The expansion of Medicaid to cover the thousands of Alaskans in the “doughnut hole” of low income between existing Medicaid coverage and subsidies under the federal Affordable Care Act has long been popular in Alaska despite its association with a president with low approval in the Last Frontier. It was one of Gov. Bill Walker’s most successful issues in his campaign against former Gov. Sean Parnell. A recent poll found support of both the governor and Medicaid expansion surpass 60 percent among Alaska residents. Yet the Legislature is so opposed to passing Medicaid expansion — and accepting the great sum of federal help with medical costs that come along with it — that Gov. Walker is already openly talking about calling legislators back into a special session to deal with the issue. It’s unusual for elected representatives to be so far out of step with the will of the people.

Since January, the tide of calls and letters to legislators has been coming in encouraging the expansion of Medicaid to cover those who aren’t covered under the Affordable Care Act but who have slightly too much income to qualify under existing limits. Those Alaskans, who earn less than $20,000 per year, are clearly unable to afford even basic coverage. Communications to legislators on the proposed expansion have strongly favored the plan. In a now-infamous email sent to conservative activists earlier this month, Rep. Lora Reinbold, R-Eagle River, admitted she and other legislators were receiving about 30 pro-expansion communications for every letter or call in opposition.

Rep. Reinbold’s response to the tide of public sentiment, sadly, was not to consider what the many Alaskans writing and calling to support expansion had to say but to write to others who opposed the changes to Medicaid to urge them to step up their calls to committees hearing legislation. “We are trying not to get the number out to pro expansion for they are much more organized so give the number out cautiously,” her email read, urging recipients not to share the number on Facebook, where pro-expansion Alaskans might see.

What makes the Legislature’s opposition to Medicaid expansion harder to understand is its clear benefit to the state, as the costs of expansion are borne entirely by the federal government through 2016. The federal share of costs slowly declines to 90 percent by 2020 and remains at that level thereafter. If the federal government were to back off from that level of funding, Alaska would be free under Gov. Walker’s plan to end its participation in the expansion. Estimates by the state Department of Health and Social Services indicate the federal investment would result in $1.2 billion in salaries and benefits to Alaska residents in the next five years, an economic boost the state could surely use.

Legislators opposed to the expansion say because of the state’s eventual 10 percent reimbursement for the expansion, the state will end out paying millions of dollars for care to residents. This claim ignores the fact that Alaskans are already paying the full cost of that care indirectly — when uninsured people show up for care now, they aren’t turned away; rather, the costs of their care get rolled into higher premiums for the rest of us fortunate enough to be able to afford coverage. Wouldn’t it be better to have the federal government repaying Alaska for the vast majority of those costs?

Throughout the legislative session and in rallies across the state last week, Alaskans have clearly and repeatedly expressed their desire for expansion of Medicaid. It shouldn’t take a special session to convince lawmakers they mean business. It’s time for legislators to listen.

— Fairbanks Daily News-Miner,

April 19