Medicaid expansion begins today in South Dakota, overcoming years of Republican obstacles

South Dakota will finally implement voter desire to expand Medicaid benefits under the Affordable Care Act to more than 40,000 low-income adults after years of fierce Republican opposition and failed Republican efforts to nullify expanded health coverage for the poor , were doomed to fail.

The expansion, which goes into effect Saturday, follows a November vote by a large majority of South Dakota residents on expanding Medicaid under the ACA by ballot, leading Republican Gov. Kristi Noem, an ally of Donald Trump, which failed multiple times, dealt a political blow to get the ACA, also known as Obamacare, repealed.

In South Dakota, voters approved the measure in November with 56% of the vote. And last June, South Dakota voters overwhelmingly rejected a measure that would have required certain voting initiatives, such as expanding Medicaid, to be passed by a 60% approval vote rather than a simple majority.

“The rollout of Medicaid in South Dakota this week is a hard-fought victory by constituents, advocates, providers and the countless individuals who have organized for years to make this possible,” said Kelly Hall, executive director of The Fairness Project, which told several States have helped expand Medicaid through voter referendums since 2017.

“It’s also a notable moment, as it marks the seventh year in a row that voters put Medicaid expansion on the ballot and won when their politicians refused to take action or completely cut off their voters’ access to health care.” , Hall added. “Now, tens of thousands of South Dakota residents will get the care they deserve thanks to this ballot measure. At a time when special interests and extremist politicians across the country are doing what they can to dismantle direct democracy and block policies that improve people’s quality of life, The Fairness Project stands ready to continue our work to stop attacks on Combating electoral measures and protecting these critical measures are tools for generations to come.”

The implementation of Medicaid expansion via an elective measure in South Dakota is the latest impetus for expanding this coverage for the poor under the ACA. In 2020, voters in Missouri and Oklahoma approved ballot initiatives to expand Medicaid, following successful ballot initiatives in Nebraska, Idaho and Utah in 2018. These states, like Maine in 2017, bypassed Republican governors and legislatures to expand Medicaid through a public referendum.

“South Dakota is the seventh state where citizen-initiated ballot measures have expanded Medicaid when right-wing politicians ignored broad, bipartisan support for the policy and refused to pass it,” the Fairness Project said in a statement released by the group released on Friday. “To date, balloting to pass the Medicaid expansion has resulted in more than one million Americans gaining affordable health insurance.”

With implementation of the initiative in South Dakota, only ten states remain to expand Medicaid under the ACA, according to KFF’s latest tally.

The expansion of Medicaid benefits under the ACA has come a long way since the US Supreme Court gave states a choice on the matter in 2012. At first, there were only about 20 states that sided with President Barack Obama when he wanted to expand the health insurance program for poor Americans.

The 10 states that have not yet expanded Medicaid have already missed generous federal funding for expanding Medicaid under the ACA. From 2014 to 2016, the ACA’s Medicaid expansion population was 100% federally funded. The federal government was still covering 90% or more of Medicaid expansion through 2020, and that was a better deal than before the ACA, when Medicaid programs were funded through a much less generous split between state and federal taxpayers’ money.

South Dakota state health officials said expanding Medicaid has “raised the income requirement to 138% of the federal poverty line and up to an income of $41,400 for a family of four,” according to South Dakota media reports this week. “It also opens up Medicaid to single adults ages 19 and older.”

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