In the Nov. 3 election, South Dakota voters are considering four proposed amendments to the state’s constitution, all placed on the ballot by the Legislature. One of the questions, Amendment I, would repeal the expanded Medicaid eligibility requirement in the state constitution if the federal government’s share of funding for the expansion drops below 90%.

There’s a dispute about whether the amendment would trigger an immediate termination of expanded Medicaid if federal funding declines, or whether the amendment would merely give lawmakers the opportunity to consider eliminating the expansion in the event of reduced federal funding.

Medicaid is a federal-state healthcare insurance program for people with low incomes. In 2022, South Dakota voters expanded Medicaid eligibility to adults with incomes up to 138% of the poverty level, to capitalize on a federal funding match included in the Obama-era Affordable Care Act. The expansion is part of the state constitution and can only be altered by voters. The state Department of Social Services reported in August that about 143,000 South Dakotans were enrolled in Medicaid, including 31,000 who were enrolled through expanded eligibility.

A yes vote approves the amendment and repeals the Medicaid expansion requirement from the constitution if federal support declines. A no vote leaves the constitution as it is.

Supporters of the measure, including state Rep. Will Mortenson, R-Fort Pierre, say it’s fiscally responsible. Opponents, including Deb Fischer-Clemens, a nurse and Democratic former state lawmaker, worry it could leave thousands of people without health insurance.

In this episode, Mortenson and Fischer-Clemens explain their positions to Searchlight Report host Meghan O’Brien, who also speaks with Attorney General Marty Jackley about the dispute over the amendment’s meaning.

Click here to access a transcript for this episode.