On Thursday morning, Gov. Bill Walker announced Alaska will become the 30th state to accept Medicaid expansion under the Affordable Care Act. The governor’s unilateral move, taken after the Legislature declined to act during their regular session and two special sessions called afterward, won’t likely win him friends in the Alaska House and Senate majority caucuses. But providing a health care option for 20,000 of the state’s most at-risk residents is worth taking some political heat.
After the Affordable Care Act’s adoption in 2010, states had the option to accept an expansion of Medicaid that would extend eligibility for the federal program to those earning as much as 150 percent of the federal poverty level wage. But if states chose not to expand Medicaid, it created a hole in the health care coverage the reform was supposed to provide. Those earning less than poverty-level wages were already eligible for Medicaid, and those making wages of more than 150 percent of the poverty threshold had to pay for private coverage but were eligible for subsidies to defray the cost of those plans. But those between 100 percent and 150 percent of poverty wages were caught in between — without Medicaid and also without subsidies that would render private insurance affordable. In Alaska, there were more than 20,000 state residents in that position.
Gov. Walker campaigned on a promise to expand Medicaid, and brought it to legislators in January as one of his top priorities. But plans for expansion were stymied by the legislative majority caucuses, whose members slow-walked the issue over concerns about the feasibility of expanding the program and fears the federal government would eventual renege on its plans to pay for the lion’s share of expansion costs.
These fears aren’t wholly without merit — Xerox, brought on to manage upgrades to the state’s Medicaid billing, had all manner of trouble. The company made such a hash of the new system initially that providers were waiting several months for payments, leading the state to file suit against them in 2014 over delays and poor implementation. Over the intervening year, however, the state Department of Health and Social Services says Xerox’s system has improved significantly, with new claims being serviced in fewer than 10 days on average and more than 90 percent of claims being paid successfully upon the bill’s first submission. The state is continuing its suit against the company to ensure the remainder of issues with the company are successfully resolved.
But opposition from majority caucus legislators seemed to stem largely from partisan political divides, whether due to a fundamental philosophical opposition to legislation drafted by President Barack Obama or differences with Gov. Walker. Rhetoric on the issue in legislative hearings was often distressingly similar to talking points distributed by national political figures.
Perhaps more disappointing was the utter lack of urgency given to the issue by state lawmakers who dragged their feet at every step of the process, speaking strongly against Medicaid expansion but offering no alternative that would provide any kind of assistance to the more than 20,000 Alaskans living without any way to pay for health care. Legislators who were only too happy to accept federal funds for projects such as the Juneau road, the public benefits of which are dubious at best, suddenly became reluctant when those dollars were for health care instead.
If there’s a knock on the governor’s acceptance of Medicaid expansion, it’s that his unilateral move may widen the rift with leaders of the Legislature’s majority caucuses, who opposed the action. That could make dealings more difficult during next year’s legislative session, when the governor and legislators will have to make hard decisions about balancing the budget.
But Gov. Walker was more or less backed into a corner — Medicaid was one of his biggest priorities, and legislators had given him little hope they would act on the issue in any kind of reasonable time frame.
Most importantly, acting to secure health care for 20,000 Alaskans was the right thing to do, and good leaders shouldn’t hesitate to do the right thing because of the political consequences.
— Fairbanks Daily News-Miner, July 17