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

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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

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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.”

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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.

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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

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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.

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“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.

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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.

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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.”

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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%.

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North Dakota ranks 15th in per capita spending on health care, according to data compiled by KFF.

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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.





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North Dakota

And he’s off

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And he’s off


BRECKENRIDGE — Coaches, teammates, friends and family gathered in the south parking lot of Breckenridge High School for another state tournament sendoff.

Friends, family, teammates and coaches joined Berndt for a photo before cheering him on as he rode off in the ceremonial convertible.

Corbin Abner Lee / Wahpeton Daily News

This year, it was Troy Berndt taking the ceremonial convertible ride. He is headed to St. Michael-Albertville High School for the Minnesota Class A State Track and Field Meet on June 4-6.

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Breckenridge track - Berndt, Erlandson and the Haires
Troy Berndt, left, give his supporters one last smile before embarking on his state journey. David Erlandson, next to Berndt, accompanied him in the convertible, and will be with him at the meet on June 4. Tom Haire, driving, and Christy Haire are in the front seats.

Corbin Abner Lee / Wahpeton Daily News

He will be running in the third heat of the 400-meter prelims, scheduled for 4:52 p.m. June 4. There are seven athletes in each heat, 21 total, and nine will advance to the finals at 6:20 p.m. June 5.

The top two finishers in each heat advance, along with the next three best times. Berndt’s personal best time of 50.67 has him seeded 13th, but the 10th-, 11th- and 12th-seeded runners are less than five hundredths of a second ahead of him. The eighth- and ninth-seeded runners are also close, at 50.33 and 50.39, respectively.

Berndt dropped nearly seven-tenths of a second from his previous personal best at the Section 6A West Subsection Meet on May 21, running 51.35, and shaved another 0.68 seconds off at the Section 6A Championships on May 28 with a time of 50.67. If he keeps lowering his time, he will have a shot at reaching the podium against the best runners in Class A.

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Breckenridge track - convoy
Berndt and company taking their spot in the convoy behind Breckenridge Fire Department and Police Department vehicles.

Corbin Abner Lee / Wahpeton Daily News

Results and photos will be available online immediately following the race June 4 and in the June 10 print edition of the Wahpeton Daily News.

Corbin Abner Lee

Corbin Lee is a sports reporter for the Wahpeton Daily News and Richland County News-Monitor. Corbin can be reached by calling (701) 291-3551 or emailing corbin.lee@wahpetondailynews.com.

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Today in History, 1971: Rugby repeats as North Dakota sand greens golf champion

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Today in History, 1971: Rugby repeats as North Dakota sand greens golf champion


On this day in 1971, Rugby repeated as North Dakota’s high school sand greens golf champion behind medalist Dwight Stempson’s winning performance.

Here is the complete story as it appeared in the paper that day:

Rugby Repeats As Sand Greens Golf Champion

RUGBY, N. D. — Rugby repeated as North Dakota high school sand greens golf champion here Wednesday, posting a four-man total of 293 strokes for 18 holes.

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Led by medalist Dwight Stempson’s medalist 36-35 — 71, the Panthers were eight strokes ahead of runnerup Stanley, which had a 301. Following were Garrison 311, Beulah 315, Leeds 322, Ashley 323, Bottineau 328, Pembina 329, Tioga 332, Parshall 341 and Hettinger 342.

See more history at Newspapers.com

Stempson and teammate Bruce Carlson each had one-under par 71s, but Carlson was unable to be at the regional and wasn’t qualified for individual honors.

Rounding out the Rugby totals were Delwin Wilson 40-37 — 77 and Dennett Hutchinson 35-39 — 74. Gary Kirchoffner, 41-39 — 80, was Rugby’s fifth entrant with the best four-of-five scores counted.

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Runnerup Stanley was led by Steve Springan’s 34-38 — 72 and Joe Springan’s 36-38 — 74. Their two-man total of 146 strokes was good enough for the doubles title. Two strokes back with a 148 was the duo of Stempson and Wilson. Stan Saathoff and Mike Stepina of Garrison each had 76s for a 152 total and the Ashley combo of Steve Maier (76) and Dave Kretschmar (78) was fourth with a 154.

Stempson was the driving contest winner with a distance of 280 yards. Chris Knutson of Garrison headed the pitch and putt competition.

