North Dakota
Concerns grow in North Dakota about increased insurance costs, medical debt
BISMARCK — North Dakota health care organizations and insurance regulators are sounding a warning about the potential increase in out-of-pocket premium costs for those using the Affordable Care Act marketplace for their health insurance needs.
Some of the concern stems from changes to the ACA marketplace included in the latest version of the “One Big Beautiful Bill” covering enrollment, personal information verification and eligibility requirements.
Another area of concern is that expanded tax credits for those on the ACA marketplace will expire at the end of the year. Talk of an extension of those credits was not included in the latest formulation of the legislation currently being reviewed by the U.S. Senate.
Concerns over rising costs, loss of coverage
About 50,000 people get their health insurance through the ACA marketplace in North Dakota, according to the state’s Office of the Insurance Commissioner.
Roughly 90% of those individuals are eligible for the expanded tax credits established during the pandemic in 2021.
Loss of these tax credits would lead to ACA insurance premiums rising on average by 75%, according to the health care information nonprofit KFF.
Without those credits, individuals would either need to pay the extra premium cost themselves or possibly lose coverage if they can’t afford the monthly payments.
“We know people are going to lose coverage,” said Tim Blasl, president of the North Dakota Hospital Association. “What that exactly looks like for North Dakota, we’ve got to work through that.”
People would still get care, Blasl said, but more uninsured means less prevention and more people showing up in emergency rooms.
This increases medical debt for consumers and for hospitals if people can’t pay themselves.
“So, there’s a concern of an increase in bad debt, and how does that impact access to health care long term? How does that impact hospital financials long term? That’s something we are really concerned about,” Blasl said.
The Congressional Budget Office estimates 700,000 people could lose coverage nationally due to changes related to enrollment, and a further 3 million could become uninsured because of increased eligibility requirements.
The CBO said the expiration of the enhanced premium tax credits will lead to 4.2 million more uninsured people nationwide by 2034.
Roughly 45,000 people in North Dakota on the ACA marketplace would pay higher premiums or drop coverage if they can’t afford it.
On June 20, a statement from the Center for Medicare and Medicaid Services said it is finalizing a rule included in the legislation that would lower the cost of ACA premiums by 5% on average, crack down on improper enrollments and rein in wasteful spending.
The statement said that in 2024, about 5 million people nationwide were potentially improperly enrolled on the ACA marketplace.
U.S. Rep. Julie Fedorchak, R-ND, said of the ACA changes included in the current legislation that, “Change is hard, change is going to require people to pay attention and make sure they’re properly enrolling and following the rules.”
Anna Paige / The Forum
Fedorchak said the program needs to be fixed so it can exist long-term amid federal budget and federal debt constraints.
The legislation could pass the Senate within the next week, then return to the House of Representatives for approval. President Donald Trump is pressing lawmakers to get the final legislation to his desk by July 4.
As for the expanded tax credits, Fedorchak said this may be taken up in another set of legislation in the second half of this year.
“There are concerns about how this will impact people and their insurance and maintaining their insurance, and there are also concerns about the cost to the federal government, which is about $350 billion to extend it in its current form,” Fedorchak said.
“So it’s about balancing those two concerns and finding the best path forward.” Fedorchak said, “We don’t want a bunch of people going off their insurance and or losing their insurance or choosing not to purchase insurance, because that’s costly to the health care system, but at the same time, you know, some of the program levels are pretty generous.”
Rural impacts, rising medical debt
Impacts from the changes and expiration of tax credits are likely to be felt more acutely in rural parts of North Dakota.
According to 2024 data, nearly 27,000 of those on the ACA in the state lived in rural areas compared to around 16,000 in urban areas.
Brad Gibbens, a board member of the North Dakota Rural Health Association and former director of the Center for Rural Health at the University of North Dakota, said a higher percentage of people in rural areas are not insured through employers.
Gibbens also said many of those on ACA plans receiving the subsidies are also likely getting food assistance through the Supplemental Nutrition Assistance Program, which is also being reformed and cut in the legislation.
“Both of those programs are being cut back so there’s going to be a profound effect in rural areas,” Gibbens said.
Those cuts will not only impact individuals who lose coverage, but also rural hospitals that treat patients in their ERs.
