With negotiations ongoing as the GOP continues to gather enough votes to pass a new health care law, those who have signed up for insurance under the current law are in the clear, for now.

As Congress wrangles with a health care bill to replace Obamacare, which many believe is unsustainable, those in the region who have been able to purchase health insurance under the law passed in 2010 are almost certain to be affected by new legislation.

The GOP-controlled Congress has so far been unable to agree on a final version of a bill to send up for vote, a task made tougher after the Congressional Budget Office (CBO) determined that the legislation in its current state would mean the loss of health insurance for an estimated 22 million people nationwide.

President Donald Trump recently advocated a repeal and replace approach, but that approach was seen as politically radioactive earlier in the year and is unlikely to gain much traction now. Trump made a swift repeal of the Affordable Care Act a campaign priority.

North Dakota was one of the few red states to participate in Medicaid expansion, a key aspect of the ACA, in 2013. Andy Lankowicz, president of St. Alexius Hospital Devils Lake, estimated last year that 20,000 people have gotten coverage under Medicaid expansion in the state since then.

The CBO provided state-by-state estimates of the ramifications of the new law, should it clear the hurdles for passage. According to the CBO, big changes would be in store for North Dakota. Its estimates conclude that about 70,000 fewer people would be insured in the state by 2022 under the new bill compared to current law.

According to the CBO estimate, North Dakota would also lose $387 million - 52 percent - of federal Medicaid and ACA funding in 2022, and price of the most inexpensive plan on the exchange would rise from $91.44 to $381, a 76 percent increase.

That loss of funding would not only be a concern for those who struggle to afford insurance, it would have an impact on rural hospitals. While the exact impact on either is unknown, the CBO’s analysis has given many pause, which has delayed a vote on the new legislation.

Lankowicz has said in the past that St. Alexius would adjust to whatever new reality the hospital faces.

“My hope is to ensure that we continue to address the needs of people who don’t have health care coverage,” Lankowicz said last November. “We’re going to do whatever we can to make sure that people are still cared for in a compassionate and respectful manner.”

St. Alexius is reportedly on more solid financial footing than other hospitals in the CHI St. Alexius system and rural hospitals in the state. The hospital recently started a campaign to raise funds for a new emergency room.

With negotiations ongoing as the GOP continues to gather enough votes to pass a new health care law, those who have signed up for insurance under the current law are in the clear, for now. Sen. John Hoeven (R) said last month that “the CBO report shows that we have more work to do,” while Sen. Heidi Heitkamp (D) said that the new legislation is “entitlement reform” rather than an Obamacare replacement.

“They're trying to tell you we're going to keep coverage the same, no one's going to get hurt, and we're going to take billions of dollars out of health care," Heitkamp told CNBC last month.