South Dakota
Why South Dakota health care is the nation's second most expensive • South Dakota Searchlight
Several months ago, Forbes, a respected business and economics publication, released an analysis of the “The Most (And Least) Expensive States for Healthcare 2024.” A striking — and concerning — finding was that health care expenses in South Dakota were the second highest in the nation.
The multiplicity of payers and the differing demographics of populations in diverse geographic areas make measuring and comparing total health care costs across different regions a highly complex undertaking. Nonetheless, the findings in the Forbes article have been supported by other research.
An extensive and very interesting paper was published several years ago by the Health Care Pricing Project. This analysis looked at both Medicare costs and private insurance expenditures in 306 health care regions across the U.S. In that study, private insurance expenditures in the Sioux Falls region were the 14th highest in the nation but Medicare expenditures were near the bottom (275th out of 306). The huge difference can be explained by the fact that Medicare prices are set by the Medicare program, whereas each private payer has to negotiate prices with the individual providers.
In eastern South Dakota, there is intense competition between two large health care systems. One could reasonably expect that costs would be lower. The results show that just the opposite is true.
How can this be? The reality is that the economics of health care do not follow the principles that govern prices in standard consumer markets.
For a conventional consumer market to function efficiently, multiple suppliers need to compete based on price and the quality of products available. Consumers need to have full understanding of both product quality as well as the price charged. They need to be free to switch suppliers if they find a “better deal.” They should have the freedom to “shop around.”
So how does all this apply to health care?
First, and probably most basic, health care providers rarely compete based on price. In fact, unless patients make an effort to ask, the price of a service may well not be known until the bill arrives. Since so much of health care is paid for by third-party payers, patients often have little incentive to ask. Additionally, there is little motivation to “shop” for the best price even if that is an option available to them, which it may not be.
Furthermore, if patients do have prices to compare from competing providers, they sometimes have skepticism about low-priced services. They may be concerned that providers have “cut corners” or that the service is less trustworthy. This follows directly from the fact that, unlike most consumer goods, patients usually do not have access to objective information about the quality of the actual service being considered. They usually rely on broad provider reputations or word-of-mouth evaluations. Such sources can provide helpful perspectives but are often lacking in specifics about particular procedures, individual providers, etc.
Treating health care as a commodity has not driven costs lower
Shopping around to get the best deal makes good sense if one is buying groceries or gasoline, but it presents major problems in health care. Limitations imposed by insurance networks are real. More basically, moving from one provider to another hinders continuity of care and raises the risk of important past history being overlooked or serious risks going unnoticed. Additionally, multiple payers with multiple sets of reimbursement rules have led to administrative complexity and enormous administrative costs.
From the provider perspective, competition all too often leads to duplication of facilities and services. Rather than refer patients/customers to a competitor, each one sets up their own service. This can be a logical action from a business perspective, but in highly technical services such as organ transplantation, small volumes raise the risk of above average cost and poorer outcomes. Competition, instead of promoting lower cost and better service, actually does the opposite.
Paying for health care services is an exceedingly complex undertaking. In the U.S., health care expenditures are the highest in the world, even though we have significant portions of our population who are not getting care. Commitment to conventional market principles has served us well in much of our economy. It is clear, however, that it is not serving us well in the health care.
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South Dakota
FCS Football Recruiting Roundup: South Dakota, Montana State Target 2027 Defensive Standouts
Welcome to another edition of the FCS Football Central Recruiting Roundup.
As spring practice winds down, recruits are still continuing to get on campus to visit schools and meet with their coaching staff. I caught up with some of the latest prospects who received an offer from an FCS program after their visit.
Amarie King | 2027 | DB | 5’7″ 140 lbs | Case High School | Racine, WI
King received his latest offer from South Dakota on April 17 after speaking with defensive coordinator Billy Kirch.
“Coach Kirch told me bout the offer, and that conversation went well. He told me a lot about the school, and asked me what my family and parents do. He said that my film was amazing and that he wanted to offer me,” King said.
“My recruitment is going well, although it is a little stressful here and there, but I am really just being patient and trusting the process, and keep working.”
He has visits to South Dakota and Drake coming up. Last season, he finished with 44 tackles, eight pass breakups, and six interceptions for the Eagles.
After a great conversation with coach kirch I’m blessed to I’ve received my first division 1 offer from @SDCoyotesFB @AntonGraham_ @MJ_NFLDraft @CoachBKirch @joshmanchigiah pic.twitter.com/jaxIYac67A
— Amarie King (@Amarieking27) April 17, 2026
Jayden Harris | 2027 | ATH | 6’2″ 170 lbs | Manteca High School | Manteca, CA
Harris picked up his latest offer from Montana State on Friday when he was in Bozeman for the Bobcats’ Junior Day, and meeting with cornerbacks coach Jordan Lee, defensive coordinator Bobby Daly, and head coach Brent Vigen.
