Insurance Commissioner Jon Godfread has an urgent message for North Dakotans: if they’re still looking for health insurance in the government marketplace, they need to work with an agent — or they could be missing out on savings.

“December 15 is the final day for that (Affordable Care Act) open enrollment,” Godfread said this week. “And so it’s really critical that for the individuals who don’t receive a subsidy, that they’re shopping with an agent, because you can get a lower price off the exchange.”

Godfread raised the issue — just days before the marketplace deadline — in a Thursday meeting with the Herald editorial board, where he spoke at length about North Dakota’s health care economy. His advice comes both as average North Dakotans’ pocketbooks are pinched by the COVID-19 pandemic — which has roiled the global economy — and as state leaders weigh a years-long trend in rising healthcare costs.

The insurance commissioner referred back to a study delivered to state lawmakers in September that showed the state’s per-capita hospital costs were the country’s highest in 2017. What’s more, hospital operating expenses grew nearly 8% year-over-year between 2010 and 2018 — nearly 3.5 points above the nationwide average.

Related: North Dakota hospitals rank high in costs, salaries and utilization, study finds

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“This whole study, to me, is a little bit of a canary in a coal mine,” Godfread said. “If hospitals’ cost trends continue where they are, health insurance is going to continue to get more unaffordable. If I’m insuring health care delivery, and that keeps going up, my insurance is going to keep going up.”

The study questioned whether the state had the right set of market incentives in place to ensure lower prices and good patient outcomes. When it was published, the state’s hospital leaders questioned whether the study offered the full picture.

“There really weren’t any sort of answers,” Tim Blasl, state hospital association chief, told Forum News Service in September, adding that hospital leaders can’t do much to control patient demand. “No reasons on why the numbers are what they are. That was my disappointment with the report.”

On Thursday, Godfread touted the study as an unprecedented look into the state’s health care economy. Though he didn’t raise policy solutions, he raised that possibility for the Legislature.

“I’m not a hospital expert, I don’t pretend to be, I don’t regulate hospitals, I regulate the insurance companies,” Godfread said. “But at least this should be, again, hopefully opening up some discussions within our Legislature on how we manage this going forward. And are there policy decisions that need to be made to help account for some of this?”

Policy solutions, Godfread said, are important to everyday North Dakotans’ bottom lines.

“We’re already kind of off the charts in a lot of areas,” Godfread said. “Our insurers, we’re not going to be able to pay for this continuing, going forward. The rates that are going to be needed from the insurance side, to maintain that level of growth, people aren’t going to be able to afford health insurance.”