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Medicaid Expansion: A Boulevard of Broken Dreams for South Dakota

FANTASY: Medicaid expansion is the only way to expand coverage for low-income South Dakotans.

REALITY: This outdated talking point hasn’t kept up with reality. Under recent federal legislation, low-income South Dakotans who work part-time get federally funded, silver-level private plans for free. But that coverage will end if South Dakota expands Medicaid and shifts them into state-funded government health care. Only non-expansion states can take advantage of this federal subsidy.

FANTASY: South Dakota can take a smart approach to Medicaid expansion that maximizes state flexibility.

REALITY: The Biden administration has made it clear it will handcuff states to a progressive vision for one-size-fits-all health care and will not approve flexibility waivers like time limits, fraud lock-outs, or work requirements for able-bodied adults.

FANTASY: Medicaid expansion will help support hospitals, especially rural hospitals.

REALITY: The opposite is true. Shifting patients off private health care plans and into Medicaid is a problem for providers, not a solution. In expansion states, costs are shifted to other patients and hospitals continue to struggle. In fact, non-expansion states have actually seen faster hospital job growth than expansion states.

FANTASY: Medicaid expansion is inevitable. Better to just accept it and move on.

REALITY: After years of shattered cost projections, the jig is up. The tide has turned. Thirteen states continue to stand firm against it, including Wyoming, Texas, Wisconsin, and Kansas.

The Six Nightmare Numbers of Medicaid Expansion


The percentage of able-bodied Medicaid enrollees who don’t work at all.1


Expansion states enroll more than twice as many individuals as projected.2


The number of low-income South Dakotans who will be shifted from their free, federally funded private insurance plans into government health care.3


The number of truly needy individuals who have died while stuck on Medicaid waiting lists in expansion states, even as able-bodied adults cut them in line.4


The amount of money spent improperly by Medicaid last year alone. In other words, the federal government wasted more money in Medicaid than South Dakota spent on everything.5


The number of federally qualified health care centers and clinics that already provide care to low-income individuals at low cost or no cost across South Dakota.67

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