On Tuesday, November 8th, a ballot measure that passed was South Dakota’s vote to expand Medicaid to include more than 40,000 low-income adults. The Medicaid expansion measure known in South Dakota as “Constitutional Amendment D” had 56% support compared to 44% opposed, a significant margin in a conservative state.

The outcome is a setback to Republican Governor Kristi Noem, who opposed the measure. With the initiative’s passage in South Dakota, there will now be just 11 states yet to expand Medicaid under the Affordable Care Act. South Dakota joins Maine, Missouri, Oklahoma, Nebraska, Idaho and Utah in expanding health care access through ballot initiatives.