Effort to expand Medicaid in South Dakota holds strong lead, proponents declare victory in press release

Initiated Amendment D would raise Medicaid eligibility to well above the federal poverty line, and offer health insurance to an estimated 42,5000 South Dakotans. Opponents say the program would likely run into higher enrollment and costs, which would be permanent.

Horizon Healthcare
The Yankton Community Health Center is one of 27 clinics that provide a low-cost option in rural and urban areas around South Dakota. Rural health clinics were part of the coalition that pushed for expanding Medicaid.
Jason Harward / Forum News Service
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SIOUX FALLS, S.D. — Proponents of an amendment to the South Dakota Constitution that would make the state join 39 others in expanding Medicaid eligibility declared victory in their campaign late Tuesday, Nov. 8, saying they "are grateful to the people of South Dakota for their support tonight."

South Dakotans Decide Healthcare, the organization that spearheaded the coalition in favor of the amendment, sent out a press release titled "South Dakotans say Yes to Medicaid Expansion" just after 11:30 p.m.

“We’re glad that South Dakota voters saw that helping our neighbors get health care is the right thing to do,” Dave Kapaska, a retired hospital executive and co-chair of the American Heart Association’s volunteer cabinet for Medicaid expansion, wrote in the release.

South Dakotans were supporting Initiated Amendment D by a margin of 54.9% - 45.1%, according to ongoing vote counting at 11:30 p.m.

If approved, the ballot measure would raise the eligibility for Medicaid to 138.5% of the federal poverty level.


"Had Amendment C passed in June, we would have stopped Medicaid Expansion, and 17,000 South Dakotans wouldn't be losing their healthcare," John Wiik, a state senator who led the No on Amendment D committee, wrote in a statement to Forum News Service. "Now to figure out how to pay for it."

Amendment C, which was defeated with 67% of the vote in June, would have required a 60% vote margin for ballot measures that would require the state to appropriate $10 million or more in the first five fiscal years.

The 17,000 figure, which the opposition has used to refer to the number of working adults that would be forced off of subsidized healthcare exchange plans and onto Medicaid, has been disputed by the proponents of Amendment D.

Currently, South Dakotans between 18 and 64 with dependent children qualify for Medicaid if they earn less than $1,001 per month, less than half of the federal poverty line.

The proponents of the measure, which include major hospital systems, the state chamber of commerce, the American Cancer Society and more, argued that the passage of Amendment D would lower health care costs and improve access for thousands of South Dakotans in the so-called “coverage gap.”

“The bottom line is that there are thousands of people in South Dakota who are stuck in the middle,” said Zach Marcus, the campaign manager for South Dakotans Decide Healthcare. “They’re people who are making too much money to qualify for Medicaid, but still don’t make enough money to qualify for insurance on their own.”

Wiik and others opposed to the measure believe that over-enrollment and related cost overruns are inevitable.

“When you start talking money in something like this, it's Monopoly money,” Wiik said. “I can just tell you this: North Dakota came in well over budget; Montana was double what they thought it was going to be.”


In the most recent campaign finance filing, No on Amendment D reported just $3,646 in donated goods and services, a drop in the bucket compared to the more than $2.1 million spent by South Dakotans Decide Healthcare between May 22 and Oct. 19.

The nonpartisan Legislative Research Council estimates that 42,500 South Dakotans would be newly eligible for health care through Medicaid if Amendment D passes.

During the first two years, the LRC estimates that the program would save the state a net total of $64 million due to federal incentives. After that, net costs to the state are estimated at $22 million annually.

However, opponents of the measure such as Keith Moore, the state director of the conservative Americans for Prosperity-South Dakota, argue that this analysis assumes no change to the federal cost-sharing of Medicaid. If the federal government rolled back its 90% cost share of this expansion, Moore says, holding up the state’s end of the bargain could get expensive quickly.

“For us, there's the piece of financial sustainability and the long-term viability of rural resources,” said Shelly Ten Napel, chief executive of the Community Healthcare Association of the Dakotas, another medical group that pushed for the amendment to pass. “But there's also the fact that these are our patients, our friends or neighbors. Whatever the impact is on our bottom line, it's hard to see people struggling.”

“We see that when things happen in the coastal areas, a few years later, they start trending toward the Midwest,” said Rep. Ben Krohmer, serving his first term in the House.

Jason Harward is a Report for America corps reporter who writes about state politics in South Dakota. Contact him at 605-301-0496 or

Related Topics: ELECTION 2022
Jason Harward covers South Dakota news for Forum News Service. Email him at
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