The story of Alaska and Montana is not front and center in the health care debate in the House. But it should be.
Montana does not get a vote. (The state does not currently have a member of Congress after former Rep. Ryan Zinke was confirmed as Secretary of the Interior.)
And Alaska ends up with legislation that is by all measures, a raw deal. No state (and no pool of voters) will lose more under the Republican replacement for the Affordable Care Act than Alaska.
Alaska only expanded Medicaid in 2016. But the program has been a success. As Chris Ashenbrenner wrote in the Anchorage Dispatch News: “Expansion is a bright spot in a dismal Alaska economy. Over 25,000 people now have health coverage at no cost to the state of Alaska. Alaska health care providers have received over $288 million in revenues since it started in September 2015.”
One reason for that is the role Medicaid plays in funding the Indian health system. Recent changes (promoted by Alaska Gov. Bill Walker) resulted in “a change to their policy resulting in even more Alaska general fund savings — projected to be over $30 million this year and growing each year. By 2022, it’s estimated to be over $90 million. This would not have happened without expansion.”
Alaska Health and Social Services Commissioner Valerie “Nurr’araaluk” Davidson recently told a state legislative committee that the American Health Care Act does not save money but shifts costs to the states. would shift the cost of health care to states.
“I get nervous every time I hear a member of Congress talk about the great savings to the Medicaid program, because what they’re saying is, it’s a savings to the federal government,” Davidson said on Alaska Public Media. “They’re not saying it’s a savings to states – they’re actually shifting that cost to states, and that’s a problem for Alaska.”
But that’s not the only problem for Alaska. The Republican plan to give taxpayers a flat rate subsidy to purchase individual plans will mean that Alaskans would pay far more for insurance. “That’s because unlike the ACA’s tax credits, the House plan’s tax credits wouldn’t adjust for geographic variation in insurance premiums,” according to the Center for Budget and Policy Priorities. “They’d be the same for a 45-year-old consumer in Alaska, where benchmark health insurance coverage costs $12,600 this year on average, as in New Hampshire, where it costs $3,600.” The total bill: A whopping $10,500 more for a health insurance policy in Alaska.
Watch Rep. Don Young in the House debate. Alaska’s only member of Congress will likely demand a special deal from the House leadership. If not, will he still vote for the bill? Young told Alaska Dispatch News that he’s undecided. And on Facebook today, Sen. Lisa Murkowski will brief Alaskans on the legislation.
A poll published by FiveThirtyEight shows that 45% of Alaskans oppose the House bill, and 33 percent strongly oppose the legislation. It’s a similar story in Montana where 43 percent oppose the bill and 31 percent would strongly say no.
Montana, like Alaska, has a short experience with Medicaid expansion. But the numbers are strong. Montana Public Radio reported after seven months the program was nearly double the projected number of people insured. “Recipients have used their benefits to get $75 million worth of health care, 100 percent paid for by the federal government. That’s a big windfall in this state with slightly more than 1 million residents,” Montana Public Radio said.
Medicaid and Medicaid expansion are a critical, and growing, source of funding for the Indian health system.
Cross-posted from Trahantreports.com
Mark Trahant is the Charles R. Johnson Endowed Professor of Journalism at the University of North Dakota. He is an independent journalist and a member of The Shoshone-Bannock Tribes. On Twitter @TrahantReports