More than a decade after the Affordable Care Act was signed into law, there are, believe it or not, still 12 states that refuse to accept Medicaid expansion. In theory, South Dakotans will be able to lower that total to 11 by way of the ballot box in the fall. In practice, it’s a bit more complicated than that.
Even in states where elected officials have balked at Medicaid expansion, health care advocates have, in several instances, been able to circumvent politicians by advancing the issue through ballot referenda. In South Dakota, proponents haven’t been able to convince the Republican-led legislature to adopt the policy embraced by several neighboring states, so they successfully put Medicaid expansion on the 2022 ballot.
To be sure, there’s no guarantee of success: South Dakota is quite conservative, and getting a majority of the state’s voters to support the policy — in an election year that’s likely to be rough for progressive candidates and causes — is a real challenge.
But for Republicans in the state, that apparently wasn’t quite challenging enough. The Washington Post’s Dana Milbank explained in a recent column:
… Republicans in the South Dakota legislature came up with a novel solution: They are moving to enshrine minority rule in the state constitution. Worse, they are attempting to force through their constitutional amendment imposing minority rule by holding the vote on a day when only hardcore Republican voters are expected at the polls.
To appreciate just how brazen the GOP legislators’ scheme is, it’s worth fleshing out the details.
Under the status quo, ballot referenda in South Dakota work the same way as they do in every other state: If a majority of voters endorse a measure, it passes.
What South Dakota Republicans — and their partners in the Koch-financed Americans for Prosperity — have come up with, however, is a shift in the standard for success. Under the GOP’s Amendment C, the state constitution would be amended to require a 60 percent supermajority for ballot measures that involve any policy that would require more than $10 million in government spending over a five-year period.
In other words, the point would be to rig the election in the fall to make success on Medicaid expansion nearly impossible.
To help ensure Amendment C’s success, and Medicaid expansion’s failure, the same South Dakota Republicans picked tomorrow for a reason. Milbank added:
South Dakota’s GOP-controlled legislature put its Medicaid-expansion-killing amendment on the ballot for June 7, the state’s primary Election Day. Because almost all the contested primaries … are on the Republican side, this essentially stacks the vote so that Democrats and independent voters won’t cast ballots.
A report in Bolts magazine added, “Some Republicans have explicitly acknowledged that they scheduled Amendment C for the June ballot to stall November’s Medicaid expansion proposal.”
Part of what makes this so extraordinary is seeing the lengths some GOP policymakers are willing to go to prevent thousands of struggling families from having access to health care coverage. But in a political dynamic like this one, there’s an additional layer that’s equally indefensible. Democratic state Sen. Troy Heinert said Amendment C was part of “a systematic assault on the will of the people.” That’s both true and important. There’s overwhelming evidence that too many Republican policymakers see democracy as an annoyance and election defeats as grounds to concoct outlandish conspiracy theories. But South Dakota’s scheme represents a classic of the genre: The voters of the state might’ve made a responsible choice in a free and fair election, so GOP officials scrambled to make sure the election would be less fair. Even a Republican legislator conceded that his partisan colleagues were acting in “bad faith.” They shrugged and proceeded anyway. If Amendment C passes, which seems like a safe bet, it’d be an overstatement to say Medicaid expansion definitely won’t pass. After all, when Idaho voters approved the policy four years ago, it passed with 61 percent support. If health care proponents in South Dakota can reach a similar total this fall, Medicaid expansion would pass despite the GOP’s efforts to subvert democracy. But the odds aren’t great. In this fight, the more South Dakota Republicans win, the more families and their democracy loses.
Steve Benen is a producer for "The Rachel Maddow Show," the editor of MaddowBlog and an MS NOW political contributor. He's also the bestselling author of "Ministry of Truth: Democracy, Reality, and the Republicans' War on the Recent Past."
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