South Dakota election results: A positive outlook for health care

Voters reject Amendment I as health care advocates look ahead to the 2027 Legislative Session

South Dakota voters delivered several encouraging results for the health care community during the November 3 General Election, including the defeat of Constitutional Amendment I, which the South Dakota Association of Healthcare Organizations (SDAHO) publicly opposed.

Amendment I Defeated: Voters Reaffirm Medicaid Expansion

One of the most significant outcomes for health care was the defeat of Amendment I, with approximately 56% voting against the measure. The amendment would have repealed South Dakota’s constitutional requirement for expanded Medicaid coverage if federal funding dropped below 90%.

The outcome maintains the protections established when voters approved Medicaid expansion in 2022, helping preserve access to health care coverage for thousands of South Dakotans.

SDAHO President and CEO Tim Rave emphasized the importance of respecting the voters’ decision:

“The defeat of Amendment I is a positive outcome for South Dakota patients, health care providers and the communities they serve. Voters demonstrated that access to health care matters, especially in our rural communities where every resource counts. Medicaid expansion provides an important safety net for hardworking South Dakotans while helping sustain the health care services our rural communities depend on.”

Federal and State Leadership: Familiar Voices Return

At the federal level, U.S. Senator Mike Rounds secured reelection, while current South Dakota Attorney General Marty Jackley won his first term representing South Dakota in the U.S. House. Both bring experience with the state’s health care challenges, including the unique needs of rural communities.

Governor Larry Rhoden and Lieutenant Governor Tony Venhuizen also secured victories, providing continuity in state leadership as health care providers continue to navigate workforce shortages, financial pressures and challenges to accessing care. The Rhoden administration played an important role in advancing South Dakota’s Rural Health Transformation Program; a significant initiative aimed at strengthening rural health care and shaping the future of health care delivery across the state.

Legislative Results: Strong Relationships Heading into 2027

SDAHO is encouraged by the election of numerous legislators with established relationships across South Dakota’s health care community.

Several health care champions are returning to Pierre, including former SDAHO Board member and health care administrator Nick Fosness (District 1), who brings valuable firsthand experience as a health care provider for the community of Britton. A few other returning lawmakers from eastern South Dakota include Senator Tim Reed of Brookings, who sponsored important legislation related to the 340B program, and Representative Taylor Rehfeldt of Sioux Falls, a health care professional. Both Reed and Rehfeldt have been recognized by SDAHO as Legislators of the Year for their contributions to health care policy. Also returning is Senator Sydney Davis of Vermillion, who served as Vice Chair of the Senate Health Committee. On the House Side, Rep.  Brian Mulder, Chair of the House Health Committee also retained his seat.

In western South Dakota, health care advocates Senator Helene Duhamel and Representative Steve Duffy of Rapid City are returning to the Legislature. Representative Mike Derby (District 34), who previously chaired the Joint Committee on Appropriations and played an influential role in securing full funding for Medicaid expansion, also retained his seat.

While this is not a complete list of the health care advocates elected to the Legislature, these individuals represent a strong foundation of experience and understanding of health care policy, rural health care delivery and the financial realities facing South Dakota providers. SDAHO looks forward to working with all lawmakers during the 2027 Legislative Session to advance policies that support health care across our state.

Looking Ahead: Health Care Advocacy Remains a Priority

While the election brought a few surprises, the overall results provide an encouraging foundation for SDAHO’s advocacy efforts heading into 2027. From preserving Medicaid expansion to maintaining relationships with policymakers in Pierre and Washington, D.C., SDAHO remains committed to advancing policies that strengthen health care across the state.

As the 2027 Legislative Session approaches, SDAHO will continue working with elected leaders and its members to ensure South Dakota’s health care community is represented through a unified voice.