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Will South Dakota Expand Medicare?

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It’s just so hard to not see the American electorate as a bunch of morons. We see this again and again, where people will vote on a single issue that they want but then will also vote for the politicians who will do everything possible to overturn those votes. We’ve seen this with both marijuana legalization and minimum wage hikes, as well Medicare expansion. And while it would be nice if we lived in a nation where voters could add 2 and 2 and realize it makes 4, we do not. So the best we can do is hope voters continue to approve Medicare expansion on its own. It seems to be about to happen in South Dakota at least.

Progressives have helped bring health coverage to tens of thousands of uninsured Americans with an exercise in direct democracy: They have persuaded voters to pass ballot measures expanding Medicaid in six states where Republican elected officials had long been standing in the way.

Now comes the latest test of this ballot box strategy: South Dakota.

An unlikely coalition of farmers, business leaders, hospital executives and clergy members have coalesced around Amendment D, a ballot measure that would enshrine Medicaid expansion in the South Dakota Constitution, over the objections of Gov. Kristi Noem, a Republican. It is widely expected to pass next week on Election Day.

It has been 10 years since the Supreme Court ruled that states did not have to expand Medicaid — the government health insurance program for low-income people — under the Affordable Care Act, and the politics around the issue have shifted. Philosophical objections to large government programs are giving way to economic considerations, particularly in rural states like South Dakota, where struggling hospitals and nursing homes are eager for federal reimbursement dollars that come from Medicaid.If Medicaid expansion is adopted in South Dakota — a state where Donald J. Trump won more than 60 percent of the vote both times he ran — advocates say it will send a strong signal to other Medicaid expansion holdouts, like Texas and Florida. South Dakota is one of 12 remaining states that have not expanded, down from 19 in 2016.

I’m sure Florida Republicans will just ban any kind of public vote for anything before allowing Medicare expansion in the nation’s oldest state by average population. But one step at a time I guess.

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