BISMARCK, N.D. (AP) — North Dakota's House Republican majority leader says the Legislature may revisit whether the state should take part in running a new health insurance marketplace that is a key part of the new federal health care law.
Lawmakers rebuffed a proposal for a state-run "health exchange" a year ago, when many Republicans hoped the U.S. Supreme Court would throw out the law — or that this year's elections would lend momentum to efforts to repeal it.
Neither happened, and lawmakers may have to rethink their next moves, said Rep. Al Carlson, R-Fargo, the majority leader.
"I don't think there's any question we have to analyze what our options are," Carlson said. "Now, I don't see any hope of (the federal health care law) being changed in Congress."
States must notify the federal government by Friday whether they intend to run their own insurance exchanges. Gov. Jack Dalrymple said the state planned to inform the Department of Health and Human Services that "we're not planning on moving forward."
"We might continue to look at ... other possibilities, such as a partnership deal," the governor said. "I think it's fair to say the law will not be repealed, and I think it's fair to say the implementation of it is going to go forward."
The exchanges are meant to make it simpler for customers to shop for health insurance by offering standard packages of benefits. Buyers may also be eligible for federal subsidies to reduce the cost of getting coverage.
The health care law gives states the option of administering their own exchanges or ceding the task to the federal government. North Dakota lawmakers, during a special session last year, opted to let the federal government do the job, in part because they were skeptical of how much autonomy state administration would provide.
Carlson said that stance could be reconsidered. One option, he said, would be to explore what the federal Department of Health and Human Services calls a "state partnership exchange," which would allow some state management of the system.
"If we're forced to have something, I would think we would look at state exchange (administration), instead of the federal side," he said.
Dalrymple said the partnership option could be acceptable, but he wants more information about how it would work. Kathleen Sebelius, secretary of the federal Department of Health and Human Services, said in a letter to governors last week that states have until Feb. 15 to choose that option.
Sen. Tim Mathern, D-Fargo, an advocate of the federal health care law, said the GOP-controlled Legislature "gave away all of its options" in an unsuccessful gamble that the law would be overhauled or junked.
"They were kind of dealing with this as a political matter more than a public policy matter," Mathern said. "They now are in this dilemma, because the things they thought would happen have not happened."
Mathern contends a federally administered health exchange would probably provide the greatest benefit to North Dakotans. However, setting up a regional operation that would include Minnesota, North Dakota and South Dakota is the best long-term strategy because the states are neighbors and the size of the territory would be manageable, he says.
"There are a lot of overhead costs here, many millions of dollars," he said. "Doing it together would save money and make the most sense."
Sixteen states have agreed to set up state-run health insurance marketplaces, while 14 have declined, according to the Henry J. Kaiser Family Foundation, which monitors health care issues nationally. None of the states so far has adopted a regional approach.
The health care law also offers states incentives to expand Medicaid, a state and federal program that provides insurance for poor North Dakotans, to cover anyone younger than 65 who has income less than 138 percent of the federal poverty level. This year, that equals $15,415 for a single person and $31,809 for a family of four.
Dalrymple said the potential state budget effects of a Medicaid expansion are still being analyzed. He expects to ask lawmakers for authority to spend federal money that would finance the expansion, but he wants to avoid a large new state spending obligation, Dalrymple said.
"If the circumstances are right, we wouldn't stand in the way of our people getting more Medicaid benefits in North Dakota," Dalrymple said. "But we have to get comfortable with the idea that this is not just a fool's trap here."
North Dakota now has about 65,000 Medicaid recipients each month. The state's Department of Human Services estimates that the proposed expansion would add another 30,000 people to the Medicaid rolls.
Mathern said the federal government would foot most of the bill for expanding Medicaid benefits to uninsured adults. In other circumstances, the Legislature has been willing to take advantage of federal support, such as providing enough state money to grab the maximum amount of federal aid available for road construction and repairs, he said.
"Up until now, we haven't been willing to do anything," he said. "But there are so many resources available to us if we cooperate that, morally, we can't let that go."