Subscribe for 33¢ / day

Looking for ways to better support Medicaid and encourage more healthy people to buy health insurance, Sen. John Hoeven, R-N.D., this week, sought ideas from health care officials on how to improve Senate Republicans’ health care bill.

“We’ve got to do some more work on it,” he said of the bill last week, after voicing disapproval of the legislation in its current form.

Cuts to Medicaid, phasing out the Obama Administration’s expansion of the program, has raised concerns.

The Affordable Care Act, in its original form, required states to expand coverage to those making less than 138 percent of the Federal Poverty Line; that was changed by a supreme court ruling making the expansion voluntary. 

Trying to mitigate some of the sting of the rollback, the Senate bill allocates $62 billion over eight years to a state innovation fund, which can be used for coverage for high-risk patients, reinsurance and other items.

The Senate’s draft bill would phase out Obamacare’s expansion of Medicaid over seven years, with no change to coverage in the first two years, Hoeven said.

Hoeven is asking two questions: “Is it enough money? Is it enough time?”

So far Democrats and industry say it’s not.

Providers have expressed fear that, as federal financial aid decreases, North Dakota could drop expanded coverage, according to Hoeven.

“How do you deliver the same quality of care with a lot less money?” asked Shelly Peterson, president of the North Dakota Long Term Care Association, adding that the state Legislature would likely have a hard time coming up with the difference in funding.

For AARP North Dakota, concern came from the higher premiums older enrollees with more health issues would be asked to pay. Under the Republican proposal, the limit on the difference in premiums would go from a 3:1 ratio to 5:1.

Hoeven said the rationale is that it will lower the cost for younger people, encouraging more to go buy insurance.

Josh Askvig, director of North Dakota AARP, said he’s not convinced that $700 in savings to someone in their 20s would be a significant incentive and the $2,100 in increases to older residents would be too much of a burden.

Hoeven said one way he would like this addressed is through a refundable tax credit, in addition to Medicaid, allowing people to buy policies on the open market.

“I do need some ideas back from you,” he told representatives from Sanford Health, CHI St. Alexius Health, AARP and the North Dakota Long Term Care Association, as he emphasized that this initial bill is just the first step.

“This is going to be a process,” he said of the involvement of a number of pieces of legislation.

Hoeven said he sees Republicans’ use of special budget rules that only require 52 votes to pass the bill as a way to get over this first hurdle and force Democrats to come to the bargaining table.

“Somehow, we’ve got to get started,” he said.

Tim Rave, the executive director of public policy for Sanford Health, said, in some ways, he sees it as better to tackle health care legislation piece by piece because larger, more comprehensive bills are harder to get through. Others, including the North Dakota AFL-CIO, have admonished Republicans for their rush to get the bill through rather than taking the time to hold committee hearings.

Hoeven estimates that Republicans could pass something through the Senate before the August recess. It would then go to the House or conference committee.

Republicans can only afford two “no” votes from their party in the Senate to pass the bill, assuming all Democrats vote against it. Sen. Heidi Heitkamp, D-N.D., last week called the Senate bill “just as bad” as the bill the House passed in early May.

Reach Jessica Holdman at 701-250-8261 or


Business Reporter