“First, it was Coach Lee, then I had meetings with Coach Daly and Coach Vigen, who broke the news while we were talking. They want me to come in and play early. They like my versatility as a defensive back, and that’s why they offered me,” Harris said.
“The visit was cool! The snow was coming down, and the coaches still showed love. Recruiting is going well right now. Most schools that are in touch with me see something in me for sure, especially since I’m a zero-star athlete, so that’s love. I feel like I’m the best DB in California, and my measurements and production speak for themselves.”
He also has offers from Idaho, Washington State, and Sacramento State. He has upcoming visits to Arizona State and New Mexico.
Last season, he finished with 63 tackles, 11 pass breakups, nine interceptions, six tackles for loss, two sacks, two forced fumbles, and two pick-sixes for the Buffaloes.
Blessed to receive an offer from Montana State University 🐾 @ballcoachLee @CoachBobbyDaly @CoachSauve @CoachSmith59 @bvigen @BrandonHuffman @Rivals_Recruits @GregBiggins pic.twitter.com/ofYdjJKcmK
— Jay Harris (@JaydenOHarris) April 18, 2026
Maurice “MJ” Harrell | 2026 | DB | 6’1″ 170 lbs | Hutchinson CC | Hutchinson, KS
Harrell picked up his first Division I offer from Houston Christian on April 17 after he spoke with cornerbacks coach DeMarcus Coleman.
“Coach Coleman called and told me he liked what we saw from the videos I sent him, and that he wanted me to be a part of his program,” Harrell said.
Last season, he finished with 20 tackles, 1.5 tackles for loss, one sack, and a fumble recovery for the Blue Dragons. Mercyhurst, Division II UTPB, and Missouri Southern are some other schools he has been in contact with.
Blessed To Receive my first d1 offer from Houstan Christian University pic.twitter.com/OBD9ITQZHS
— MauriceHarrell (@M_Harrell19) April 18, 2026
Jadhari Young | 2026 | WR | 6’1″ 200 lbs | De Anza College | Cupertino, CA
Young received his latest offer from Eastern Illinois on April 15 after speaking with wide receivers coach Tino Smith.
“Coach Smith called me, and we had a long and great conversation. He told me he believes in me and that he thinks I can be great under his coaching,” Young said. “My recruitment has been going great since I graduated two weeks ago. A lot of coaches have expressed a lot of interest in me.”
Young also has offers from Sacramento State, Prairie View A&M, and Chicago State. Last season, he hauled in receptions for 559 yards and seven touchdowns for the Mountain Lions. He was named a Golden Coast Conference First Team selection.
He will be taking his official visit to Eastern Illinois on April 24. Gardner-Webb, West Florida, Monmouth, Stony Brook, and UMass are some other schools he is hearing from.
Blessed to receive my 5th D1 offer from Eastern Illinois University — Dhari Young “DEBO” (@dharigogetit) April 15, 2026
Thank you Coach @coachtinosmith for believing in me💯 pic.twitter.com/yMZjnsfRvK
AJ Moore | 2027 | RB | 5’9″ 200 lbs | College of Dupage | Glen Ellyn, IL
Moore received his first Division I offer from Lindenwood on April 17 after speaking with running backs coach Lane Lawson.
“Coach Lawson called and offered me. He just told me he’d be really excited to have me over and thinks I could be a part of something special with the program they got going over there,” Moore said.
Last season, he finished with 81 carries for 518 yards and five touchdowns, while adding nine receptions for 73 yards and two touchdowns for the Chaparrals, who won their fifth consecutive NJCAA Division III national championship. Moore is working on scheduling his official visit to Lindenwood.
#AGTG After a great conversation with @CoachLawsonLU I am blessed to have my first division 1 offer from Lindenwood University @LindenwoodFB @Dupage_Football @JUCOFFrenzy @AllenTrieu @JordanWesty1 pic.twitter.com/DGLjZC4gIA
— AJ Moore (@ajmoore6_) April 17, 2026
Leshem Nyante | 2027 | OT | 6’5″ 265 lbs | Anna High School | Anna, TX
Nyante picked up his latest offer from Texas Rio Grande Valley on April 17 after he spoke with offensive line coach Jeff Bowen.
“Coach Bowen reached out this morning to officially extend the offer. It was a great talk, and he mentioned they really liked my film and how I would fit their system. So we are focused on building that relationship now,” Nyante said.
“I’m really grateful for how my recruiting process is unfolding so far. Things are definitely moving fast with spring ball right around the corner, and it’s been great seeing the increase in interest every week.”
He also has offers from Arkansas State, Division II Midwestern State, and East Central University. Old Dominion, Texas State, UTEP, and New Mexico are some other schools he is hearing from. Nyante will be taking an official visit to Arkansas State in June.
