North Dakota

Concerns grow in North Dakota about increased insurance costs, medical debt

Published

12 months ago

June 27, 2025

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.”

Rep. Julie Fedorchak speaks Friday, Feb. 14, 2025, at Northern Cass High School in Hunter, North Dakota.

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.”

North Dakota

Challengers declare victory after ND Supreme Court rules against Legislature’s attempt to alter term limits

Published

6 hours ago

June 25, 2026

Press Room

Challengers declare victory after ND Supreme Court rules against Legislature’s attempt to alter term limits

BISMARCK — A constitutional ballot measure to amend the state’s term limits law as proposed by the Legislature will not appear on November’s ballot, the North Dakota Supreme Court ruled Thursday, siding with petitioners who argued the Legislature exceeded its authority and violated the state constitution in proposing the changes.

“The people’s voice was heard,” Grand Forks County Commissioner Terry Bjerke said in reaction to the news.

Bjerke was a member of the sponsoring committee behind the successful 2022 effort to pass a term limits initiative, which amended the state constitution by capping legislative term limits to eight years in the House and eight years in the Senate. The amendment, which became article XV of the state constitution, also included a clause barring the Legislature from making constitutional changes to term limits.

During the 2025 session, however, lawmakers narrowly approved Senate Concurrent Resolution 4008, in which the legislature proposed Constitutional Measure 1, a ballot measure to amend the term limits language to allow legislators to decide in which chamber they want to serve their 16 years, and to repeal the clause limiting the legislative assembly’s authority to propose an amendment to alter or repeal term limits.

Bjerke and former Minot legislator Oley Larsen brought the lawsuit challenging the validity of the Legislature’s action in January, and the state Supreme Court

heard oral arguments in the case

this spring.

“Those term limits may only be altered by a measure proposed by the people rather than the Legislative Assembly. And yet a few years later, the Legislative Assembly is doing what they are prohibited from doing,” attorney Zachary Wallen argued on Bjerke and Larsen’s behalf.

Petitioner’s attorney Zachary Wallen, right, jots down notes for a rebuttal during a North Dakota Supreme Court hearing dealing with a term limits ballot measure on Thursday, April 2, 2026.

Tanner Ecker / The Bismarck Tribune

The Legislature’s attorneys argued the clause prohibiting legislative proposals to alter the constitutional term limits language “infringes on our republican form of government” by “limiting the people’s ability to vote on amendments proposed by their elected officials.”

Justice Jon Jensen seemed skeptical of that argument during the April 2 hearing, questioning whether a second vote was appropriate.

“The public did speak on this. The public spoke on it when it passed the original constitutional amendment and they said, ‘Legislature, you don’t even get to propose a change.’ They have already spoken on it,” Jensen said. “You want a second shot, or a second bite at the apple, not a first one, a second.”

In Thursday’s ruling, all five justices sided with Bjerke and Larsen.

“We … conclude the Legislative Assembly’s adoption of S.C.R. 4008 violated N.D. Const. art. XV … and declare S.C.R. 4008 and Constitutional Measure 1 void … We enjoin the Secretary of State from placing Constitutional Measure 1 on the November 2026 general election ballot,” the ruling said.

Bjerke thanked the legal team that worked on behalf of their lawsuit, and said he was grateful the court reached the conclusion it did.

“I’m thrilled that what the people voted on and approved has been validated,” Bjerke said.

He added that the Legislature had “multiple opportunities” to address term limits prior to 2022’s initiated measure and chose not to, and gave a nod to the country’s coming milestone and the process by which voters expressed their support for term limits.

“We’ve lasted 250 years,” Bjerke said. “I have two words for those elected leaders who think they aren’t: everyone’s replaceable.”

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North Dakota

Fargo woman convicted in North Dakota fraud case now faces charges in Minnesota: A deeper dive

Published

17 hours ago

June 25, 2026

Press Room

Fargo woman convicted in North Dakota fraud case now faces charges in Minnesota: A deeper dive

FARGO, N.D. (Valley News Live) – A North Dakota woman who was sentenced to 180 days in jail in Cass County for defrauding healthcare providers and Medicaid programs is now facing additional fraud charges in Minnesota.

Christine Marie Pryor, 55, pleaded guilty in November 2024 to theft by deception involving more than $50,000. She was sentenced to first serve 180 days with a 3-year sentence suspended. She received credit for 44 days already served.

Pryor was ordered to pay $82,584.78 in restitution to Southeast Human Services in Fargo, where she worked between 2018 and 2019.

How the scheme unfolded

According to court documents, Pryor worked at multiple healthcare facilities in North Dakota and Minnesota between 2018 and 2023, using the identities and credentials of three licensed professionals without their knowledge. She submitted fraudulent Capella University diplomas and transcripts to gain employment.

