WASHINGTON, D.C. – The following op-ed by Congresswoman Julie Fedorchak (ND-AL) appeared in the Bismarck Tribune this week. “Our health care system is broken, and North Dakotans know it. “The law that was supposed to make things better—the Affordable Care Act (ACA)—has not lived up to its name. “‘If you like your plan, you can keep it,’ leaders assured us. “‘A typical family will save up to $2,500 a year,’ they promised. “‘The ACA will help bring down health care costs and even reduce the deficit,’ they claimed. “Fifteen years later, none of that matches what North Dakotans have lived. Instead, we pay higher premiums and have fewer choices. And Washington is trying to hide the true costs with more and more subsidies instead of fixing the underlying problem. “The latest debate in Congress is over something called the Enhanced Premium Tax Credits. You’ve probably heard about these temporary credits and how they’re set to expire on January 1, 2026. Here’s what you’re not hearing: “First, the original Affordable Care Act subsidies do not expire. That support remains in law for everyone who qualifies, including the majority of the 42,000 North Dakotans who used the exchange last year. “What’s being debated now are the temporary extra subsidies Democrats added during COVID to make the credits more generous and expand eligibility to people earning beyond 400 percent of the federal poverty level. In North Dakota, that means a family of four earning over $125,000 a year. “From the beginning, Democrats wrote these enhanced subsidies to expire. Now, many of those same lawmakers are exasperated by the expiration date they set themselves! “Second, making these temporary subsidies permanent is enormously expensive : $350 billion over the next 10 years. And despite that massive taxpayer investment, experience proves just one thing: Americans will continue to pay more—a lot more—for health care. “Since the enhanced credits were enacted in 2021, insurance companies have raised premiums by 31 percent nationally. “Third, these payments don’t show up in your wallet to buy down the cost of your healthcare. This money goes directly to insurance companies, with no requirement that it’s used to reduce prices or improve care. “Lastly, massive fraud plagues this program. ‘Phantom Enrollees’—people enrolled on paper but who have zero claims—now make up roughly 35 percent of marketplace enrollees. National insurance companies get paid for millions of nonexistent ‘phantom’ patients, while North Dakota farm families and small business owners continue to pay rising premiums. This makes no sense. “Some in Washington celebrate all this and call it ‘affordable.’ North Dakotans know better. Pouring more taxpayer money into a program every year to make it look affordable, isn’t affordable at all. “Clearly, we need an off ramp from these massive payouts to insurance companies. They aren’t working. So, what are the alternatives? “Republicans have been working for years on reforms to drive down costs, increase transparency, and put patients back in charge. In fact, we passed several improvements in the Working Families Tax Cut plan (One Big Beautiful Bill) earlier this year. According to the nonpartisan Congressional Budget Office (CBO), our House-passed reforms to crack down on fraud and support cost sharing reductions would have reduced ACA premiums by nearly 13 percent and saved taxpayers more than $130 billion over 10 years. Sadly, Democrats stripped these out of the final bill in the Senate. These reforms are a good starting point. “Importantly, we should direct tax credits to individuals, not insurance companies, and strengthen direct-to-patient tools like Health Savings Accounts and flexible spending accounts. Let’s put families back in the driver seat of their own care and encourage healthier decisions. “And while we work toward these fundamental changes, we have other bipartisan reforms ready to go: Price transparency legislation—including the Lower Prices, More Transparency Act—which passed the House last year to give patients clear information to compare costs and quality. Comprehensive PBM reform to end practices that drive up drug prices. Patent reform to increase the number of lower-cost generic medications available to patients. 340B reform to direct discounts to patients and strengthen the rural hospitals the program was designed to support. Prior authorization reform to stop unnecessary delays that prevent patients from getting timely care. “North Dakotans, and Americans everywhere, are fed up with our health care system. It’s time for all stakeholders in the system, and leaders in Washington, to move beyond the superficial talking points to real reforms that make health care affordable.” ###