Congresswoman Julie Fedorchak of North Dakota has published an opinion piece in the Bismarck Tribune, criticizing the Affordable Care Act (ACA) and recent efforts to extend enhanced premium tax credits. In her op-ed, Fedorchak argues that the ACA has failed to deliver on its promises, stating: “Our health care system is broken, and North Dakotans know it.”
She contends that assurances made during the ACA’s rollout—such as being able to keep existing health plans and reducing costs for families—have not been realized. “Fifteen years later, none of that matches what North Dakotans have lived. Instead, we pay higher premiums and have fewer choices,” she wrote.
The congresswoman addresses ongoing discussions in Congress about the Enhanced Premium Tax Credits, which are set to expire on January 1, 2026. She clarifies that while original ACA subsidies will remain for qualifying individuals—including most of the 42,000 North Dakotans who used the exchange last year—the debate centers on temporary additional subsidies introduced during COVID-19. These expanded benefits were designed to increase eligibility and generosity but are scheduled to end unless Congress acts.
Fedorchak criticizes proposals to make these enhanced subsidies permanent due to their projected $350 billion cost over ten years. She claims that despite this investment, insurance premiums have risen by 31 percent nationally since 2021. “These payments don’t show up in your wallet... This money goes directly to insurance companies, with no requirement that it’s used to reduce prices or improve care,” she added.
The congresswoman also highlights concerns about fraud within the program, alleging a significant number of "phantom enrollees" who exist only on paper but generate payments for insurers.
As alternatives, Fedorchak points to Republican-backed reforms aimed at reducing costs and increasing transparency. She references measures included in the Working Families Tax Cut plan—which passed the House but were removed from final Senate legislation—that would have reduced ACA premiums by nearly 13 percent and saved taxpayers more than $130 billion over ten years according to Congressional Budget Office estimates.
She advocates for directing tax credits straight to individuals rather than insurance companies and strengthening direct-to-patient financial tools like Health Savings Accounts. Additionally, she calls for bipartisan reforms such as price transparency laws; comprehensive pharmacy benefit manager (PBM) reform; patent changes intended to boost generic drug availability; improvements in the federal 340B drug discount program; and updates regarding prior authorization requirements.
Fedorchak concludes: “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.”
