Because Medicaid expansion will obligate the state for as much as $20.8 million more a year in spending, it would be subject to the three-fifths hurdle, making its passage as a ballot measure more difficult.
Critics of HJR 5003 objected to placing it on the primary ballot, when fewer people vote. The bid by Dakotans for Health to refer it to the general elections could have, if successful, delayed its vote to the general election.
Supporters of HJR 5003 argue that the Legislature can’t raise taxes without a three-fifths majority, and the same hurdle should apply to ballot measures.
Currently, there are three different petitions drives seeking to put Medicaid expansion on the November 2022 ballot.
Medicaid is a government medical program where the federal and state governments share its costs. Historically, the program was created to help impoverished children, the elderly and people with disabilities. But the Affordable Care Act, or Obama Care, expanded eligibility to include more adults. The federal government promised to pay for a greater share of that expanded pool.
Medicaid expansion was mandatory in the original act, but the U.S. Supreme Court struck down that provision, allowing states to decide for themselves if they wanted to opt in. South Dakota is one of a dozen states that has not expanded the program to include more adults.