Kicked from the Medicaid card game
As most citizens know, the Alaska legislature, in good faith, has spent countless hours exploring the campaign ideas put forth by the current governor to expand Medicaid, which are in direct conflict with promises made by many legislators to reduce government dependency.
Throughout the process, it became apparent that the current Medicaid program is filled with systemic errors which result in abuse and require meaningful reform.
Additionally, it was impossible to wade through the inconsistent financial projections which would accompany an expansion of this nature. At the end of special session, there was a mutual agreement by both the Governor and the legislative body to allocate financial resources in order to come back to the table with meaningful, substantiated fiscal projections and necessary reform to ensure viability of the program.
Fast forward to Thursday, July 16, 2015, Governor Walker made an unprecedented unilateral decision to usurp the process and void the agreement with the legislative branch.
We are in a serious financial crisis, withdrawing billions from savings this fiscal year, and the state’s fiscal situation does not seem to be looking rosy, anytime soon.
At best, this expansion may be a temporary financial benefit to the state at the expense of taxpayers, followed by an intensified fiscal budget crisis.
The financial impact on Alaska’s known revenues will be substantial. Increased mandatory medical costs to the State will put any other mandated services such as K-12 education funding, pensions, safe infrastructure etc, in serious jeopardy.
1. Some federal funded facilities are the biggest beneficiaries of the expansion because they get paid a much higher flat rate than the private sector physicians for an office visit (up to ten times more).
1. Veterans and the elderly will be at greater risk because the newly eligible group of childless adults, under Medicaid expansion, will have a higher reimbursement rate for medical care, than Tri care or Medicare in many cases.
2. There will likely be an increase in premiums for the private sector because an additional pool of people will get full government coverage, leaving a smaller group of private sector consumers to spread out risks/costs in the private sector.
3. There is not an “identified” revenue source for this expansion going forward, which will put every Alaskan’s pocket book at risk, requiring state taxation on the working class, almost definite.
HB 84, the federal receipts Accountability Bill I sponsored, would help with long term solutions. This bill would require all state agencies and municipalities to reveal federal dollars they receive and require them to have a plan to cover program costs or adjust their fiscal plan when federal receipts undoubtedly, dry up.
It is extremely unfair to burden Alaskans with expansion without proper vetting by the legislature, the people and first put critical reform measures put in place.
To gain any buy in from the skeptics, meaningful reform must take place first! Some reforms being considered include: recipients need to have “skin in the game” including higher co-pays or mandatory volunteer hours to help give back to society, implementing mandatory drug screenings in addition to time limitations so the program does not continue to expand.
If we so desperately want federal dollars back into the state we should accept funds as block grants, and improve our existing clinics in the state and gain support from the providers on how to fix Alaska’s unique healthcare needs.
We must tighten our fiscal belt first before considering taking on greater long term fiscal commitments under Medicaid expansion which would surely put our bond rating at greater risk.
Ultimately, without fixing the existing Medicaid problems is equivalent to building a second and third floor on a defective foundation. We are prone to a Medicaid earthquake!
In the end, these are concerns many legislators including myself have regarding Medicaid in Alaska. The governor, with his arbitrary actions have excluded us from the Medicaid card game. The wild card is your PFD.
Reinbold is the state representative for Eagle River. See story on expansion on page 10, and more op-eds on Medicaid expansion are on page 6.