Obamacare Medicaid expansion: Alaska can do better

Americans watching Obamacare’s failure to launch and failure to deliver are left wondering when enough is enough. After being guaranteed affordability and increased accessibility, more are losing their insurance policies and paying higher premiums, with higher out-of-pocket costs.


To date, very little of the Obamacare experiment is working. While some want to blame a faulty website for the program being in complete disarray, the problems run much deeper. Promises have been broken, assumptions proven wrong, and several key deadlines and provisions remain unworkable or delayed. Obamacare’s package of interdependent policy trade-offs is unraveling.

In spite of this, Alaska is being urged to accept one of Obamacare’s biggest, most costly pieces: Medicaid expansion.

As governor, I take seriously my responsibility to make decisions in the best interests of all Alaskans, and I cannot in good conscience grow an already broken system. Accepting the Obamacare Medicaid expansion is akin to buying a high-priced ticket on a sinking ship.

Medicaid is already one of Alaska’s biggest and most costly government programs. Here are some statistics:

■ Alaska’s Medicaid program currently costs $1.5 billion per year, and covers approximately 140,000 Alaskans.

■ By 2020, without the Obamacare Medicaid expansion, Alaska’s Medicaid program costs are expected to grow from $1.5 billion to $2.5 billion.

■ With the Obamacare Medicaid expansion, costs will skyrocket, by billions.

Effectively, the state’s operating budget would revolve around the Medicaid program with the proposed expansion. Recognizing this, Alaska asked for flexibility from the federal government to more narrowly tailor Medicaid expansion for Alaskans.

Alaska’s requests were denied by Secretary of Health and Human Services Kathleen Sebelius. Without flexibility, accepting the Obamacare Medicaid expansion would have meant higher cost health care and health insurance for Alaskans, and financial risk as well.

In recent meetings with health care providers and stakeholders from across Alaska, I made it clear that the state is committed to funding the safety net of health care services already available to Alaskans, including Alaska’s 25 regional health care centers that offer care on a free or sliding-scale basis.

Instead of accepting the Obamacare Medicaid expansion, Alaska will look to address gaps in Alaskans’ access to health care where they are not currently eligible for Medicaid. We will focus on ways to restructure Medicaid in Alaska, making it a sustainable program, and take care of the safety net we have.

To meet this goal, this week I proposed the creation of a Medicaid Reform Advisory Group to study and produce a proposal bending the cost curve of Alaska’s Medicaid program. I have also proposed a path forward to address gaps in health care access for those Alaskans not eligible for Medicaid.

The Medicaid Reform Advisory Group will include legislators, and will be charged with meeting three key reform mandates:

■ Stability and predictability in budgeting.

■ Increasing the ease and efficiency of navigating the system by providers.

■ Providing whole care for patients by uniting physical and behavioral health treatment.

The panel’s final report must be submitted to the Legislature for approval no later than Nov. 15, 2014, and be ready for inclusion in the governor’s FY 2016 budget proposal.

On the health care safety net, we will identify the gaps, evaluate what’s working, and determine how health care access can be improved for those Alaskans who get health care through other avenues, such as the neighborhood clinics.

The bottom line is that Obamacare is broken and the Obamacare Medicaid expansion will not fix it. It currently would add substantial cost and financial risk to Alaskans. With the private insurance market collapsing before our eyes, Congress must fix this mess by either repealing or substantially changing Obamacare.

While our federal government works to unwind the national healthcare mess, we will continue the conversation here about how best to improve health care access and affordability for all Alaskans.

Sean Parnell is governor of Alaska.


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