Election '26: How candidates view Medicaid expansion

Simplified: Sioux Falls Simplified spoke face-to-face with dozens of legislative candidates in the metro area. All candidates were asked the same slate of questions, and you can find comprehensive coverage for each district at sfsimplified.com.

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Here's what we asked:

South Dakota voters supported medicaid expansion in 2023 – Do you think they made the right choice? How will/will you support ongoing access to healthcare for vulnerable residents and ensuring providers are adequately funded?

Here's what candidates said:

District 2

Adam Long: "I obviously want everyone to be able to get medical care. I want it to be accessible. I want it to be quality. I want there to be providers.

"But the other side of that is that we have to be very cautious about putting too much government money into the healthcare system ... I don't want our healthcare to become government healthcare," Long said, noting that he's experienced VA healthcare as a veteran and that the standard of care there is "not where it should be ... because there's so much red tape."

Manuel Luschas: "That's a tough question ... looking at the state budget, I don't think so.

"Because if you look at the last state budget, medicaid has exploded, and the cost for those programs have exploded significantly. ... I don't think that was necessarily anticipated by the population that voted for it, nor by the legislators that have to deal with it now.
"How do we ensure adequate access for vulnerable populations – I’m not an expert there. I cannot really speak to that and need to educate myself more in that field. But I think the way that it's currently funded is way out there, and we need to dial that back somehow."

Blake Rife: "I am a nurse, and I see this every single day. Nobody deserves to be sick.

"A sick person can’t function. A sick person cannot engage in economic growth and development, cannot be competitive. Yeah, I think South Dakotans made the right call.
"If you live in a small town in South Dakota, and you are struggling to make ends meet, and you get hit with a major medical bill – I don’t think that you deserve to be punished for that. And that’s really what this is.
"If you do not address the needs – health, security and basic needs of people – we’re not functioning well as a government."

See more from District 2 candidates here:

District 6

Garret Campbell: "I do believe they made the right choice – whatever choice they made is the right choice, but in this case I have heard people who are afraid their benefits might disappear.

"My idea for protecting that sort of stuff is a trigger law–if it disappears federally, I want to make sure locally we make our own local similar thing to what was there federally if it disappears."

Jerry Jongeling: "Again, I've got to be honest with you, that's not a topic I did follow. I'm more of an engineering/infrastructure type of person.

If that's what was voted on, you have to respect the voters. I'd have to look at every part of it to give you a complete answer, but if that's what's voted on you have to respect the voters."

Elliott Neff: "In the short term, it made a lot of financial sense, because you've got such a major federal dollars supporting this. Well, what if those dry up? What if that changes? Then you have a position where you're now stuck with a major bill, and now the taxes are half to fund your commitments. Is that sustainable? Is that what we want? So, I don't know that those questions were fully vetted back when it was passed in the first place. And now we are stuck with that, and what are we gonna do about it – so, this is this is a tough issue."

Austin Wolf: "I do think they made the right choice. ... Any time the voters speak, that's the answer.

"A big part is just holding people accountable. Finding funding for those types of things – it comes down to accountability. It's all in how we appropriate these things."

See more from District 6 candidates here:

District 9

Amanda Potter: "I do support it, and I think it is such a huge and important part of rural healthcare and making sure that we do have providers and facilities in our rural areas.

"People should not have to drive multiple hours for care or to have a baby, but that's what's happening. It's really important that we not only keep medicaid expansion, but also make sure that, maybe, we look at strengthening it even more.
"Making sure that providers can afford to stay in smaller communities and facilities can continue to stay open is such an important priority."

Megan Tschetter: "As far as the government, I think they should protect our rights. And while people have the initiative to work and prosper, when they truly need help, I think we need to look at that.

"But we also need to look at whether the expansion is sustainable. If it's not sustainable where are the funds going to come from? Is it going to fall on the state? We have to live within our means.
"I’m probably always going to be a little conservative on that idea, but I also understand there are real needs and real people suffering, and I don't that's right either. I will always support the will of the people."

Tesa Schwans: "I think it was for the best of intentions to make sure that the people that are the most vulnerable are getting the help that they need.

"I think, overall, medicaid expansion is something that helps the vulnerable and helps keep people in an area to where they can have a certain lifestyle.
"But I still believe in the quality of work, and I do think that it shouldn't be something we just depend on, but it should be something that's incentivized. ... I think it's a very delicate balance."

See more from District 9 candidates here:

District 10

Liz Larson (Senate): "Yes. The voters clearly chose to expand Medicaid and we need to protect what they wanted. Myself and my caucus are going to do everything that we can to make sure that Medicaid remains either the same or increases.

