Her biggest is advocating for the expansion of Medicaid, a key element of President Obama's 2010 health care overhaul. States have the option of accepting millions in federal funding to expand their Medicaid rolls to other low-income people. So far, 26 states have chosen to expand.

Gov. Dennis Daugaard has ruled out expansion this year, though he said recently he may try to offer benefits to the most needy of those not now on Medicaid. But that doesn't mean the Legislature can't take action itself.

Buhl O'Donnell said there are few reasons not to expand Medicaid, since she said it would improve the quality of life for 48,000 poor South Dakotans.

In addition, she said she believed it would limit the growth of insurance premiums for the rest of the state's population. The 48,000 who would be covered by the expansion are the same group that can rarely pay their medical bills. As a result, clinics and hospitals shift those costs to patients with insurance, she said.

"I think the most compelling reason for the expansion is that it's such a better use of taxpayer dollars," she said. "Realistically, those 48,000 people don't just go away."