But proponents for expansion have found success through ballot measures across GOP-dominated states, and a wide coalition of health care groups and organizations backed a well-funded ballot campaign this year in South Dakota.Dave Melemseter, also voting in Sioux Falls, said he backed expansion even though he worried it would weigh heavily on the state budget.The federal government pays 90% of costs under a 2021 federal COVID-19 relief package, so the state would receive $1.3 billion in federal funding over five years for expansion.In an effort to head off the Medicaid expansion vote, Republican lawmakers had proposed a separate constitutional amendment in this year’s primary election that would have required a 60% vote threshold on ballot measures that raise taxes or spend significant government funds.___Follow the AP’s coverage of the midterm elections at https://apnews.com/hub/2022-midterm-elections and check out https://apnews.com/hub/explaining-the-elections to learn more about the issues and factors at play."