On Election Day, South Dakota voters will decide whether to expand Medicaid coverage.
The move could extend health care benefits to an additional 42,500 low-income residents.
Critics worry the estimate of eligible residents is low and that expanded Medicaid could cost the state more than anticipated.
The fight over Medicaid coverage in South Dakota was defined early on by former Gov. Dennis Daugaard. In 2015, he announced intentions to expand the program.
During a speech before the state legislature, he said it bothered him that some families fell through the cracks.
“But we have to remember the single parent with three children,” Daugaard said during the 2015 budget address. “Between work and childcare, a parent in that situation sometimes can’t work enough hours to get insurance. They simply can’t pay for it. They can’t exceed the poverty line and they can’t get subsidized coverage. They just can’t insure themselves at all.”
Daugaard said the state budget could handle Medicaid expansion. He announced his intention to seek tribal and legislative support for the idea. Lawmakers did not agree.
South Dakota is one of 12 states that have not expanded Medicaid coverage. The Rushmore state has the second-highest uninsured rate among neighboring states. Wyoming’s is higher. It also has not expanded Medicaid.
Now, South Dakota voters could bypass the state’s Republican supermajority legislature.
Zach Marcus is a spokesperson with South Dakotans Decide Healthcare. That’s the group backing the ballot question. Marcus said South Dakota should keep some of the federal money that helps pay for Medicaid.
“Every year, $328 million of our taxes, that could be staying here in our economy providing healthcare for hardworking South Dakotans, is leaving our state to fund health care for 38 other states, like California and New York, that have already expanded Medicaid.”
There are currently 140,000 South Dakotans on Medicaid. Expansion would cover an additional 42,500 low-income residents who make too much to qualify, but too little to for federal subsidies to buy private insurance.
The Medicaid expansion deal has only sweetened since Daugaard’s time in office. The recent American Rescue Plan offers states additional federal money for two years after expansion takes effect.
However, critics worry the proposal will cost the state more than advertised.
Keith Moore is the state director for Americans for Prosperity—South Dakota. Moore said Medicaid expansion will add able-bodied and childless adults to the rolls.
“We think it’s unfair to the truly needy,” Moore said. “The program Medicaid itself, originally, was set up to serve low-income kids, seniors and people with disabilities—physical and mental disabilities. We just think people are going to be crowded out.”
If expanded, Moore said the state’s share of Medicaid payments will blow a hole in the budget.
Moore said other states have underestimated the number of new enrollees.
“They estimate 43,000 new enrollees for us, but in other state’s that’s doubled. Or nearly doubled,” Moore said.
When Montana expanded Medicaid in 2016, officials estimated 70,000 additional enrollees. That has increased to 108,000, according to the Kaiser Family Foundation. But North Dakota expanded its Medicaid program in 2013 and anticipated an additional 20,000 enrollees. Expansion now accounts for 26,000 additional adults in North Dakota.
One state lawmaker points to North Dakota’s numbers as a better example.
Republican Representative Wayne Steinhauer says North Dakota’s Medicaid expansion population of about 26,000 suggests that South Dakota’s expansion may actually come in lower than officials estimate.
“I’m not finding fault with them. I’d much rather have us be surprised and it come in less than more than we anticipate," Steinhauer said.
Recent polls show narrow support for the Medicaid expansion ballot proposal. Election day is November 8.
