A ballot measure authorizing South Dakota state officials to consider work requirements for Medicaid expansion recipients was winning in unofficial results.

The tally was 56% in favor of Amendment F and 44% opposed as of 9:45 a.m. Central time Wednesday, with about 90% of statewide votes counted.

Medicaid is a federal-state health insurance program for people with low incomes. In the past, Medicaid was not available to able-bodied adults younger than 65, unless they were below the poverty line and had young children.

In 2022, South Dakota voters expanded Medicaid eligibility to adults with incomes up to 138% of the poverty level. The expansion is part of the state constitution and can only be altered by voters. It includes a ban on “greater or additional burdens or restrictions,” such as a work requirement.

Earlier this year, legislators decided to put Amendment F on the ballot. The amendment will allow lawmakers to consider a work requirement if the federal government permits it. The Democratic Biden administration does not allow it, but a future Republican administration might.

On Wednesday morning, the Vote No on Amendment F coalition, including several health-related organizations, predicted the measure may “place harmful government red tape around access to health care for thousands of South Dakotans.”

“Ensuring our neighbors get health care is the right thing to do and this result may inhibit that process,” said retired Yankton physician Mary Milroy, Vote No on Amendment F chair, in a statement. “Health care access for hardworking South Dakotans is good for them and their families, good for the employers who need them more than ever, and good for the economic progress of this state.”

She added that the measure could allow lawmakers and bureaucrats to write new rules governing Medicaid eligibility, and the measure “provides no specifics on what those rules will be nor how they will be enforced.”

At the polls Tuesday, Parker Stewart, a 38-year-old Sioux Falls resident, said he voted yes on the amendment. He counts himself as a supporter of Medicaid and Medicaid expansion, but sees a work requirement as a protective measure against abuse of the system.

“We have family members who are dependent on that program for medical reasons,” Stewart said. “But at the same time, there are those who take advantage of it.”

Jessica Aguilar, a 43-year-old from Sioux Falls, said she voted against the measure.

“Medicaid expansion was passed by South Dakotans last election,” she said. “Let it stand as it was passed.”

In the first presidential election since the U.S. Supreme Court allowed state governments to determine if, when and why a woman can end a pregnancy, former President Donald Trump, who touted during the campaign he “was able to kill Roe v. Wade” appeared poised to be reelected early Wednesday. Simultaneously, at least five out of 10 states voted to restore or expand abortion rights, according to early election results.

National anti-abortion groups celebrated Trump’s impending victory over Democratic Vice President Kamala Harris, who campaigned heavily on restoring reproductive rights. They also celebrated the defeat of Florida’s and South Dakota’s abortion-rights amendments, and foreshadowed a full assault on reproductive freedom throughout the country.

Abortion-rights measure loses in South Dakota

“Now the work begins to dismantle the pro-abortion policies of the Biden-Harris administration,” said Susan B Anthony Pro-Life America President Marjorie Dannenfelser in a statement. “President Trump’s first-term pro-life accomplishments are the baseline for his second term. In the long term, GOP pro-life resolve must be strengthened and centered on the unalienable right to life for unborn children that exists under the 14th Amendment.”

Despite their losses, abortion-rights advocates said the ballot question victories signal widespread American support for abortion protections even in red states.

Most significantly, Missourians voted to overturn a total abortion ban. Voters also approved an abortion-rights amendment in Arizona, which will override the current 15-week ban. Voters agreed to expand reproductive-rights protections in Colorado, Maryland and New York. Ballot measure races in Montana and Nevada were too close to call as of early morning Wednesday.

“This is an especially historic win for Missouri,” said Nancy Northup, president and CEO of the national legal advocacy group Center for Reproductive Rights. “In fact, the amendment goes even further, calling for ‘a fundamental right to reproductive freedom, defined to include abortion and all matters relating to reproductive health care.’ By saying yes to this powerful language, voters have demanded the return of the essential human rights and freedoms they lost after Roe was overturned.”

