that any measure that appropriates $10 million in any of the first five years requires 60 percent approval by voters.

That’s clearly aimed at Medicaid, and the money the state would have to provide to “match” the much-greater infusion of federal dollars.

Some argue, however, that the supermajority requirement could be taken beyond that. Get lawyers involved in parsing words and the law, and could the $10 million provision apply to undetermined costs in other changes in law brought to the ballot by citizens?

Probably not. But maybe. I’m not sure. It’s another issue that should be debated on its own and voted on separately in a general election. It should not be mixed in with placing higher voter standards to pass tax and fee increases and then stuck into the primary election.

All told, there’s a lot wrong with Amendment C, which is why it’ll be so easy for me to vote “no” sometime between now and when the polls close near the end of the day on June 7.

I think you should vote “no,” too, whenever you choose to do it.

Click here to access the archive of Woster's past work for SDPB.