This week, voters in Missouri soundly rejected two state constitutional amendment ballot measures proposed by the Legislature that had implications for issues such as Medicaid expansion and other health policy issues. Proposed Amendment 4 (defeated 80% to 20%) would have required future proposed constitutional amendments in Missouri to achieve an individual majority in every congressional district in order to pass rather than just a majority statewide of all voters. Due in part to gerrymandering, requiring ballot initiatives to win a majority of votes in each congressional district is a tactic that undermine the will of the majority of voters on issues where support is broad but not evenly dispersed across the state. Had this limit been in place when Missouri voters approved a constitutional amendment expanding Medicaid in the state in 2020, the amendment would have failed even though it passed by a majority of 53.25% to 46.75% with over 1.2 million voters weighing in on the measure.
Missouri voters also rejected proposed Amendment 5 (defeated 83%-16%) that would have eliminated property taxes in the state and allowed the legislature to institute expanded and broader sales taxes. Many voters apparently saw this measure as a bridge too far in making large and uncertain changes to the tax system.
For more on what happened in Missouri, check out this Missouri Independent story by Rudi Keller.
In a few months, voters in South Dakota will get a chance to weigh in on a state constitutional amendment similar to Missouri Amendment 4. South Dakota legislators have put a measure on the November 3rd General Election ballot. If approved, it would take a 60% supermajority for future ballot measures to pass. South Dakota passed Medicaid expansion in 2022 through a previous ballot measure with a vote of 56.2% to 43.8%. Had this new requirement been in place, Medicaid expansion would have failed despite having solid majority support.
South Dakota legislators also have another proposed constitutional amendment on the November 3rd ballot that would alter voter-passed Medicaid expansion in the state by requiring Medicaid expansion to end if federal funding for the expansion dropped below the current 90% share that the federal government pays.
Asking voters to limit their own health insurance benefits and make it harder for them to amend their own state constitution may be a heavy lift — especially given the rejection of the recent proposed amendments in Missouri. NPR’s Ashley Lopez provided a nice overview last month of how these ballot measure debates are playing out in the states with a focus on how many state lawmakers are looking to limit voters’ ability to pass their own constitutional amendments, like in Missouri and South Dakota.
Expansion of Medicaid coverage by ballot measure was approved by voters in seven states. Ballot measures in these states are seen as a way for voters themselves to weigh in on issues that legislators may not want to address. We’ll be following how these ballot measure debates play out in November and beyond.