South Dakota House Rejects Health Care Provider Conscience Exemption Bill

Proposed legislation aimed to allow providers to refuse services based on personal beliefs failed in a 41-25 vote.

Published on Feb. 10, 2026

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The South Dakota House of Representatives voted 41-25 against a bill that would have allowed health care providers in the state to refuse to perform services that violate their personal conscience, such as abortions, vaccinations, and transgender surgeries. Supporters argued the bill would protect providers' religious freedoms, but opponents expressed concerns about the potential unintended consequences and impact on patient trust and care.

Why it matters

This vote highlights the ongoing debate around balancing health care providers' rights to practice according to their personal beliefs versus patients' rights to access the care they need. The rejected bill aimed to expand protections beyond federal laws and existing health care organization policies in South Dakota.

The details

The bill, introduced by Republican Rep. Leslie Heinemann, sought to allow health care providers to refuse participation in services that violate their conscience. Opponents, including Republican Rep. Nick Fosness who is a healthcare CEO, argued the legislation was too broad and could create unintended consequences and additional regulations for health care systems. Democratic Rep. Taylor Rehfeldt, a nurse anesthetist, said the bill would compromise the integrity, safety, and compassion that South Dakota patients deserve.

  • The South Dakota House of Representatives voted on the bill on February 11, 2026.

The players

Leslie Heinemann

A Republican state representative who introduced the bill to allow health care providers to refuse services based on conscience.

Nick Fosness

A Republican state representative and CEO of the Avera Marshall County Healthcare Center, who spoke against the bill due to concerns about unintended consequences and additional regulations.

Taylor Rehfeldt

A Democratic state representative and nurse anesthetist who spoke against the bill, arguing it would compromise patient trust, safety, and compassion.

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What they’re saying

“No one should be forced to choose between their faith and their profession.”

— Leslie Heinemann, State Representative (southdakotasearchlight.com)

“There's unintended consequences from the legislation that feels like one more regulation for our health care systems.”

— Nick Fosness, State Representative, CEO of Avera Marshall County Healthcare Center (southdakotasearchlight.com)

“I believe that our moral, ethical and religious responsibility is to defend the system where patients do come first, not personal ideology. This bill compromises the integrity, safety and compassion South Dakota patients deserve.”

— Taylor Rehfeldt, State Representative, Nurse Anesthetist (southdakotasearchlight.com)

What’s next

The rejected bill is unlikely to be reconsidered in the current legislative session, but the debate over balancing provider rights and patient access to care is expected to continue in South Dakota and other states.

The takeaway

This vote highlights the ongoing tensions between protecting health care providers' religious freedoms and ensuring patients have access to the care they need. While the bill was rejected, the underlying issues it raised will likely persist as state legislatures continue to grapple with these complex ethical and policy questions.