What’s happening: A 2018 Gallup survey ranked South Dakota as the third most conservative state in the country. Republican supermajorities have governed it since 1996. Despite this, a string of efforts from powerful progressive corporations has brought gender ideology to the state.

The corporate efforts: Sanford Health is a powerful South Dakota-based health care conglomerate. The corporation has lobbied and mobilized efforts in Republican Gov. Kristi Noem’s office to kill legislation that would ban transgender women, or biological men, from women’s sports because of financial interests in its own sports complex.

Puberty blockers and transition surgeries pay: Sanford Health sells puberty blockers and performs sex-change surgeries. To protect its interests, it lobbied against bills allowing doctors to abstain from sex-change and abortion surgeries on moral grounds. It also successfully lobbied against a bill to ban puberty blockers and sex-changes for children under 16.

Paying off the legislators: Though laws prohibit corporations like Sanford Health from donating directly to candidates that control legislation in South Dakota, the health care conglomerate found a workaround: Outside advocacy groups that Sanford executives run successfully funded candidates to unseat conservative lawmakers and lobbied against conservative legislation.

Big picture

Though the state is conservative and primarily against radical gender ideology, corporate lobbying has brought progressivism to the state. The state failed to end youth sex changes in 2020 and has done little to address the issue since. Also, after hesitation, only public backlash led  Gov. Noem to ban biological men from playing in women's sports.