South Dakota is one of 18 states yet to decide if it will adopt the Medicaid expansion program proposed as part of the national health care overhaul.
Twenty states have already agreed to expand their Medicaid programs; thirteen have exercised their right to opt out.
Medicaid expansion is part of the national health care overhaul that intends to make health care affordable to the poorest in the nation.
"We just can't afford it," Canton resident and Medicaid patient Christina Rose said.
Christina Rose is on Medicaid. Her husband is not. In fact, he doesn't have any health insurance, so together, they're having a hard time paying thousands of dollars out of pocket for his recent shoulder surgery.
Medicaid expansion in South Dakota would mean more than 160,000 of the state's poorest people would have access to affordable health care.
"It's done a lot to help us out and we'd like to expand it to other people also," Rose said.
On the flip side, opponents say expanding Medicaid only makes government bigger.
Joy Smolnisky with South Dakota's Budget and Policy Project breaks down the finances. For the first three years, the federal government would pay 100 percent of the health care expansion costs. Only starting in the fourth year would South Dakota start sharing a portion of the bill, maxing out at 10 percent by the year 2020.
"So that means 90 percent of those costs are coming into the state as federal dollars being spent in the state to provide health care," Smolnisky said.
Smolnisky says the state really faces a political decision because financially, it brings millions of additional dollars to the state.
"It's a political decision as to whether states want to expand health care to cover poor people, all poor people, to make it accessible for all poor people or if you want to keep health care expansion as small as you possibly can by leaving out this every poor segment of non-elderly adults," Smolnisky said.
South Dakota, like all other states, has the option to opt in or out of the Medicaid expansion at any time.
More than 100,000 people are believed to be living without health insurance in South Dakota today.
If you have an opinion on whether South Dakota should expand Medicaid, now is the time to raise your voice. The state legislature holds a hearing Wednesday to learn more about how South Dakotans want them to vote.