This is in business with Almanac North.

I'm Ken Ber.

Thank you for joining us.

You know, medicine used to be a whole lot simpler back in the day.

A person became a physician, moved to a small town, hung up their shingle, and practiced medicine the oldfashioned way.

You know, like Dr.

Galen Adams in Gunsmoke, played by Milbourne Stone.

And who could forget Dr.

Quinn, medicine woman, played by Jane Seymour.

Oh, I was in love with her.

That simple old-fashioned kind of medicine.

One doctor, one shingle, one office.

In my hometown, it was Doc Lee.

He had an office.

He had a receptionist.

He had a nurse.

Well, she wore a uniform.

We don't really know what her medical skills were, but she did have the uniform.

In Duth, William Baggley made a difference in our community.

Dr.

Dr.

Baggley and his associate practiced medicine here in Duth in the 1930s and 40s and were quite successful as in the Bagley Nature Center at UMD.

Their office probably looked like this, which was like many of the small town doctors across the country back in the day.

You got a medical degree, moved to a nice town, set up a practice, and became influential in your community because you were taking care of the health care needs of the citizens.

Well, that's all changed.

We are in mega conglomerate medicine today.

It's worth trillions of dollars a year.

What we spend twice as much on individual healthcare in America than any other industrialized country around the world.

It's big business and it's all about to change because in a week and a half on December 31st, the ACA, the Affordable Healthc Care Act, could expire.

And with it goes subsidies that have been around since the pandemic to help people pay for their health insurance.

Without those subsidies, what are 22 million people going to do?

That is the big question and that's what we'll talk about on in business with Almanac North.

We have experts from Washington DC from here locally at the University of Minnesota Duth and we'll tell you what could possibly happen if ACA expires as it might at the end of this year.

And because it's the holidays, we're going to take you on a sweet treat to a confection air known across the region that dates back to 1905 and talk about candy stores of the past because this is the sweetest time of year.

So stay with us for in business with Almanac North.

Welcome to In Business with Almanac North.

I'm Ken Buler.

Tonight we're examining a major federal policy issue that could have serious consequences for small businesses, workers, and rural communities across Minnesota.

The subsidies under the Affordable Care Act might expire and what happens next could impact how employers attract workers.

How families afford health care and how rural hospitals stay open.

We'll start in Washington DC with a nonpartisan organization that tracks federal policy and translates it into realworld impacts for states like Minnesota.

My name is Banga Agillori, chief economist for the Center on Budget and Policy Priorities.

Well, thank you very much for joining us on the program today.

Let me ask you, if the ACA is not renewed and expires at the end of the year, what changes and what changes the fastest?

So, what's going to change the fastest is the premiums that people who who are currently on the Affordable Care Act are going to pay.

So, over the last couple years, they've had the premium tax enhancements and that's kept their premiums a little bit uh cheaper, but starting January 1st, they're going to start paying the higher rate because those tax credits have now expired.

And you said that small businesses are particularly vulnerable to this.

Uh why is that?

So one of the best uh things about the Affordable Care Act is that it provides options outside of being employed uh for health insurance.

And so the ACA provided opportunities for small businesses and self-employed workers to be able to do it.

There's numbers about 5 million self um self-employed workers and small businesses who have been using the Affordable Care Act.

And so now their costs are going to go up, which is tough for small businesses.

And totally they're talking about like 22 million people being affected by this.

Yeah.

So we have 22 million people who use get health coverage through the Affordable Care Act.

And so because of this, you know, we've had estimates of 4 million people are going to lose coverage because it's just going to be way too expensive.

ACA of course is entitled for lower income individuals.

But if ACA goes away, could higher income people be affected by this and how?

Yeah.

So, while we focus on low-income people, they sometimes have options of Medicaid.

But with the ACA, we'll look at people who are 400% of the federal poverty level.

So, it hits a lot of middle inome folks who have been using that for the last couple years.

This is in business with Almanac North.

So, we try to have a focus on business.

So small business is priority across our region because that's like most of America who employs most of the people in America.

What is the ripple effect to small businesses when it comes to their ability without ACA to hire and retain employees?

Yeah.

So the biggest problem is that now their costs are going to go up.

And so when the cost goes up, we know with small businesses they have already thin margins.

So they have to figure out how do you adjust and so a lot of it they're going to have to drop health coverage.

