Constitutional amendment I jeopardizes Medicaid expansion.
John’s note: I added Lieutenant Governor Tony Venhuizen’s comment on this piece to the end of my column. I invite readers to review it as an additional consideration as to how constituional amendment I would affect Medicaid expaonsion if it passes.
Constitutional amendment I would yank Medicaid eligibility for some 30,000 South Dakotans if the federal commitment to fund 90% of the cost of Medicaid expansion were to cease or be reduced. I get that Medicaid expansion passed by a vote in 2022, when it was clear that the feds would pay for 90% of it. If for some reason that promise changes and drops to a level below 90%, constitutional amendment I would end the program.
This seems harsh to me.
A peremptory denial of health care to people desperately in need of it based on a change in the funding formula is inhumane. We South Dakotans can do better, particularly in a state that consistently brags about its budget surpluses. 2026 marked 15 consecutive years during which our state has had a budget surplus.
Finding a way to use that excess cash for poor people who need health care seems like the right thing to do.
Vote no on this harsh and uncharitable dismissal of needy people.
Lt. Governor Venhuizen’s response to the above: Amendment I is not an automatic trigger. SD's participation in Medicaid Expansion is required by our State Medicaid Plan, which is an agreement between the state (Dept. of Social Services) and the feds, and participation in expansion is also built into the state budget.
If Amendment I were to pass, and then at some future point the feds backed down from their 90% match (as they very nearly did in 2025 in the One Big Beautiful Bill), the effect of Amendment I would be to remove the constitutional requirement that the state participate. But it would not preclude the state from continuing to participate. And continuing to participate would be the default, because expansion would continue to be part of the State Medicaid Plan.
John Tsitrian is a businessman and writer from the Black Hills. He was a weekly columnist for the Rapid City Journal for 20 years. His articles and commentary have also appeared in The Los Angeles Times, The Denver Post and The Omaha World-Herald. Tsitrian served in the Marines for three years (1966-69), including a 13-month tour of duty as a radioman in Vietnam. Republish with permission.
Photo: public domain, wikimedia commons
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