"I don’t see it possible for us to increase, but at every turn a lot of people in the legislature are trying to get rid of Medicaid or reduce it back or create situations in which we could reduce it back in the future. ...
"I don’t understand why some of my colleagues in the legislature feel like hardworking people should have to put up with that. They didn't. Their parents didn’t, and their rhetoric is just kind of gross."

Michael Dupic (Senate): Declined to be interviewed.

Adam Bair (House): "South Dakota voters made it very clear that we wanted Medicaid expansion. We made it very clear that that is what we wanted, and it’s very discouraging to see the state government try time and time again to usurp the will of the people and to not provide those programs. We’re seeing it again this year.

"We also know that when more people have access to healthcare that all of our healthcare costs go down. ... We need to do everything that we can to stop that growth in cost. Part of that is providing care to communities who otherwise would not have it."

Kathleen Brudvig (House): "Medicaid is an issue near and dear to my heart ... I personally have been on Medicaid when I was a young mom. I had my son when I was very young, and I needed Medicaid coverage for myself and my son.

"I think the voters absolutely got it right with Medicaid expansion. Healthcare is foundational. You cannot live a successful life without being healthy and having access to healthcare. Healthcare, housing, education — that investment helps people thrive.
"When you take away Medicaid access you’re going to see rural hospitals close and you’re going to see healthcare be cut because people are going to be unable to access preventive care. When you don’t have that to access preventive care, you’re going to have more expensive healthcare down the line."

Kimberly Petterson (House): "I wasn’t 100% in support of it. I did believe at the time that we had a good Medicaid program for the state.

"I wasn’t necessarily always for the increase in any kind of overall funding unless it’s more scrutinized as to where it’s going to go. I think it should be going to the people that absolutely need it. We do have residents that need healthcare, and they need to be able to access those kinds of things when they need them."

John Pohlman (House): "I think it’s far exceeded what we thought it was going to be when we approved it. I was all in favor of approving it — those were federal dollars that were available to us. I think it was the right call at the time.

"I know there’s legislation we’re talking about to try to put some guardrails on that so it doesn’t get totally out of control.
"We have a constitutional obligation to provide for Medicaid. I think we have to look long and hard at exactly how much we commit given what those things will eat into our other basic services that are absolutely important to South Dakota, and we have the obligation to balance our budget on top of it. We can’t just go in the red this year and pick it back up next year."

See more from District 10 candidates here:

District 11

Chris Karr (Senate): Did not respond to interview requests.

Aaron Matson (Senate): "I do think they made the right choice, and I think we need a budget that reflects the will of the voters.

"If you talk about putting like 12% in reserves, that’s not helpful for the citizens. Facing a choice like that or providing healthcare for people, we should provide healthcare for people.
"I’m a novice when it comes to state appropriations, so I’d need to defer to members of the committee on how to make that happen, but it would be a priority for me to make that all happen and to work together on how we can make that happen."

Brian Mulder (House): "I've been advocating for 100% funding for providers when it's possible, but I understand the dollar amount and what that would take. When we fund them ... let's just make sure providers get paid for what they're doing. That'd be the idea.

"My struggle with the Medicaid expansion that we did here in South Dakota ... I didn't support that personally on the ballot because I don't like it in the constitution and where it's at. There's a big cost to that where we're going. We've seen what it's done to our state budget. But Medicaid is support – use of those dollars is for the most vulnerable of our population centers and making sure they're getting funded first."

Sonja Mentzer (House): "We depend in South Dakota on a public-private partnership for private companies to provide those services, not just companies like mine but hospitals, clinics, dentists across the state.

"We have to reimburse them adequately so that they stay open. We’re not doing any good if we can’t pay a fair compensation to the dentists and the doctors. They’ll close up or stop being providers, and then we can have vast deserts of non-Medicaid-available services across the state.
"Access is one of the biggest barriers. Every single day I’m talking to people trying to figure out how they can get to their doctor appointment because they don’t have access, don’t have their own car, can’t afford a private company. And we’re in Sioux Falls."

Tracey Quint (House): "I do believe that everybody should have access to healthcare, and making sure that it’s funded is going to be one of the most difficult aspects of that.

"One of the things I’ve always been a believer in is we need to overhaul our healthcare system in some way or another. ... What are we doing to make sure that costs of medical procedures themselves are staying low? Why has the cost of medicine in the U.S. ballooned so much so that the average person goes into debt because of a medical emergency? What are some ways that we can offset that?
"It's probably not something I can even touch in a district seat. But, in the meantime, making sure that funding is there and working on redistributing the budget as needed to make sure people are getting the healthcare and the Medicaid they need is important."

