By Jon Godfread

It is time to have an honest discussion about health care, not only in our state but in our country as well.

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As the November election approaches, we have heard many claims. Unfortunately, some of those claims are based in an attempt to invoke fear. By now, you have likely heard that if the Affordable Care Act (ACA) is repealed or overturned, nearly half of the population of North Dakota would lose insurance coverage because they have a pre-existing condition. This claim is not true and is frankly irresponsible. Just last month, the Associated Press agreed and issued a fact check on the numbers with a headline that read, "Heitkamp overstates pre-existing denials."

We can only have an honest discussion about the health care if we operate with facts and not fear.

Prior to the implementation of the ACA, North Dakota's health insurance market was not facing the problems the ACA sought to fix. Today, nearly 84 percent of North Dakotans receive their health insurance through an employer or are covered under a government program like Medicare or Medicaid. Individuals with pre-existing conditions have been and will continue to be covered under those health plans.

Another 8 percent of the population is uninsured and changes to the ACA would have no impact on this group. Why is 8 percent of our population uninsured? It is simple. Higher premium and deductible costs have made health insurance unaffordable for those who do not qualify for subsidies. These small business owners, farmers and ranchers, live on main street North Dakota. They support our agriculture community and are the risk takers that drive our economy forward. We cannot forget about that population, and unfortunately, the ACA has left this group to deal with dramatically higher premiums.

North Dakota has always worked, at the state level, to find coverage for every one of our citizens. In 1981, the North Dakota Legislature passed the Comprehensive Health Association of North Dakota (CHAND). This program provides coverage for high-risk individuals, such as those with pre-existing conditions. Regardless of what happens to the ACA, CHAND has and will continue to provide coverage to those with pre-existing conditions. The program is robust with capped premiums that are subsidized by the insurance companies doing business in North Dakota.

I have not met one person that does not want to find a way to provide affordable coverage to all North Dakotans. I have not met one person that does not want to provide coverage for those of us who have pre-existing conditions. Both sides of the political aisle agree that the ACA is in desperate need of reform or replacement, which is why this conversation needs to be grounded in facts and not politics.

There have been attempts to reform the ACA in the past, most notably plans like Graham-Cassidy and the American Health Care Act (AHCA). All of those plans included provisions for guaranteed coverage for pre-existing conditions. They also included additional money and more flexibility to help keep premiums more affordable for all North Dakotans including those with pre-existing conditions.

Most importantly, these plans returned control of health care, where it belongs in the hands of the states. The ACA is a one-size-fits-all solution that does not fit North Dakota. Plans like Graham-Cassidy and AHCA return health care decision-making to the states where we can build programs that best fit our unique needs. As this debate continues on, I hope we can all agree that North Dakotans are best suited to solve North Dakota problems.

Jon Godfread is North Dakota's insurance commissioner.