The Republican-dominated state of South Dakota passed ObamaCare Medicaid Expansion Tuesday at the ballot box, which was a key component of President Obama’s Affordable Care Act legislation. Now the South Dakota Freedom Caucus, a group of conservative Republican legislators, are demanding Republican party leadership deliver solutions at the next upcoming legislative session, accusing some in the GOP party of “creating the billion-dollar financial problem of Medicaid Expansion in the first place.” 

“I was raised that you clean up the messes you create, and this is the mess Republican leadership needs to clean up,” said Representative Mulally of the South Dakota Freedom Caucus.

The measure that passed will force individuals from 18 to 65 years of age that make up to 133% above the federal poverty line onto Medicaid, with a 5-year projected total cost of $1.5 Billion dollars, according to estimates from the Legislative Research Council’s June 17, 2021 memorandum on the subject. 

Opponents to the expansion point out that after the first two years the state will be responsible for a significant share of the costs – which some worry the state may not be able to afford in the long run. The Freedom Caucus also argues that many South Dakotans may lose their current health coverage after being forced onto Medicaid, something the Republican party promised to stop but some in the party promoted, according to statements from the Freedom Caucus.

“We understand that officially the South Dakota Republican Party didn’t promote Medicaid Expansion,” said Representative Randolph of the Freedom Caucus, “but the Republican party didn’t oppose it based on the tenets of the party platform either.”

The Freedom Caucus said the push by key leaders in the Republican party for “state-level ObamaCare” started in 2007 under Republican Governor Mike Rounds, owner of Fischer, Rounds & Associates Insurers, who started the Zaniya Project, a state task force to create a state-run health care system chaired by Lt. Governor Dennis Daugaard at the time. Coincidentally, following Rounds the year Daugaard was elected Governor, ObamaCare was enacted, and the Daugaard administration, with his Lt. Governor Matt Michels, openly advocated for the ObamaCare Medicaid expansion component throughout his term.

Around the time Governor Daugaard took office, the South Dakota Republican Party adopted a stance against socialized, or “government run,” healthcare as a part of their platform, illustrating a growing division between party leadership and their conservative membership. A disconnect that the South Dakota Freedom Caucus says the group was born out of according to some of its members.

Now the Freedom Caucus is demanding that the South Dakota Republican party and its members who supported the Medicaid Expansion passage, such as Senator Steinhauer who supported 2022 Senate Bills 102 and 186 to expand medicaid, or Representative Greg Jamison who publicly promoted its passage at the ballot box, come with solutions for the financial shortfall the state is anticipated to face along with the issues the Freedom Caucus says many South Dakotans will be facing in the coming years through losing their private insurance options.

The 2023 legislative session begins on January 10, 2023.