Keri Weems (House): "That’s a really challenging question because the voters voted for Medicaid expansion, and so we should do everything we can to make that a feasible program. But, then again, at the national level, we don’t get to make the decisions what comes to us, so those are some challenges that we will have to deal with.

"I’m really glad that we have the rural health care dollars that can maybe add in some efficiencies for us that can help make healthcare better and maybe make it more accessible."

See more from District 11 candidates here:

District 12

Amber Arlint (House): "Around providers being adequately funded, some incredible work was done in my first two years in the legislature about increasing reimbursement rates. We worked really hard on the reimbursement rates with Medicaid expansion."

Arlint also detailed the structure of how Medicaid is written in the state constitution, with the federal government funding 90% and the state funding 10%. She said she's concerned about what could happen if the federal government decreases its share.
"I am not someone who’s overly comfortable right now relying on the federal government. ... I think it’s important to continue to address that and make sure on the state side we’re prepared and don’t have to make a cut to funding education or other needed programs."

Stephanie Arne (House): "Yes, I support Medicaid and Medicare.

"What I’m hearing in District 12 is people constantly saying they are terrified of losing healthcare support. ... From my conversations on the doors, there are people who are able-bodied and want to work but feel stuck because of how benefits interact with employment. They're trying to find the balance where they can work, contribute to the community and economy, and still get the health support they need."

Kerry Loudenslager (House): "I remember when that came on the ballot. I actually did not like how that bill was written and placed on the ballot, and here’s why. I’m in favor of Medicaid expansion for ages 18 to 65 – and we’re really not talking about the elderly, disabled, or pregnant because they were already covered. We’re talking about those that fall in the 133% threshold of the federal poverty level, including some able-bodied workers.

"Take a look at other states that have a work requirement. I think most South Dakotans wouldn’t be in favor of providing Medicaid to those who can work but choose not to. ... I think there needs to be some kind of work requirement for those who are able to work."
Loudenslager also voiced his support for Constitutional Amendment I, which would revoke Medicaid expansion if federal funding dropped below 90%.

Kari Shanard-Koenders (Senate): "We need to provide healthcare to those who are truly needy, and Medicaid does that in a way. It doesn’t get to everyone, but the expansion, I think — some of my Republican colleagues would probably disagree — but I do think that was a good idea. ...

"I worry about the federal government backing out of that and us having to limit services for our residents. I don’t like the sound of that.
"I don’t really want to cut Medicaid funding, but if the federal government does what we feel like is a possibility, then we may have a problem. I’m definitely a hand-up, not a hand-out type of person. I want to help those who truly need it, but I don’t want to put undue burdens on those who get Medicaid either and make them feel like second-class citizens."

Joe Zweifel (Senate): Could not be reached for comment.

See more from District 12 candidates here:

District 13

Ali Rae Horsted: "Yes, I think voters were correct in voting to expand Medicaid.

"I am concerned about Amendment I because it would revoke Medicaid expansion and potentially take healthcare away from many South Dakotans. I know there was a large excess in the DSS (Department of Social Services) budget as well, and I think the state could do a better job of helping people become more aware of the programs that exist. I’d like to help make it easier for people to get the healthcare they need."

John Hughes: "I’d love to have more information from the Department of Health and Department of Social Services, which are somewhat at odds with each other when it comes to the rural healthcare transformation money. We need to spend our money way better.

"I would’ve supported Medicaid expansion with a trigger. Around 14 states that exercised their right to expand Medicaid did it by statute, and they have trigger provisions."
Hughes also criticized the voter's choice to approve Medicaid expansion as a constitutional amendment rather than an initiated measure.
"Yeah, we do have a legislature that says no, but they could’ve initiated a measure. We voted in medical marijuana as an initiated statute rather than an amendment."

Jack Kolbeck: "I don’t have a problem with it.

"The thing that does bother me a little bit is the fact that the federal government isn’t going to fund it at 90% forever. We as citizens of South Dakota have to come up with the excess money for that. We’re trying to force the federal government not to be able to do that."

See more from candidates in District 13:

District 14

Taylor Rae Rehfeldt: Could not be reached for comment before deadline.

Tyler Tordsen: "It is a delicate balance. I do get leary of putting too much faith in the federal government, presidential administration and Congress to keep their word.

"Overall, I think I was more so supportive of Medicaid expansion with work requirements and that aspect. That’s another one of those core essential functions of government. People want the same thing – education, access to healthcare, shelter, economic opportunity, infrastructure, public safety. ... We can’t expect core functions like that and for providers to operate at a loss."

