South Dakota Expands Medicaid

“South Dakota is one of the most Republican states in the nation. … In the 2020 presidential election, President Donald Trump won in a 26-point romp,” according to the Almanac of American Politics.

However, on November 8, South Dakota voted for a constitutional amendment to expand Medicaid by big margin: 56% to 44%. It joins 38 other expansion states, including many GOP-led states and every Midwest state except Wisconsin. Not to mention that in Kansas the GOP-led Legislature passed Medicaid expansion, but it was vetoed by Republican Governor Sam Brownback.

Wisconsin remains an outlier.

The South Dakota ballot measure was strongly supported by the South Dakota Chamber of Commerce and Industry, the State Medical Association (SDSMA) and the South Dakota Association of Healthcare Organizations (SDAHO). The business group said: “The South Dakota Chamber of Commerce and Industry believes that expanding Medicaid will have a positive impact on helping people in low wage jobs secure healthcare services and remain in the workforce as healthier people.”

The South Dakota medical association said: “The SDSMA advocates not just for adequate funding for the Medicaid program, but for Medicaid eligibility expansion.” And the hospitals group said: “Its passage will provide the opportunity for more South Dakotans to have access to affordable healthcare coverage.”

South Dakota, like much of Wisconsin, is rural and agricultural. The state Farmers Union praised the vote: “Medicaid expansion will be a crucial opportunity for farmers and ranchers across South Dakota to accept affordable healthcare coverage for the first time. … This will allow farmers and their families to keep tradition alive and keep taking advantage of the opportunities living in rural communities provides.”

“In addition to the 90% federal matching funds available under the ACA (Affordable Care Act) for the (Medicaid) expansion population, states can also receive a 5 percentage point increase in their regular federal matching rate for 2 years after expansion takes effect. The additional incentive applies whenever a state newly expands Medicaid and does not expire,” the Kaiser Family Foundation noted.

What is Wisconsin waiting for? Wisconsin is losing out on billions of dollars in federal funding and coverage for an additional 90,000 Wisconsinites, mostly low-income working adults. Medicaid eligibility expansion will be needed to cover thousands of other Wisconsinites who will lose their eligibility when the COVID-19 public health emergency is ended.

Moreover, Joan Alker, Georgetown University’s Center for Children and Families, said: “We have over 400 studies showing why Medicaid expansion is a good thing. It has not busted the budgets of the states that have done it, it’s supported their budgets, it’s reduced mortality, it’s improved health outcomes, it’s supported hospitals – the evidence is piling up. And, so saying ‘no’ is getting harder and harder.”

Time for Wisconsin to move forward. State doctors and healthcare executives must provide persistent leadership on this issue.

Finally, I implore retired GOP state Senators Luther Olsen and Dale Schultz, both supporters of Medicaid expansion, to form an advocacy expansion lobby with business, civic, healthcare, labor and political leaders – “Wisconsinites for Common Sense on Healthcare Coverage.”

We can do this and join what are now 39 expansion states.

Bill Kaplan wrote a guest column from Washington, D.C., for the Wisconsin State Journal from 1995 – 2009.