JUNEAU -- Gov. Sean Parnell vowed Thursday to work to shift back to the federal government costs associated with implementing President Barack Obama's health care overhaul.
Parnell told reporters that Thursday's U.S. Supreme Court decision upholding the overhaul "should rally Americans to action and galvanize support for congressional change." Tweets issued from his Twitter feed on the issue included the hash-tag "FullRepeal."
Alaska was among the states that had challenged the constitutionality of the law, particularly a provision requiring that people buy insurance or pay a penalty.
Chief Justice John Roberts explained the court's view of the mandate as a valid exercise of Congress' authority to "lay and collect taxes." State Republican leaders seized on that characterization, with Parnell calling the provision a tax on the working poor and middle class, and U.S. Sen. Lisa Murkowski and Rep. Don Young seeing it as another reason to repeal and replace the law.
U.S. Sen. Mark Begich, a Democrat, said the law is not perfect but the status quo wasn't an option either, with health care costs rising and insurance companies "in charge of escalating those costs." He said he looks forward to the state working toward implementing the law. "It is time to move past the politics and come together to make the law work for Alaskans," he said.
State Sen. Hollis French, D-Anchorage, agreed, saying the state should not wait until the November presidential election -- or to see what Congress might do in response to the court decision -- to act.
"You have a law in place that's now been upheld," said French, who has spoken in support of the law and encouraged Parnell to move ahead on provisions like a health care exchange. "As good public servants, you need to work with the rules as you find them."
State officials were still reviewing the decision and Parnell said it could be months before the state knows how it will proceed with provisions like Medicaid expansion and a health care exchange. He said timing on a decision wasn't tied to the election but on understanding what the decision means for Alaska.
When it comes to individual freedom and the insurance mandate, "we may have lost the battle but we're not going to stop fighting," he said.
Parnell said he remains concerned about the impact the federal health care law will have on individual and states' rights, and, where reasonable, he wants to shift back to the federal government costs that are being imposed on Alaskans.
The state earlier this year hired a consultant to help design a health insurance exchange, or marketplace for coverage options. Part of the consultant's charge was to evaluate such things as the cost of the exchange and its effect on the market. A final report is expected soon.
Josh Applebee, deputy director for health care policy for Alaska's health department, has said states have until January to certify they're able to establish an exchange.
Under the federal health care law, the government could step in and establish exchanges in states where none exist.
Parnell said one of the options the state will consider is whether to let the feds do so -- an option in line with the idea of shifting costs back to the federal government.
The court also held that states can't lose existing Medicaid funding if they don't expand their Medicaid coverage levels for adults to 133 percent of the federal poverty threshold beginning in 2014. A January 2011 state report, providing a long-term forecast of Medicaid enrollment and spending in the state, estimated an expansion would cover an additional 32,000 people at a cost of nearly $220 million, starting in 2014.
The report says the federal government would cover the cost for the first three years, with the state contributing toward the cost of the newly eligible individuals after that.
"Free is never free," Parnell said.
He said the program, as it stands, continues to grow and he said he would like more flexibility from the federal government in handling Medicaid.
A look at the health care law in Alaska
NUMBER OF UNINSURED: 125,000 state residents are uninsured, or about 18 percent.
WHERE THE STATE STANDS: Alaska, which is among the states that sued over the constitutionality of the federal health care law, has yet to implement a health care exchange. The health department has hired a consultant to help design one and that report is expected soon.