The Dispatch’s Laurel Andrews wrote about what has been on the top of the minds of people who think about such things: Is it possible for Gov. Bill Walker to fulfill his campaign promise to immediately expand Medicaid given the numerous problems with the state’s Medicaid billing system? Taking the issue further, can Walker expand Medicaid-which would most immediately affect about 40,000 Alaskans–without legislative approval, and if he tries, what kind of repercussions might that have?
The answer to the first is no, according to Val Davidson, the new commissioner of the Department of Health and Social Services. According to the Dispatch article, the Medicaid billing system needs to be fixed lest the implementation of expansion be “sloppy.”
That’s likely to take a long time. Xerox has been working on upgrading the 25-year-old system since 2007. With Xerox’s assurances, the payment system went live in October 2013, and immediately problems ensued as a result of the 546 defects. In September, there were still 460 defects. Commissioner Davidson told the Dispatch that currently, there are 324 defects. All of which means that each month, tens of thousands of claims still aren’t being processed, and providers aren’t getting paid appropriately.
But even if the system were up and running, it’s still unclear if Walker needs legislative approval before expanding Medicaid. A legislative legal opinion indicates that Walker could take executive action, but the Legislature would need to appropriate any commensurate funds. Even though the feds have agreed to pay 100 percent of expanded cost of coverage through calendar year 2016, there will likely be other costs associated with implementation.
And then there’s the political question: Even if he could expand Medicaid with a snap of the finger, would it be smart to do so without legislative buy in? And is buy-in even possible?
Sen. Mike Dunleavy, who will be sitting on the Finance Committee, has to be convinced, he said. He also said that it would be “wise” of the governor to hear the Legislature’s concerns.
“We all believe that everyone should have good health care and that everyone should have access to good healthcare. Does Medicaid expansion do that? Are we going to be creating more problems? I’m doing my research,” Dunleavy said.
Sen. Peter Micciche echoed Dunleavy’s sentiment. “Conceptually I think we can get there, but I’m still carefully evaluating any potential hidden liabilities for the state,” he said. “There are obviously challenges and concerns that the last administration had that haven’t vanished.”
House Finance Co-Chair Mark Neuman, who’s meeting with Walker on Tuesday, says that he thinks that the Legislature and the governor can work together on expansion. In the last few years, Neuman has been in charge of DHSS’s budget and has been immersed in DHSS issues. He thinks that Alaska might be able to expand it in a way that works for the state.
“I don’t think it’s going to be as big of a boogeyman as some might think it is,” Neuman said.
It sounds very reasonable, and it might end up being that way. However, one thing that nobody brought up that will likely be a big struggle is the abortion issue that’s attached to Medicaid expansion.
Alaska’s state Supreme Court has made it clear that if Medicaid is going to pay for births, then it also must pay for medically-necessary abortions. Last session, the Legislature passed a law clarifying “medically necessary,” which might have ameliorated anti-abortion objections to expansion. However, the court system has ordered that the law be put on hold pending a challenge by Planned Parenthood of the Great Northwest.
According to the state’s Bureau of Vital Statistics, roughly 550, or 38 percent of the reported 1,450 abortions performed in the state in 2013 were paid for by Medicaid.
Contact Amanda Coyne at amandamcoyne@yahoo.com
You have it correct. The ANTHC is trying to get funding to provide transportation for its customers to the urban centers. This was stated a year ago at the “State of Reform” meeting in Anchorage. The proponents of Medicaid expansion also believe that federal money is free and it magically appears. The real number of beneficiaries who are uninsured is from 11,000 to 14,000. This does not include Alaska Natives and veterans because they already have health care. The media continues to use the 40,000 number that the ANTHC came up with.
That’s the dumbest thing I’ve read in the past week. Expanding Medicaid can’t happen over night. Maybe you’re nickname could be “ah ha, I’ve got another bad idea”
Our last governor was known by the nickname Captain Zero. I propose that our current governor have the nickname ‘Walk-Back Walker’ since his administration had to start walking back his biggest campaign promises on day one.
