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Setting the Record Straight on Kevin Cramer and the North Dakota GOP’s Attacks on People with Pre-Existing Conditions

By August 22, 2018No Comments

For years, Republicans, including Congressman Kevin Cramer (R-ND), have waged a war on our health care trying to repeal the Affordable Care Act (ACA) and its protections for people with pre-existing conditions like cancer, diabetes or heart disease. Today, Republicans in North Dakota, in a scene out of Bizarro World, are holding a press conference to try to convince us that’s not really what they are doing.

They can’t change the facts. Republicans have repeatedly voted to repeal the ACA in its entirety. What that would mean is insurance companies could go back to denying or dropping coverage, or charging more, because of a pre-existing condition. They have tried to sabotage our health care at every turn which would make health coverage unaffordable for people with pre-existing conditions, essentially the same thing as repealing the protections all together. And they are now asking the court to do what they couldn’t do legislatively.

Here are the ways Republicans in North Dakota have attacked the 316,000 people in the state with a pre-existing condition:


Rep. Kevin Cramer voted multiple times to eliminate protections for people with pre-existing conditions:

2013: Cramer Voted For A Full Repeal Of The ACA. Cramer voted for HR 25, which created a reserve fund for the full repeal of the Affordable Care Act. [HR 25, House Vote #88, 3/21/13]

2013: Cramer Voted For A Total Repeal Of The ACA.  Cramer voted for HR 45, an act “to repeal the Patient Protection and Affordable Care Act and health care-related provisions in the Health Care and Education Reconciliation Act of 2010.” [HR 45, Roll Call Vote #154, 5/16/13]

2015: Cramer Voted For A Total Repeal Of The ACA.  Cramer voted for HR 596, an act “to repeal the Patient Protection and Affordable Care Act and health care-related provisions in the Health Care and Education Reconciliation Act of 2010.”  The bill also ordered House committees to develop a replacement that would “provide people with pre-existing conditions access to affordable health coverage,” but provided no specifics. [HR 596, Roll Call Vote #58, 2/3/15]

In fact, Cramer’s own website acknowledges his vote would “repeal the affordable care act in its entirety.” “Today Congressman Kevin Cramer voted with the U.S. House of Representatives to repeal the Affordable Care Act in its entirety.” [Cramer Website, 2/3/15]

Attorney General Wayne Stenehjem Filed a Lawsuit that Would Repeal The ACA And Its Protections For 316,000 North Dakotans With Pre-existing Conditions. North Dakota Attorney General Wayne Stenehjem joined conservatives in 19 other states in the Texas v. United States lawsuit to overturn the Affordable Care Act in its entirety. If the lawsuit were successful, here is how it would impact the people in the state:

  • Insurance companies would be able to deny, drop or charge more for coverage for people with pre-existing conditions. In North Dakota, 316,000 people have a pre-existing condition.
  • It would repeal provisions that lower prescription drugs for people on Medicare
  • It would repeal the provision allowing young adults to stay on their parents’ insurance until age 26
  • It would allow insurance companies to impose annual and lifetime limits again
  • It would allow insurance companies to charge women more for coverage
  • It would repeal tax credits that help  up to 17,000 North Dakotans purchase health coverage.
  • It would repeal Medicaid expansion, which has helped 21,400 North Dakotans get coverage.

Insurance Commissioner Jon Godfread Is “Extremely Supportive” of Stenjehm’s Lawsuit To Overturn Protections For People With Pre-existing Conditions, And Has Filed An Affidavit Of Support In The Case. “In a letter on Tuesday, North Dakota’s Democratic-NPL Party called for Stenehjem to withdraw from the 20-state lawsuit, citing consequences for the state’s Medicaid expansion and state residents afforded protections by the federal health care law. Godfread said his department has filed an affidavit in the case, outlining issues he sees in North Dakota. ‘In short order, we are extremely supportive of the attorney general continuing this lawsuit and have assisted him along the way,’ he said.” [Grand Forks Herald, 8/9/18]

State Senator Armstrong Agreed That AG Stenehjem Had An “Obligation” To Join The Suit To Overturn Protections For Pre-Existing Conditions.  “North Dakota Attorney General Wayne Stenehjem announced he would join Texas in the lawsuit. Stenehjem has ‘an obligation to pursue’ the lawsuit if he ‘thinks the law is unconstitutional,’ Armstrong said in a statement to the Herald. ‘We all agree that we must protect people with pre-existing conditions, but it is clear that Obamacare is a complete failure in North Dakota,’ Armstrong said. The Unaffordable Care Act is unpopular with providers and customers. It’s broken. Everyone knows it’s broken.’” [Grand Forks Herald, 8/3/18]


Patient groups, physicians, and hospitals emphasize how much the lawsuit could threaten care for people across the country:

