South Dakota Republicans trying new way to limit access to Medicaid with Amendment F on November ballot
South Dakotans have a complicated ballot this year, with seven different statewide questions, including the issues of reproductive rights, repealing the tax on groceries, legalizing recreational marijuana and converting to a top-two primary system.
Meanwhile, our Republican-controlled Legislature has placed Amendment F on the ballot, which would impose a work requirement on Medicaid recipients.
As is often the case with complicated ballot proposals, the devil is in the details. In the 2022 general election, South Dakota voters approved Medicaid expansion with a 56% majority. Specifically, Medicaid is now available to South Dakotans between the ages of 18 and 65 whose income is at or below 133% of the federal poverty level.
While the majority of states had already taken advantage of this federal program as part of the Affordable Care Act (ACA), Gov. Krisit Noem and the South Dakota Legislature had made it clear that they weren’t interested in making health coverage available to more of our citizens. Therefore, an initiated measure was the only path to expanding health care coverage in South Dakota. In that year's primary election, Rep. Dusty Johnson and Americans for Prosperity (the infamous Koch brothers' organization) had tried and failed in their effort to amend the state Constitution to require a “super majority” of 60% for the Medicaid expansion ballot measure to succeed that November.
While Amendment F authorizes a work requirement for Medicaid recipients, it does not spell out how this would work. Medicaid is a federal program, and federal law supersedes state law. If Kamala Harris wins the presidency in November, we can assume that a South Dakota work requirement will not be approved. On the other hand, a Donald Trump administration, seeking to weaken the ACA, would presumably allow it.
State Rep. Tony Venhuizen, a Sioux Falls attorney who formerly served as chief of staff to Gov. Dennis Daugaard, who was both his boss and his father-in-law, argues in the official voter pamphlet that “(our) state already does this in other social programs, and we know how to do it.”
While it's true that welfare programs like TANF and SNAP (food stamps) impose a work requirement, Venhuizen should know better. A cancer patient who is too sick to work but not certified as disabled could be denied health-care coverage at a critical time in their treatment. Amendment F could also cripple some of our struggling rural hospitals which will provide emergency and compassionate care, hoping for reimbursement.
Oyate Health, a medical non-profit organization that is governed by the Great Plains Tribal Leaders Health Board and provides health care to tribal members, depends on Medicaid to cover a substantial portion of its budget.
Amendment F would pull the funding out from under struggling South Dakota hospitals and deny medical coverage for sick South Dakotans when they need it most. It is a naked partisan effort to reduce the federal dollars that currently strengthen our state’s health-care network.
While our state bureaucrats may well “know how to do it,” that does not mean that it’s a good idea.
Jay Davis is a retired Rapid City attorney and frequent contributor to The South Dakota Standard.
