Amendment D | Local News

Expanding Medicaid would benefit thousands in SD, says campaign manager

PIERRE — It’s time, said Zach Marcus.

Time for ending the concerns of thousands of South Dakotans worried about paying for needed health care.

Time to stop the sleepless nights for small-business owners who can’t afford to provide health care coverage to their employees.

Time to get off the increasingly diminishing list of states that haven’t expanded it.

It’s time to expand Medicaid in South Dakota, said Marcus, the campaign manager for South Dakotans Decide Healthcare, which is sponsoring Amendment D, which if approved by voters on Nov. 8, will do exactly that by amending the South Dakota Constitution.

“No one should have to decide if they can afford life-saving health care, for themselves or their families,” he said. “But right now, thousands of South Dakotans are stuck in the middle. They can’t get insurance through their jobs, and they can’t afford insurance on their own because costs are sky-high.

“Voting yes on Amendment D means thousands of South Dakotans who work, but don’t make enough money to afford health insurance will be able to get it. South Dakotans who make less than $19,000 per year will be able to get health care, including hard-working near-retirees who don’t have jobs that provide health care; small business owners who can’t afford health care for themselves and their workers; and farmers and ranchers.”

The South Dakota Legislative Research Council estimates an additional 42,500 people in the state would be eligible for Medicaid in the first year. That total would grow to 43,000 in the second, 43,400 in the third, 43,800 in the fourth and 44,300 in the fifth year. Right now, about 12 percent of the state’s adult population is without health-care coverage.

Marcus has more fleeting ties to South Dakota, although he is quick to note he now lives in Sioux Falls. He is a Virginia native who has worked for political campaigns in his home state as well as in New Mexico, Virginia and Massachusetts before coming to South Dakota to lead South Dakotans Decide Healthcare.

The total cost of adding these people to the program would be $1.515 billion over five years, with the state’s share $166,244,000. That is a savings of $162,473,000 to the State General Fund, according to the LRC.

“The estimate includes general fund savings due to expansion, including an offset in funds for correctional health care, behavioral health care, and Indian Health services, as well as the movement of certain populations from the regular Medicaid group to the expansion group,” according to a June 17, 2021, letter to South Dakota Secretary of State Steve Barnett from LRC Director Reed Holwegner.

“The general fund savings also reflect a temporary two-year incentive for Medicaid expansion provided under the American Rescue Plan Act,” Holwegner wrote. “These savings do not necessarily need to be applied to the Medicaid program and could be used for other appropriations.”

Marcus said $328 million of South Dakota’s tax dollars annually wind up in California, New York, and 37 other states to pay for their health care instead.

“Voting yes on Amendment D ends that,” he said. “It means we can keep those dollars right here in South Dakota, so hard-working South Dakotans can get health care coverage without raising taxes. Amendment D will strengthen health care in South Dakota, which will generate an estimated $3.5 billion in new economic output in South Dakota by 2025, including $800 million in 2023.”

Marcus said expanding the program would have ripple effects across the state.

“Amendment D will ensure our workforce remains healthy, which leads to healthy businesses and a healthy economy. Amendment D will strengthen rural hospitals and clinics and make it easier for people in rural South Dakota to get health care,” he said. “It’s common sense to keep our tax dollars for our citizens’ health care. Vote yes on Amendment D to keep South Dakota’s tax dollars in South Dakota to help our communities. We believe South Dakotans are ready for Amendment D and appreciate the public health and economic benefits that Amendment D will bring to our state.”

If approved, South Dakota would be the 39th state, along with the District of Columbia, to expand Medicaid since the Affordable Care Act became law in 2010. It offered states 100 percent federal matching funds to provide coverage to people previously ineligible, including adults under the age of 65 with incomes up to 138 percent of the federal poverty level. The matching total dropped to 90 percent in 2014.

The ACA, dubbed “Obamacare” because it was passed when Barack Obama was president, originally made Medicaid expansion mandatory. But in 2012, the U.S. Supreme Court, while allowing Obamacare to remain in place, made expansion optional for states. South Dakota has, until now, resisted calls to add people to its Medicaid rolls.

