Lawmakers in Pierre are deciding whether more people in the state should be eligible for Medicaid.
Under the Affordable Healthcare Act, the federal government will pick up the cost of the expanded coverage for the first three years. States would have to pick up 10 percent of the costs in the future. Lawmakers heard public arguments on Wednesday for and against the proposal.
Expanding Medicaid would add between 40,000 and 50,000 South Dakotans to the list of those eligible to receive the government-funded health insurance. But opponents to the measure say the government simply can't afford it.
"We all have heard many stories that tug at the heartstrings but we have to be realistic," Florence Thompson said.
Stephanie Strong of Rapid City agrees, saying she supports limited government and South Dakota should be a leader by not expanding.
"I don't believe in government coming in and fixing all of our problems. I think the free market will fix our problems, give us more choices, give us better healthcare," Strong said.
Supporters of Medicaid expansion presented arguments based on moral and economic grounds.
Without expansion, some argued more people will be uninsured. Those people will typically land in the emergency room rather than receive less expensive preventative care. Hospital officials say when patients can't pay their bills, patients with health insurance and healthcare facilities take the hit.
"In our institution, about 50 percent of our expenses are in salaries and that helps employ people. It puts sales tax back into dollars so I think this is also about economic development," Avera St. Benedict Health Center in Parkston CEO Gale Walker said.
But, others say expansion would help offset current losses caused by changes in Medicare.
"There are funds that have been committed by all of the providers in the state currently to help with the Medicaid expansion and I would urge you to consider that," Sanford Vermillion CEO Tim Tracy said.
Governor Daugaard is calling for caution on the issue, saying he's unsure whether the Federal government can keep its promise to fund its share of the expansion. Expansion supporters say state lawmakers could always pull back the expansion if the federal government doesn't pay.