Other things they may not be able to hire as many people.

It's just going to make things a lot more difficult.

And we see that small businesses already have been squeezed this year because of the tariff regime.

Expansion for small businesses.

Obviously, that's an issue.

If you can't hire more people, how do you expand?

You don't expand.

What you do is you just try to maintain and try to get through this.

And so, this is why it's so difficult.

The reason why we don't have this, you know, expansion of credits to keep their costs low.

Banga Angelori is our guest right now.

We're talking about the possible expiration of the ACA benefits.

And I want to know exactly um if these go away, how does that affect hospitals that um maybe are now going to see people later in their illnesses?

It's a very good point.

One of the biggest things with hospitals is that they are going to see people.

They're going to serve people whether they have health insurance or not.

What health insurance does is that it helps keep their costs low.

So now you're going to have a lot of people who are going to drop their coverage.

You mentioned the small businesses, but they're going to get sick.

When they get sick, usually if you have health insurance, you're going to take care of it quickly.

If you don't, you're going to try to wait it out, try to see, oh, I'll be okay.

But then if it gets really serious, then you go to the hospital.

It's, you know, it's much later.

It's going to be more expensive.

And then what ends up happening is that they'll take care of you, but now you have all these uncompensated care costs for the hospitals.

That's going to impact their financial viability, which is a big case and a big issue, especially with rural hospitals.

That's what I was going to say.

This is going to affect smaller rural hospitals much more than the huge big mega complexes.

Exactly.

And this is something that we've seen over the last 20 years where we've had not just rural hospital closures, but the ones that stay open, they have to figure out what they're going to do with their services.

And so sometimes they cut services and usually the one that gets cut is OBGYn services, which then have a rigle effect for rural communities.

We talked about workforce stability just a moment ago.

What can a business do to uh counteract this?

what what what can a small business owner do to say how can I still attract people without this ability to have them have some healthcare coverage?

It's going to be difficult.

And so you have to find ways of making your workplace attractive and understand that you know you don't have health coverage at the moment but there are other things that we could do maybe certain perks but ultimately what you have to do is just advocate for yourself for your business and talk to your representatives because that's what they're there for.

Talk about this.

tell the story about how important this is so that they understand this.

Mr.

Judge Lori, I want to ask one more question and that is um going forward.

So, let's say the ACA does expire as it's expected to at the end of this year.

What can a small business owner and I'm more thinking about like farmers, individuals who are self-employed, gig workers, what can they do to prepare for this in the very short time it's going to take before this hits.

So the thing is is to think about savings to think about prioritizing what are the important expenses that you have and you know a lot of times you know the difficult thing is they're already on thin margins they're already making the best decisions that they can this is going to make it harder for them and that's why I always go back to advocate for yourself advocate for your community.

Talk to your representatives.

Tell the story and tell them why this is going to be important for you to be able to keep your cost down and have health coverage.

Banga Angelori is the chief economist for the Center for Budget and Policy Priorities.

Thank you very much for your time.

Thank you for having me.

For 15 years, the Affordable Care Act has been a major feature of the US health care system and a frequent subject of political debate.

This is in business with Almanac North.

Thank you for joining us.

Passed in 2010 without any Republican votes in the final House or Senate passage, the Affordable Care Act, also known as Obamacare, created health insurance marketplaces and incomebased subsidies to help Americans afford their insurance coverage.

Those subsidies were temporarily expanded during the CO 19 pandemic.

Under current law, the enhanced subsidies are set to expire at the end of this year unless Congress acts.

Last week, the Senate considered two separate proposals.

one backed by Democrats to extend the enhanced subsidies and the other backed by Republicans that included health savings account provisions.

Neither measure received the 60 votes needed to advance.

The House has not yet voted on extending the subsidies, though a discharge petition has been filed that could force a vote on the floor at a later date.

Without Congress heading into recess, though, no legislation has been passed so far.

According to federal estimates, about 20 to 22 million Americans are currently enrolled in health plans through the ACA marketplaces, and most receive some form of subsidy to help pay their premiums.

Economists and health policy analysts say the expansion of the enhanced subsidies would likely lead to higher premium costs for many enroles and could result in some people losing their coverage.

To discuss the potential economic effects, we're joined by University of Minnesota DUTH economics professor Jennifer Schultz.

Professor Schultz, thank you for being here.