#AGTG After a great conversation with @CoachJeffBowen , I am blessed to receive a D1 offer from @UTRGVFootball !!@8_parr @Coach_Rigg @tylerdedwards33 @Sevier5 @jessedstew @AnnaCoyotesFB @CoachTBush @Perroni247 @SWiltfong_ @CKennedy247 pic.twitter.com/6o9H13baAb
— Leshem (Shem) Nyantee (@leshemnyantee10) April 17, 2026
Matthew Lashley | 2027 | DB | 6’1″ 198 lbs | Riverside City College | Riverside, CA
Lashley received his latest offer from East Texas A&M on April 15 after speaking with safeties coach Luke Jaicks.
“Coach Jaicks called and offered me. He’s a great coach, and I would love to play for him,” Lashley said. “My recruitment is going well; it’s starting to heat up after spring ball.”
He also has an offer from Southern Utah. Last season, he finished with 14 tackles and two interceptions for the Tigers.
Blessed to receive another D1 offer to @Lions_FB! @JacksonSimon25 @nilsonsports pic.twitter.com/X4iLU8VRID
— Matthew Lashley (@MatthewLashley_) April 15, 2026
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South Dakota
Nature: Prairie chickens in South Dakota
South Dakota
Democrats fail to field candidates for a majority of South Dakota legislative seats
(SOUTH DAKOTA SEARCHLIGHT) – Democrats are running for 46 of South Dakota’s 105 legislative seats — leaving 56% of seats without a Democratic candidate.
That doesn’t bode well for the party ahead of November, said Michael Card, professor emeritus of political science at the University of South Dakota.
“It doesn’t put them in a position to actually put forward their ideological policy preferences and have much of a success at getting those enacted,” Card said.
In the state Senate alone, Democrats have failed to field a candidate for 22 seats, which is nearly two-thirds of the chamber. In the House, Democrats have failed to field a candidate for 38 seats, which is 54% of the chamber.
There is only one Democratic legislative primary in the state: a state Senate race in District 26, which includes the Rosebud Reservation.
There are no statewide Democratic primaries, after announced candidates for governor and U.S. House dropped out or failed to gather enough petition signatures to make the ballot, leaving one Democrat in each of those races.
Statewide candidates will have less name recognition than Republican candidates ahead of the general election, since they didn’t have primaries, Card said. In the Legislature, Card said Democrats “are guaranteeing they won’t get a majority.”
In contrast, Republicans have primary races for governor, U.S. House and U.S. Senate. Five legislative districts do not have Republican primaries, but do have Republican candidates. There is a Republican candidate running for every legislative seat, except for one House seat in District 27, which includes the Pine Ridge Reservation.
Card said there are several factors leading to poor candidate turnout among Democrats, including a self-fulfilling cycle of failure.
“A lack of winning makes fewer people willing to take a chance on running for office,” Card said. “Why run if I think I’m going to lose?”
Democrats haven’t held a statewide office since 2015, and they haven’t held a majority of either legislative chamber since 1994.
Joe Zweifel, deputy executive director of the South Dakota Democratic Party, said the organization worked “really, really hard” to convince Democrats to run for office.
“But you can’t force people to run for office,” said Zweifel, of Sioux Falls, who’s running for a legislative seat himself in District 12.
He’s heard the open seats called a “failure.” But he disagrees, choosing to focus on the Democrats who did step forward.
“We’re running quality, good candidates in those races,” Zweifel said.
The South Dakota Democratic Party hopes to build on legislative successes, such as a new law from Rep. Kadyn Wittman, D-Sioux Falls, that commits state funding to cover the family portion of reduced-price school meals.
“That specifically is a return on investment for our donors, and it shows that Democrats are doing good things for the people of South Dakota,” Zweifel said.
Wittman’s success helped inspire Democratic District 13 House of Representatives candidate Ali Rae Horsted, of Sioux Falls, to take a second run at the Legislature. Horsted ran unsuccessfully for the Senate against Sen. Sue Peterson in 2024, garnering 42% of the vote.
Horsted plans to build on that success and the name recognition she already has in the district. She hopes she’ll have “better odds” in this election, since there are two House seats for every district.
Horsted said it would better serve South Dakota if the state had a more balanced Legislature. While the latest Legislature was 92% Republican, 52% of voters in South Dakota are Republican. South Dakota has the lowest percentage of Democrats, 7.6%, in the Legislature nationwide.
“I think it’s important that people have options on the ballot,” Horsted said, “and people are able to vote for candidates that represent their values and their vision for the future of South Dakota.”
Makenzie Huber is a lifelong South Dakotan who regularly reports on the intersection of politics and policy with health, education, social services and Indigenous affairs. Her work with South Dakota Searchlight earned her the title of South Dakota’s Outstanding Young Journalist in 2024, and she was a 2024 finalist for the national Livingston Awards.
South Dakota Searchlight is part of States Newsroom, the nation’s largest state-focused nonprofit news organization.
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