01/26/2026
Rapid City Ward 1 Alderman Stephen Tamang posted this morning:
There is a sequence of events unfolding that matters deeply for rural South Dakota. It is easy to miss when each step is discussed in isolation, but when viewed together, the policy direction becomes clear.
First, Congress passes what many have dubbed the “big beautiful bill” in early 2025. The legislation reduces long term Medicaid funding growth by tightening eligibility, changing financing formulas, and shifting more financial risk to states.
Second, to prevent widespread collapse in rural healthcare systems, Congress created the Rural Health Transformation Fund. This is a temporary, one time, multi year pool of federal dollars intended to help rural states transition through the Medicaid changes. It is not a permanent fix. It is explicitly designed as bridge funding.
Third, South Dakota brings HB 1044 during the January 2026 legislative session. This bill does not spend state dollars. It simply authorizes the Department of Health to access and spend federal Rural Health Transformation funds if and when they are awarded. Without this authorization, South Dakota could receive federal funds on paper but be unable to use them in practice.
During deliberations in the Joint Committee on Appropriations, amendments were proposed to limit this federal spending authority. Those amendments failed. Ultimately, only two members voted against granting the state sufficient authority to access the funds.
Those two members were Taffy Howard and John Carley.
That vote matters. Limiting or denying expenditure authority does not reduce federal debt. It simply increases the likelihood that federal dollars meant for rural South Dakota flow to other states instead.
Then comes the policy tension that is harder to ignore.
In the same legislative session, Sen. Howard cosponsored House Joint Resolution 5002, which could significantly undermine Medicaid expansion in South Dakota. Medicaid expansion is the single largest stabilizing force for rural healthcare providers in this state. Removing or weakening it would dramatically increase uncompensated care and push fragile systems closer to failure.
Taken together, these actions form a coherent policy posture: opposing Medicaid, opposing transition funding, and accepting increased risk to rural healthcare systems as the cost of ideological consistency.
Here is the summary: Congress reduced Medicaid support. Congress offered temporary mitigation. South Dakota moved to accept that mitigation. Two legislators voted no. One of those legislators is simultaneously advancing efforts to weaken Medicaid itself.
This clarity is being missed right now, and voters deserve to know what is at stake.
