PIERRE, S.D. (KELO) — State senators will consider whether South Dakota should make more people eligible for Medicaid.

The Senate Health and Human Services Committee decided 4-3 Monday to recommend SB 186.

The full Senate will debate the change, possibly as soon as Tuesday afternoon. It would expand the income level for eligibility to 133% of the federal poverty level and as high as 138%.

The bill’s prime sponsor is Senator Wayne Steinhauer, R-Hartford. He said a state law is preferable to locking expansion into the South Dakota Constitution.

A November general-election ballot question seeks to add expansion to the state’s constitution.

Republican legislators including Steinhauer last year put a measure on the June primary-election ballot that would require some measures, including Medicaid expansion, to get 60% support to pass.

“This thing is going to pass if we don’t do something with it legislatively,” Steinhauer said. His legislation allows South Dakota to opt out if the federal government stops providing 90% of the expansion cost. “The question, is are we going to be driving the train or get run over by the train?”

Senator V.J. Smith, R-Brookings, wanted the committee to send Steinhauer’s bill to the Senate without recommendation “for the purposes of greater public conversation on the issue.”

Steinhauer disagreed. He called for the committee to endorse the bill’s passage. “This is a hugely complex issue,” he said.

Senator Blake Curd, R-Sioux Falls, who’s a surgeon, said healthcare was one of the targets of budget cuts during state government’s 2011 fiscal crisis. “Healthcare has never been made whole,” Curd argued. As for Medicaid expansion, he said, “I think it’s the wrong policy at the wrong time.”

Smith, Curd and Senator Jim Bolin, R-Canton, voted against recommending the bill. Voting yes were senators Red Dawn Foster, D-Pine Ridge; Arthur Rusch, R-Vermillion; Erin Tobin, R-Winner; and Steinhauer.

A long list of healthcare, county and municipal groups testified in favor of expansion Monday. The two main opponents were the state Department of Social Services and the South Dakota branch of Americans for Prosperity.

Last year Americans For Prosperity spent $339,423.39 in donated goods and services against the Medicaid-expansion ballot measure. The state department’s opposition Monday meanwhile centered on the costs to South Dakota taxpayers and signals the possibility that Governor Kristi Noem could veto the bill if it receives the Legislature’s approval.

Social Services Secretary Laurie Gill said her department would need to add an estimated 64 full-time equivalent positions. Deputy secretary Brenda Tidball Zeltinger said the additional employees would cost state government $6.3 million to $10 million, with $3 million coming from state government’s general fund.

Tidball Zeltinger said the broader benefits that would be paid to healthcare providers would cost $48 million to $51 million in state general funds and $408 million to $420 million in federal aid in fiscal 2024. Those amounts would rise, reaching $62 million to $65 million of state funds and $520 million to $533 million for 2028.

She predicted 52,000 to 58,000 more people ages 18 to 64 would enroll by 2028. Currently about 115,000 people, including children, are eligible for medical services available through Medicaid in South Dakota.

Thirty-eight states, including all of South Dakota’s neighbors other than Wyoming, have expanded Medicaid eligibility.

Steinhauer disagreed with Tidball Zeltinger’s enrollment estimate. He pointed to North Dakota, which has seen its enrollment rise 19,000 to 20,000. If South Dakota’s enrollment raised by a proportionate number, he said, there would be another 22,000.

The Legislative Research Council, in an official fiscal note assembled last year for the Medicaid ballot measure, estimated 42,500 to 44,300 people would become eligible and the program’s total cost would be $297 million to $309 million.