Boosting health-care access and tapping into federal aid are often cited as reasons to expand Medicaid. But a new report says South Dakota would also see new jobs and more revenue. The nonpartisan Commonwealth Fund analyzed the nearly dozen states that haven't expanded their Medicaid programs. If South Dakota acted, the report says the state could see more than four-thousand new jobs and nearly 10-million dollars in economic activity. Shelly Ten Napel heads the Community HealthCare Association of the Dakotas, backing one of two Medicaid ballot initiatives in the state. She cites benefits from the care that is already provided free of charge to uninsured patients.

Napel suggests policymakers sometimes get too bogged down with the financial ramifications, and may forget about what's at the core of the idea. More than a decade ago, the Affordable Care Act incentivized states to expand Medicaid, with the federal government picking up most of the tab. The new American Rescue Plan offers added incentives. Generally, conservatives cite budget concerns, and Governor Kristi Noem has been a staunch opponent of Medicaid expansion. These ballot campaigns are aimed at the November 2022 election.

Beyond economic factors, a new American Cancer Society Study says cancer patients in states with lower Medicaid income-eligibility limits had worse long-term survival rates. Supporters hope these findings convince enough South Dakotans to back the initiatives. The Legislature added a wrinkle by passing a proposed constitutional amendment for the June 2022 primary. It would raise the approval threshold for future ballot questions to 60-percent, meaning Medicaid expansion would need more than a simple majority to pass.