Doug Burgum, the Republican candidate for North Dakota governor, said Tuesday he may be open to reauthorizing the state's Medicaid expansion, a key provision of the Affordable Care Act.

The North Dakota Legislature passed a Medicaid expansion bill in 2013. The program is available to people between the ages of 19 and 65 years old with household incomes up to 138 percent of the federal poverty level, according to the North Dakota Department of Human Services.

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But the section of the law creating the Medicaid expansion program expires Aug. 1, 2017. The Legislature will meet again in Bismarck in January.

In a Grand Forks press conference Tuesday afternoon, Democratic gubernatorial candidate Marvin Nelson said the loss of Medicaid expansion would be "devastating" to North Dakota's rural hospitals.

"Almost none of the hospitals in the rural areas will be able to survive," he said. "It's just too big of a part of their revenue stream."

Nelson, a state representative from Rolla, said his local hospital relies heavily on Medicare and Medicaid.

"They can't take these big hits," he said.

Burgum, a Fargo businessman, often criticized what he characterized as Attorney General Wayne Stenehjem's support of the Affordable Care Act during their heated primary battle, although Stenehjem denied he had supported the law.

Burgum said there are "many benefits" to expanded Medicaid in North Dakota, such as the 20,000 people who have health insurance. But he said it's part of a "larger problem."

"And it's part of a larger problem called Obamacare," he said before door-knocking in a Grand Forks neighborhood.

Still, Burgum signaled he was open to reauthorizing Medicaid expansion.

"This isn't about a simple vote in the state Legislature about, 'Do we reauthorize for another two years?' We very well may choose to do that," he said. "We may say that's the best decision for right now for North Dakotans. ... But when we vote to reauthorize for another two years, we will be participating in a program that's not actuarially sound."

Currently, the federal government pays 100 percent of the cost to cover Medicaid expansion enrollees, said Maggie Anderson, the DHS executive director. But North Dakota will begin paying 5 percent of the cost on Jan. 1, and that share will gradually increase to 10 percent by 2020.

Burgum said the bigger challenge for North Dakota leaders will be figuring "out a health care system that actually works."

"The role of a state should be to be a platform for innovation," he said. "The role of a state shouldn't be to rubber-stamp federal programs that just don't work."