South Dakotans to decide Medicaid expansion in November election

A coalition of health care organizations, backed by Sanford and Avera, has gathered enough petitions to put the question of expanding the federal healthcare program to tens thousands of low-income South Dakotans on the upcoming general election ballot, says Secretary of State Steve Barnett.

Monument Health in Rapid City, S.D.
File photo
We are part of The Trust Project.

PIERRE, S.D. — South Dakota voters will play a decisive role in a longstanding health care debate, whether to expand Medicaid at the ballot box later this year.

The Rushmore State, a deeply red political bastion, has long been one of the remaining holdouts from the federal low-income health care program. But on Monday, Secretary of State Steve Barnett announced that he'd validated the petitions for the Medicaid expansion measure, which will appear on the November ballot as Amendment D.

Leaders of the petition push, backed by a coalition of health care organizations , including the state's largest hospital systems Sanford and Avera, cheered the Monday, Jan. 3, announcement.

"It will boost our economy, save rural hospitals, create jobs, help ensure hard working South Dakotans don't drown in medical debt, and bring our hard earned tax dollars home," said Zach Marcus, campaign manager. for South Dakotans Decide Healthcare.

The organization is endorsed, as well, by the Great Plains Tribal Chairmen's Health Board, AARP South Dakota, and the American Cancer Society Cancer Action Network.


The Republican supermajority in Pierre has, for a decade, adamantly opposed a policy tucked into the 2009 Affordable Care Act, the signature act of President Barack Obama, that they say drives up federal debt.

In December 2015, then-Gov. Dennis Daugaard voiced support for expanding Medicaid, so long as the expansion would be cost-neutral for the state. A year later, however, Daugaard walked back his recommendation amid a belief the Trump administration would pull the plug on the ACA -- a threat that fell short.

Since then, Medicaid proponents have built support among various organizations. However, GOP leaders in Pierre last year voted to approve sending a separate ballot measure to voters in the upcoming June primary election that would set a super-majority threshold (60%) for constitutional measures that would increase taxes -- ostensibly in an effort to thwart Medicaid expansion.

South Dakota is one of a dozen states not to expand coverage for low-income adults under the ACA. According to an analysis by the Associated Press , the expanded coverage would be open to individuals making $17,000 annually or families making $35,000, which would encompass approximately 42,000 South Dakotans.

Related Topics: SOUTH DAKOTA
Christopher Vondracek covers South Dakota news for Forum News Service. Email him at or follow him on Twitter at @ChrisVondracek.
What to read next
Since their introduction in the state less than a decade ago, zebra mussels have found their way into 13 bodies of water across South Dakota, most notably leaping westward into Pactola Reservoir last month. Some interest groups think the Department of Game, Fish and Parks could be doing more to slow the spread.
In the eight days of data provided by the South Dakota Highway Patrol, troopers reported three fatalities and 66 injuries across 53 crashes.
As Upper Midwest cities grow they face choices of how to pay for roads. Advocates for active transportation say making streets safer rather than wider is a better investment in the long term. Yet, local leaders face a constant pressure to fill potholes and expand roads at all costs.
With nearly $1.6 billion in state and federal funding for water and sewer improvements entering the coffers of cities and rural water systems, engineering and contracting firms in the state are bracing for impact.