Voters Reject Medicaid Cut, Approve Berkeley Soda Tax

South Dakota voters turned down a measure that would have ended Medicaid expansion, while Berkeley voters raised the sugary drink distributor tax.

Updated on Nov. 4, 2026 in Elections

Voters Reject Medicaid Cut, Approve Berkeley Soda Tax

Live Poll

Would you support a sugary drink tax to fund local health programs?

South Dakota voters rejected Amendment I on Tuesday, a constitutional amendment that would have ended Medicaid expansion if federal funding fell below 90%. In Berkeley, California, voters approved Measure AA, which raises the sugary drink distributor tax from 1 cent to 2 cents per ounce.

Why it matters

The votes set the state's Medicaid expansion framework for South Dakota residents and advance a funding model for nutrition and health programs in Berkeley. Berkeley previously became the first U.S. city to approve a sugary drink tax more than a decade ago.

Amendment I would have ended Medicaid expansion if the federal share of funding dropped below 90%, a threshold that was not met by voter approval. Measure AA raises the sugary drink distributor tax from 1 cent to 2 cents per ounce, with 42.5% of revenue going to Berkeley Unified School District nutrition and gardening programs and another 42.5% to community health services and drinking water access.

The players

American Heart Association

A national nonprofit focused on cardiovascular health that encouraged its Heart Powered advocates to act on these ballot measures before the election.

The details

Voters cast ballots on both measures Tuesday. Measure AA caps administration, public oversight, and annual reporting at 15% of revenue, with the remainder split between school programs and community-based nutrition education, health services, and drinking water access.

November 3, 2026: Voters rejected Amendment I and approved Measure AA.
More than a decade ago: Berkeley became the first U.S. city to approve a sugary drink tax.

Need to Know

Measure AA builds on Berkeley's first-in-the-nation sugary drink tax approved more than a decade ago, doubling the distributor rate to 2 cents per ounce. Amendment I's rejection leaves South Dakota's Medicaid expansion in place, a policy that has been contested at the ballot box in the state.

For South Dakota residents, the rejection of Amendment I keeps Medicaid expansion in place rather than ending it under the 90% federal funding trigger. In Berkeley, the doubled distributor tax will affect the price of sugary drinks sold in the city over time.

The takeaway

Ballot measures can reshape both state health coverage and local consumer costs in a single election. Residents affected by these changes should watch how the Berkeley funds are allocated across schools and community programs.