South Dakota Voters Defeat Amendment I to Protect Medicaid Expansion

South Dakota Voters Defeat Amendment I and Reaffirm Medicaid Expansion

South Dakota voters rejected Constitutional Amendment I during the November 3 General Election, securing Medicaid expansion protections for thousands of residents across the state. Approximately 56% of the electorate voted against the measure, which would have repealed the state’s constitutional requirement for expanded Medicaid coverage if federal funding dropped below 90%.

The decision preserves the protections established when voters approved Medicaid expansion in 2022. For rural communities where every resource counts, the safety net remains intact.

Tim Rave, President and CEO of the South Dakota Association of Healthcare Organizations (SDAHO), pointed out the practical stakes of the vote.

The defeat of Amendment I is a positive outcome for South Dakota patients, health care providers and the communities they serve. Voters demonstrated that access to health care matters, especially in our rural communities where every resource counts. Medicaid expansion provides an important safety net for hardworking South Dakotans while helping sustain the health care services our rural communities depend on.

Familiar Federal and State Leaders Return to Office

At the federal level, U.S. Senator Mike Rounds won another term, whereas Marty Jackley, the current South Dakota Attorney General, achieved his initial victory to represent South Dakota in the U.S. House. Both bring experience with the state’s health care challenges, including the unique needs of rural communities.

Meanwhile, executive leadership remains steady. Governor Larry Rhoden and Lieutenant Governor Tony Venhuizen secured victories, providing continuity in state leadership as health care providers continue to deal with workforce shortages, financial pressures and challenges to accessing care. South Dakota’s Rural Health Transformation Program was heavily supported by the Rhoden administration, serving as a key project designed to bolster rural medical services and guide the evolution of care delivery statewide.

Experienced Health Care Advocates Return to Pierre

With the 2027 Legislative Session approaching, SDAHO feels encouraged by the election of numerous lawmakers who already maintain strong ties throughout the health care sector in South Dakota. Several health care champions retained their seats in the Legislature.

In District 1, former SDAHO Board member and health care administrator Nick Fosness returns to bring firsthand experience as a health care provider for the community of Britton. Senator Tim Reed of Brookings, who backed key 340B legislation, and Representative Taylor Rehfeldt of Sioux Falls, a clinical practitioner, are among the other returning politicians from the eastern part of the state. Both Reed and Rehfeldt have been recognized by SDAHO as Legislators of the Year.

Senator Sydney Davis of Vermillion, who served as Vice Chair of the Senate Health Committee, also retained her seat, joined on the House side by Representative Brian Mulder, Chair of the House Health Committee. In western South Dakota, Senator Helene Duhamel and Representative Steve Duffy of Rapid City are returning to the Legislature. Having previously led the Joint Committee on Appropriations and played a pivotal part in winning full backing for Medicaid expansion, Representative Mike Derby of District 34 also successfully held onto his post.

Preserving Advocacy and Rural Health Priorities for 2027

As the election outcomes become final, the medical community across the state shifts its focus toward the upcoming legislative agenda. SDAHO maintains its dedication to promoting policies that enhance medical care throughout the region, collaborating with both its members and elected officials to guarantee that South Dakota’s health care sector speaks with one cohesive voice.

Voters can review the full list of election results through the South Dakota Secretary of State Election Results page, while further details on provider advocacy initiatives remain available through the SDAHO Advocacy Portal.

The stability guaranteed by the defeat of Amendment I leaves providers better positioned to confront ongoing economic pressures when legislators convene.

Earlier coverage: South Dakota Voters to Decide Medicaid Expansion Funding Trigger in Constitutional Amendment I

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