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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.

North Dakota’s senators attended separate public events on health care reform in Bismarck yesterday as legislation repealing major parts of the Affordable Care Act awaited them back in the nation’s capital.

Hours after Republican Sen. John Hoeven met with hospital executives, the AARP and long-term care providers, Democratic Sen. Heidi Heitkamp participated in a rally against Republican health care legislation across town. The events came as senators across the country returned to their home states for the holiday recess during a national debate on health care reform.

Heitkamp railed against Republican health care legislation that she said presents an “immoral choice” by giving tax breaks to the wealthy while leaving millions more uninsured.

“This is about the future and the morality of our country,” she said at a rally organized by the North Dakota AFL-CIO and the local Indivisible group.

Members of the crowd got testy at times when a handful of supporters of President Donald Trump arrived, with one chanting, “Repeal and replace.” But they were outnumbered by the attendees who opposed the legislation, including one man holding a sign that played on the president’s campaign slogan: “Don’t make America sick again.”

The crowd cheered when reminded that Hoeven doesn’t support his party’s bill in its current form. He announced his position shortly after Senate Majority Leader Mitch McConnell, R-Ky., said a vote would be delayed until after the July 4 break.

On Thursday, Hoeven sought input from stakeholders on how to improve the legislation. The discussions covered a wide range of topics, including Medicaid funding. The Better Care Reconciliation Act would reduce Medicaid spending, prompting concerns from North Dakota medical groups.

“We need to reform our health care system,” Hoeven told a gathering at the North Dakota Long Term Care Association’s office. “And we have to kind of get people to take a deep breath and say, ‘This is a process.’”

Waylon Hedegaard, president of the North Dakota AFL-CIO, told Hoeven the Affordable Care Act, commonly known as Obamacare, isn’t perfect but Congress is moving too quickly.

“If this takes three years to do, then let’s do it right,” he said. “This thing should be brought back and started over with the ideas from all sides that are going to work.”

Hoeven emphasized that a Senate vote, which could come by August, is only one step toward reforming the nation’s health care system. He said lawmakers need to address the ACA’s shortcomings, like rising premiums.

Hoeven’s spokeswoman, Kami Capener, said both Blue Cross Blue Shield of North Dakota and Sanford Health Plan have indicated they will propose premium increases for 2018.

In a statement, Blue Cross spokeswoman Andrea Dinneen said they’re “expecting premium increases in 2018” to account for an ACA provider fee and an increase in claims, but said specific rates aren’t available due to the regulatory review process. Kirk Zimmer, executive vice president of Sanford Health Plan, said they couldn’t provide details on next year’s premium rates because they’re pending state approval.

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Hoeven’s appearances, announced Wednesday, were smaller and much more subdued than some of the raucous town hall events elsewhere over health care legislation. One man came to the Long Term Care Association meeting with a sign that said, “Health care is a right, doncha know,” and rally attendees later in the day chanted: “Where is Hoeven?”

During a radio appearance Monday, Hoeven took questions from callers about the contentious legislation, including one who asked whether he planned to have any face-to-face town halls with constituents. The second-term senator and former North Dakota governor said he’s been meeting with health care groups and individuals along with participating in media interviews, and Kapener said he planned to do another radio town hall.

“I’ve been getting a lot of input, talking to a lot of people, meeting with people when they ask to meet,” Hoeven said. “North Dakota’s not a big state. When people want to meet to talk about this issue or other issues, I meet with them and talk to them.”

Senate Democrats have been unified in opposition to the bill, leaving Republican leadership little room for disagreement in their own ranks to get to 50 votes. That was made more difficult by a Congressional Budget Office analysis released last week that said the Senate bill would increase the number of uninsured by 22 million by 2026 while reducing the federal deficit by $321 billion.

Leaders of two North Dakota medical groups, the North Dakota Hospital Association and North Dakota Medical Association, urged Heitkamp and Hoeven to vote against the Senate bill in an op-ed to the Bismarck Tribune Wednesday. They pointed to reduced federal support for Medicaid, which was expanded in North Dakota under the ACA.

“Who supports this bill?” Heitkamp said. “What we need to do is we need to start over.”

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