Alaska senators follow party lines in health care vote

They're of split opinions on the legislation, which will cost an estimated $1 trillion over 10 years and expand health care coverage to an additional 30 million Americans.

"I don't think this is the positive change that people were hoping for," said Republican Sen. Lisa Murkowksi, who voted against the bill in what was a party-line decision early this morning.

The vote was 60-39.

But Sen. Mark Begich, a Democrat, said he believes the legislation will be good for Alaskans and the rest of the country. He's especially proud of provisions that he says he thinks will help keep insurance companies honest, beginning with prohibiting insurers from excluding coverage of pre-existing conditions. That will be phased in over time, but for children, it will take effect immediately.

Begich also said he's pleased there are stronger requirements for insurers to spend a greater percentage of the premiums they collect on patients, rather than administrative costs or profits.

"That's what I heard from people in Alaska, that 'we just don't want to be jacked up anymore by insurance companies,' " Begich said.

There are a number of Alaska-specific provisions, as well, Begich said.

Three hospitals -- in Soldotna, Juneau and Sitka -- will continue for another five years a pilot program that allows them to offer round-the-clock emergency medical care to Medicare patients. The program was expanded, Begich said, so that as many as 30 other rural hospitals nationwide can qualify for the program, too.

Also, the bill expands the loan repayment rate for National Health Service Corps providers who elect to work in areas they're needed. The legislation expands the loan forgiveness amount from $35,000 to $50,000 annually. Many of those providers will end up in Alaska, Begich said.

"I wish I could measure what this means in total value, that I could say it's going to save 'X' billions," he said. "But what it will do is when you add a supply of this magnitude on the table, of more primary care providers, it will have a dramatic impact in delivery of service."

Begich said he wasn't wooed with state-specific provisions in exchange for his vote on the legislation. One recalcitrant senator, Democrat Ben Nelson of Nebraska, has been criticized for exchanging his vote on the measure for the promise that his state won't ever have to foot the bill for expanding Medicaid to poor people.

"I have a different view of how to do the politics here," Begich said. "I think some of that style, I'm not very comfortable with and don't necessarily like."

"We did it in a way that's about policy rather than these special deals," he said. "If I do something like this, I want to make sure not only it affects me, in the sense of our state, but it affects other states. Why? Because then I get allies and I'm not on the front page of the paper getting just one item for just my state."

The legislation also allows for the creation of the Alaska Health Care Task Force, which will be empowered to take a look at state-specific problems with health care. They'll be looking at the intersection of the care provided in Alaska for its veteran population, as well as the Medicare reimbursement rates that have led many providers to drop older patients because they don't believe they're paid enough for their care.

Murkowski said because the final version of the bill only surfaced Saturday morning, she doesn't feel as though there has been enough time to examine the full implications of 2,000-plus pages of legislation. Mostly, she has concerns about the cost of the measure and what it means for the federal deficit.

But she also has some specific concerns, including a provision of the bill that requires all employers of 50 people or more to provide health insurance or be penalized -- except for construction companies, which must provide insurance if they have five or more employees. That could adversely affect Alaska, Murkowski said.

Murkowski said she does like parts of the bill, including portions that focus on wellness and preventive medicine that she worked on as a member of the Senate Health, Education, Labor and Pensions Committee. She also is pleased that the legislation reauthorizes the Indian Health Care Service. That reauthorization had passed the Senate but stalled in the House of Representatives, and it was a priority of both Alaska senators.

But Murkowski said in general, she is concerned the Senate will be passing legislation with support from just one party.

"I think it's very unfortunate that with an issue of this magnitude and this importance that we have not been able to come to a resolve that would garner bipartisan support," Murkowski said. "As I understand it, this is the first real major piece of legislation that the Senate has ever passed -- that the Congress has ever passed -- where it is a straight partisan vote. And I don't think that that's good for the country. I don't think the vote is good for Alaskans."