The American Rescue Plan, passed in 2021 in the wake of the COVID-19 pandemic, raised the matching funds total to 95 percent for two years for states that expanded the program.

Medicaid, created by Congress in 1965 and signed into law by President Lyndon B. Johnson, is a joint federal and state program that helps cover medical costs for some people with limited income and resources, including nursing home care and personal care services.

It is often confused with Medicare, a federal insurance program also founded in 1965 that largely covers people 65 and older, as well as younger disabled people and dialysis patients. It is basically identical in all states.

For a while, South Dakotans Decide Healthcare was one of two campaigns to expand Medicaid. Dakotans for Health had prepared an initiated measure for the 2022 ballot, but after the two groups conferred, Dakotans for Health asked that IM 28 be removed.

On July 11, the groups announced they would work together to expand Medicaid.

“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,” said Dakotans for Health co-founder and chair Rick Weiland of Sioux Falls, a longtime Democratic Party activist and former candidate for Congress and the U.S. Senate.

The group is now working to place a proposed constitutional amendment ensuring the right for a woman to have an abortion on the 2014 ballot. South Dakota banned virtually all abortions after the U.S. Supreme Court’s June ruling in the Dobbs v. Jackson case tossed out national protection for the procedure.

Marcus, 33, has more fleeting ties to South Dakota, although he is quick to note he now lives in Sioux Falls. He is a Virginia native who has worked for political campaigns in his home state as well as in New Mexico, Maryland and New Hampshire before coming to South Dakota in 2021 to lead South Dakotans Decide Healthcare.

First, defeating Amendment C

This is actually the second election this year for Medicaid expansion proponents. First, they had to defeat proposed Amendment C, which would have changed the voter requirement threshold for future ballot questions, requiring 60 percent approval for measures that increase taxes or fees, or that would require the state to appropriate $10 million or more in the first five fiscal years.

Amendment C backers, including leading Republicans in the South Dakota Legislature, placed it on the June primary ballot, both in an attempt to block Medicaid expansion and to seek victory in an election with a traditionally smaller turnout.

But Medicaid expansion advocates, along with supporters of Initiated Measure 27, which calls for legalizing recreational marijuana, worked in tandem to defeat Amendment C. It was soundly rejected 67.43 percent to 32.57 percent.

South Dakotans Decide Healthcare is supported by patient advocates, nurses, health-care providers, farmers, faith leaders, educators and more, Marcus said. It has been endorsed by the American Cancer Society Cancer Action Network, AARP South Dakota, South Dakota State Medical Association, South Dakota Nurses Association, South Dakota Association of Healthcare Organizations, South Dakota Education Association, South Dakota Farmers Union, Community HealthCare of the Dakotas, Great Plains Tribal Chairmen’s Health Board, Avera Health, Monument Health, Sanford Health, American Heart Association, American Lung Association, South Dakota Faith in Public Life, and more.

It has been supported by some prominent South Dakotans, including Rapid City Mayor Steve Allender and longtime agricultural announcer and personality Jim Woster.

“It is one of the broadest coalitions to ever launch a ballot measure campaign in the state’s history,” the campaign claims on its website.

That coalition has provided a bountiful amount of funding, with South Dakotans Decide Healthcare having raised nearly $4.3 million for the campaign, including $3,710,409.67 in cash and another $577,199.15 in in-kind contributions.

It has received $600,000 from SDAHO Enterprises, an offshoot of the South Dakota Association of Healthcare Organizations, as well as $500,000 each from the three major health-care organizations in the state: Avera and Sanford of Sioux Falls and Monument of Rapid City. Earlier this year, it received $250,000 from the South Dakota Farmers Union.

While it has spent around $3.7 million during the campaign, primarily for advertising, the campaign committee reported having $524,672 on hand for the closing run.

Marcus told The Pioneer the broad range of support indicates South Dakotans are ready to amend their Constitution and expand Medicaid.

“We are grateful to have a broad coalition of organizations behind Amendment D,” he said. “We appreciate the many varied groups that want to see this measure pass and we are glad to have all of their support.”

Marcus said that wide-ranging support will be displayed in the closing days of the campaign.

