Medicaid Cuts Loom Large for South Dakota if "Big Beautiful Bill" Passes Senate

Strategic Insights -

A new analysis of the "One Big Beautiful Bill Act" reveals that 13,000 South Dakotans would lose Medicaid coverage and the state would face a $931 million funding cut by 2034 if the bill is passed in its current form. The budget reconciliation bill aims to reduce federal Medicaid spending through various policy changes, including setting a work requirement for some enrollees and more frequent eligibility checks. Democrats argue that these changes would increase barriers and result in eligible people losing health insurance, while Republicans claim they would reduce waste, fraud, and abuse in the program.

Key Takeaways:

  • The "One Big Beautiful Bill Act" would result in 13,000 South Dakotans losing Medicaid coverage and the state facing a $931 million funding cut by 2034.
  • The bill would reduce federal Medicaid spending through policy changes, including setting a work requirement for some enrollees and more frequent eligibility checks.
  • Democrats argue that the changes would increase barriers and result in eligible people losing health insurance.
  • Republicans claim that the policies would reduce waste, fraud, and abuse in the program.
  • The budget reconciliation bill would reduce federal Medicaid spending by about $793 billion.
  • An estimated 10.3 million fewer people would be enrolled in Medicaid nationwide by 2034, according to the Congressional Budget Office.
  • The projected number of uninsured South Dakotans rises to about 20,000, combined with the expected expiration of the Obama-era Affordable Care Act's enhanced premium tax credits at the end of this year.

Statistics:

  • 13,000 South Dakotans would lose Medicaid coverage by 2034, according to an updated analysis from KFF.
  • The state would face a $931 million funding cut by 2034.
  • Federal Medicaid spending would be reduced by about $793 billion, according to the Congressional Budget Office.
  • Nationwide, 10.3 million fewer people would be enrolled in Medicaid by 2034, according to the Congressional Budget Office.
  • The projected number of uninsured South Dakotans rises to about 20,000, combined with the expected expiration of the Obama-era Affordable Care Act's enhanced premium tax credits at the end of this year.

Sources:

  • (https://southdakotasearchlight.com/2025/05/22/repub/sd-rep-johnson-votes-yes-as-u-s-house-republicans-push-through-massive-tax-and-spending-bill/)
  • (https://southdakotasearchlight.com/2025/04/17/thune-talks-medicaid-town-halls-tariffs-south-dakota-watertown-appearance/)
  • (https://www.kff.org/medicaid/issue-brief/allocating-cbos-estimates-of-federal-medicaid-spending-reductions-and-enrollment-loss-across-the-states/)
  • (https://www.instagram.com/p/DKiKAd6vfaS/)
  • (https://southdakotasearchlight.com/subscribe)