“They’re going to be coming in through the ERs when they’re sicker, when we would have liked to have seen them earlier to address an issue, rather than when they come back and it’s more acute,” Gibbens said. “There isn’t any money then, to treat them, so that comes back as more bad debt for the hospital.”
Gibbens said the moves are a “real step backwards” and would lead to significant negative impacts on the health of individuals but also on the financial viability of rural hospitals and clinics.
Centrist think tank Third Way published a report June 23 examining the impacts on health care from changes in the One Big Beautiful Bill and estimated 5.4 million more people would be pushed into medical debt nationwide, increasing total medical debt by $50 billion.
Former Democratic-NPL U.S. congressman for North Dakota and former insurance commissioner Earl Pomeroy said the health care cuts in the One Big Beautiful Bill are a “common budget trick” made to pay for extending prior Trump tax cuts.
“They haven’t lifted a finger to keep health insurance affordable, and as a result, premiums will soar,” Pomeroy said. “Everyone knows higher health insurance premiums really hurt family budgets.”
At the end of May, the National Association of Insurance Commissioners, currently led by North Dakota Insurance Commissioner Jon Godfread, sent a letter to both U.S. Senate and House majority and minority leaders highlighting changes to the ACA marketplace.
The letter said the potential expiration of the tax credits would have a “negative impact on insurance markets” and the “health care system as a whole.”
The NAIC letter said the rule changes would lead to fewer individuals covered and market disruptions as soon as 2026, and that the changes do not allow sufficient time for insurers, regulators and consumers to prepare.
The letter also stated the new eligibility requirements would prevent many consumers from getting insurance promptly, particularly if they lose jobs or their income changes.
Since 2020, overall enrollment on the ACA marketplace in North Dakota increased by about 87%.
North Dakota ranks 15th in per capita spending on health care, according to data compiled by KFF.
This story was originally published on NewsCoopND.org.
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This story was written by one of our partner news agencies. Forum Communications Company uses content from agencies such as Reuters, Kaiser Health News, Tribune News Service and others to provide a wider range of news to our readers. Learn more about the news services FCC uses here.
FARGO — Drivers can expect to see a slight uptick in gas prices as a result of the Iran conflict.
As of Monday, March 2, the average for North Dakota is $2.65 a gallon. While that is a $0.13 increase from a month ago, it is significantly lower than prices a year ago.
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GRAND FORKS – The Study ND, formerly Humanities North Dakota, has received $15,000 from the National Endowment for the Arts for a statewide theater and humanities initiative in recognition of the 250th anniversary of the founding of the United States.
This commemorative investment is meant to bring historical events and figures – such as the framers of the U.S. Constitution – to life through virtual and live performances that celebrate the nation’s history.
The grant, along with funding from private sources, has made it possible for The Study ND to host “America 250” activities after the organization sustained a considerable cut in funding from the National Endowment for the Humanities last year, according to Brenna Gerhardt, The Study ND executive director.
“We absorbed a 50% budget cut, resulting in a loss of $467,645 in funding,” Gerhardt said. “As a result, we had to significantly scale back our American 250 initiatives focused on American history and civics education.”
Funds received from the National Endowment for the Arts will be used to present public readings, theatrical portrayals and guided discussions to encourage audience members to reflect on the nation’s founding in 1776 and on its democratic ideals, while engaging in contemporary conversations about civic life.
All of the programming in the series organized by The Study ND, titled “American Heroes,” will be livestreamed statewide.
In the grant application submitted to the National Endowment for the Arts, “we framed the project around a simple idea: democracy requires more than information, it requires citizens who can think historically, listen well, and argue in good faith,” Gerhardt said.
“This series uses living history performances to bring consequential figures into the room, then turns the room into a civic space through moderated dialogue and related public events. We define ‘heroism’ as civic courage under pressure, the willingness to contend with hard truths, and the capacity to enlarge a community’s moral imagination,” she said.
“The project does not ask audiences to agree on a single interpretation of a figure. It invites them to grapple with complexity together, and to connect the past to the responsibilities of the present.”
When Gerhardt and her colleagues received the application for grant proposals from the National Endowment for the Arts, “we were already planning a line-up of America 250 events and it fit perfectly with what we were already planning, so then we just wrote the grant,” she said.
