BISMARCK — With the death of Supreme Court Justice Ruth Bader Ginsburg this month and the Trump administration's nomination of her likely conservative successor, the long odds of a legal case to overturn Obamacare have gotten considerably shorter.

The challenge to the Affordable Care Act, a lawsuit driven by the state of Texas since 2018, has been endorsed by North Dakota and many of its Republican lawmakers. Nearly 21,000 North Dakotans are currently enrolled in the federal health care program.

State Insurance Commissioner Jon Godfread, who oversees and regulates the implementation of the ACA in North Dakota, is a vocal proponent of repealing the program.

"It hasn't really necessarily adjusted any of the problems in North Dakota, in my opinion," said Godfread, a Republican. "What it has done, is it's placed a lot of burden on those small business owners — the farmers, the ranchers, the folks who don't have access to that large group market or the economies of scale. They're the ones paying that full weight of the ACA implementation."

In the two years that the Texas lawsuit has taken to reach the country's highest court, many legal observers have argued that the state's case against the constitutionality of the ACA, also known as Obamacare, is unlikely to hold water before the Supreme Court. But after Ginsburg's death, and with the Republican Senate's clear path to fill her seat with a conservative successor, the conditions for the court to strike down the hallmark program of the Obama administration may have fallen into place.

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Jon Godfread
Jon GodfreadSubmitted photo

Still, as with other states that have endorsed the Texas lawsuit, North Dakota officials have not shared a plan to replace the ACA. In a news conference of Democratic legislative candidates on Tuesday, Sept. 29, Terri Hedman, a candidate for state senate in Fargo, drilled in on that gap.

"The Republican lawsuit will take away these protections, and they have no plan for a replacement," Hedman said. "Most of us are at risk."

Hedman pointed to the consequences of stripping the ACA's protections for people with pre-existing conditions. She argued that the long-term health consequences of COVID-19 are not clear, and lend renewed urgency to the ACA's protections.

Republicans and Democrats agree on at least one point: The repeal of the federal ACA would put considerable new responsibility into the hands of individual states.

Godfread argues that, for North Dakota, this would be a welcome change.

"When you're talking the ACA, I think you have to look at it with a North Dakota lens on it," he said, making the case that a federally imposed one-size-fits-all program wouldn't respond to issues unique to North Dakota.

He points specifically to some 20,000 additional North Dakotans who purchase their own individual insurance programs, but who are not enrolled through the ACA. These independents have been priced out of affordable health care coverage, Godfread argues.

And if the Supreme Court does repeal Obamacare, Godfread stresses that the changes in North Dakota would not happen overnight. He predicts that those currently enrolled through the ACA wouldn't actually see changes to their plans until 2022 "at the very earliest."

That's plenty of time, he argues, for North Dakota lawmakers to come up with a state-level plan.

Readers can reach reporter Adam Willis, a Report for America corps member, at awillis@forumcomm.com.