SIOUX FALLS, S.D. (KELO) — It’s been more than a decade since the Affordable Care Act was passed and signed into law by President Barack Obama.
And in the 10-plus years since, South Dakota elected officials have rejected expanding government-run health coverage provided to people with limited incomes. Medicaid expansion was a major part of the ACA, also commonly referred to as Obamacare.
In 2021, there’s now two groups working to get Medicaid expansion on the 2022 ballot either as a Constitutional Amendment or Initiated Measure. According to the South Dakota Secretary of State, there are four possible 2022 ballot questions approved by the state to start collecting the proper threshold of signatures from South Dakota voters.
Three of the four possible ballot questions are all focused on Medicaid expansion — including both an Initiated Measure and Constitutional Amendment by the organization Dakotans for Health. As of March 25, the organization South Dakotans Decide Healthcare has been approved to begin circulating petitions for Medicaid expansion.
“Time has come,” Dakotans For Health co-founder Rick Weiland said. “We are going to do this. We are going to get this on the ballot and let the voters decide in 2022.”
Weiland, a 2014 Democratic candidate for the U.S. Senate, told KELOLAND News the Dakotans For Health organization has up to 200 people collecting signatures since November and more than 600 people have signed up to help the campaign in some sort of way.
“Every state surrounding us, with the exception of Wyoming, are participating in it,” Weiland said about Medicaid expansion. “We are confounded by this opposition. The only thing you can really point to is that here’s this philosophical opposition to the Affordable Care Act, to the government being involved in health care.”
Along with South Dakota, the 11 other states holding out against the Medicaid expansion are Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, Tennessee, Texas, Wisconsin and Wyoming. The Wyoming House of Representatives passed a bill during the state’s 2021 session supporting Medicaid expansion but the bill ended up being defeated in the Senate.
Weiland said some Republican leaders in Wyoming and across the country have warmed to the idea of Medicaid expansion. He noted states like Oklahoma and Missouri recently supported the cause and said South Dakota voters should be voting on such an important issue.
“We have demonstrated if you put a solid idea like this in before the voters, nine times out of ten, they’re going to do the right thing,” Weiland said.
If you count all the years rejecting Medicaid expansion since 2010, Weiland said South Dakota has passed on more than $2 billion in federal aid. The South Dakota Legislative Research Council reported on the fiscal note about Medicaid expansion more than 42,000 South Dakotans would be eligible for health coverage, costing $300 million, with the state only needing to pay $20 million.
Adam Weiland, Dakotans for Health co-founder, also noted rural hospitals would see additional funding if more South Dakotans were covered under health insurance by Medicaid expansion.
“This is a boon to those hospital services,” Adam said. “This will set up those hospital services for the next 20 years.”
Adam Weiland also noted the most recent coronavirus relief package signed by President Joe Biden, includes a big financial incentive for states that have opted against expanding Medicaid. He said South Dakota would have an additional $180 million if the state would expand Medicaid.
For a Constitutional Amendment to get on the ballot, it must receive a minimum of 33,921 valid signatures submitted to the Secretary of State’s office by Nov. 8, 2021.
KELOLAND News reached out Gov. Kristi Noem’s office asking about Medicaid expansion. We will update this story when comment is received.
Legal challenges on ballot initiative process
In addition to promoting Medicaid expansion, Dakotans for Health is in two active legal battles over the ballot initiative process in South Dakota. The group recently filed a lawsuit against Gov. Kristi Noem, the attorney general and the secretary of state asking a judge to stop Senate Bill 180 from being enforced.
“It’s just more sand in the gears to make it harder,” Rick Weiland said. “It’s like death by a thousand cuts. They continue to try and slow down the people’s right to petition their government and to pass public policy that they want passed that their Legislature won’t do.”
Dakotans for Health is also fighting a recently passed resolution in court. House Joint Resolution 5003 narrowly passed in the Senate 18-17 and 51-17 in the House. It calls for South Dakotans to vote at the 2022 primary election on amending the Constitution to require the Medicaid initiative and all future initiatives that would spend or tax significant sums pass by a 60% vote threshold instead of a simple majority.
Rick Weiland said the super majority requirement is aimed directly at Medicaid expansion.
“We’re fighting it,” Rick Weiland said. “I believe the Supreme Court will make a decision or ask for oral arguments.”
Weiland said he hopes the South Dakota Supreme Court rules in favor of letting just a simple majority of voters to decide about Medicaid expansion rather than a super majority.