But abortion-rights advocates suffered a major loss in Florida, which barely failed to clear a 60% supermajority threshold, more than any of the other state abortion initiatives. With 58% voting in favor to overturn a strict abortion ban and enshrine protections, Florida is the first state to fail to secure abortion rights since Roe v. Wade was overturned two years ago.

Abortion-rights organizers who spearheaded and funded Florida’s Yes on 4 campaign said the result still shows majority approval for abortion rights among Floridians, and they vow to continue trying to restore abortion rights in the state that six months ago was an abortion-access haven for the Southeast region.

“We’re incredibly proud to have stood with doctors, patients, and advocates impacted by this ban,” said Yes on 4 Florida campaign manager Lauren Brenzel in a statement. “Their stories, along with the countless women who will continue to suffer under Florida’s cruel and extreme abortion ban, remind us that our fight is far from over.”

Attorney and anti-abortion activist Catherine Glenn Foster told States Newsroom she is celebrating the fact that Floridians blocked attempts to enshrine abortion in their state constitution. However, she acknowledged that state abortion bans have created real problems, including women dying of preventable pregnancy-related causes and being denied routine miscarriage care. She said states that ban abortion should increase social supports, something that largely hasn’t happened since states started banning abortion, and should implement a robust training system around treating health emergencies.

“We need to have a real reckoning,” said Foster, who has previously worked for major anti-abortion groups like Americans United for Life and Alliance Defending Freedom. “We’ve created an environment where doctors are scared. They don’t know how to respond and how to treat, and that’s a big problem. We have to address that before we pass anything else.”

Abortion ballot initiative results 

Since Roe v. Wade was overturned in June 2022, seven states — California, Kansas, Kentucky, Michigan, Montana, Ohio and Vermont — have approved reproductive-rights state constitutional amendments or rejected anti-abortion constitutional amendments. This year reproductive-rights coalitions put abortion on the ballot in 10 states. Arkansas had collected enough signatures to qualify for the ballot, but this summer the state Supreme Court ruled that Arkansans for Limited Government, the committee behind the initiative, did not submit the correct paperwork. The  group opposing abortion, marijuana and education measures in the state was led by a top adviser to Republican Gov. Sarah Huckabee Sanders, Arkansas Advocate reported.

Arizona — Proposition 139, to enshrine abortion rights until fetal viability — APPROVED

YES: 63%

NO: 37%

In this swing state, abortion is currently legal until 15 weeks’ gestation. Earlier this year, a few Republicans crossed party lines to repeal a Civil War-era near-total abortion ban the legislature had revived. This citizen-initiated amendment would also prevent any penalties for someone who helps a person get an abortion. And it would allow for exceptions later in pregnancy for the patient’s life or physical or mental health.

Colorado — Initiative 79, to allow public insurance to cover abortions — APPROVED

YES: 62%

NO: 39%

The citizen-initiated amendment proposes to expand abortion access in a state that currently has no gestational limits but does have a 40-year-old public funding ban. The amendment also proposes to prevent government interference in pregnancy and allow public insurance to cover abortions.

Florida — Amendment 4, to enshrine abortion rights until viability — FAILED

YES: 57%

NO: 43%

This citizen-initiated amendment would have overturned a 6-week abortion ban that has impacted the Southeast. Republican Gov. Ron DeSantis’ administration mounted fierce opposition against the abortion-rights campaign that involved a state-sponsored misinformation campaign. Florida was the only state in this election to require a 60% supermajority for ballot measures.

Maryland — Question 1, to protect reproductive autonomy — APPROVED

YES: 74%

NO: 26%

This legislatively-referred amendment would enshrine an individual’s right to make “decisions to prevent, continue, or end” a pregnancy. Maryland has become a major abortion-access haven for the country; it is legal here until fetal viability and after for reasons related to the health of the fetus or pregnant person.

Missouri — Amendment 3, to enshrine abortion rights until fetal viability — APPROVED

YES: 52%

NO: 48%

This citizen-initiated amendment would overturn a near-total abortion ban that only has exceptions to prevent the death of the pregnant person. The ban’s ambiguous language led at least one Missouri hospital system to stop providing emergency contraception to patients, a move that forced the state attorney general to announce that Plan B and contraception remain legal.