“We have dozens of organizations and hundreds of volunteers across this coalition talking to voters and reminding them of the critical importance of passing Amendment D,” he said. “We are certainly grateful to the many contributors who understand the benefits Amendment D will bring to South Dakota and South Dakotans.”

The proposed amendment is well ahead in all polls so far.

“As many public polls have shown, including a poll conducted by Glenn Bolger for ACS CAN and other partners, and the SDSU poll, we believe we are in a strong position to win this race,” Marcus said. “But we will continue to work hard to earn every vote, and communicate with as many South Dakota voters as we possibly can about why Amendment D will be good for our state.

“We need to continue to communicate our message to South Dakota voters about why Amendment D is good for our health, good for our economy, and good for our state,” he said. “If voters continue to hear from us, we are very confident we will win on Nov. 8.”

Medicaid expansion opponents say they oppose ‘government restraints’

PIERRE — It sounds like a good idea, but when you take a closer look, expanding Medicaid in South Dakota would be a serious mistake for several reasons.

That’s the argument being made by Americans for Prosperity-South Dakota State Director Keith Moore, whose organization opposes the proposed Amendment D, which would expand the joint federal-state program.

“Americans for Prosperity exists to promote and advocate for the everyday American,” Moor said. “We believe in giving South Dakotans the opportunity to live prosperous lives without government restraints, while also encouraging a functional government model that fills the gaps where people need it most. Although the sentiment behind Medicaid is one of positive virtue, the system itself is inefficient and in need of reform.

“An expansion of this program is not ideal and will not only burden taxpayers as we’ve seen in several other states who have adopted Medicaid expansion like Ohio, Montana and Louisiana, but it will take away the private health plan offered to non-expansion state, low-income residents which accounts for over 17,000 South Dakotans.”

He said there are other good reasons to reject Medicaid expansion — it’s bad for business and ultimately detrimental to people who rely on the program.

“Expanding Medicaid will also incentivize able-bodied adults to reduce their working hours in order to qualify for the program, effectively contributing to the existing labor shortage in South Dakota,” Moore said. “Most importantly, the influx of new Medicaid recipients will crowd out the most vulnerable like the disabled, elderly, and children, making it harder for them to receive care. Since 2013, nearly 22,000 patients have passed away waiting for care. Expansion will surely keep that trend going.”

Moore said Medicaid was originally created to be a safety net that provided basic medical care for individuals with nowhere else to turn, like low-income kids, seniors and those with severe physical conditions or developmental disabilities.

“It’s unfair to the truly needy in South Dakota that they will have to compete with able-bodied working-age adults for the pool of money available to Medicaid,” he said. “On average, expansion states have enrolled twice as many individuals as expected. If we simply follow the average, that would add 86,000 able-bodied, working-age individuals to state government health care. That’s the total population of Rapid City and Spearfish combined.”

Placing that many people on Medicaid will come with a cost, Moore said.

“This will blow a hole in state budgets and South Dakota will have to cut core services — like education and law enforcement or be forced to raise taxes and or fees to fund key services,” he said. “Medicaid is riddled with waste, fraud, and abuse. Last year $86 billion was spent improperly by Medicaid. That’s more than 47 out of 50 states spent on everything in their entire budgets last year.”

Medicaid, created by Congress in 1965 and signed into law by President Lyndon B. Johnson, is a joint federal and state program that helps cover medical costs for some people with limited income and resources including nursing home care and personal care services.

It is often confused with Medicare, a federal insurance program also founded in 1965 that largely covers people 65 and older, as well as younger disabled people and dialysis patients. It is basically identical in all states.

Americans for Prosperity was founded in 2004, with funding coming from billionaire brothers David and Charles Koch. It advocates for conservative and Libertarian positions. As a private organization, it does not disclose its funding sources or expenditures.

“AFP’s efforts are part of our FY budget,” Moore said. “We have some of the best volunteers, and we count on them.”

A support group, NO ON AMENDMENT D, was formed by state Sens. Ryan Maher, R-Isabel, and John Wiik, R-Big Stone City, this fall. It reported raising no money but stated it did accept an in-kind donation of $3,646.40 to pay for canvassing.

Maher said he wasn’t involved in discussions to create the ballot questions committee.

