GOP faces another blow to the red state in Tuesday’s Medicaid expansion vote in South Dakota

South Dakota voters will decide Tuesday whether to expand Medicaid through a ballot initiative, which could be another blow to Republicans and their anti-Obamacare health policies.

A vote this week in South Dakota to expand Medicaid under the Affordable Care Act would be seen as the latest blow to Republicans, especially in the Trump era, as the former president and his party make repealing the law a landmark act. part of their health policy agenda. for more than a decade.

But Republican-leaning South Dakota is poised to become the sixth successful ballot campaign to expand Medicaid to hundreds of thousands of Americans since Trump took office in 2017.

“It is getting harder and harder for conservative politicians to get behind the idea that the… [Affordable Care Act] is only one lawsuit away from revocation or nullification”, says Kelly Hallthe executive director of the Fairness Project, which works with supporters of the South Dakota voting initiative as part of the effort’s “Yes on D” campaign, and has helped other states win Medicaid expansion.

Republicans including: Government of South Dakota Kristi Noem is against the ACA and the ballot measure, which would expand Medicaid to more than 40,000 in the state.

But the campaign in South Dakota, as in other states, involved a bipartisan group of lawmakers, health care providers, corporations and unions. In rural states like South Dakota, where hospitals have been hit financially hard during the pandemic, there is widespread support for expanding Medicaid.

In a New York Times story last week on the Medicaid expansion vote in South Dakota, a conservative Republican lawmaker said the effort to broaden coverage “just makes sense.”

“It’s time to get over it,” said Rep. Greg Jamison in South Dakota told the Times.

The South Dakota campaign is the latest momentum to expand Medicaid coverage for the poor under the Affordable Care Act. In 2020, voters in Missouri and Oklahoma approved voting initiatives to expand Medicaid, following successful voting initiatives in 2018 in Nebraska, Idaho and Utah. Those states, like Maine in 2017, bypassed Republican governors and lawmakers to expand Medicaid through a public referendum.

South Dakota remains one of only 12 states yet to expand Medicaid under the Affordable Care Act.

The expansion of Medicaid benefits under the ACA has come a long way since the U.S. Supreme Court gave states a choice in this matter in 2012. Initially, only about 20 states sided with President Barack Obama to expand the health insurance program for poor Americans.

The 12 holdout states, including South Dakota who have yet to expand Medicaid have already missed out on the generous federal funding of the Medicaid expansion under the ACA. The Fairness Project estimates that just passing the vote in South Dakota “would keep $328 million in (federal) tax dollars in the state each year.”

From 2014 to 2016, the ACA’s Medicaid expansion population was funded 100% by federal dollars. The federal government still picked up 90% or more of the Medicaid expansion through 2020, which was a better deal than it was before the ACA, when Medicaid programs were funded through a much less generous split between state and federal tax dollars.

“If passed, Amendment D would instruct the state to expand Medicaid next year to any person ages 18 to 65 with incomes up to 133% of the federal poverty level — about $19,000/year for an individual or $39,000/ years for a family of four,” the Fairness Project said in a press release issued last week.