Montana — Constitutional Initiative 128, to enshrine abortion rights until fetal viability — RESULTS NOT FINAL

YES: 58%

NO: 42%

This citizen-initiated amendment would guarantee protections in a state where abortion is currently legal but where Republican lawmakers have attempted to pass restrictions since Roe fell in 2022. Preliminary results show supporters of the measure were leading opponents as of 11 p.m. local time.

Nebraska — Initiative 434, to ban abortion after the first trimester vs. Initiative 439, to enshrine the right to abortion until viability

Initiative 434  — APPROVED

FOR: 55%

AGAINST: 45%

Initiative 439

FOR: 49%

AGAINST: 51%

Nebraska was the only state to have two competing abortion-related initiatives on the ballot.

Nevada — Question 6, to enshrine abortion rights until fetal viability — RESULTS NOT FINAL

YES: 63%

NO: 37%

In this swing state abortion is currently legal up to 24 weeks of pregnancy, but this citizen-initiated measure would enshrine abortion rights into law. The measure will need to be approved by voters again in 2026 to become law.

New York — Proposal 1, to bar discrimination based on pregnancy status — APPROVED

YES: 62%

NO: 39%

This legislatively-referred measure would guarantee abortion rights in a state where abortion is legal up to 24 weeks of pregnancy — later if a provider determines the procedure is necessary to save a patient’s life or health, or if the fetus is nonviable.

South Dakota — Amendment G, to allow abortion through the end of the first trimester — FAILED

YES: 39%

NO: 61%

This citizen-initiated measure would have allowed regulation in the second trimester for maternal health reasons and allow lawmakers in the third trimester unless the procedure is necessary to save the life or health of a pregnant patient.

Races where abortion took center stage  

Minnesota Congressional District 3

Democrat Dr. Kelly Morrison: 59%

Republican Tad Jude: 41%

Minnesota State Sen. Kelly Morrison, DFL-Deephaven, won the Minnesota 3rd Congressional District race to replace Democratic U.S. Rep. Dean Phillips in a seat that before 2018 had for decades gone to Republicans, AP reported. Morrison is a practicing OB-GYN who supports abortion rights. Currently, the only OB-GYNs in Congress oppose abortion. Her Republican opponent, Tad Jude, has called every abortion a “tragedy” and supported the overturning of Roe v. Wade.

A special election in Minnesota will determine who takes over Morrison’s state Senate seat, whose term ends in 2026.

Wisconsin Congressional District 8

Republican Tony Wied: 60%

Democrat Dr. Kristin Lyerly: 40%

Of the close races in the swing state of Wisconsin, the 8th Congressional District was the least likely to flip from Republican control. But Dr. Kristin Lyerly launched a fierce campaign emphasizing a commitment to restoring reproductive health access to Americans, something she is uniquely positioned to advocate for as a longtime OB-GYN and abortion provider. Lyerly is also one of the plaintiffs in a lawsuit that successfully blocked an 1849 Wisconsin feticide law that was temporarily enforced as a state abortion ban. Her campaign attracted national campaign cash and support. Her opponent, Republican Tony Wied, a former gas station owner, largely ran on his Trump endorsement.

Tennessee State House District 75

Republican Jeff Burkhart: 55 %

Democrat Allie Phillips: 45 %

Incumbent Republican Rep. Jeff Burkhart defeated former day care operator and political newcomer Allie Phillips, who largely campaigned on reproductive rights. The 29-year-old drew national attention after speaking out about being denied a necessary abortion in Tennessee, where abortion is banned, when her desired pregnancy became nonviable and dangerous at 19 weeks. She ultimately traveled out of state to obtain the abortion. Phillips joined a legal challenge to the state’s strict abortion law. She pledged if elected to immediately push for a policy that would carve out exceptions for fetal anomalies to Tennessee’s abortion ban, which she’s named “Miley’s Law” after the baby she and her husband lost.