Ulmer: Here’s hoping you stay healthy

So why did the Democrats demand that the Biden health care subsidies be included in reopening the government? Here's what moneygeek.com said after reviewing 50 states' 2026 rate filings:

"Enhanced federal subsidies are set to expire on December 31, 2025. The Congressional Budget Office estimates the number of uninsured people will increase by 3.8 million on average each year from 2026 to 2034 without a permanent extension. Unsubsidized consumers (about 2.4 million nationally, often self-employed or early retirees earning just above subsidy limits) bear the full impact of gross premium increases."

Both my loyal readers know that after working as a lobbyist for North Dakota's largest health insurer for 20 years, I consider myself somewhat of an expert on the Affordable Care Act (aka Obamacare). It was my job to track and understand the details in the act. For the record I also fully understood Truman Care, Nixon Care, Carter Care, Hillary/Dole Care along with most viable international single-payer systems.

Obamacare imposed hundreds of much-needed reforms in health insurance access and benefits. For instance, prior to these reforms insurance could refuse to enroll you based on whatever preconditions you had and even deny covering the cost of preexisting ailments. The ACA forced insurers to take everyone. In addition it required insurers to pay at least 85% of your premiums on actual care rather than pocketing it on administration costs. If companies didn't reach that threshold, they hadto refund the difference to policyholders. The act also laid out the minimum benefits that insurers had to provide, and they were much broader in the sense that approved plans had to provide many benefits than many plans didn't provide before this requirement (BTW this did raise costs).

The ACA ended up being over 2,000 pages of reforms, one of which mandated that everyone had to have health insurance. The upside of this is that it forced young people into the overall pool, which would reduce costs because health insurance costs are based on utilization and young people need less care than old people. But the Republicans didn't like the concept of mandating insurance, like Medicare and Social Security and such, because forcing citizens to buy private insurance was considered socialized medicine (BTW that's precisely what Medicare is).

In order to help afford insurance the ACA provided subsidies to folks who met the income requirements on a sliding scale. The result is that 20 million Americans now depend on these subsidies to afford health insurance.

President Joe Biden enhanced these subsidies in his Inflation Reduction Act so even more families could afford health insurance. Then part of the latest Big Beautiful Bill did away with these subsidies, and the Democrats tried hard to restore them in the latest government shutdown debacle but failed.

So the Senate finally settled the shutdown, and the Democrats settled for a promised vote on the subsidies in December.

In the meantime over 20,000 North Dakotans along with 20 million U.S. citizens have to wait to see if the Grinch once again steals Christmas.

Of course the Republicans have said they have a concept of a plan to resolve all this, but a reality check seems to indicate that there really is no such plan. I really tire of all the politics because like it or not Obamacare preserved the private health care system, and amazingly Republicans have vehemently opposed it in their efforts to stave off Medicare for all. Like it or not Obamacare/ACA has left our health system far better off than he found it.

Anyway, here's hoping you stay healthy during the upcoming political firestorm over whether we the people are still willing to share a portion of our wealth taking care of each other ... peace.