Investigators say Pryor admitted she searched state licensing websites for therapists who shared her first name, then used those therapists’ last names and license numbers when applying for jobs.

At Southeast Human Services, where she worked as a Licensed Addiction Counselor, Pryor earned $55,584.82 while providing therapy services to approximately 150 patients. She also opened her own counseling center, NIAM Brain Injury Center, in Fargo between 2020 and 2021, and worked at The Lotus Center in Moorhead, Minnesota, from 2021 to 2023.

Court documents say the three licensed professionals whose identities were used told investigators they had no knowledge of Pryor’s actions and did not give her permission to use their information.

Two additional charges against Pryor in North Dakota, unauthorized use of personal identifying information, were dismissed on motion of the state.

Additional charges in Minnesota

Pryor is also facing charges in Minnesota. Minnesota Attorney General Keith Ellison announced on Tuesday charges against Pryor in Clay County District Court for six theft offenses and six identity theft offenses related to defrauding Minnesota’s Medicaid program of more than $150,000.

According to the Minnesota complaint, Pryor claimed to provide psychotherapy and alcohol and drug counseling services to Medicaid recipients despite having no license or credentials to do so. Prosecutors allege she used the credentials and identities of three licensed professionals while claiming to provide Medicaid-funded services to 169 clients.

The Minnesota charges were filed as part of National Health Care Fraud Takedown Day, a joint effort involving the Department of Justice and more than 40 state Medicaid Fraud Control Units.

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North Dakota

NCAA Set to Change Unpopular Football Rule Just in Time for North Dakota State’s FBS Jump

Published

1 day ago

June 24, 2026

Press Room

NCAA Set to Change Unpopular Football Rule Just in Time for North Dakota State’s FBS Jump

North Dakota State playing in the FCS playoffs and College Football Playoff in back-to-back years? It’s likelier than you think.

That’s because on Wednesday, according to a report from Ross Dellenger of Yahoo! Sports, the NCAA Division I cabinet voted to repeal a rule that effectively barred teams transitioning from FCS to FBS from playing in postseason games in their first FBS seasons. The Bison are making that move along with Sacramento State in 2026.

The reported change has been a long time coming; the rule has hampered teams from immediate bowl eligibility for decades. Its good intentions of dissuading teams from rashly making the FCS-to-FBS leap have been rendered obsolete in recent years by the fact that programs generally arrive in FBS more prepared than ever before.

Consider the number of new FBS teams that have had to work within the provision in the past decade alone

Curt Cignetti’s James Madison program was impacted by the rule preventing teams transitioning up from FCS to play in the FBS postseason. | David Yeazell-Imagn Images

That list includes: Liberty (home for the holidays at 6–6 in 2018), James Madison (8–3 in 2022 under coach Curt Cignetti, and barely able to play in a bowl at 11–1 in ’23 due to a lack of bowl-eligible teams), Jacksonville State (8–4 in ’23 before backing in like the Dukes), Missouri State (7–5 in 2025, also backed in) and Delaware (6–6 in ’25, ditto).

James Madison in particular became a cause célèbre in ’23 because it started the season 10-0, climbing as high as No. 18 in the AP Poll in mid-November. Then-Virginia attorney general Jason Miyares bandied about suing the NCAA before the Dukes lost 26–23 to Appalachian State, an event that caused the program to back off and accept a bid to play Air Force in the Armed Forces Bowl. James Madison lost that game 31–21, by which time Cignetti had left for Indiana.

There was a time when the FCS-to-FBS jump was an imposing one, and the NCAA did not want to incentivize making it lightly—not even a proud Florida A&M program could make a mid-2000s attempt at a jump stick. However, the Flames, Dukes and other teams have shown it’s not so great a climb for programs with the right resources and management.

Now the Bison and the Hornets stand to benefit.

How far can North Dakota State and Sacramento State go in the near term?

The Bison opened 12–0 last year before a shock loss to Illinois State in the FCS playoffs’ second round, so that question may answer itself. North Dakota State does not play a single Power 4 team—a potential strength-of-schedule albatross if it has designs on really surging. A potential roadblock: the fact that the Bison have to visit the Mountain West’s two favorites, UNLV (Oct. 10) and New Mexico (Oct. 24).

It’s a different story for the Hornets, a 7–5 squad a year ago whose move to the FBS is widely seen as a gamble on their growth potential. Sacramento State also does not play a major-conference team, but has a breakneck travel schedule ahead of it—the Hornets will visit Ypsilanti, Mich.; Bowling Green, Ohio; Muncie, Ind.; Mount Pleasant, Mich. and Honolulu. Combine that with a first-year coach—Oakland native and ex-MC Hammer choreographer Alonzo Carter—and it could be a long FBS debut in California’s capital.