Health bills may hurt some Alaskans, consultant says

REFORM: Older residents could have more trouble seeing doctors.

December 10, 2009 

The health care reform bills before Congress that would extend insurance coverage to tens of thousands of Alaskans who are uninsured wouldn't necessarily be good for all Alaskans, according to an economic consultant who is tracking the health bills for the University of Alaska.

The bill passed by the U.S. House Nov. 7 could make it harder especially for older Alaskans on Medicare to get in to see doctors -- and it could hurt Alaska's economy if Alaskans have to pay more taxes for medical care but get less back, says Mark Foster, a contract consultant for the Institute for Social and Economic Research, an arm of the University of Alaska Anchorage.

He analyzed the House bill, and has some observations about the Senate bill that's center stage now, but can't tell yet how the Senate version would affect most Alaskans.

Assuming the Senate passes a bill, a conference committee would attempt to craft a compromise between the House and Senate bills.

Foster's report, and a Congressional Budget Office report on the effects of the bill proposed in the Senate, give a sense of who might benefit, and who could be hurt.

MEDICARE PATIENTS

Foster believes Alaskans who use Medicare, the federal insurance for senior citizens, will be harmed if the House bill prevails. Many seniors already can't find primary-care doctors who will accept Medicare because it pays doctors below Alaska market rates, and even below the rates paid by the joint federal-state Medicaid insurance available to low-income people.

In most states, Medicare pays better than Medicaid.

Both House and Senate bills call for expanding Medicaid coverage.

"... if the proposed Medicaid expansion and public option are available to previously uninsured ... Alaskans, thousands of additional Alaskans will essentially move ahead of Medicare beneficiaries in line for health care," Foster wrote.

MEDICAID PATIENTS

If Medicaid is expanded, more Alaskans would be eligible for the government-paid insurance.

But Foster says such expansion, and the House proposal to establish a new government-sponsored insurance program called the public option, would likely drive up medical care costs in Alaska.

"If costs for health personnel grow and reimbursement is squeezed," health care professionals may leave, or not be attracted to the state in the first place, he said.

UNINSURED PEOPLE

Foster estimated one version of the Senate bill would increase the number of Alaskans with health insurance by 65,000 in 2016, when the law would be fully in effect. It would mandate that most legal residents of the U.S. obtain health insurance, and would set up insurance exchanges through which many people could get government subsidies to buy it.

The percentage of uninsured people would drop roughly from 16 percent of the residents to 8 percent, he said.

However, the provisions included in the Senate bill are changing, which could change how many of the uninsured get insured.

EMPLOYER INSURANCE

The Congressional Budget Office report on the Senate proposal says that nationally the cost of health care premiums for either small businesses or large would remain about the same with or without the Senate bill.

However, Foster says the House version would stress Alaska's small employers with a mandate to provide employee health insurance. That provision "could be especially disruptive to Alaska, compared with states that have lower costs and fewer small employers," Foster wrote.

INDIVIDUAL INSURANCE

Alaska's two U.S. senators have produced dueling press releases on how Alaskans with individual insurance would fare under the Senate bill.

Health insurance premiums for this group would generally rise 10 percent to 13 percent nationally, but more than half the people would be eligible for government subsidies to buy the insurance. For those people, costs generally would drop.

Republican Sen. Lisa Murkowski said nearly 28,000 Alaskans -- an estimate of the pool of people who have individual insurance policies -- would see premiums rise. Premiums wouldn't rise for the portion of that group that gets subsidies. Foster said he doesn't have a feel yet for how many people that would be in Alaska.

Democratic Sen. Mark Begich put out a press release saying people with individual policies in Alaska could see premiums shrink. He was talking about people who already have decent individual health care coverage and could get the same level of insurance for less.

Many people with individual plans have bare-bones coverage. They might have to pay more, with insurers being required to upgrade the plans.


Find Rosemary Shinohara online at adn.com/contact/rshinohara or call her at 257-4340.

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