North Dakota House Advances ACA-Compliant State Employee Health Plan

North Dakota's House of Representatives approved Senate Bill 2160, which aims to transition the state's health insurance plan to one compliant with the federal Affordable Care Act (ACA). The change is intended to provide the state with more flexibility in designing insurance plans and potentially save money amidst rising healthcare costs, without additional expenses to employees. The bill reflects a shift from the current state plan, which does not allow for employee health insurance premiums, to an ACA-compliant framework that could introduce such options.

Supporters highlight benefits such as increased coverage for preventive care services, including colonoscopy screenings and mammograms, and counting co-pays toward out-of-pocket maximums. These enhancements are expected to help reduce long-term costs by enabling earlier intervention for health issues. Advocates also note that the private sector has largely adopted ACA-compliant plans due to their flexibility.

Critics of the bill express concern that its passage might lead to the imposition of premiums on state employees, which is currently prohibited, potentially impacting employee compensation and recruitment. Additionally, some state agencies, including the Office of Management and Budget, have voiced apprehensions about the plan's costs and effects on the state's ability to attract and retain workers.

Legislators are divided, with some urging caution and requesting comprehensive data on costs and stakeholder support before fully committing to the change. Proponents argue that any savings realized could be redirected toward employee wage increases, enhancing recruitment and retention in state employment.

The matter will next be considered by the North Dakota Senate for further approval. The bill's fiscal impact is projected at $6.6 million for the 2025-2027 budget period and over $25 million for 2027-2029, underscoring the need for careful financial planning.

This legislative development reflects broader trends in state employee health insurance, where regulatory compliance with federal standards and cost management remain central concerns for policymakers aiming to balance fiscal responsibility with workforce benefits.