Erinn Williams: "Yes, I agree that Medicaid expansion was the right thing to do.

I think especially right now when you see what’s happening with the federal government, I wonder if they even have any concern about all of those people who are on Medicaid.
There's a huge amount of women who give birth on Medicaid in South Dakota. There’s a huge amount of children on Medicaid in South Dakota, and it just is an afterthought. Again you guys figure this out — we’ll be over here sitting on our stockpile of money and we’ll do it. So much of what I believe in is we should’ve been, from the beginning, taking care of our neighbors, and we’re just not doing a very good job of it."

See more from District 14 candidates:

District 15

June CopperStad (House): "We definitely made the right choice. I wish we had made it a little sooner but healthcare for more of our neighbors is a good thing.

"I was lucky enough to get to do part of my social work internship with Midwest Street Medicine and got to sign folks up for Medicaid who were newly eligible. That was a really impactful thing.
"One thing that people don’t know is that a lot of folks who are unhoused or really low income are working. They are going to work during the day full-time or at night, overnight whenever it may be, and then they are having to return to a shelter, the street, couch surfing, sleeping in a car – whatever it may be.
"We have requirements increasing here. We’re going to see the impact of that. But I would not support more restrictions or barriers to people accessing that care and that vital healthcare coverage, because people are already working so hard and the barriers are just exponential."

Brenda Lawrence (Senate): Could not be reached for comment before publication deadline.

Erik Muckey (Senate): "South Dakotans made the right choice because they decided it was the right choice for them. The amount of folks who’ve accessed the program is about half what we projected. As a leader of the Medicaid work group in appropriations, my primary focus has been how do we make sure we balance the budget while also making sure every person in South Dakota has access."

Joni Tschetter (House): "It’s a very complex situation. You can’t second-guess what happened in 2023; at that time people had the information they had and they voted for it. That’s where we’re at right now—we can’t change the past. We’ve got to work with what we have.

"If the U.S. government isn’t going to give South Dakota the money needed for Medicaid or specific programs, South Dakota should not have to pick up the entire share of funding. We can only use the money that is there and already allotted.
"To reach the vulnerable, there are plenty of organizations that can help – from homeless organizations that can meet a person’s need and maybe just meet that need every day, to pregnancy and childcare services. The downtown Link can suit needs much better than what I might say Medicaid should help."

Kadyn Wittman (House): "Yes, I think voters made the right choice. I was one of those voters. I am strongly in favor of Medicaid expansion.

"If you wanted to get even deeper into it, I think that healthcare is a right. I think everybody should be able to go to the doctor whenever they need without worrying about being crushed by medical debt. I will fight against any attempt to include more work requirements or greater documentation for families. I support it wholeheartedly.
"I’ve worked with (District 11 Rep.) Brian Mulder quite a bit when it comes to reimbursement especially for cognitively and physically disabled community members and getting to that 100% methodology. We want to make sure they’re remaining whole. And if Medicaid ever federally changed their guidelines, it would be super expensive for South Dakota."

Andre Zachariahs (House): "Medicaid is something we have to continue to prioritize and budget for as something that the people of South Dakota want. We want to have that. It’s covering our most vulnerable residents in that sense, and I think we have a societal obligation to protect them.

"There’s the balance of budget. The fact that the federal government covers 90% helps. We can continue to fund that $35–45 million obligation, and I think we should. Did voters make the right choice? We as a community can lean into the idea of loving our neighbor, and I think it’s a good thing to be doing."

See more from District 15 candidates here:

District 16

Lisa Bogue: Could not be reached for comment.

Tim Rhead: "I understand that it is a huge cost to the state of South Dakota. However, I would never go against the people’s will.

"Do I think they made a mistake in passing that? Absolutely not. When you live in a democracy, that’s the way things work. Continuing funds for that – yes, that is a difficult thing to come up with, and I don’t have a good answer on how we continue to do that.
"I know every year it’s going to become more of an issue. The feds are trying to pass more onto the state. There will continue to be something that will have to be funded."

John Shubeck: "That’s a tough one. The thing that is difficult is the way they put it into the constitution.

"It now exceeds our spending on education. It makes it really tough that we really can’t tinker with it because it’s in the constitution, so we have to fund it. There's discussion of having mechanisms in place so that if federal funding is reduced, then we’re not left holding the bag.
"Our state budget as it stands at the moment won’t be able to withstand that. Ultimately it was up to the voters and they chose the way they did. As long as we can fund it, then it’ll remain where it is, but if the federal funding goes away we’re going to have to get creative."

See more from District 16 candidates:

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