Amendment C, Medicaid Expansion and Institutional rule setting

O’Mahen and Petersen in an article I keep on circling back to make the very clear point that institutions and rules matter in the context of Medicaid Expansion:

Larger numbers of veto players reinforced by the logic of negative agenda control and buttressed by other legislative rules requiring a supermajority increase barriers to passing Medicaid expansion. In response, expansion supporters have advocated another institutional pathway: direct democracy. Numerous states have procedures for citizens to gather signatures and put a legislative proposition directly on the ballot. If voters approve the proposition, it becomes law….

Like gubernatorial powers that can be used to implement expansion, direct democracy institutions are malleable. State governments often control the citizen initiative process itself and can make it harder for voters to engage in direct democracy….(MY EMPHASIS)

This is what we saw last week in South Dakota with the primary vote on a state constitutional amendment. Amendment C would have changed the threshold for passage of any program that had significant revenue or expenditure obligations from 50%+1 to 60%. This is a very large hurdle. This amendment was offered as an attempt to make it harder for Medicaid Expansion to pass by referendum in November, 2022.

Amendment C was defeated by South Dakota voters on June 7. With 99.7% of precincts reporting, the ‘No’ vote was at 67.43% (122,387), and the ‘Yes’ vote was at 32.57% (59,111). The amendment would have changed the voter requirement threshold for future measures. Learn more:

— Ballotpedia (@ballotpedia) June 8, 2022

Amendment C got crushed even as it was offered in a low turn out, Republican dominated early summer primary.

The rule set of what a required winning coalition matters a lot. It may look boring, but it determines the possibility space. Shifting from a 50%+1 threshold to a 60% threshold severely restricts the possibility space. Other Republican dominated states that have passed Medicaid Expansion via direct ballot measures have been able to assemble winning coalitions of just over 50% to just over 60%. Three of the four states (Utah, Oklahoma, Missouri) had Medicaid Expansion pass with between 50% and 53% of the vote. Only in Idaho, did Medicaid Expansion clear 60%. Institutional design matters. And it has always mattered in Medicaid Expansion efforts.