What Happens to Medicaid Expansion if Stenehjem’s Lawsuit is Successful?

If Attorney General Wayne Stenehjem and Insurance Commissioner Jon Godfread are successful in their lawsuit against the Affordable Care Act, what does it mean for North Dakota’s Medicaid Expansion? It seems that unless an act of Congress were to follow, the program would be eliminated and nearly 20,000 North Dakotans would lose their insurance. Where are the voices of those tasked with defending the program?

In 2013, North Dakota unexpectedly expanded Medicaid as a provision of the ACA. Republican Governor Jack Dalrymple included the program in his executive budget submitted to the Legislature. House Majority Leader Al Carlson stripped it from the budget and made the provision stand on its own. His intent was to defeat Medicaid Expansion. He failed. After a full court press from lobbyists, advocates, and experts it passed both chambers in a bipartisan fashion.

Approximately 21,000 North Dakotans received insurance. Hospitals received the payments needed to maintain their bottom line and stay open in rural parts of the state. The program has been a success for North Dakota. That is all threatened.

Medicaid Expansion was passed but with stipulations. One, it must be conducted through a private insurance company. Sanford took it on, but this method greatly increased the program’s costs. Second and perhaps more importantly, the insurance “may be reduced or eliminated if federal participation is reduced or eliminated.” Elimination of the program is one of the aims of the Stenehjem lawsuit.

The hope would be that Congress would continue the program and the appropriation of Medicaid Expansion in the event that Stenehjem is successful. That seems unlikely given the current makeup of Congress. In North Dakota, we have seen where candidates land on health care. Congressman Kevin Cramer has voted approximately 60 times to repeal the law, ending Medicaid Expansion. Senator Heidi Heitkamp has defended the program. Congressional candidates Mac Schneider and Kelly Armstrong have differing views of the program as well. Schneider joined the bipartisan push in the State Senate to pass Medicaid Expansion. Kelly Armstrong voted against the program.

As the lawsuit progresses along with the midterm election, I wonder where those who successfully pushed the program in 2013 are? Why is the Long Term Care Association silent when it comes to protecting nursing homes? Where is the Hospital Association to defend their member’s bottom line and keep these rural hospitals open? Where is Sanford and Blue Cross Blue Shield? Where is AARP? Where is the North Dakota Chamber of Commerce? Ironically, Jon Godfread was with the Chamber in 2013. I guess he was for Medicaid Expansion before he was against it.

Silence in this matter is unacceptable. Unfortunately, some of the associations and the individuals who run them show a pattern of shying away when tough discussions present themselves. Perhaps this is the culture of intimidation I wrote about when I created this page. Nothing is more frustrating in politics than when people tasked to stand for something fail to show up. Hopefully, they’ll find their voice soon to demonstrate the importance and success of programs like Medicaid Expansion.

Tyler Axness
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