Dual Medicaid ballot initiatives join behind one constitutional amendment

A joint news release on July 11 announced that Dakotans for Health would be withdrawing its initiated measure from the November ballot, allowing them and South Dakotans Decide Healthcare to focus on a single movement to expand health care in the state.

SD-Decides-HC (1).png
Image provided by South Dakotans Decide Healthcare
Contributed / South Dakotans Decide Healthcare
We are part of The Trust Project.

SIOUX FALLS, S.D. — Two parallel ballot initiatives seeking to expand Medicaid in South Dakota have now joined forces, quelling concerns that voter confusion from the similar measures may have stymied both efforts.

Dakotans for Health , the group backing Initiated Measure 28, announced in a joint news release on Monday, July 11, the withdrawal of its measure from the ballot. The group said it will support Constitutional Amendment D , an initiated amendment backed by South Dakotans Decide Healthcare that will appear on the November ballot.

“I think a constitutional measure is the most effective way to ensure that voters actually receive what they vote for,” Zach Marcus, the campaign manager for South Dakotans Decide Healthcare, told Forum News Service in a phone interview Tuesday morning, July 12.

Although both measures had language prohibiting the Legislature from imposing any restrictions on eligibility or enrollment, Amendment D also includes a clause that requires expansion be implemented by July 1, 2023.

While the Legislature can amend or repeal an initiated measure on its own, the Legislature is unable to make changes to an initiated constitutional amendment without the consent of the voters on a new ballot measure.


In the joint news release, Rick Weiland, the co-founder of Dakotans for Health, wrote, “After conversations with South Dakotans Decide Healthcare members, we have agreed that the best path forward to accomplishing this goal is to join efforts behind one campaign.”

In addition to the backing of the state’s major health care providers and national health care organizations such as the American Cancer Society, Marcus pointed to the backing of organizations including the South Dakota Municipal League, the South Dakota Farmers Union and the South Dakota Education Association as examples of a broader coalition pushing for expanded health care access.

“There's a whole host of reasons why organizations might be involved in our work,” Marcus said. “And I think that that's a really important part of this story.”

The Legislative Research Council estimates that 42,500 people in the state would be eligible for subsidized insurance if the expansion passes. The measure would save the state around $63 million during the first two years due to a 95% cost share incentive provided by the American Rescue Plan Act. After that, the state would spend around $20 million per year after offsetting savings in areas such as “correctional health care, behavioral health care, and Indian Health services,” savings that track with the experiences of other states.

The Affordable Care Act, passed in 2010, extended Medicaid eligibility to adults under the age of 65 with incomes up to 138% of the federal poverty level. The measure required states to opt in; currently, 38 states and the District of Columbia have chosen to participate in the program, 90% of which is covered by the federal government. Before that, Medicaid was targeted to disabled adults and adults with young children.

According to the 2020 United States Census, about 12% of South Dakotans under the age of 65 are uninsured.

"We need to throw out a mechanism to get those [excess] dollars back in the hands of the people," Rep. Chris Karr, of Sioux Falls, said of the $170 million proposal.

Jason Harward is a Report for America corps reporter who writes about state politics in South Dakota. Contact him at 605-301-0496 or

Jason Harward covers South Dakota news for Forum News Service. Email him at
What To Read Next
A resolution looking to allow the legislature to consider work requirements on the newly expanded Medicaid program is one step closer to the 2024 ballot.
A look into some of the personalities that created the legend of Deadwood, one of the Wild West's most infamous towns.
Rep. Taylor Rehfeldt, a Republican from Sioux Falls, said conversations with doctors convinced her the current "life of the pregnant female" exception was too vague.
A new tool to allow neighboring counties to crowdfund shared jails is on its way to the Senate after passing committee 7-1.