Walker has begun the “process” to get Medicaid expanded. Did anybody really think he could just sign a piece of paper on his first day in office and Medicaid would be immediately expanded? Clearly it’s not a quick process, but it’s not HIS fault the process isn’t instantaneous and it’s naïve of anybody that thought that was the case. I am very happy with our new Governor and appreciate him following through with this campaign promise.
Radical,
When I worked in the private sector my employer and I funded my health care and, like you, I also worked in the public sector when the taxpayer subsidized my health benefits. You can bet that the Federal and State budgets include the cost of employee health insurance subsidies.
As government employees, who funded that portion of our health insurance not directly funded by ourselves and, just as importantly, who paid for that “employer funded” amount other than those who pay taxes? These elected officials are, in fact, “employees” of the voters. These same voters pay taxes which funds the federal and state government who then provide provide health insurance to these officials. And this is not “government funded” health care? Also aren’t employee health benefit payments a business expense which entitles the employer to a tax reduction which is a form of government support for providing health benefits?
I don’t see the “bright line” between the two systems that you seem to see and at best I would recognize a “yellow apples”to “green apples” comparison.
ANTHC/ANMC et al are pushing hard to get IHS patients enrolled in Medicaid and want the program expanded to protect against the inevitable day when IHS funding gets cut back.
3 million Americans who are classified as American Indians or Alaska Eskimos get 100% free medical care and then some under a program that was passed in the ’20s. There is no time limit and no real qualification other than having some native blood. Look no further than the Palins – Todd is half so Bristol is quarter making her kid Tripp one eight. They all qualify.
Lynn,
You call it “government-funded” healthcare. I call it “employer-funded” healthcare. When I work in the private sector, the options provided to me and funded by the employer for me and my family are a consideration I weigh. When I work in the public sector (as I do at the moment), it is no different. You shouldn’t expect your employer to take care of my health insurance, and I don’t expect mine to take care of yours. Employer-funded insurance for government workers vs. Medicaid expansion for able-bodied, working adults employed elsewhere is an apples to oranges comparison.
Lynn, I don’t know who ‘lied’ in those instances or even if ‘lies’ were told. You’ve offered this as an excuse but not offered any specifics or proof.
It’s actually sort of childish don’t you think? Pointing your finger and saying ‘But, He Lied Too…’
Ah,
And who is responsible for the now very probable “lies” regarding gas pipe lines, bridges across Knik Arm, roads from Juneau, a Susitna dam, and other claims of politicians.
Motion should not be confused with actual progress and , as with expansion of Medicaid and a rural energy emergency, all we have with any of these promises is motion.
All these legislators who seem to be against expanding Medicaid are provided government funded health insurance for themselves and their families. I hope they will reflect on that fact before they began to rant about the”communism” of government provided health insurance.
Nobody wants to be sick and health care for the uninsured will cost the state in any event. Sick people do not prosper as do healthy folks. While government has an obligation to protect private property, it also has an obligation to provide opportunity for citizens to prosper.
@Anonymous, either way it’s a lie.
I am very suspicious that a significant portion of the people who would be covered under this expansion are Indian Health Service beneficiaries who are already receiving health care benefits from IHS as a result of a treaty obligation. All one needs to do is walk down the halls at ANMC or SEARHC to see the plethora of posters promoting Medicaid.
If this is true then what is really happening is IHS and it’s derivative organizations are attempting to double dip funding.
Why did Walker make two promises that he couldn’t deliver on – Mediciad and energy state of emergency? Either he hasn’t given much thought to the details and just told Alaskans what he thought they wanted to hear or he lied to us. Not good. Alaskans are going to find out that however well intentioned Walker may seem, the best that could be said is he didn’t know what he is talking about on the campaign trail.
The legislators you quote sound entirely reasonable and fair to me. It would be the poorest of judgement to disregard their questions and concerns. Moreover, at this point Representative Neuman knows the department budget better than the governor and the commissioner do combined.
Government begins programs with ease and only ends them painfully. Just how many Alaskans that are not covered by socialized medicine in all its forms would be covered by the proposed Medicaid expansion? Do we have recourse if it happens that the federal government leaves us to pay for this at exactly the same time that the state operating and capital budgets have been reduced by 35% or more compared to current levels? Is this proposed expansion some sort of scam to pass costs now paid by the BIA on to the state (as some bloggers say)?