Associated Press

North Dakotans who lack health insurance should be eligible to buy into a plan that covers state employees at a price that reflects their ability to pay, the Democratic candidate for governor says.

Fargo state Sen. Tim Mathern, at news conferences today, said he also would push to expand the state Children's Health Insurance Program to take full advantage of federal subsidies to cover children younger than 19 years old.

At present, the federal government pays most of the program's health insurance costs for families earning 200 percent of the federal poverty wage, which equals $42,400 for a family of four. North Dakota limits eligibility to families earning 150 percent or less, which equals $31,800 for the same family.

The proposals would extend coverage to about 65,000 North Dakotans who lack health insurance, Mathern estimated.

He said he also would push for a low-interest loan program, to be financed by the state-owned Bank of North Dakota, that would provide money for rural hospitals to keep their facilities in good repair.

"Almost every rural hospital in North Dakota is threatened financially," Mathern said."If nothing is done, they'll go out of business. This would be a huge blow to rural North Dakota, and to the economy of the state."

Mathern is opposing Republican Gov. John Hoeven's bid for a third term. Hoeven was on a state tour of his own today to advertise his proposals for increasing child-care availability in the state.

As a state lawmaker, Mathern has long pushed the idea of opening a state health insurance plan that covers North Dakota government workers - and legislators themselves - to North Dakotans who do not have insurance.

He said today a system could be devised to allow families who lack insurance to pay premiums on a scale determined by their income to join the plan. Those participants would be in a separate insurance pool, Mathern said.

He estimated the proposal would cost $76 million every two years. Expanding the eligibility standards for the Children's Health Insurance Program would cost about $18 million every two years, Mathern said.

Offering health coverage to uninsured families and children should save money in the long term by encouraging preventive health care, he said.

"These proposals are not about government spending huge sums of money to cover these people," Mathern said. "This is about making insurance available and affordable for working people, for businesses who can't afford it now."

Kimber Wraalstad, chief executive officer of Presentation Medical Center of Rolla, said changes in how hospitals are paid for Medicaid services to the poor are crucial.

"There is a fundamental flaw in health care reimbursement if 22 out of 27 rural facilities (in North Dakota) are losing money," Wraalstad said. "It's not because we don't know what we're doing."