Every South Dakotan deserves greater access to more affordable quality care. Expanding a failed government program is no solution to improving South Dakotans’ health care access. As nonsensical as it might seem, a ballot measure to do just that faces Coyote State voters this fall. Known as Amendment D, the measure would actually restrict health care access to those who truly need it if a simple majority of voters approve it.

Should it pass, the amendment would alter the South Dakota Constitution, requiring state taxpayers to provide Medicaid benefits to all adults between 18 and 65 with incomes below 133% of the federal poverty level beginning in July 2023. Prior to voting, South Dakotans should ask themselves a few key questions to critically evaluate Amendment D. 

Do you want to help more people get back to work or have more people sidelined by welfare?

Placing able-bodied individuals on Medicaid causes an overall decline in employment by 3 percent, studies show. In fact, the Affordable Care Act’s tax structure encourages layoffs while discouraging people from returning to work and incentivizing them to reduce their work hours to below full time. 

POINT: Amendment D good for South Dakota health, economy

The timing couldn’t be worse. South Dakota already faces a worker shortage that increased by 29,000 openings between October 2021 and April 2022. An increased labor shortage through Medicaid expansion would cause even greater problems, including higher inflation, smaller incomes, more taxes and a broken economy. There should be little wonder why South Dakota has so far resisted Medicaid expansion under the ACA. 

Do you want to remove about 17,000 South Dakotans from their current private health insurance and shift them into Medicaid? 

Under recent federal legislation, lower-income South Dakotans receive federally funded silver-level private plans at no cost to them – in non-expansion states. The expanded federal subsidies help with premiums and significant reductions in out-of-pocket expenses. 

If voters approve Medicaid expansion, those federal subsidies to low-income South Dakotans will end, and they lose the benefits of a well-paying private plan. They shift to government health coverage, and the tab shifts from federal to South Dakota taxpayers through Medicaid expansion. 

Overall, expanding Medicaid would cost the taxpayers over $1.5 billion over the first five years, adding to the monstrous financial burden already caused by the program. In Ohio, for example, Medicaid grew from 19 percent of the state’s 2000 budget to 38 percent in 2022. In Florida, Medicaid spending has increased by 227 percent and now devours 32 percent of the state’s annual budget. Other states including Arizona and New Hampshire have been forced to cut important public services just to pay for costly Medicaid expansion. 

Do you want to prioritize able-bodied adults or the disabled, elderly, and children?

Most importantly, Medicaid was designed as a safety net for the truly vulnerable that need it the most – the elderly, disabled and children. Voters will need to consider who they want at the front of the line for help with health care. The devastating reality is that expanding Medicaid to able-bodied adults crowds out those who truly need it while failing to offer more or better care to those who qualify. 

Meanwhile, the waiting list for Medicaid care is already miles long. Over 700,000 patients must currently wait for home and community-based services. Since 2013, nearly 22,000 patients have passed away waiting for care. The conclusion is obvious: Medicaid is a broken system in need of reform, not expansion.

Reform and innovation

Policymakers have attempted to reform Medicaid to empower states like South Dakota to support the most vulnerable. One method involves the use of waivers – Medicaid Waivers, or Section 1115 waivers, to give states the choice to innovate beyond Medicaid’s traditional top-down structure.

There should be continued work for states to tailor their Medicaid requirements to their citizens’ needs. Unfortunately, the Biden administration’s continued health emergency disallows unenrollment. And the proposed Amendment D leaves us with the inability to tailor Medicaid to the able-bodied population through work requirements, lifetime benefit limits, enrollment freezes or fraud lockouts.

On the flip side, health care innovations are giving people more choice and more control than ever before over their own health care. Policymakers should continue to lower the barriers in the way of greater access to affordable care, innovations in expanded telehealth and full scope of practice for providers.

With these thoughts in mind, South Dakotans can fill out their ballots with confidence this November and cast a decisive vote on the issue of Medicaid expansion. By voting “NO” on Amendment D, voters will keep the door open to workable solutions without enshrining a failed program in our Constitution.