One of the courses you teach is healthcare economics.

What are the economics of the ACA?

And more importantly, is it working the way it was intended to when it was approved 15 years ago?

Well, that's a great question, Ken.

I'm glad to be here tonight.

So, this was the biggest reform since we passed Medicare and Medicaid in 1965.

And the phase one of the Affordable Care Act was to expand coverage, get more people covered.

And it was very successful at doing that.

It cut the number of uninsured by half.

So today, 40 million people benefit from the ACA either through the individual market, like you mentioned, or through Medicaid expansion.

Now, phase two was supposed to address health care costs and reduce that growth.

And Republicans in Congress spent so much time trying to repeal the ACA, I think it was like 97 times, that they really didn't get to work on phase two and address healthc care costs.

But yes, it was successful at expanding coverage and providing those subsidies to address affordability.

If it does uh end at the end of the year, what are some of the alternatives uh for these people that are currently getting coverage and more importantly subsidies to help pay for it?

Yeah.

So, right now uh you know, it doesn't look like Congress is going to pass an extension until maybe possibly next year.

So individuals are going to end up paying probably double what they have been paying in the past with subsidies.

It's been forecasted that about 10 million people will lose subsidies and another potentially 5 million will become uninsured because they can't afford the premium.

So for those individuals, they may qualify for Medicaid and if they don't, they'll probably be relying on community health centers that have very low rates or free care and then charity care from our local hospitals.

The detractors of ACA say it's costing $35 billion a year uh for these subsidies and that's unsustainable.

Is that number accurate?

Yeah.

So the CBO, Congressional Budget Office, nonpartisan, they've estimated that will be about $16 billion next year if they continue the enhanced advanced premium tax credits.

And the cost in 2024 was about 14 billion.

Now, they've estimated it was 30 350 billion over 10 years, but it's about 16 billion if they extend it one year, which is a rounding error for our federal budget because it's about 02% of the 7 trillion we spend.

So, really, it's not expensive uh in rel relative to all the federal spending.

And you know, we subsidize large corporations of $180 billion.

they get corporate tax uh rebates and subsidies and deductions and exemptions that you know could total a trillion dollars.

So, you know, $16 billion isn't a lot.

And I know President Trump just handed Argentina $20 billion.

So, I', you know, personally, I'd rather help Americans afford health care uh than um help bail out countries like Argentina.

Let's talk about the elephant in the room who I understand has a broken leg uh is needing high-cost medications and is going to be on long-term care and that of course is health insurance itself and why it's so expensive.

What's the economics behind the high cost of medicine and the high cost of insurance?

Yeah.

Well, these subsidies really just kick the can down the road.

We really need to address the high health care prices.

That is why we spend more than twice as much as other countries on health care.

So the answer is simple.

We have higher medical prices.

Um but trying to solve that is more difficult because every dollar we spend in health care is someone else's income.

So there's a lot of stakeholders involved.

So politically it's been very challenging for our elected officials uh to address high prices and those we have high prices because we've seen very uh large amounts of consolidation in healthcare.

So we have monopoly pricing in hospitals, in pharmaceuticals, in medical device industry.

So we really need to tackle that underlying problem of why we have high health insurance premiums.

It's because we have high medical prices.

We're talking with uh Jennifer Schultz.

She's an economics professor specializing in healthcare at the University of Minnesota here in Duth.

And this is in business with Almanac North.

This is a business program.

So what can a business owner do in your mind to prepare if this subsidy is gone at the end of the year?

Yeah, so small businesses have been really struggling to afford health insurance.

And so when these exchanges came on, I think it was a great service to small businesses.

160 million Americans get their insurance through their employer.

And it's still expensive.

About I think a family of four spends about $27,000 in their health insurance premium.

So employers are really struggling.

And if tomorrow they could be offered an option where they didn't have to be providing health insurance coverage, they would all jump at that and they would save a lot of money.

They could make that spending and increase their employees wages and other benefits if we had an alternative choice.

Uh in Indiana, businesses are getting together.

They formed the Indiana Business Health Collaboration.

I encourage businesses to get together, figure out why they're paying high prices, and really put pressure on providers and drug companies to reduce prices.

But they need to know that information first.

And I would I would recommend that they look to Indiana to see what they're doing.

Jennifer Schultz, thank you very much for being with us.

She is an economics professor from the University of Minnesota, DUTH.

