Dana Hess writes for South Dakota Searchlight, an online news organization.

Throughout the recent past, Republicans in the South Dakota Legislature have had a tempestuous relationship with Medicaid expansion. When the federal government offered a way to expand the pool of people who receive Medicaid benefits, the Republican supermajorities refused to go along.

When Medicaid expansion became a constitutional amendment in the 2022 election, Republicans took a twofold approach to defeating it. Not only did they oppose the amendment, they forced onto the primary election ballot a constitutional amendment that would have required a 60% vote threshold on ballot measures that raise taxes or spend significant amounts of government funds.

Both strategies failed. Voters defeated the attempt to change the vote threshold and then, in November, approved encasing expanded Medicaid coverage in the state constitution.

Medicaid is a federal-state health insurance program. Those who are eligible include low-income adults, children, pregnant women, the elderly and people with disabilities. Currently, nearly 129,000 South Dakotans are enrolled. When Medicaid expanded, it opened the program to people whose incomes are at 138% of the federal poverty level or less. That’s up to $41,400 for a family of four.

Unable to head off Medicaid expansion at the ballot box, the next tactic was unique: indifference. According to a South Dakota Searchlight story, enrollments in expanded Medicaid are lower than expected because, as a representative of the Department of Social Services explained to the Joint Appropriations Committee, the state isn’t advertising the fact that more people are eligible. The department is leaving that task for community health organizations who don’t have anywhere near the resources of state government.

At the budget hearing, Rep. Linda Duba, a Sioux Falls Democrat, wondered if it might be more cost effective to sign up people while they are healthy. It seems 80% of new enrollees are placed on Medicaid rolls when they have a “health care issue.”

“If we were more proactive, people would be using preventative services,” Duba said, “instead of coming in when they’re sicker or they’re in greater need, which drives our utilization costs up.”

It seems that a state that spends at least $6.5 million to attract new workers through the Freedom Works Here campaign, in which the governor dresses up as various kinds of workers, could invest a little to ensure that the people who are already here know that they’re eligible for Medicaid. Tracking those dollars in health care and measuring their success would likely be easier than it has proven to be in workforce development. One of the few quantifiable results of the Freedom Works Here campaign is that now the governor has a closet full of costumes for Halloween. Now Republican lawmakers have decided that Medicaid will return to the ballot box this year in the form of Senate Joint Resolution 501, which would impose a work requirement on “certain individuals who are eligible for expanded Medicaid.”

A similar attempt failed in the Legislature last year, making it through the House but failing in the Senate Health and Human Services Committee. This year’s attempt to add the work requirement amendment to the ballot was approved 28-4 in the Senate and 63-7 in the House. Both were party line votes with Democrats in those chambers casting the only no votes.

Rep. Ton Venhuizen, a Sioux Falls Republican and a prime sponsor of the resolution, has characterized the work requirement amendment as a “clarification” of what the voters approved in 2022. However, the 2022 amendment specifically prohibits a work requirement. So does the federal government, which pays for 90% of the cost of the program. Venhuizen has said he hopes the federal rules change, but at this point the status of a work requirement seems pretty well clarified.

Opponents of SJR 501 are concerned about how the work requirement will be applied. Venhuizen said exemptions for work requirements for people on cancer treatment and for new mothers are things that “we all agree about” and can be worked out later.

However, the “we” Venhuizen refers to doesn’t exist. The work requirement amendment will be on the ballot at the same time as Venhuizen and all of his legislative colleagues. There’s no telling what the next batch of lawmakers would “agree” on as far as which Medicaid recipients should be required to work.

Far from a mere “clarification,” legislation like this springs from a right-wing belief that the social safety net is nothing but a web of corruption. SJR 501 has its roots in the notion that poverty is a scam designed to fleece taxpayers into paying for luxuries like food stamps, government health insurance and free school lunches.

Instead of a work requirement amendment that’s already superseded by federal guidelines and risks being defeated by voters, lawmakers could be working on legislation that would help raise their constituents out of poverty and ultimately off the Medicaid rolls.