Port: Sanford wants to protect health care choice ... by limiting your choices?

"Sanford, which has moved into the health insurance business, is using price pressure to get North Dakotans to give up coverage for non-Sanford care. Will the Legislature do something about it?"

Sanford's corporate headquarters in Sioux Falls.
Special to The Forum

MINOT, N.D. — It's unfortunate how much time we've had to spend talking about the ephemera of the culture wars this legislative session — things such as book bans and drag show restrictions — and not more consequential debates. Like the growing efforts to price-pressure North Dakotans into limiting their own health care choices.

House Bill 1416 , introduced by Rep. Dwight Kiefert, a Republican, would prohibit the sale of health insurance policies that freeze out independent health care providers as long as the provider "is located within the geographic coverage area of the health benefit plan and is willing and fully qualified to meet the terms and conditions of participation, as established by the health insurer."

Dwight Kiefert.jpg
State Rep. Dwight Kiefert, R-Valley City
Official portrait

It's a sensible proposal necessitated by the move toward vertical integration in the health care industry, where companies are beginning to act both as your insurer and your health care provider. Sanford is the primary example of this in our region. The company has long operated hospitals and clinics, but not so long ago began operating a health insurance company too.

Now Sanford's insurance wing is selling policies that cover only the care you receive from Sanford physicians. The company and its various flacks are defending this as providing more choice in the insurance market, and Sanford will indeed give you a discount on your policy if you choose to lock yourself into their system.

While saving some money on premiums is nice — any relief for health care costs comes as welcome news these days — remember that there is no such thing as a free lunch. That discount's cost is your ability to get covered care from providers who don't also work for your insurance company.


Should it be legal for health care providers to be in the insurance racket? We all know about the tension between doctors and insurance companies. Your doctor might insist that a treatment is medically necessary, and your insurance company might disagree. In that scenario, your doctor is supposed to be the advocate for you and your health.

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How can a doctor do that if their work on your behalf puts them at odds with the company that employs them?

HB 1416 doesn't address that problem. It only ensures that companies such as Sanford can't use pricing pressure to herd North Dakotans onto insurance plans that lack coverage for independent care providers. Providers who don't work for Sanford.

The bill has passed the House on an 84-9 vote, and it's currently before the Senate Human Services Committee, where it had a hearing this week. The Senate killed a bill similar to this last session. Will they do so again?

A couple of votes worth watching are those of Senate Majority Leader David Hogue, and influential Sen. Karen Krebsbach, each of whom serves on the board of Trinity Health , a health care provider based in Minot.

Sanford's push to ice out independent providers has significant implications for Trinity's business. You would expect Hogue and Krebsbach to push back. Unless, that is, the rumors about the always-acquisitive Sanford possibly buying up Trinity and its new hospital are true, in which case Hogue and Krebsbach may roll over.

Opinion by Rob Port
Rob Port is a news reporter, columnist, and podcast host for the Forum News Service. He has an extensive background in investigations and public records. He has covered political events in North Dakota and the upper Midwest for two decades. Reach him at Click here to subscribe to his Plain Talk podcast.
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