We're glad you were with us.

We started out our program this week with a nostalgic look at the way medicine used to be practiced with family doctors hanging their single shingle out and caring for almost every aspect of their patients medical needs from cradle to grave.

We visited Dr.

Bagley's imagined office and exam room portrayed at the Lake Superior Railroad Museum by the St.

Louis County Historical Society in their Oldtown exhibit at the St.

Louis County Depot.

Dr.

Bagley was one of those small town doctors in the growing city of Duth from back in the day.

There were many others in towns and cities all across America.

We reached out to the Minnesota Medical Association to find out if there are still any single shingle doctors left in the state of Minnesota.

They found two.

One is in Cold Spring, Minnesota, and the other MMA single practice physician is even colder.

He's up north in International Falls at the one doctor, Northern Plains Family Medicine and Behavioral Health PC.

They call him Dr.

Gray.

International Falls isn't really a small town, but you have a small town approach to medicine.

What is it?

Well, one of the things is that um you can't always cure, but you should care.

And one of the uh more important things is the relationships with people.

And uh sometimes um and it's not just the um it's it's not just the um the the medical part of it but that that that aspect that make the relationship the healing relationship uh uh kind of special.

You need that get to know people and them know you.

What's the most difficult part about being a single shingle doctor in International Falls?

Well, let me put it this way.

I am um I think I mentioned before I couldn't run a lemonade stand and I took this thing off and I knew how to be a a a physician, a doctor.

I know how to take care of people.

And um I'm not going to be the richest man in the graveyard, that's for sure.

And so if you are kind of looking at what I'm doing um um you kind of need to uh have your pri priorities uh correct.

So uh part of the issue my first year I mean I'm doing everything my my own credentiing working with the insurance companies and so forth.

now have a billing service and it's pretty good that I went through that process but uh um I did not um and it's one of the areas I think we can do a better job of preparing people like myself for the business side of of this and you know this like crazy rules I can do the same thing as uh some of my my colleagues at uh uh some of the local institutions yet they get paid more and stuff because of facilities charges and all this sort of stuff.

So, I don't even get paid at the same rate.

But what I wanted to do was keep my doors open.

But I would say that financial part, but on the other hand, you really have to appreciate, at least I I do.

I'll put it this way.

I'm poor as a church mouth, but happy as a clamp.

Dr.

Gray, a single shingle physician practicing on his own in International Falls with quite a history and quite a reputation.

We're very glad that you shared both of those with us.

Uh in the meantime, thank you for your time today and uh stay warm and stay local.

I appreciate this opportunity and if anything, I hope we can encourage others uh to follow this path.

Before we get to tonight's final story, let's take a look at some of the top business headlines making news across the region this week.

Beginning January 1st, 2026, new protections go into effect to help business owners recover from business identity theft.

The Business Filing Fraud Prevention Act gives the Minnesota Secretary of State new authority to quickly investigate and correct fraudulent filings.

For the first time, business owners will have a direct way to file a declaration of wrongful filing without having to go to court.

MINDOT has been awarded $17.9 million in federal grants to upgrade rural bus fleets and transit facilities.

The funding will replace vehicles aging and transportation fleets that are not as clean as new ones burning propane technology.

And they'll do this all across northern and rural Minnesota.

All legal work is complete now for Elite to become part of the Canadian Pension Plan investments and global infrastructure partners.

Elite will remain headquartered here in Duth with local management and no rate impact for customers.

Shareholders will receive $67 per share in cash.

How does it go this time of year?

I and my kirchief and modern cap had just settled down to a long winter's nap.

Something about blah blah blah blah.

The children with visions of sugar plums danced in their heads.

Candy and the holidays go together.

And the old confectioners of the past like the Gramps Family Candy Kitchen in Loyal, Wisconsin, they were institutions in your community.

And I'm going to tell you about a few others as well.

Let's go inside.

The Gramps Family Candy Store in Wisconsin wasn't the only old-fashioned confectioner in the day.

I remember one in downtown Superior on Tower Avenue, Gennards.

They shipped their candy during the holidays all over the world.

They were that wellknown.

They were located right next to the old Beacon Theater.

I remember going next door to Gennard's, buying our popcorn, and then sneaking it into the theater because, well, he used real butter and it was just so much better.

