South Dakota has been governed by bicameral Republican supermajorities since 1996. Democrats haven’t carried a statewide race in more than a decade. In a 2018 Gallup survey, the Mount Rushmore State was ranked the third-most conservative in the country, with self-identified “conservative” residents outflanking self-identified liberals by some 31 points.
It is not a state where one would expect to find a major trade conference for transgender medical specialists.






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