As ACA tax credits expire, a North Dakota rural hospital braces for 2026

BISMARCK, N.D. (KFYR) – With federal health care tax credits set to expire, rural hospitals in the state warn the ripple effect could strain their budgets while they are already operating on thin margins.

The Emergency Department at Jamestown Regional Medical Center is gearing up for more patients to come into their doors, uninsured, starting Jan. 1.

“We could be affected as early as January of the coming year. So it would happen very, very quickly. And nobody really knows what’s going to happen,” said Mike Delfs, the CEO of Jamestown Regional Medical Center.

Many rural residents are on the Affordable Care Act marketplace. Since premiums are predicted to spike significantly, some people will drop insurance, and they will be forced to go to the ER when they get sick. Hospitals cannot refuse emergency patients, and will have to shoulder the cost on thin margins.

“We would be looking at anticipated bad debt, but to what degree we don’t even know, and it is kind of scary to think about,” said Delfs.

Hospital leadership and staff say that the uncertainty is wearing on them, on top of the common stressors rural providers have to deal with.

As of now, they say their best bet is to hope that Congress can put aside partisan differences and come up with a solution.

“We have real people who are either going to lose their insurance or its going to get so expensive they literally can’t afford it. And the downstream effect of that is now you are endangering hospitals in rural locations just by their mere viability,” said Delfs.

According to hospital leadership, without congressional action in 2026, the end of the year could leave the hospital with nearly one million dollars in unpaid medical bills.

North Dakota’s Republican congressional delegation says the Rural Health Transformation Fund will greatly benefit rural hospitals and blames democrats for voting against their healthcare plan.

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