After a last-minute court decision required Native Americans in North Dakota to have street addresses instead of PO boxes, the affected tribes and other organizations mobilized to created the needed documents. Election returns from the 2018 midterms show that the attempt to suppress them only energized them.

In Sioux and Roulette Counties, home to the Standing Rock and Turtle Mountain Indian Reservations, voter turnout in the 2018 midterm elections actually exceeded turnout in the 2016 presidential election. This remarkable achievement contrasts with the state of North Dakota and the nation as a whole, where midterm turnout is nearly always lower in midterms. In Sioux County, voter turnout in the 2018 midterm was more than double that of the 2014 midterm.

Nevertheless, Democratic Senator Heidi Heitkamp still lost. In fact, she lost by 35,000 votes, far more than the 7,600 votes that Native Americans could have provided her even with 100% turnout (assuming the same 82% vote for Heitkamp). Early polls had suggested a tighter race, possibly within 5,000 votes, in which the Native vote could have made the difference.

There are still gains to be made in the Native vote. While turnout on reservations was abnormally high compared to past elections, it was still less than the statewide average.