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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The South Dakota Lottery offers multiple draw games for those aiming to win big.
Here’s a look at March 4, 2026, results for each game:
Winning Powerball numbers from March 4 drawing
07-14-42-47-56, Powerball: 06, Power Play: 4
Check Powerball payouts and previous drawings here.
Winning Lotto America numbers from March 4 drawing
33-38-39-47-51, Star Ball: 07, ASB: 02
Check Lotto America payouts and previous drawings here.
Winning Dakota Cash numbers from March 4 drawing
02-18-22-30-32
Check Dakota Cash payouts and previous drawings here.
Winning Millionaire for Life numbers from March 4 drawing
12-13-36-39-58, Bonus: 03
Check Millionaire for Life payouts and previous drawings here.
Feeling lucky? Explore the latest lottery news & results
Are you a winner? Here’s how to claim your prize
- Prizes of $100 or less: Can be claimed at any South Dakota Lottery retailer.
- Prizes of $101 or more: Must be claimed from the Lottery. By mail, send a claim form and a signed winning ticket to the Lottery at 711 E. Wells Avenue, Pierre, SD 57501.
- Any jackpot-winning ticket for Dakota Cash or Lotto America, top prize-winning ticket for Lucky for Life, or for the second prizes for Powerball and Mega Millions must be presented in person at a Lottery office. A jackpot-winning Powerball or Mega Millions ticket must be presented in person at the Lottery office in Pierre.
When are the South Dakota Lottery drawings held?
- Powerball: 9:59 p.m. CT on Monday, Wednesday, and Saturday.
- Mega Millions: 10 p.m. CT on Tuesday and Friday.
- Lucky for Life: 9:38 p.m. CT daily.
- Lotto America: 9:15 p.m. CT on Monday, Wednesday and Saturday.
- Dakota Cash: 9 p.m. CT on Wednesday and Saturday.
- Millionaire for Life: 10:15 p.m. CT daily.
This results page was generated automatically using information from TinBu and a template written and reviewed by a South Dakota editor. You can send feedback using this form.
PIERRE — A bill from South Dakota Attorney General Marty Jackley to criminalize the creation or sharing of deepfakes was amended this week to more clearly define what constitutes nudity before it reaches Gov. Larry Rhoden’s desk.
The amendment, added on the floor of the House of Representatives, came in response to concerns about unintended consequences.
Senate Bill 41 creates a class of felony crime for the creation or distribution of images digitally altered to depict a person in a state of nudity or involved in a sexually explicit act, commonly referred to as deepfakes.
In testimony in the House Judiciary Committee on Monday in Pierre, Jackley pointed to the case of Mark Rathbun, a former Division of Motor Vehicles employee who is accused of taking images of women and girls from state databases and creating sexual images.“This is real, and it’s something that we unfortunately are seeing happen in our state,” Jackley said.
The judiciary committee voted 8-3 to send the bill to the House floor but not before a discussion on its potential to criminalize political memes.
The bill’s definition of nudity originally encompassed a partial state of nudity. Fort Pierre Republican Rep. Will Mortenson asked Jackley if that would include a fabricated topless photo. Jackley said yes. Then Mortenson asked if a fabricated image of Democratic Illinois Gov. J.B. Pritzker without a shirt, if shared by President Donald Trump on social media, would put the president in line for felony charges.
Jackley said a Pritzker image wouldn’t qualify because Pritzker is male, but Mortenson pushed back.
He noted that partially nude fabrications would be a felony if done with the intent to “self-gratify or alarm, annoy, embarrass, harass, invade the privacy of, threaten, or cause emotional, financial, physical, psychological, or reputational harm to that individual.”
Nothing in the bill specified that a person in a digitally fabricated topless image must be female.
“We just said that half-nude is a state of nudity, and so now he’s shirtless, and the point of this is to embarrass this guy,” Mortenson said of his topless Pritzker meme scenario.
Mortenson voted against the bill in committee but brought an amendment Tuesday to define nudity as inclusive of male or female genitalia, buttocks or the female nipple.
The amendment passed, but it did not address every concern about the bill.
Democratic Rep. Kadyn Wittman of Sioux Falls asked Jackley during the bill’s committee hearing why he didn’t use it to enhance penalties for people who film others in states of undress or participating in sexual activity against their will.
That behavior is a felony if it involves the recording of a minor, or if it happens repeatedly. The new penalties for deepfakes would be added to the same chapter of South Dakota law.
“Why is the first time hidden recording a misdemeanor generally, but a digitally fabricated image would automatically be a classified felony,” said Wittman.
Jackley said he feels that the creation of digitally manipulated sexual images, even if they aren’t shared, signals “significant criminal intent.” He told South Dakota Searchlight after the committee meeting that he’s open to addressing that issue, but that SB 41’s primary purpose was to target deepfakes.
On the House floor, Wittman was one of two representatives to say the bill’s felony penalties could be unnecessarily harsh in instances where young people make “a stupid decision” and create a deepfake.
“I feel like, in a lot of situations, this bill covers behavior that could be covered by a lower level of offense,” Wittman said.
Supporters countered that the creation of fake nudes can do real psychological damage to real people, and that the state needs to clearly signal that doing so is a serious crime.
“It’s only fun and games until it happens to you,” said Rep. Mary Fitzgerald, R-St. Onge.
The bill passed the House 60-6. It now moves to the state Senate, which passed the bill 32-0 on Jan. 16. The Senate would need to approve the amended version of the bill before it could be delivered to Gov. Larry Rhoden to sign or veto.
The South Dakota Lottery offers multiple draw games for those aiming to win big.
Here’s a look at March 3, 2026, results for each game:
Winning Mega Millions numbers from March 3 drawing
07-21-53-54-62, Mega Ball: 16
Check Mega Millions payouts and previous drawings here.
Winning Millionaire for Life numbers from March 3 drawing
09-10-13-25-54, Bonus: 05
Check Millionaire for Life payouts and previous drawings here.
Feeling lucky? Explore the latest lottery news & results
Are you a winner? Here’s how to claim your prize
- Prizes of $100 or less: Can be claimed at any South Dakota Lottery retailer.
- Prizes of $101 or more: Must be claimed from the Lottery. By mail, send a claim form and a signed winning ticket to the Lottery at 711 E. Wells Avenue, Pierre, SD 57501.
- Any jackpot-winning ticket for Dakota Cash or Lotto America, top prize-winning ticket for Lucky for Life, or for the second prizes for Powerball and Mega Millions must be presented in person at a Lottery office. A jackpot-winning Powerball or Mega Millions ticket must be presented in person at the Lottery office in Pierre.
When are the South Dakota Lottery drawings held?
- Powerball: 9:59 p.m. CT on Monday, Wednesday, and Saturday.
- Mega Millions: 10 p.m. CT on Tuesday and Friday.
- Lucky for Life: 9:38 p.m. CT daily.
- Lotto America: 9:15 p.m. CT on Monday, Wednesday and Saturday.
- Dakota Cash: 9 p.m. CT on Wednesday and Saturday.
- Millionaire for Life: 10:15 p.m. CT daily.
This results page was generated automatically using information from TinBu and a template written and reviewed by a South Dakota editor. You can send feedback using this form.
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