SIOUX FALLS, S.D. (KELO) — The debate on Medicaid expansion will be decided by South Dakota voters through the ballot measure Constitutional Amendment D. 

Medicaid is a federal and state government program that helps cover healthcare costs for people with limited income. The June 2021 fiscal note from the Legislative Research Council says Medicaid expansion in South Dakota would cover 42,500 new individuals in the state for a cost of $1.5 billion in the first five years. 

In the first year, the state’s cost would be $32 million, while the federal government’s cost would be $297 million. Over five years, the state would pay $166 million and earn a general fund savings of $162 million, according to the LRC. 

On this week’s edition of Inside KELOLAND, KELOLAND’s Dan Santella talks with both sides of Amendment D. You can watch Santella’s conversation with Keith Moore, who is against Amendment D, and Kim Malsam-Rysdon, who supports Amendment D, in the player above. 

Moore serves as the state director for the group Americans for Prosperity and said Medicaid is currently built to serve those who need it most – seniors and people with disabilities. 

“If and when we pass Medicaid expansion, it’s going to add able-bodied, childless working age adults and you’re going to see those who it’s intended for be crowded out and service is going to be tougher to get,” Moore said. “We just feel like we need to stay right where we’re at right now and serve the people that Medicaid was meant to serve.” 

Malsam-Rysdon, who used to serve as South Dakota’s Secretary of Health and represented the Yes on Amendment D campaign, said South Dakota can see the benefits from 38 other states that have passed Medicaid expansion. 

“We know that folks have better health when they have health care coverage,” Malsam-Rysdon said. “They’re able to get preventive care. They use the ER less. Better management of chronic conditions and we know that folks have a higher rate of cancer screenings when they have insurance coverage.” 

Malsam-Rysdon said the estimated 42,500 people who would receive Medicaid coverage through Amendment D are currently stuck in the middle of the healthcare system. 

“They make too much to be on Medicaid today but don’t make enough to be able to purchase a plan on the exchange or Obamacare,” Malsam-Rysdon said. “Their employers don’t offer insurance so they’re largely uninsured.” 

Moore rounded the LRC estimation up to 43,000 people and said other states that have expanded Medicaid coverage populations have doubled. He believed there could be 86,000 people covered by Medicaid and worried about the cost increases for the state after five years.

“We believe that there can be greater access and that there can be better quality through different legislation other than Medicaid expansion,” said Moore, who added Americans for Prosperity and other lawmakers are waiting to see what happens with Amendment D before drawing up alternative plans to help provide healthcare to people with lower incomes. 

Malsam-Rysdon said Medicaid expansion would help South Dakotans sooner rather than later and highlighted benefits from other states that have passed expansion. 

“What we’re seeing is that people that are part of the (Medicaid) expansion population are able to work more, not less,” Malsam-Rysdon said. “That’d be a huge benefit to our employers across the state. Small businesses definitely benefit from Medicaid expansion, because we know they want their employees to be insured, but they just can’t offer the insurance themselves. It’s very expensive.”

The South Dakota Chamber of Commerce and Industry announced it would support Amendment D because it would benefit working people. 

Moore said he believes there could be better healthcare options for people in the private marketplace and the conversation would be different if he believed in the Medicaid program. 

“I grew up under the Indian Health Service with my dental care and my healthcare. It was bad then and it’s worse now,” Moore said. “The last thing that I want is for that to be the case for more South Dakotans – that we expand a federal program that is already failing.” 

Will Amendment D raise taxes? 

Much of the arguments against Medicaid expansion revolve around how tax dollars are spent. 

Moore said he believes more than 42,500 South Dakotans will be eligible for Medicaid through expansion because it allows people over 18 and under 65 whose income is at or below 133% of the federal poverty level which is at $13,000 for one person. 

“It’s going to cost us and I think down the road, we’re going to find that it’s going to cost us more,” Moore said. “We’re trusting the federal government to continue to pay the rate that they say they’re going to pay now. I don’t think at this point in time we can trust the federal government to hold up to what it says it’s going to.” 

On the topic of taxes, Malsam-Rysdon said Medicaid expansion would bring federal tax money back to South Dakota and the state budget would only see an increase of roughly $3.8 million over the first five years. 

“To put that in perspective, last year, we had a budget surplus of $115 million. The year before that we had a surplus of $85 million,” Malsam-Rysdon said. “I think we can afford Medicaid expansion within the existing budget in terms of the state cost. If we expand Medicaid in South Dakota, $320 million of our federal tax dollars would stay in South Dakota every year, instead of going to states like New York and California.” 

Malsam-Rysdon also noted the diverse organizations that have come together to support Amendment D including all the major healthcare systems, religious organizations, the South Dakota Farmers Union, the South Dakota Municipal League and the AARP. 

“A lot of people have really looked at this issue hard over many years now and have come to the belief that this makes sense for South Dakota,” Malsam-Rysdon said. “We can afford it.”