Out here, we plan for the hard times. We put aside what we can and we help our neighbors when the bottom falls out.

And we expect our leaders to keep their word. That's why what's happening to health insurance costs right now feels like such a betrayal – especially to those of us in rural America.

The Trump administration and Congressional Republicans promised to lower costs for families like ours. Instead, they're letting ACA premiums surge and subsidies lapse – and they're pointing the finger everywhere but themselves.

Here are the facts:

* Health insurance companies are hiking prices again next year – up about 26% on average because of higher hospital and drug costs – when health insurance premiums are already about 10% higher on average in rural areas than in urban areas.
* With key federal help set to expire, families could see their bills more than double from about $900 to nearly $1,900 a month – when over one-third of rural Americans already report skipping needed care because of cost.
* In rural areas, where care already costs more, local hospitals will feel the strain, too – even as 45% of rural hospitals report operating with negative financial margins.
* Nearly 27% of farmers and 48% of small-business owners rely on ACA coverage to get affordable care – and every one of them could be priced out entirely from purchasing that care.

None of this is inevitable. These higher healthcare bills are preventable. Congress can extend the enhanced tax credits and stabilize those costs right now – but Republicans are blocking these solutions at every chance they get and hoping you won't notice that they're responsible.

In places like Mantador – the little North Dakota town where I grew up – we don't play around with people's health. Ever . Farming families shouldn't have to gamble on going uninsured and business owners shouldn't be at risk of shutting the doors because premiums ate all of their margins.

Real leadership means showing up for one another, not turning our backs when things get tough. So, we'll keep fighting to make sure rural families aren't left holding the bill for Washington's inaction – because farmers, teachers, nurses, and mom-and-pop shop owners deserve better.

We can still choose the responsible path. Let's take it.

Heidi

Heidi Heitkamp, Former U.S. Senator for North Dakota
Founder, One Country Project



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