If South Dakota voters pass a referendum to expand Medicaid under the ACA in November, it will likely be the last to do so "for some time to come," Politico reported Oct. 14.
Only three of the 11 other holdout states — Florida, Mississippi and Wyoming — allow voters to collect signatures for a ballot measure, and none are likely to do so in the near term, according to the report.
In Florida, a Medicaid expansion ballot measure would need to reach a 60 percent voter threshold, which makes doing so challenging, according to the report. Running a campaign in the country's third-largest state makes cost a potential hurdle as well.
Mississippi's Supreme Court halted an expansion effort in 2021 when it "effectively declared the entire ballot initiative process unconstitutional," according to the report. In Wyoming, expansion advocates are focusing efforts on legislative passage.
Six states voted to expand Medicaid between 2017 and 2020, according to the report. Maine voted for expansion in 2017, Idaho, Nebraska and Utah approved expansion in 2018 and Missouri and Oklahoma did so in 2020.