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Published November 22 2012

Forum editorial: ND should help steer reform

It’s an understatement to say that leaders in the Capitol in Bismarck are not fans of what’s commonly called Obamacare. The Republican supermajority in the Legislature gave a super thumbs down to the idea of North Dakota launching its own state-created health insurance exchange, an online marketplace to allow consumers to comparison shop for their coverage.

We understand state officials’ distaste, including significant uncertainties involving cost and implementation – we believe the Affordable Care Act brings too much governmental intrusion into health care. We worry that it will fail to restrain unsustainable costs, and could in fact exacerbate them. But health reform is now the law of the land, having been upheld by the U.S. Supreme Court. It was given a path to full implementation when President Barack Obama won re-election and the Democrats kept a majority in the U.S. Senate, meaning repeal will not happen, as Republicans had hoped.

So, like it or not, states must plan for Obamacare. The big decisions facing states are two-fold: How to go about handling the health insurance exchanges, and whether to expand coverage under Medicaid to people with incomes up to 133 percent of poverty levels ($14,893 for individuals, $30,657 for a family of four).

Minnesota under Gov. Mark Dayton decided to create its own exchange and is moving ahead to do so. Having rejected that option, North Dakota Gov. Jack Dalrymple and legislators have two basic alternatives. One is to sit back and allow the federal government to create an exchange to hand the state. The other is to create an exchange in partnership with Washington.

In other words, the choice is to have no say in the way an exchange would work, or to have some say. Given North Dakota’s disdain for “one size fits all” solutions imposed from Washington, it’s a logical choice to opt for the partnership track to make the best of a bad situation.

That reality seems to be registering with leaders, including Dalrymple and Rep. Al Carlson, R-Fargo, the House majority leader. Both of them have said health reform now will move ahead, and the state must rethink its options. The governor has said he is open to considering a “partnership deal,” which would allow some state management of the system, including eventual state administration of an exchange, targeted to start in 2014.

States now have until Feb. 15 to choose that option. Opting for partnership would allow state officials to decide which insurance plans qualify, and allow legislators and officials to plan to take over the exchange in 2015. It’s clearly the best way for the state to retain some influence in shaping how health reform will be run in North Dakota.

Forum editorials represent the opinion of Forum management and the newspaper’s Editorial Board.