Ads featured in The Forum on June 3, 1971. Newspapers.com

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Kate Almquist

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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10 Small Towns In North Dakota Were Ranked Among US Favorites

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10 Small Towns In North Dakota Were Ranked Among US Favorites


Walhalla keeps the oldest buildings in North Dakota, fur-trade posts from the 1840s still standing near the Canadian line. Medora sits out in the Badlands, where a French aristocrat tried to build a beef empire in 1883. Garrison fishes one of the largest reservoirs in the country, and Jud has turned nearly every wall in town into a mural. The frontier era left marks across North Dakota that most of the Plains has paved over, and these ten towns still carry them. Each one holds a specific piece of the state’s history and geography.

Garrison

Downtown street in Garrison, North Dakota. Image credit: Andrew Filer, CC BY-SA 2.0 via Wikimedia Commons.

Garrison sits on the north shore of Lake Sakakawea, the reservoir the Garrison Dam holds back on the Missouri River and one of the largest reservoirs in the country. Anglers come year-round for walleye, northern pike, and chinook salmon, and the lake also draws boaters, campers, and shoreline hikers. In town, the open-air Heritage Park Museum preserves a one-room schoolhouse, a railroad depot, a country church, and a homesteader cabin from the turn of the last century. Fort Stevenson State Park, three miles southwest, marks the site of an 1860s military post with an interpretive guardhouse, a marina, a campground, and lakeside trails. Garrison leans into its self-declared title as the Walleye Capital of North Dakota with Wally the Walleye, a 26-foot fiberglass fish on Main Street.

Mayville

Mayville State University in Mayville, North Dakota
Mayville State University. Image credit: Tammy Chesney via Shutterstock.

Mayville State University anchors this Red River Valley town in Traill County. The public four-year college opened in 1889 as one of the six original state normal schools authorized at North Dakota statehood, and its calendar still drives the town through Comet athletics, theater productions, and the annual Festival of Trees. Island Park, set along the Goose River where it runs through downtown, holds the town’s main recreation space with picnic areas, playgrounds, and a community pool. The volunteer-tended Rainbow Garden along the riverbank mixes themed plantings with folk-art sculptures. The Mayville Water Park runs its pool and slides from Memorial Day through Labor Day.

Lisbon

Downtown streets of Lisbon, North Dakota
Downtown Lisbon, North Dakota. Image credit: Andrew Filer, CC BY-SA 2.0 via Wikimedia Commons.

Lisbon grew up along the Sheyenne River in Ransom County as a Northern Pacific Railroad town, and its 1889 Opera House, now restored and on the National Register, still hosts theater and music. Brick storefronts from the same era line Main Street. Just south of town, the Sheyenne National Grassland protects 70,000 acres of tallgrass prairie, the largest publicly owned tallgrass prairie in the country, with trails open to hikers, riders, and limited hunting. Prairiewood Vineyard, about six miles out, grows cold-climate grapes and pours tastings on weekends.

Fort Ransom

Fort Ransom Wildlife Management Area in North Dakota
Fort Ransom Wildlife Management Area. Image credit: Danita Delimont via Shutterstock.

Fewer than 100 people live in Fort Ransom year-round, deep in the wooded Sheyenne River Valley. Fort Ransom State Park preserves the site of an 1867 Army outpost built to guard settlers and the wagon route toward the Black Hills, and it now offers camping, paddling on the Sheyenne, and cross-country skiing. The park’s Sodbuster Days each September run horse-powered farming, threshing, and traditional-craft demonstrations, and the Sheyenne Valley Arts and Crafts Festival fills it over the Fourth of July weekend. The town anchors the Sheyenne River Valley Scenic Byway, a 63-mile route through some of the most varied terrain in the state.

Devils Lake

High water at Devils Lake, North Dakota
High water at Devils Lake, North Dakota.

Devils Lake takes its name from the Dakota “Mni Wak’áŋ,” or Spirit Water, and sits beside the largest natural lake in North Dakota. Between 1993 and 2011, floodwaters more than doubled the lake, swelling it from roughly 70 square miles to over 200 and swallowing roads, farms, and woodland as it rose. Today it holds one of the most productive perch and walleye fisheries in the Upper Midwest. Graham’s Island State Park, on the western shore, is the main access point, with cabins, a campground, a swimming beach, and boat ramps. Fort Totten State Historic Site nearby preserves an 1867 military post with sixteen original buildings restored to tell its story through 1890.

