A House committee on Wednesday advanced a proposed constitutional amendment that would ask South Dakota voters whether to repeal Medicaid expansion, reopening a debate voters settled just four years ago.

The House State Affairs Committee voted 8–4, with one member excused, to send House Joint Resolution 5002 to the full House with a do-pass recommendation. If approved by lawmakers, the measure would appear on the 2026 general election ballot.

HJR 5002 is sponsored by Rep. Aaron Aylward, R-Harrisburg, who told lawmakers the state faces mounting budget pressure from Medicaid costs.

“Numbers from LRC show that even if we stay at the 10 percent contribution rate from the state, that will pay anywhere from $35 million to $40 million over the next five years,” Aylward said.

Voters approved Medicaid expansion in 2022, and it took effect in July 2023, covering adults earning up to 138 percent of the federal poverty level. The federal government currently covers 90 percent of the cost.

Opponents, including healthcare providers and advocacy groups, said repealing expansion would harm working adults, rural hospitals, and patients with chronic health conditions.

Erik Nelson, government relations director for AARP South Dakota, said voters already decided the issue.

“The voters clearly expressed their decision to adopt the straightforward Medicaid expansion by approving Amendment D,” Nelson said.

Healthcare providers told lawmakers the program has stabilized access to care.

Kim Malsam-Rysdon with Avera Health said Medicaid expansion patients have significantly higher rates of serious illness.

“Of those people that get Medicaid expansion, they have four times the rate of cancer, six times the rate of heart disease, two times the rate of diabetes,” Malsam-Rysdon said.

During committee debate, Rep. Erin Healy, D-Sioux Falls, said lawmakers should consider human consequences.

“Compassion is also a policy choice,” Healy said.

The resolution now moves to the House floor.