North Dakota Commissioner Warns of Healthcare Premium Hikes as Shutdown Threatens ACA Tax Credits
The current impasse in Congress centers on a continuing resolution to fund the government. Democrats have insisted that any such resolution must include an extension of the ACA premium tax credits and a rollback of recent cuts to Medicaid enacted through the “One Big Lovely Bill Act.” Republicans, including North Dakota’s congressional delegation, are resisting these demands, arguing that the ACA requires comprehensive reform and that using the tax credits as leverage is a political tactic.
“We’re willing to work on it,but it needs reform,and we can’t work on it unless we have the government back open,” Senator John Hoeven (R-N.D.) stated on Tuesday. “The actual tax credit doesn’t expire until the end of the year…let’s fund the government with a clean CR and get back to work on it.”
Godfread, who also serves as president of the National Association of Insurance Commissioners, warned that delaying action until the end of the year is not a viable option. He fears that prospective enrollees will be deterred by unexpectedly high premiums during the open enrollment period, which begins in November.
“I’d argue that we can’t wait ’til the end of the year to continue the enhanced premium tax credits because individuals will start shopping right away in November and December, and if they go in and shop and they see a massive sticker shock, the chances of them coming back and reshopping or reapplying after Congress takes action…I worry about those individuals who may not take another bite at the apple,” godfread explained.
Nationally, the Kaiser Family Foundation (KFF), a nonpartisan health policy research institution, estimates that ACA premiums woudl double on average – rising from $888 to $1,904 – if the tax credits are allowed to lapse.
godfread acknowledged the need for potential reforms to the ACA marketplace and the tax credits themselves, but stressed that the immediate priority should be preventing disruption to current coverage. He expressed frustration that the issue has become entangled in the broader government shutdown debate.
“Extending the credits should not be a political question,” Godfread asserted. he noted that insurance commissioners across the country, nonetheless of political affiliation, overwhelmingly support extending the tax credits.
North Dakota has historically maintained a relatively low uninsured rate,around 10-11%. However,this progress could be reversed if premiums spike. Approximately 3,000 additional North Dakotans utilized the ACA Health Insurance Marketplace and received tax credits between 2023 and 2024, a trend Godfread fears will be curtailed by increased costs.
The commissioner highlighted the financial vulnerability of many North Dakotans, especially those in agriculture and small business.”If you’re a small business owner, if you’re a farmer, if you’re a rancher, you can rack up some pretty significant medical bills pretty quickly,” he said. “That could mean your business. That could mean your farm.”
Hoeven suggested that any extension of the tax credits should be targeted towards lower-income individuals, rather than those earning up to 600% of the poverty level.
Beyond the immediate crisis surrounding the tax credits, Godfread emphasized the unsustainable trajectory of rising healthcare costs. He believes that state-level reforms are needed to address these underlying costs and ensure long-term affordability. He hopes the state legislature will take up this issue during its 2027 session.
“We’re on a trajectory that is not sustainable,” Godfread concluded.”We’ve got to put in some reforms on our side to be able to at least put some guardrails around the cost of receiving health care in this state, which will hopefully then bring down the cost of insurance.”
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