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Sen. Heidi Heitkamp, D-N.D., left, addressed a crowd of about 120 during a rally for the Affordable Care Act organized by the North Dakota AFL-CIO at Custer Park in Bismarck in July. A handful of pro-President Trump supporters verbally clashed with rally goers causing a few brief contentious moments. "We need to backup and have a reasonable discussion," Heitkamp said.

Medica plans to leave North Dakota's health insurance exchange in 2018.

In North Dakota, 3,073 people bought Medica on the Affordable Care Act, also known as Obamacare, health care exchange.

Citing uncertainty over congressional action on ACA cost-sharing reductions, which are payments made by the federal government to insurance companies to help low-income customers with out-of-pocket costs, Medica decided not to sign an agreement to offer individual health insurance through the North Dakota exchange next year, said North Dakota Insurance Commissioner Jon Godfread. Customers who have Medica health insurance plans through their employers, buy it on their own or who purchase Medicare supplemental coverage from Medica will still be able to get coverage.

Correction: An earlier version of this story incorrectly stated where policy holders affected by Medica's exiting the health care exchange lived. The 90 percent figure should have referred to percentage of Bismarck-Mandan customers who have Medicare supplemental coverage.

Medica provides health insurance to a small number, just under 15 percent, of the 20,691 people who buy coverage on North Dakota's exchange. Blue Cross and Blue Shield of North Dakota is the largest provider and will still have plans available, along with Sanford Health Plan.

The company originally filed rates in North Dakota assuming federal funding for cost-sharing reductions would be available, but later requested North Dakota Insurance Department approval of higher rates for 2018 under the assumption those would not be paid. The department declined to approve the rate increase saying, if Congress does fund the payments, it may not be possible to then reduce the rates and recover the cost to consumers.

"With this in mind, the department felt it was our responsibility to err on the side of caution and protect North Dakota consumers from any unnecessary increases," Godfread said in a statement.

The company said it remains hopeful it could be available on North Dakota's exchange next year, according to the Associated Press.

Reach Jessica Holdman at 701-250-8261 or jessica.holdman@bismarcktribune.com

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