There was a distinct partisan tone to the reactions of Alaska leaders to the new federal health care bill, which President Obama signed into law March 23.
Sen. Mark Begich, a Democrat, said the reform bill ends the status quo of families going broke because of unpaid medical bills.
"Alaskans have been told the sky will fall if health reform passes, but that's just not true," he said. "The Senate bill contains the toughest insurance reforms in history. It creates a health insurance pool so people can get more affordable coverage. Americans who have insurance now get the peace of mind of knowing they won't lose it if they get sick or change jobs."
Alaska Congressman Don Young, a Republican, said minutes after the U.S. House narrowly approved the legislation March 22 that the bill does nothing for Alaskans or the country.
"This bill doesn't include real health care reform, it's reform in name only," he said. "What we passed is composed of ego and partisanship."
Alaska Sen. Lisa Murkowski, also a Republican, said the costs of the bill were too great.
"Proponents of the health care bill say that the public will like the bill once it is passed," she said. "Will they like the fact that Americans will have to pay four years of taxes before they get the benefits? That's like making mortgage payments for four years before you can move into your new home."
Republican Gov. Sean Parnell had similar things to say.
"This is public policy at its worst," Parnell said. "I am very concerned with the impacts this bill will have on Alaska's seniors, families, small businesses, and physicians."
The governor directed Attorney General Dan Sullivan to conduct a legal review of the legislation. Several other states have taken similar action. Some 15 states have filed suit to block the federal legislation, all from states with Republican governors.
Alaska businesses and health providers are more cautious in their reactions. Some were even optimistic.
Becky Hultberg, regional director of communications and marketing at Providence Health Systems, said her hospital group already has implemented many of the requirements of the bill.
Providence supported health care reform, she said.
Having more people under health insurance will help ease the hospital's losses from uncompensated care. Last year Providence recorded $24.6 million in "charity" care, Hultberg said. These are unpaid bills for medical service provided to low income people within 400 percent of the federal poverty level.
The full cost of uncompensated care is probably higher, she said.
"This number likely doesn't cover those who come in for treatment and don't have insurance," Hultberg said.
Providence officials are still combing through the law's provisions to determine the effect it will have, Hultberg said.
Cheri Gilliam, vice president for marketing at First National Bank Alaska, said officials there are still trying to understand how the legislation will affect self-insured businesses like the bank.
"It remains to be seen how much latitude for organizations like ours, good corporate citizens, who are putting forth effort to make sure employees have the coverage they need. We are looking for definition and that will be coming in days to come. We'll see where we are aligned and adjust accordingly," Gilliam said. "We are standing by to understand more about it so that we can find cost effective solutions to the mandates. There are things that will be required that we will either have to adjust, add or may already be in our plan."
Wayne Stevens, president of the Alaska State Chamber of Commerce, said there aren't many people who have a comprehensive idea about what change means.
"I haven't a clue either," he said.
He does believe the legislation misses the real problems in health care, including lifestyle decisions people make, like smoking and drinking too much, that put them on the road to health problems.
"America seems to have lost its way. We expect someone else to take care of our problems instead of taking care of ourselves," Stevens said. "If you weigh too much, drink too much and smoke, then you go to the doctor saying you still feel bad. Why is that the government's responsibility? Why is it the government's responsibility to take care of me? Don't I have a responsibility to take of myself? The public expects the government to solve our problems without any sweat equity from themselves. What are we doing?"
State administration officials, meanwhile, said they are still analyzing the legislation.
Bill Streur, the deputy commissioner for the state Department of Health and Social Services, said he and other department officials are still assessing the added costs to Alaska due to expanded Medicaid services required by the federal legislation.
"The cost of (Medicaid) care may be less because there will be increased federal support, more people covered by insurance, better practice of care by providers, less bad debt for hospitals. We're still working on the details," Streur said.
Division of Insurance Director Linda Hall said there are some concerns about whether Alaska has enough insurance companies writing coverage here to make an efficient, effective insurance exchange.
The federal legislation mandates creation of insurance exchanges to promote competition.
Hall is concerned whether there will be enough people in Alaska who will enroll in an exchange to make it worthwhile for insurance companies to participate.
"If there are more people in position to purchase insurance, then there will be undoubtedly be more companies looking at our state. Insurance companies need to know they can write enough policies to be profitable," Hall said.
Some of this will depend on how effective the mandate is to require individuals to purchase insurance if they are not covered by an employer, she said.
"I have heard people talk about the penalties are not adequate to see that it is enforced. We will have to wait and see how that operates," Hall said.
Premera Blue Cross, the major health insurer in Alaska, echoed that concern.
"This legislation does not have strong incentives for individuals to purchase and maintain coverage, thus increasing the likelihood of adverse selection, where many individuals will only purchase coverage when they are in need," Premera spokesman Eric Earling said in a statement. "That runs counter to the concept of insurance, where a broader pool of customers participates in the system. Our experience with such environments, including in Washington state in the 1990s, is that premiums soar and consumers eventually lose access to coverage. That is not desirable."
But federal healthcare reform has been about two things: expanding access and dealing with rising cost of medical care, Earling said.
"We've long supported reforms that would accomplish both goals," he said. "The legislation offers a mixed bag in terms of actual solutions. It will extend access to millions of more Americans. Taken in isolation that's a very good thing. It may also drive costs higher for our members and businesses we serve. We're very concerned about that."
Alaska Journal reporters Andrew Jensen and Sean Manget contributed to this report.
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