Medora

Sunrise over Theodore Roosevelt National Park
Sunrise over Theodore Roosevelt National Park. Image credit: Zak Zeinert via Adobe Stock.

Medora is the gateway to the south unit of Theodore Roosevelt National Park, set in the Badlands of western North Dakota. The Marquis de Mores, a French aristocrat, founded the town in 1883 and named it for his American wife, Medora von Hoffman; his Chateau de Mores hunting lodge still stands as a state historic site with the family’s original furnishings. The Maltese Cross Cabin, near the park visitor center, is the cabin Theodore Roosevelt used during his 1880s ranching years, the period that shaped his later conservation work. Each summer the Burning Hills Amphitheatre stages the Medora Musical, a Western-themed show running since 1965 in a natural bluff theater over the Badlands. The North Dakota Cowboy Hall of Fame keeps permanent exhibits on ranching, rodeo, and Indigenous horse culture.

Walhalla

Downtown streets of Walhalla, North Dakota
Downtown Walhalla, North Dakota. Image credit: In memoriam afiler, CC BY-SA 2.0, via Wikimedia Commons.

Walhalla, founded in 1845 on the banks of the Pembina River, is among the oldest towns in North Dakota. The Kittson Trading Post, built by American Fur Company agent Norman Kittson, stands at the Walhalla State Historic Site and is often called the oldest building in the state; the nearby Gingras Trading Post, the 1840s home and store of Métis trader Antoine Blanc Gingras, holds an equal or older claim. Pembina Gorge State Recreation Area cuts the deepest canyon in North Dakota, carved by the Pembina River, with trails for hiking, biking, and ATVs. Frost Fire Mountain runs downhill skiing and snowboarding in winter and an outdoor theater season in summer.

Valley City

Bridge over the Sheyenne River in Valley City, North Dakota
Sheyenne River in Valley City, North Dakota, the City of Bridges.

Valley City earns its nickname, the City of Bridges, from the eleven bridges that cross the Sheyenne River and its tributaries within the city limits. The Hi-Line Railroad Bridge, finished in 1908 and listed on the National Register, runs 3,860 feet across the valley and stands 162 feet above the water, one of the longest single-track railroad bridges in the country. The town sits at the eastern end of the 63-mile Sheyenne River Valley Scenic Byway, and Valley City State University, founded in 1890, keeps the local calendar busy with Vikings athletics and the annual Hi-Liner Days festival.

Jud

Jud, North Dakota, post office building
Jud, North Dakota, post office building. Image credit: Andrew Filer, CC BY-SA 2.0 via Wikimedia Commons.

Jud holds fewer than 100 residents in LaMoure County and is named for Judson LaMoure, an early state legislator. Since the early 2000s, residents and visiting artists have painted murals across nearly every building in town, including the post office, the grain elevator, the fire hall, and several houses, turning the place into a walkable open-air gallery of prairie wildlife, rural scenes, and abstract patterns. The annual Jud Art Festival each summer brings in regional artists and live music. Most travelers come for the murals and the sight of an entire town organized around one creative project.

Bottineau

Tommy Turtle statue in Bottineau, North Dakota
Tommy Turtle, symbol of Bottineau, North Dakota. Image credit: Bobak Ha’Eri, CC BY 3.0 via Wikimedia Commons.

Bottineau sits a little over ten miles south of the Canadian border as the gateway to the Turtle Mountains. Its mascot, the 30-foot fiberglass Tommy the Turtle, went up in 1978 riding a 34-foot snowmobile and is billed as the world’s tallest turtle statue. Pride Dairy on Main Street is the last small-town creamery still operating in North Dakota, known for its Juneberry ice cream. Lake Metigoshe State Park, about fifteen miles north, offers boating, kayaking, fishing, and winter ice fishing. Bottineau Winter Park, the largest ski area in the state, runs ten runs across 200 vertical feet plus a tubing hill, and Dakota College at Bottineau, established in 1906, anchors the campus side of town.

Where The Frontier Still Shows

What these ten towns share is how much of the frontier they kept. The Missouri River and Lake Sakakawea shaped Garrison. The Sheyenne River Valley runs through Fort Ransom, Lisbon, and Valley City. The Pembina Gorge holds Walhalla on the Canadian border, the Badlands hold Medora, and the Turtle Mountains rise behind Bottineau. Each one still keeps its 19th-century buildings and the kind of small-town institutions that have closed almost everywhere else.

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