  • American Cancer Society, American Cancer Society Cancer Action Network, American Diabetes Association, American Heart Association, American Lung Association, and National Multiple Sclerosis Society: “Striking Down These Provisions Would Be Catastrophic And Have Dire Consequences For Many Patients With Serious Illnesses.” Invalidating the ACA in whole or in part “would be devastating for the millions of Americans who suffer from serious illness or have preexisting conditions and rely on those protections under current law to obtain life-saving health care. If either the plaintiffs’ or the administration’s position were adopted by the court, people with serious illness are likely to be denied coverage due to their preexisting conditions or charged such high premiums because of their health status that they will be unable to afford any coverage that may be offered. Without access to comprehensive coverage, patients will be forced to delay, skip, or forego care. Striking down these provisions would be catastrophic and have dire consequences for many patients with serious illnesses.” [American Cancer Society et. al, 6/14/18]
  • American Medical Association, The American Academy of Family Physicians, The American College of Physicians, The American Academy of Pediatrics, and the American Academy of Child and Adolescent Psychiatry: “​Invalidating The Guaranteed-issue And Community Rating Provisions—or The ​entire A​CA—would Have A Devastating Impact On Doctors, Patients, And The American Health Care System As A Whole.” “Congress declined to do what the Plaintiffs ask this Court to do for a reason: the consequences of repealing the ACA would be staggering…Plaintiffs’ proposed remedies . . . would strip health care from tens of millions of Americans who depend on the ACA; produce skyrocketing insurance costs; and sow chaos in the nation’s health care system​…The ACA’s ‘nationwide protections for Americans with pre-existing health conditions’ has played a ‘key role’ in allowing 3.6 million people to obtain affordable health insurance. Severing those vital insurance reforms would leave millions without much-needed insurance.” [AMA et. al, 6/14/18]
  • American Hospital Association, Federation of American Hospitals, The Catholic Health Association of the United States, and Association of American Medical Colleges: “A judicial repeal would have severe consequences for America’s hospitals, which would be forced to shoulder the greater uncompensated-care burden that the ACA’s repeal would create.” The relief sought by Texas and its allies “would have devastating consequences, kicking millions of Americans off of coverage and inflicting on them all the harms that come with being uninsured. These harms would fall on the low-income families least able to cope with them. ​And a judicial repeal would have severe consequences for America’s hospitals, which would be forced to shoulder the greater uncompensated-care burden that the ACA’s repeal would create.” [American Hospital Association et. al, 6/14/18]
  • Public Health Scholars and the American Public Health Association: “The Foreseeable Public Health Consequences Of The Injunction Are Nothing Short of Catastrophic.” “Without the ACA, the health of millions of Americans would be harmed. Consider the grim analyses of proposed legislation partially repealing the ACA: In 2017, the nonpartisan Congressional Budget Office (“CBO”) assessed the impact of a bill partially repealing the ACA and found (among other things) that it would, in “the first new plan year following enactment of the bill” alone, increase the number of uninsured Americans by 18 million. That number would grow to 27 million after the “year following the elimination of the Medicaid expansion,” and then to 32 million by 2026. Still more is at stake here: Unlike the injunctive relief plaintiffs seek, the bill analyzed by CBO would have staggered its partial repeal of the ACA to avoid catastrophic results. Here, plaintiffs ask the Court to eliminate, as preliminary injunctive relief, a complex statute in its eighth year of implementation—a statute whose repeal through democratic means has been attempted innumerable times but has never succeeded.” [Public Health Scholars et. al, 6/14/18]
  • AARP: Before ACA’s Protections, Discrimination Against Those With Pre-Existing Conditions, Age Rating, And Annual And Lifetime Caps Made Accessing Health Care Out Of Reach For Older Adults. “Uninsured pre-Medicare adults faced nearly insurmountable challenges to securing insurance because they were denied coverage based on preexisting conditions or offered costly policies that excluded coverage for needed care. Even without preexisting conditions, insurance premiums for older adults were as much as 11 times greater than their younger counterparts solely based on their age. Even a healthy person who was age 50 to 64 with no preexisting conditions faced markedly higher insurance premium rates than a younger person. Age rating put the cost of insurance out of reach for many pre-Medicare adults. Annual and lifetime caps—which were easily exceeded by treatment for a single illness such as cancer, heart disease, or diabetes—meant that many older adults either went without treatment until they became eligible for Medicare or incurred financially ruinous medical debt.” [AARP, 6/14/18]

Health insurance companies warn that the lawsuit could lead to mass coverage losses:

  • America’s Health Insurance Plans: “Abruptly threatening or even cutting off billions of federal dollars that allow individuals to purchase insurance and that fund benefits offered through Medicaid or Medicare would have devastating effects.” “The healthcare system, while constantly evolving, cannot pivot to a new (or, worse yet, non-existent) set of rules without consequences. Abruptly threatening or even cutting off billions of federal dollars that allow individuals to purchase insurance and that fund benefits offered through Medicaid or Medicare would have devastating effects.​ Enjoining enforcement of federal laws like the federally-facilitated marketplaces and the products sold on them would be similarly disruptive.” [AHIP, 6/14/18]
  • The Ability Of Millions Of Low-Income, Medically Vulnerable People To Access Necessary Treatments Would Be Cast Into Doubt. “The Medicaid program would likewise experience significant disruptions​. Stopping the funding for individuals made newly eligible for Medicaid under the ACA would harm the 34 states that have chosen to expand their Medicaid programs and potentially disrupt healthcare coverage for the 12 million people added as a result of that expansion​…The coverage of millions of low-income and medically-vulnerable patients—and their ability to receive necessary treatments and prescription drugs—would be cast into doubt. At the same time, state Medicaid programs would see drug costs increase considerably for all enrollees (including children, disabled, and elderly) due to the loss of the ACA’s enhanced prescription drug rebates​.” [AHIP, 6/14/18]


In nearly every state where data is available, premium rates are higher because of Trump-GOP sabotage than they otherwise would be. In North Dakota, preliminary rates indicate proposed increases as high as 29.33 percent.

Recent research from the the Brookings Institute finds that premiums across the country are higher than they would be absent actions taken by the Trump administration and its Republican allies. It estimates that premiums would fall by an average of 4.3 percent nationwide, absent Republican efforts to sabotage the law, rather than improve it.