BALLOT WATCH: Legislation attacking healthcare, democratic process advance in South Dakota

State legislature seeks to roll back Medicaid expansion passed by voters through 2022 ballot measure

For second time, lawmakers try to push through supermajority requirement to amend state constitution by ballot measure – a scheme voters previously rejected

Pierre, SD – Despite heralding their state as the birthplace of ballot measures, South Dakota lawmakers have voted to advance two antidemocratic resolutions that would undermine the ballot measure process and overturn measures previously passed by voters. This comes as state legislators across the country have launched similar attacks on the ballot measure process in their respective states after citizens approved multiple progressive measures in 2024. 

HJR 5001 would make the state’s existing Medicaid expansion conditional on a 90% federal funding match, as the Trump administration seeks to claw that funding back. South Dakota’s Medicaid expansion was successfully enshrined in the state constitution through Amendment D in 2022 by a coalition of local organizations and the Fairness Project, which also helped pass Medicaid expansion in six other states since 2016.

“Medicaid is a lifeline to tens of millions of Americans, more than 70 million of whom rely on the program as their sole source of healthcare coverage,” said Kelly Hall, Executive Director of the Fairness Project. She continued, “South Dakota legislators are giving permission to their counterparts on Capitol Hill to defund this wildly successful program while excusing the state from making up the difference. The people of South Dakota made their choice clear at the ballot box: they want Medicaid to be expanded, not dismantled.” 

Meanwhile, another joint resolution, HJR 5003, would end majority rule in South Dakota by establishing a 60% supermajority threshold for the passage of constitutional amendment ballot measures. The amendment would restrict South Dakotan’s freedom to make decisions about their own lives and hand even more power to out-of-touch politicians. A similar legislatively referred amendment was soundly defeated by South Dakota voters in 2022. In that prior attempt, the Fairness Project and its partners in the state succeeded in rallying popular support for maintaining this critical tool of direct democracy.

“South Dakota’s out-of-touch politicians are once again working to give themselves the power to completely ignore the will of the people,” said Hall. “A powerful few want to change the rules of the game because they know that their hardline views are out of step with the majority of voters,” she continued.

South Dakota’s lawmakers join other extremist politicians in Utah, who voted on March 6 to refer a 60% win threshold question on the state’s 2026 ballot. Similar efforts are underway in Oklahoma, Arizona, Missouri, North Dakota, and Idaho to raise the win threshold from a simple majority to 60%, effectively enacting minority rule. Meanwhile, legislators in Oklahoma, Missouri, Oregon, Michigan, Montana, Washington, Nebraska, Florida, Arkansas, and Arizona are advancing bills that would create onerous signature requirements to make it more difficult to qualify measures for the ballot. Already this year, state legislators nationwide have introduced over 100 separate pieces of legislation attacking the ballot measure process in their respective states. 

Hall cautioned that extremist legislators are trying to roll back voters’ rights as a tactic to stop popular progressive ballot initiatives from becoming the law of the land, following a year of remarkable wins. The Fairness Project was the largest funder of abortion rights ballot campaigns in the 2024 election cycle and helped voters across the country protect reproductive rights, raise wages, and secure paid leave through the ballot. 

“These cowardly politicians know they can’t win in the battle of ideas, so instead they’re attacking the system in an attempt to take away their voters’ voices,” said Hall. “South Dakota voters have defeated their attempts before, and we’re confident voters will prevail again.”