South Dakotas vote to expand Medicaid under Affordable Care Act

Here's the Politico story, and here's a story from the New York Times a few days before the election.  

An excerpt from the Politico story by Megan Messerly is here:

South Dakota voters on Tuesday approved a measure to expand the state’s Medicaid program under the Affordable Care Act.

The program, which takes effect in July and is expected to cover more than 40,000 people, passed with about 56 percent support.

The Republican-controlled state, where lawmakers have long resisted Medicaid expansion, is the seventh in the last five years to do so at the ballot box — and likely the last to do so for some time.

“We are thrilled by this victory, which took years of work, coalition building, and organizing to achieve,” said Kelly Hall, executive director of the Fairness Project, which helped pass the ballot measure. “Citizens took matters into their own hands to pass Medicaid expansion via ballot measure — showing us once again that if politicians won’t do their job, their constituents will step up and do it for them.”

Opponents of Medicaid expansion tried to make passage of the ballot measure more difficult through a June initiative, Amendment C, that would have raised the voter approval threshold to 60 percent. That measure was overwhelmingly defeated.

Under the American Rescue Plan, the federal government encouraged states to expand Medicaid by covering an extra 5 percent of the costs of the program, in addition to the 90 percent it covers for newly eligible individuals under Obamacare.

The Kaiser Family Foundation estimates those incentives will send $110 million to South Dakota.

Opponents of Medicaid expansion, including Republican Gov. Kristi Noem, argued the measure would cost the state in the long run, force lawmakers to raise taxes, and discourage able-bodied adults from getting jobs.

And here's the NYT overview from a few days before the election.  It is written by Sheryl Gay Stolberg and provides ample context:

Progressives have helped bring health coverage to tens of thousands of uninsured Americans with an exercise in direct democracy: They have persuaded voters to pass ballot measures expanding Medicaid in six states where Republican elected officials had long been standing in the way.

Now comes the latest test of this ballot box strategy: South Dakota.

An unlikely coalition of farmers, business leaders, hospital executives and clergy members has coalesced around Amendment D, a ballot measure that would enshrine Medicaid expansion in the South Dakota Constitution, over the objections of Gov. Kristi Noem, a Republican. It is widely expected to pass next week on Election Day.

It has been 10 years since the Supreme Court ruled that states did not have to expand Medicaid — the government health insurance program for low-income people — under the Affordable Care Act, and the politics around the issue have shifted. Philosophical objections to large government programs are giving way to economic considerations, particularly in rural states like South Dakota, where struggling hospitals and nursing homes are eager for federal reimbursement dollars that come from Medicaid.

If Medicaid expansion is adopted in South Dakota — a state where Donald J. Trump won more than 60 percent of the vote both times he ran — advocates say it will send a strong signal to other Medicaid expansion holdouts, like Texas and Florida. South Dakota is one of 12 remaining states that have not expanded, down from 19 in 2016.

“It is harder and harder for conservative politicians to stand behind the idea that the A.C.A. is just one lawsuit away from being repealed or overturned,” said Kelly Hall, the executive director of the Fairness Project, a national nonprofit that is behind the “Yes on D” campaign.

“Our work,” she said, “is about how do we build odd-bedfellows coalitions delivering the message that Medicaid expansion is good for the economy, brings back tax dollars to the states, is helpful for small businesses and is not just ‘Do you support Obamacare?’”

In the tiny farming town of Conde, where a road sign puts the population at 140, that is exactly the argument that Doug Sombke, the president of the South Dakota Farmers Union, is making.