Alaskans on Medicare should gain from health care reform

Meeting Tuesday with reporters in the Capitol, Rep. Les Gara of Anchorage and other minority caucus Democrats said the health care overhaul opens the opportunity for states to supplement federal Medicare payments out of their own budgets.

That's critical in Alaska and a few other states where Medicare reimbursement rates, mainly for office visits, are far below the private insurance scale and also less than the break-even point for medical professionals, Gara said.

Gara described the fix, inserted into the health bill by Sen. Mark Begich, D-Alaska, as the "Plan B" option. Plan A would've been simply more federal money.

"Sen. Begich, and before him Sen. (Ted) Stevens, tried to increase the Medicare reimbursement rate that the federal government provides. Sen. Stevens had some success, but not enough," Gara said. "Sen. Begich's Plan A got filibustered." The overhaul removed a federal law that banned states from supplementing Medicare payments. The new law says that if states decide to provide Medicare reimbursements, they have to do it from funds that have not been co-mingled with Medicaid, the federally supported health care program for people with low incomes.

With Alaska's share of Medicaid spiking -- it's expected to top $1.2 billion this year -- getting a majority of legislators to agree to spend additional money on Medicare could be a difficult task, though seniors across the economic spectrum would be the beneficiaries and they comprise a potent voting bloc.

Gara acknowledged it's late in the legislative session to bring up the question, especially when he has no idea how much money would be required. He said a $20 or $30 supplement on average for each recipient's office visit would probably allow clinicians to break even, and $60 or $70 would allow them to make a profit.

The House Finance Committee co-chair, Rep. Bill Stoltze, R-Chugiak, said he was interested in hearing more, but wasn't prepared to go further.

As it is, a University of Alaska survey last year found that only one in four primary care doctors in Anchorage and the Mat-Su would accept new Medicare patients. Some doctors tell their patients turning 65 to go elsewhere.

Stoltze and his co-chairman, Rep. Mike Hawker, R-Anchorage, already support providing state funds to a proposed nonprofit primary care clinic for seniors that would hold down costs by using a single full-time physician, with nurses and part-time doctors filling out the staff. Stoltze predicted the final capital budget would contain a grant for the clinic, which was seeking $1 million.

A bill that would set up a statewide clinic program has had no hearings and appears to be dead. It was introduced by three House Democrats from Anchorage -- Gara, Sharon Cissna and Lindsey Holmes.

Cissna, for eight years a member the Legislative Health Caucus and an advocate for the estimated 133,000 Alaskans who have no health insurance, said she was thrilled that President Obama had signed the health care bill shortly before the morning press conference.

"There's a plan -- there's a health plan," she said. "I'm still shaking with excitement over that."

Other legislators had quite a different reaction.

During a meeting with reporters of majority caucus senators, Sen. Charlie Huggins, R-Wasilla, said he's been talking to the governor's office and the attorney general about suing the federal government to stop the health care overhaul.

"I have a lot of constituents that are very concerned about that issue and I share their concern," Huggins said. "It's the relationship between the state and the federal government and states' rights, and I have to come down on the side of states' rights just about the majority of the time, every time. The business of mandating that my son, daughter or wife has to have insurance -- I'm not so sure that I want to sign up for Mr. Obama, no matter how he signs the bill."

If Huggins favored a state approach over a federal one, he was asked, what has the state done to see that uninsured Alaskans could get medical coverage?

"I will get you an answer to that comprehensively," he said. "We've taken a number of actions." By Tuesday evening, he hadn't provided such a list.

Gara said the talk of lawsuits was political posturing.

"You can spend as much of the public's money on lawsuits as you want -- it's not going to change the fact that Congress passed a bill," he said. "I suppose if folks in this building want to get votes by pretending to file a fake lawsuit, go ahead. But at some point we have to move ahead and get a gas line going."