Nate Hochman of National Review follows up his punchy short piece attacking South Dakota Gov. Kristi Noem for stabbing social conservatives in the back, now publishing a terrific investigation in how conservative South Dakota became so transgender-friendly -- thanks in large part to Kristi Noem and the medical branch of woke capitalism. Excerpts:

[South Dakota] is not a state where one would expect to find a major trade conference for transgender medical specialists.

But on January 13, the Sanford Research Center in Sioux Falls is scheduled to host just such an event. The “3rd Annual Midwest Gender Identity Summit,” billed as an effort to “review the needs of transgender patients in healthcare,” is evidence that a variety of factors have converged to make “cherry-red South Dakota the unlikely epicenter of a transgender uprising on the American Great Plains,” as the Washington Post reported in 2020. The summit is co-hosted by Sanford Health, a Sioux Falls–based health-care conglomerate, and the Transformation Project, a local transgender advocacy group.

Both Sanford and the Transformation Project are representative of the larger forces that are working to bring the transgender movement to the deepest-red corners of the United States — a coordinated, well-funded campaign for which South Dakota has become something of a trial run. That campaign’s influence has reached the Republican-dominated state legislature, where dozens of anti-gender-ideology bills have failed over the past decade. “No one thought South Dakota was a state where this could be stopped,” Libby Skarin, the campaign director for the ACLU of South Dakota, boasted in February. “I think the fact that we have consistently stopped these bills has been a source of hope for folks, like if they can do it in South Dakota, we can do it in our state.”

More:

The women’s-sports bill wasn’t the only social-conservative legislation that Sanford had lobbied against — and the sports complex wasn’t its only business interest implicated in transgender debates. The health-care company sells puberty blockers and performs “gender-reassignment” surgery. Its lobbyists appeared at the state legislature to oppose legislative initiatives including conscience rights for medical practitioners who object to performing abortions and sex-change operations, and a ban on puberty blockers and sex-reassignment surgery for children under 16. Both proposals ultimately failed to pass. “The bill to prevent doctors from giving hormone-blocking drugs to kids — when it failed, that was all Sanford,” John Mills, a Republican lawmaker representing South Dakota’s fourth house district, told NR. “You want to believe it’s not about the profit, but you also witness the reality of what’s happening on the ground and can’t help but wonder.”

At the time, concerns about Sanford’s influence centered on Noem herself. The governor’s close relationship to a company with a record of left-wing cultural activism raised new questions about her own missteps. But that relationship had broader implications, too. What was unfolding in South Dakota was the all-too-common story of a powerful progressive business interest that was pushing a deep-red state leftward — even over the express wishes of its broadly conservative voter base.

The state, and its legislature, are overwhelmingly Republican. So why is the legislature, and the governor's office, where social conservative concerns go to die? Here's the key graf:

But no set of institutions in South Dakota has embraced gender ideology more than the state’s Sanford-dominated business community, which sits well to the left of the state’s political center of gravity. (In November 2020, Sanford replaced its CEO of 24 years after he informed employees that he wouldn’t be wearing a mask around the office, arguing that he had recently recovered from the Covid virus and therefore posed no threat of spreading it.) The state’s Chamber of Commerce chapters, which are closely tied to Sanford, regularly lobby against social-conservative bills, including medical conscience rights, the prohibitions on sex changes for minors, birth-certificate gender changes, transgender locker room use, and bans on men in women’s sports.

Please read the whole thing -- it's important. Terrific work by Hochman! The health care giant Sanford Health, which calls itself the largest rural health care system in the country, basically owns the South Dakota legislature, according to Hochman's reporting. If Woke Capitalism can conquer deep-red South Dakota, against the will of its conservative voters, it can do what it wants anywhere -- unless voters elect conservative lawmakers who are not afraid to stand up to Woke Capitalism.

I've been told in the past by religious liberty lobbyists that in state legislatures, it's very hard to go up against the immense money that major corporations sling around to buy off conservative lawmakers' opposition to woke legislation. If social and cultural conservatives want to have a future, they are going to have to get radical about facing down Big Business, which hates us. Again: Ronald Reagan is dead, and so is the world he represented.