Sen. John Thune and Rep. Kristi Noem are two of the federal health overhaul's most consistent critics. But the South Dakota Republicans take a more measured approach to a key provision of the law in their own state.
Both Thune and Noem say they want the law repealed. But when asked this week about the state's debate over whether to expand Medicaid
coverage, both refrained from criticizing state officials.
"Each state must look at their unique situation and weigh whether the federal government will be able to maintain the funding commitments it made in the healthcare law," Thune said.
The Medicaid expansion issue has been at the forefront in South Dakota
this week. Federal officials told Republican Gov. Dennis Daugaard they couldn't accept a proposed compromise that would see South Dakota expand Medicaid coverage to 100 percent of the poverty line. A key provision of the law gives states the option of expanding Medicaid to cover people earning up to 138 percent of the federal poverty level.
Accepting the Medicaid expansion could mean millions of dollars for South Dakota. But Daugaard, like Thune and Noem, has been an early and consistent critic of the law. He and South Dakota's Republican-held legislature have maintained that anyone above the 100 percent poverty level can buy subsidized insurance under the health care law.
Daugaard's attempt to find an acceptable deal, and the relative silence of Thune and Noem, highlights a complex reality of the health overhaul at the state level. Most Republicans remain deeply opposed to the law and South Dakota's elected Republicans are not exceptions. But the Medicaid expansion, which could mean millions in federal funding for health care, is enticing.
About half of states, including neighboring North Dakota, have accepted the expansion.
In South Dakota, Thune and Noem have broadly criticized the health care law and called for its repeal.
Noem, who was elected in 2010, made national Democrats' support of the law an issue in her victory over Democratic Rep. Stephanie Herseth Sandlin. It didn't matter that Herseth Sandlin voted against the federal law.
Since being elected, Noem has made the law and its impact a focus of public events, solicited stories about the law's effects from South Dakotans and spoken against it on behalf of House Republicans.
But she did not criticize Daugaard or other governors for considering Medicaid expansion or some type of compromise.
"This ill-conceived law has put states in a bad position," she said. "So governors across the country are looking for ways to protect their citizens. My preference remains to repeal the healthcare law and push forward a consumer-driven alternative that addresses the fundamental drivers of rising health care costs."
Thune is a member of the Senate's Republican leadership team and has similarly been at the forefront of opposition to the law. At regular press conferences of Senate Republican leaders Thune has often derided the law. His Facebook page is filled with critiques of the law, including a post Thursday that asked, "If Obamacare is as great as Democrats say it is, why are they constantly having to delay parts of it?"
South Dakota's other senator, Tim Johnson, is a Democrat who is retiring. He voted for the federal law and has continued to support it.
Daugaard's next step is not clear. He said Thursday that he hoped that federal officials would change their mind on his proposal.