South Dakota voters approve Medicaid expansion; say no to marijuana

November 9, 2022

South Dakotans voted to expand eligibility for the state’s Medicaid programs Tuesday.

Constitutional Amendment D was winning with 56% of the vote as of 1 a.m. Nov. 9, or roughly 166,879 votes.

While the state is one of 12 that hadn’t expanded eligibility for its Medicaid programs, it was the only state to feature the question in the 2022 election.

The proposal would offer Medicaid coverage to an estimated 42,500 low-income South Dakotans ages 18 to 64.

About 16,000 of those people don’t currently qualify for any government assistance with health coverage even though their income falls below the federal poverty level.

Medicaid, the nation’s leading public health insurance program for low-income and disabled Americans, covers more than 82 million people and is jointly financed and operated by the federal and state governments. The 2010 Affordable Care Act allows states to offer coverage to more people, with the federal government paying 90% of the costs.

“Increasing Medicaid eligibility means more South Dakotans will have access to comprehensive coverage, including cancer screenings, diagnostic testing, treatment services and follow-up care needed to survive the disease that will kill 1,740 South Dakotans this year,” said Matthew McLarty, American Cancer Society Cancer Action Network (ACS CAN) South Dakota government relations director in a prepared statement.

Keith Moore, director of Americans for Prosperity in South Dakota, told Kaiser Health News ahead of the election that he opposes expanding Medicaid because the taxpayer-funded program has been victim to billions of dollars in fraud and error. Moore also pointed to states that ended up spending more than expected on expanded coverage.

Americans for Prosperity supported an effort to create a 60% approval threshold for constitutional ballot questions that cost $10 million or more to implement, which would have included Medicaid expansion. In June, voters overwhelmingly defeated that proposal, so the expansion amendment needed only a simple majority to pass in November.

Marijuana measure headed for likely defeat
Another ballot measure faced a likely loss early Wednesday morning. South Dakotans appear to have rejected recreational cannabis on an election day that saw the five states considering

As of Wednesday morning, Initiated Measure 27 had the support of just 47% of voters. The measure would have legalized the possession, use and distribution of recreational marijuana for people 21 years and older.

Vote tallies from the state’s two largest counties had yet to fully report results in the early morning hours. IM 27 was winning in Minnehaha County, but the gulf between yes and no votes stood at around 20,000. The measure was winning in Minnehaha County by more than 6,000 votes.

Arkansas and North Dakota also voted against legalizing recreational marijuana, while Maryland and Missouri will join 19 other states and the District of Columbia in allowing use. Jurisdictions with legal recreational marijuana ahead of the Nov. 8 election accounted for about 44% of the U.S. population.

This was the second time a measure to legalize recreational marijuana has appeared on South Dakota ballots. Residents passed Amendment A with 54% of the vote in 2020.

Amendment A was struck down in February 2021 as unconstitutional on the grounds that it violated the state’s single-subject rule for ballot initiatives. The case was appealed to the state supreme court, which upheld the decision in November 2021.