Most of these oldtime candy stores are gone now, except for one in our own backyard.

a confectioner dating back to 1905.

Okay.

Well, I guess I'll start.

Um, it was originally started in 1905 and that makes us uh Minnesota's oldest continuously running candy store.

And it was started by four brothers.

One was my grandfather, Gus, and his other brothers, Chris, Nick, and Tom.

And they started the store in 1905, and we've been here ever since.

Uh, my dad was a second generation, my uncle Leo.

Then then they sold it when they retired in 1982 to Jim China who had it for 36 years.

We bought it back in 2018 back into the Kink family.

It's been a fun adventure ever since.

My dad loved the store and he became more and more nostalgic for it as the years went by and he lived to see our other store open in Knife River, Great Lakes Candy Kitchen, which opened in 2007.

We started that one because we were nostalgic for the family history and the candy.

We wanted to learn how to make all the candy.

So, when this one came up for sale in 2018, Jim was retiring.

We're like, "Well, we know how to do it.

Let's do it."

So we're happy we get he always says that the turtles are our slowest mover when because when you think of turtle candy it's turtle but it's actually they move fast out of this is a pan of our famous caramel pecan turtles that's coming out of our cooling belt which is about 30 feet long and that's hamming to get um to get them pulled down quicker.

But the turtles are all made by first layering um a layer of the pecans first and then they cook the caramel in the copper kettle and then once the co uh caramel's done, the candy maker will take a funnel with a stick and um put the little circles of caramel on next.

And once that cools, then they'll go with the same funnel and dip uh little circles of chocolate on top.

So that's it.

And then when they're ready to pack them, they just come right out and they're a beautiful thing to see.

Hot air is our biggest seller.

And then um the turtles are the next biggest and then we have a lot of popular candies in between.

People love our fudge, our toffee, our caramel, thermal apples.

We now have um dipped wild rice that's been popped and dipped in chocolate.

We learned it from the Net Lake reservation.

Yeah.

and they told us we could use the recipe and and that's been really popular here.

And um we just like preserving the history of the store, our family history.

It's been very very nice.

Well, it came from my dad actually and my uncle Leo.

They they um they just brought home that enthusiasm, the passion for it, that it was part of their family.

Um you know, my dad, both Leo and John, who was my dad and Leo's Michael, they grew up in the candy making.

They weren't like us.

We just did.

We didn't really work here that much as kids, but um they had to work here and but then they loved it at the same time.

So part of their family, so and then they love showing it off to people and giving them tastes and and everybody agreed that it was some of the best candy they've ever had.

So they're it's a pride thing.

So they brought that pride back to us, but they also said it was a lot of work.

And so we were warned warned a couple times that it was too much work.

So, when we opened our store in in Knife River in 2007, my dad said, "Be sure to get enough health."

And that kind of um kind of got me because I thought, "Yeah, my dad always work too hard probably."

So, we we decided we we won't overwork except for the holidays, which will be all over work.

It's something we just can never get enough help to get everything done.

So we're here mo a lot in the holidays and then we live in Deloo so we're home quite a bit in Deloo during the week.

We are of retirement age but we're enjoying the store very much.

It's uh we have to keep this thing rolling for another 100 years.

It has to go because they're I agree.

Yeah.

So that's what our goal is to do, you know, and we're going to have to just keep it rolling.

It's fun.

And there's nothing what else would we be doing?

You know, we we enjoy it because there's been many people coming back and they're um reliving memories when they were kids.

They'd come in through the back door for lunch hour during high school.

They would buy they would spend their lunch money on a bag of chips and a soda fountain drink, the Green Rivers and the Cherry Cokes.

And we hear memories like that.

Yesterday we had a lady that called and we know her, but she said, "You know, I worked here 72 years ago."

So, it's just amazing that people keep their memories um alive and they can kind of relive them a little bit when they come in.

Um it's been over 100 years.

So, yeah, let's keep going.

So, we're doing all we're doing is for the next generations to keep it going for the next group.

Yeah.

We got to make it easy for them.

At our age, that's a a really a great accomplishment we feel for our family to just keep their legacy going.

Yeah.

I'm Ken Ber.

Thanks for watching In Business with Almanac North.

If you missed any parts of tonight's show, you can always watch it at pbsnorth.org or listen on Mondays at 5:30 on the north 1033.

Thanks again for watching and until next time, let's take care of each other.