Private funds, including matching funds from the Bismarck-based Tom and Frances Leach Foundation, have also been provided for this project.
Details about all the events will probably be posted on the website
www.TheStudyND.org
in March, Gerhardt said.
The America 250 events, which are planned to take place at Bismarck State College, are 5-6 p.m. July 8, “Reading of the Declaration of Independence, with John Adams,” and 6-7:30 p.m. July 9, “Alexander Hamilton Speaks,” both performed by William Chrystal.
The Living History programs are planned for 7-8:15 p.m. Sept. 17, “Thomas Paine,” performed by Doug Mishler, and Oct. 6, 7-8:15 p.m, “Frederick Douglass,” performed by Nathan Richardson. Both will be moderated by Susan Frontczak.
The performers Chrystal and Richardson live in Virginia, Frontczak in Colorado,and Mishler in Nevada.
Another program, “Hemingway and Gellhorn,” is set for Sept. 16-18 at Bismarck State College, Gerhardt said. “It is part of our broader Chautauqua/living history programming connected to America 250 … (and) will feature performances and discussion centered on Ernest Hemingway and Martha Gellhorn, using their lives and writing as a way to explore major questions about American identity, war reporting, public memory, and the stories we tell about freedom, conflict and responsibility.
“What I am excited about with this event is that it gives us a way to approach America 250 beyond founding-era material. In other words, it helps us show the American story is not just about 1776, but also about the generations that followed and how Americans wrestled with democracy, power, truth and moral courage.”
This program “expands the initiative beyond commemoration into reflection, dialogue and interpretation, which is where the humanities are especially valuable,” she said. “It helps us reach audiences who may be drawn in through literature, journalism and performance, not only traditional history events.”
The Hemingway and Gellhorn program fits in with America 250 in that “it broadens the frame and adds depth to the larger effort.”
Gerhardt is hoping that these activities will give participants “a better understanding of all the debates and issues going on when our country was founded, and how those debates are continuing today,” she said, “and just to be more thoughtful and informed citizens.”
College students and members of the general public will also be invited to participate in a workshop aimed at teaching participants how to build a living history performance from primary sources and historical research.
Last year, The Study ND lost a substantial amount of funding – nearly $468,000, about half of its annual budget – from the National Endowment for the Humanities for its fiscal 2025 year.
The loss of that much funding was discouraging, Gerhardt said. “Very much so, because we had a lot of activities planned for America 250 and we had to cancel a lot of them, or – like in this case – seek other funding, which we were lucky to get.”
The Study ND currently has four full-time employees, she said. “We eliminated a part-time marketing position after the cuts.”
A nonprofit organization, The Study ND provides civics, arts and cultural education programming. The organization’s programs – which include online classes, book talks, lectures and more – reached about 24,000 people in 2024, Gerhardt told the North Dakota Monitor in April 2025.
During the summer, the organization hosts a civics education program for high school and middle school social studies teachers, she said.
On this day in 1943, two North Dakota army officers, Second Lieut. Arthur B. Kuntz and First Lieut. Bernard A. Anderson, were killed in separate medium bomber training crashes in Florida and Georgia.
Here is the complete story as it appeared in the paper that day:
Army Plane Crashes Kill Two N. D. Men
Two North Dakota officers in the army air forces were killed Sunday in bomber crashes during training flights, Associated Press dispatches revealed Monday.
Second Lieut. Arthur B. Kuntz of Harvey (Wells county) was killed with 10 others from the Avon Park, Fla., army bomber base when two medium bombers collided during a routine formation flight. Both planes crashed and there were no survivors.
First Lieut. Bernard A. Anderson of Warwick (Benson county) was one of six killed when a medium bomber from MacDill field, Tampa, Fla., crashed near Savannah, Ga. Lieutenant Anderson was co-pilot of the plane.
None of the other victims of either accident was from the Dakotas or Minnesota.
Lieutenant Kuntz, son of Mr. and Mrs. Roy Kuntz of Harvey, was graduated from the army air force navigation school at Hondo, Texas, as a second lieutenant last October, and received his wings as a navigator.
Kate Almquist is the social media manager for InForum. After working as an intern, she joined The Forum full time starting in January 2022. Readers can reach her at kalmquist@forumcomm.com.
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