BISMARCK, N.D. (AP) — North Dakota's 15 community health care centers could see their funding slashed and three additional ones might not be built at all if the U.S. Supreme Court overturns the federal health care law on Thursday, a state health official says.
"The Affordable Care Act has allowed us to expand and if the money goes away there will be a lot more people without care," said Stacie Fredenburg, a spokeswoman for the Community Health Care Association of the Dakotas. "If it is struck down, all money set aside for future operations and expansion might disappear."
Gov. Jack Dalrymple declined to talk about the federal law until the Supreme Court rules. House Speaker David "Skip" Drovdal said the state would try to help the centers find money if their funding evaporates, but it's unlikely the state would fund them.
North Dakota is one of many states that haven't created state-run health exchanges, an idea in the law aimed at subsidizing coverage for the uninsured and making it more affordable for small businesses to cover workers. Legislators say some planning has been done for such an exchange and might be resurrected if the law is upheld, but it wasn't clear how much support the idea would have given that majority Republicans rejected it late last year.
U.S. Census Bureau data show 83,000 North Dakotans, or about 13 percent, had no health insurance in 2010.
The community clinics are aimed at residents who may not have health insurance, or those who live in communities that can't support a private clinic and have to travel long distance for services. They are treating a growing number of North Dakotans. Fredenburg said 32,404 patients sought care at them last year, up from 25,938 just three years earlier.
"Health centers provide access to vulnerable population, such as those who are low-income or geographically isolated," Fredenburg said.
Shuttering any of the facilities would worsen the problem of lack of access to affordable care, she said.
Additional health centers in New Town, Grand Forks and Fargo are in the planning stages but may never break ground if the health care law is overturned by the Supreme Court, Fredenburg said.
"The opportunity for those to be funded is going to be low," she said.
Funding for community health centers in North Dakota and South Dakota comes solely from the federal government, Fredenburg said.
While other states provide funding, neither of the Dakotas does, she said. Funding from the states "is definitely something we'd be trying to pursue, regardless of the Supreme Court ruling."
Whatever the Supreme Court's decision, North Dakota lawmakers have much work to do addressing the state's health care needs, said Rep. George Keiser, R-Bismarck.
"Access and affordability have not gone away," he said. "Premiums are rising regardless of what happened in the past or the consequences of this law."
Legislators last year rejected a state-run health insurance exchange. Majority Republicans said approval would have been tantamount to embracing the overall law. They also said it could be too expensive and complex.
Keiser, the chairman of the Legislature's interim health care committee, said a health insurance exchange plan has been crafted and could be ready for consideration during a special session should the Supreme Court uphold the law.
"Preliminary work has been done and it could be implemented in a very short time," Keiser said. "The plan is designed by North Dakotans for North Dakotans and not by Californians for North Dakotans. That part is a positive thing."
Lawmakers may opt to delay any action until after the November elections, to see who wins the presidency and the control of Congress, Keiser said.
"We're going to have to follow the federal law if it's upheld," said Drovdal, a Republican from Arnegard. "We'll have to implement it. I don't see that we have a choice. We don't go into session until January so we have some time to react to it."
But not much time. The state would have to move quickly in order to have its own exchange; the federal government set a Nov. 16 deadline for states to submit their plans so the federal government has time to approve them by Jan. 1.
Keiser and Drovdal said parts of the law have support from many North Dakotans, including a requirement that insurers cover young adults on their parents' policies until they turn 26.
"Some of it's good," Drovdal said of the law.
State officials are aware of the potential cuts in funding to the community health centers and other programs if the law is overturned, Keiser said.
"If it's defeated in its entirety, we'll have to figure out solutions and work with all affected parties," he said.
Drovdal said the state could explore low-interest loans or help seek grants for community health centers if funding for them is threatened. But he said it was unlikely the state would help pay for them.
"The state is reluctant to come in and start paying peoples' bills," he said.
