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LRC Notes Medicaid Expansion Will Cost One South Dakota Dollar for Every $15 in Federal Funding

The Legislative Research Council has posted its fiscal notes for Dakotans for Health’s proposed initiated law and constitutional amendment to expand Medicaid under the Affordable Care Act (the measures are practically identical, as are the fiscal notes):

Based on eligibility requirements and income methodology set in federal law as of September 2020, the proposed expansion of Medicaid benefits could result in an additional 42,500 eligible individuals. The total annual estimated cost of Medicaid expansion is $301,800,000 with the state’s share of that cost being up to $20,800,000 [Legislative Research Council, fiscal note for proposed initiated measure to expand Medicaid, 2020.09.15].

The Legislative Research Council is limited to 50 words in its fiscal notes on initiatives (because the last thing the Republican Legislature wants is for voters to get more detailed information about ballot measures from a government agency with a mandate to be non-partisan), so the fiscal notes don’t have a chance to get into a full fiscal analysis. If they had just eighteen more words, they could say, “The influx of federal dollars will stimulate the economy, increase tax revenues, and make this plan budget-neutral.” Or, with just four more words, they could say, “Read Dakota Free Press,” which would direct every voter toward explanations of the  positive economic, fiscal, and health impacts that have been demonstrated in every state that has expanded Medicaid.

Dakotans for Health point out that even before we dig into economic and health effects, every dollar the state would spend to expand Medicaid brings in $15 from Uncle Sam, and that by putting politics over practicality, we’ve already given up $1.8 billion in federal funding that could have gone toward helping low-income South Dakotans pay for health care.

Dakotans for Health can start circulating its initiative petitions on November 8. They’ll need 16,961 signatures on the initiated measure petition and 33,921 signatures on the constitutional amendment petition to put Medicaid expansion on the 2022 general election ballot.


  1. Jake 2020-09-24 18:02

    Simply mind boggling how South Dakota GOP leadership can’t seem to get enough Federal $$$ to flow toward the state per military (B-21s, Bational Guard et. al.), and Farm payouts from a chaotic president who pays off our farmers with checks from taxes raised from US citizens to the tune of 20 to 30 billion dollars because of tariffs on Chinese goods and the average American has no clue we’re the ones paying those farmers for Trump’s screw-up. At the same time denying Medicaid expansion per the Affordable Care Act (Obamacare) as most other states have. Is it simply that they hate the underclass poor in this state so badly they can’t see the economics or what? They salivate at the thought of divvying up the $1.25 billion (or what’s left after Noem’s work) but this is timely given the need for healthcare reform in this country. Don’t mention the supposed health bill Trump and the GOP have promised for years-they obviously don’t have a clue or want to.

  2. mike from iowa 2020-09-24 18:31

    Noem Nothing has a perfectly good excuse to deny Medicaid for the poors. drump’s ideologue ridden Scotus will make short work of the ACA and drumpf will blame Dems for the millions that lose health care.

  3. Debbo 2020-09-24 21:52

    Dakotans for Health better be sure to get the amendment on the ballot. Based on states like Idaho that passed a similar initiated law, the state lege will trash it so citizens still don’t get what they voted for and need.

    My question is, why does ALEC hate expanded Medicaid?

  4. Cory Allen Heidelberger Post author | 2020-09-25 05:45

    Jake, apparently low-income people with medical problems and medical bills don’t come to Lincoln Day dinners and write checks.

    Debbo, ALEC hates anything that empowers the working poor. Make it easier for the working class to get health care and enjoy a better quality of life, and the working class will have more time to read the news and vote.

  5. Jake 2020-09-25 18:11

    Cory, exactly correct un your reply to Debbo. They can’t seem to fathom how the real economy simply works; ie. from the bottom up. The lower income always spend into the economy, circulating money. The higher and higher the incomes seem to either hoard more or hide it in overseas or SDak trusts.

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