PIERRE, S.D. -- When the Affordable Care Act was adopted, most states that expanded Medicaid did so through their legislatures. But in states that refused, there's been a push for citizens to bypass those decisions through ballot initiatives, and South Dakota is now part of that movement.

This November, signature gathering will begin to get two Medicaid expansion questions on the 2022 ballot in South Dakota. One would be a constitutional amendment, and the other would be an initiated measure directing the state Legislature to take action.

John Tsitrian, co-publisher of the nonpartisan blog South Dakota Standard, recently authored a post calling for the state to support such a move.

"I think the outcomes, both in health and just general economic benefits, are almost too big to ignore," Tsitrian said.

The South Dakota Legislative Research Council says an expansion of Medicaid benefits could help more than 42,000 residents become eligible. The federal government would provide $300 million annually to cover the costs, with the state covering $21 million.

Opponents, including Gov. Kristi Noem, argue about the effect that would have on the state budget.

But Tsistrain said those state contributions would pay off because of the larger federal investment and the economic impact it would have, in addition to the added health benefits to those who need coverage. He pointed to research from the University of Montana, which analyzed that state's expansion.

"They believe it had a specific affect on increasing the state's GDP. And they believe it boosted overall personal incomes since it was implemented in 2015," he said.

The U.S. Supreme Court will soon hear another challenge to the ACA, which could affect Medicaid expansion. But supporters of the idea say that doesn't mean organizers should give up, citing that the law has largely survived many other attempts to do away with it.


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The long-delayed Farm Bill could benefit Virginia farmers by renewing funding for climate-smart investments, but it's been held up for months in Congress.

Some lawmakers want this bill to expand funding for such programs as the Environmental Quality Incentives Program, or EQIP, which gives financial and technical help to farmers and ranchers to make conservation a priority. About $250 million was allocated for the program, but more than 9,000 applications were submitted, bringing it to $475 million.

Gabrielle Walton, federal campaign associate with the Chesapeake Climate Action Network, said these programs' popularity proves their necessity.

"This money allows them not only to practice more efficiently - and to preserve the environment that they love so much and they're so attached to - but it also saves them money that they can devote to other concerns," she said, "and provides them stability for their pocketbooks going forward."

One issue with the new Farm Bill is a proposed increase in so-called "reference pricing," which critics have said only benefits large farming operations and would come at the expense of more widely used social and climate-smart programs.

Walton said she thinks political divisiveness and competing priorities have held up the new Farm Bill.

The previous Farm Bill was extended to this September, but lawmakers have said they aim to have a bill ready by Memorial Day. Along with climate-smart investments, the Farm Bill also funds social safety-net programs.

Geoff Horsfield, a policy director at the Environmental Working Group, said people don't always know how helpful nutrition programs are to families.

"There's a misconception that things like SNAP only benefit urban communities," he said, "and we just know that that's not true - that folks in all counties rely on nutrition assistance programs, some of these social programs, to be able to make ends meet."

SNAP and other nutrition programs received 75% of funding in the 2018 Farm Bill. More than 876,000 Virginians use SNAP and EBT benefits, since food insecurity has been a longstanding issue in the state.

Today, groups working with lower-income families in Connecticut are raising awareness about the state's "benefits cliff" with a day of action.

The benefits cliff is when a person might get a raise, have a kid with a part-time job, or some other income increase which then makes them ineligible for certain benefits. The changes can have severe impacts on communities and disproportionately affect families with children.

Stephen Monroe Tomczak, professor of social work at Southern Connecticut State University, said it is part of a larger workforce problem.

"People, particularly people of low income, are in a sense disincentivized to participate in the labor force and denied adequate jobs and income when they try to do that," Tomczak explained.

Several General Assembly budget bills could have dealt with the issue but most failed, which inspired today's action, a mock funeral procession to the governor's office to eulogize the bills, including the refundable Child Tax Credit, a housing voucher funding boost bill, and a bill eliminating the asset limit on the HUSKY C medical insurance program.

Social service advocates know the bills will resurface in next year's budget process.

Rose Ferraro, program lead of health justice policy advocacy for the Universal Health Care Foundation of Connecticut, said people are taking alternate steps like going to food banks or avoiding medical care to cover lost benefits.

"Folks will lose their rental assistance and then, they will sort of have to make some tough decisions," Ferraro noted. "'Do I put food on my table or do I make sure to pay rent?' And, so it becomes a sort of untenable position."

Ferraro added interwoven state and federal funding makes it hard to reach the core of the issues leading to benefits cliffs. One eulogized bill would have established a benefits cliff pilot program. For two years, it would have provided subsistence for people who've reached the benefits cliff.

New York towns are reaping many benefits since the Inflation Reduction Act was passed.

Along with funds for larger clean energy projects, the state was awarded $158 million for the IRA's Home Energy Rebates program.

Smaller towns and villages use these grants to implement their climate action plans.

Brighton Town Councilmember Robin Wilt said an IRA grant they applied for will help upgrade the town's HVAC system.

"We will be implementing geothermal and then use a solar array to make the system close to net zero, not quite," said Wilt. "I think we'll get 55% of our energy back with the solar panels."

The bureaucratic process to access the funding was challenging, but some groups are working with the Department of Energy to improve it.

Wilt said feedback on the clean energy projects has been positive. Future projects using IRA funding include increasing walkability and sustainable redevelopment.

Critics have said the IRA includes multiple provisions to increase fossil fuel production.

Towns nationwide are using IRA grants to bolster clean energy projects.

Joel Hicks is a council member for the Borough of Carlisle, Pennsylvania.

They've just applied for a grant to work on energy efficiency and solar projects with Harrisburg. He said this will have positive impacts beyond establishing clean energy.

"We were really excited at this potential," said Hicks, "because we saw that the cost savings we would have for putting in substantial solar projects on our public property would actually fund many of our other public municipal goals."

These include purchasing an electric vehicle fleet and having more efficient solid waste programs.

One thing Hicks said he wants to see in future is state and local governments helping small towns and municipalities with putting together their IRA grant proposals.