“I was asked to be the treasurer of the committee, because I don’t have an Avera or Sanford Health facility in my legislative district,” he said.

Maher said he opposes the ballot measure because it is another amendment to the Constitution that “doesn’t belong there.” He also is concerned about the potential expense.

“This is also going to cost the state of South Dakota $30 to $40 million per year. That means we are going to have to take it from some other agency and department,” Maher said. “Which most likely will come off the backs of education because that is the biggest part of the state budget. Also, people need to be aware that there is no work requirement to be eligible for Medicaid. So, you can be 25 years old living in your parent’s basement, smoke weed all day, and be eligible for Medicaid. All the while the rest of us are working 40-plus hours a week to be responsible and pay our own way.”

He said it’s been an uphill battle.

“Absolutely, look at the millions of dollars that are being put into the yes campaign by Avera and Sandford health systems,” Maher said. “Because they know they stand to make hundreds of millions from Medicaid expansion. This way they can hire more helicopters to dry their golf courses in Sioux Falls, and build more stadiums to put their name on.”

Gov. Kristi Noem, a Republican seeking a second term, has opposed Medicaid expansion, saying it would be too expensive for South Dakota. Noem has not focused on the issue during her race. Her campaign spokesman, Ian Fury, did not respond to a request for comment.

State Sen. Lee Schoenbeck, a Watertown Republican and the leader of Senate Republicans, has been an ardent foe of Medicaid expansion. He was one of the advocates for the proposed Amendment C, which would have required 60 percent approval for ballot measures that would increase taxes or fees, or require the state to appropriate $10 million or more in the first five fiscal years. It was placed on the June primary ballot, but was defeated in a landslide, 67.43 percent to 32.57 percent.

On Thursday, Oct. 27, Schoenbeck was still opposed to expanding the program and adding thousands of names to the roll.

“Amendment D expands welfare in our state, and puts that large welfare program in our state Constitution,” he told The Pioneer. “More welfare programs won’t make our state stronger, and putting the welfare program in the Constitution means we can’t tweak or fix the inevitable flaws in it. Nobody that understands how a constitution works can think that’s a good idea for South Dakota.”

Schoenbeck said he was not actively campaigning against Amendment D.

“I don’t have to make the case. I’m voting my one vote. The other 830,000 South Dakotans get to vote theirs,” he said. “But, sadly, the ads and information they get are driven by the businesses and organizations that get millions of tax dollars from the welfare program. The voters will decide and then live with whatever the result. If it passes, their tax dollars will make the welfare payments.”

A poll released on Oct. 25 showed Amendment D with a massive lead, confirming earlier surveys that placed the amendment well in front. It has been approved in all 37 states where voters cast ballots on it.

But Moore said they are running all the way to the tape, not giving up until all the votes are cast and counted.

He is a South Dakota native who was born on the Rosebud Indian Reservation and is half Rosebud Sioux. Moore moved off the reservation when he was 8 years old and he grew up in Kennebec.

He now lives in Sioux Falls with his wife and children. Moore was named to the post in November 2021. He previously served as the state director of Fellowship of Christian Athletes and has worked for the Bureau of Indian Education, the University of South Dakota, and the South Dakota Department of Education.

Medicaid has been expanded in several states, many traditionally conservative-leaning, in recent years. Maine did so in 2017; Idaho, Nebraska and Utah in 2018; and Missouri and Oklahoma in 2020.

Eleven states other than South Dakota that have not expanded Medicaid: Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, Tennessee, Texas, Wisconsin and Wyoming. Only three of those states, Florida, Mississippi and Wyoming, allow voters to place the issue on the ballot.

“There has been a broad push to get Amendment D across the finish line from progressive groups, but we understand the ramifications of expansion,” Moore said. “We’re doing our best to educate voters on Amendment D to ensure they make the right choice for themselves and their families. There are many variables at play here, but one thing’s for sure, nothing from the government is free. In the long hall, businesses, communities, and families will suffer if Amendment D passes.

“A win for us is a win for all South Dakotans,” he said. “We are working day and night to educate voters about the impact this will have on everyday South Dakotans and encouraging them not to take the bait that progressives have laid out.”

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