Here is a sampling of editorial opinions from Alaska newspapers:
Nov. 24, 2013
Fairbanks Daily News-Miner: Medicaid decision not best course
Gov. Sean Parnell’s skepticism about the Affordable Care Act is understandable, given that recent breakdowns in its structure are following the predictions that skeptics have long put forward.
However, the governor’s decision not to seek an expansion of Medicaid can’t be well enough justified by the law’s broader troubles. Expanding Medicaid in Alaska to cover all low-income adults would be a good policy regardless of the other difficulties in the national health care law.
The expansion made sense for Alaska for a few reasons. First, it would avoid forcing Alaska to subsidize other states with no return to itself. The federal government will pay the vast majority of the bills in states that do expand Medicaid. So, without a similar expansion here, Alaska’s residents and businesses would be paying the taxes to provide Medicaid to those states that do expand services, while seeing none of the money come back here. If we don’t expand, we’ll see a net drain of tax money to other states.
Of course, this assumes that the federal government actually would cover the expansion costs in Alaska and other states. Parnell has expressed doubts about whether Congress could afford to do so. That, again, is a reasonable fear. Federal deficits, while declining, are still mind boggling and need to be reduced. The proponents of the Affordable Care Act say its increased costs, such as the Medicaid expansion, won’t contribute to the deficit, but that assertion relies in part on a big assumption — that the federal government will cut billions from Medicare (which pays for health care for Americans over 65) by dialing back reimbursements to doctors and hospitals. Those cuts will be opposed vigorously and perhaps successfully in Congress.
Nevertheless, the state could expand Medicaid while also compensating for the uncertainty. It could make the expansion contingent upon the federal payments materializing. That’s the path that the Alaska State Chamber of Commerce recommended. It wouldn’t be ideal, but it would protect the state’s budget.
The second reason for expanding Medicaid is just a matter of fairness. The Affordable Care Act offers sliding-scale subsidies to purchase health insurance for those people whose incomes range from 100 percent to 400 percent of the federal poverty level. Under the original law, Congress assumed those who made less would be covered by expanded Medicaid. But that assumption rested upon another: that states would expand Medicaid to cover all people below the poverty level (not just primarily parents, children and disabled people, as the program exists today). When states decline to expand eligibility to all poor people, it creates the bizarre situation in which middle-income families have their health care federally subsidized but some who are truly poor do not.
Gov. Parnell, in an op-ed piece published here Nov. 16, said Obamacare is unraveling. Indeed, when President Obama today back-pedals and promises to deliver on his broken campaign promise — that if you like your plan, you can keep it — he’s undermining a key policy that makes the law work, in theory at least. That key policy is the requirement that young, relatively healthy people buy a mandated level of insurance. If the law doesn’t force those cheaper people to buy the more expensive, broader insurance plans, the people left buying those plans will have to pay a lot more for them, which will increase opposition to the law.
Whether that opposition is enough to unravel the law isn’t yet clear. And even if other aspects of the law do unravel, the Medicaid question can still be considered as a stand-alone. Given that the governor has made up his mind, though, perhaps it’s time for the Legislature to take up the issue.
Nov. 20, 2013
Anchorage Daily News: Governor wrong on Medicaid
Gov. Sean Parnell had a chance to help as many as 40,000 Alaskans to secure health care insurance.
Instead, he gave them an advisory commission, a promise and a claim that Alaska can do better.
Parnell had a chance to rise above ideology and his own deep opposition to Obamacare and do what was best for Alaskans.
Instead, he took the opportunity to once again condemn Obamacare and use its woes as an excuse not to help Alaskans.
The governor had a chance to lead. Instead he chose to react.
On Nov. 15, Parnell announced that he would not sign on to Medicaid expansion, citing the costs and his lack of faith in the federal government to keep its commitment about covering all of the costs for three years and 90 percent thereafter.
The governor seemed to be leaning the other way after several prominent Alaska organizations, from chambers of commerce to AARP, urged him to reconsider his opposition. No doubt President Obama’s bogus claims about who could keep their policies and the wretched performance of the website emboldened Parnell, who wrote in a “Compass” that Obamacare is unraveling.
That may be wishful thinking on the part of Parnell, who has opposed Obamacare every step of the way. Clearly, Obamacare needs work. But Parnell’s decision isn’t about Obamacare. It’s about his refusal to provide better access to health care for thousands of Alaskans.
That’s real, that’s available. Or was available, until Parnell said no.
The governor easily could have put safeguards in a decision to accept the expansion. Alaska’s participation could be made contingent on the feds keeping their word on their share, giving the state freedom to opt out if Uncle Sam didn’t follow through. That’s what Republican Gov. Jan Brewer did in Arizona.
Parnell could have accepted this care for Alaskans and meanwhile set out to prove, rather than just claim, that Alaska can do better. Medicaid expansion is voluntary for the states. So take it until we come up with a better system, then make the transition.
He would have been putting Alaskans first, making sure they had swift, effective access to health care while he worked to do better than Obamacare. That’s a position that Alaskans across the political spectrum could support: Do right by the people you serve, and then do even better.
Even if Parnell is right, that Obamacare is a “failed experiment” just waiting to die, how would it then hurt to provide even a few years of coverage for thousands of Alaskans? Yes, politically it would be hard to take that coverage away. But in the meantime, an Alaskan could get her child in to see a doctor, a bad tooth wouldn’t have to become oral surgery. It’s necessary to think in the long term. However, people live day by day, not by fiscal years and committee schedules.
Further, if the governor is serious about filling those gaps in Alaska’s health care coverage, we wouldn’t need to take coverage away. By mid-2015, according to his own timetable, we’d be on the verge of something better. Why make thousands of Alaskans wait? Why keep jacking up hospital bills and emergency room costs? Why turn down a tremendous return on investment and more health care jobs?
This was a reactionary decision, one that reflects a greater dedication to ideology than to the people of Alaska.
This was the wrong decision.