If you had $23 million, would you trade it for a guaranteed $1.1 billion? What if you had real confidence that there were "no strings attached" and completing the trade would help thousands of people?
The Alaska Native Tribal Health Consortium (ANTHC) published a commissioned report from the Urban Institute and Northern Economics, Inc., on the benefits to Alaska of expanding Medicaid as allowed through the Affordable Care Act. The report suggests that for just $23 million in the "out year" (2020), the state of Alaska will receive additional Medicaid revenue of $1.1 billion.
At issue in this debate is whether the governor should accept $1.1 billion in federal monies appropriated to cover an expanded Medicaid-eligible population. Unlike in other debates raging across the state (the Senate Bill 21 oil tax reduction, or whether to develop the Pebble prospect), I have heard no serious arguments in opposition to Medicaid expansion. The state would immediately halve its population of uninsured citizens if these monies are accepted and it would pay precisely nothing in the process. The newly insured would be our friends and neighbors earning in the range of $19,803 for individuals to $26,744 for two-person families. 41,500 people, now without health insurance, would receive it. The study commissioned by the ANTHC concludes that 4,000 people would be employed from the infusion of Medicaid dollars into the state's economy. New wages and salaries would generate an additional $1.2 billion into the state.
The newly covered would be citizens incurring medical bills that Alaskans won't need to pay, indirectly, through increased premiums, as presently happens. (According to the Alaska Journal of Commerce, Alaska hospitals lost $178 million in bad debt in 2010 alone). Expenses to Alaska businesses would be reduced, since the ACA requirement that some employers cover their employees would disappear -- many low income employees would now be covered by Medicaid. ANTHC's commissioned report actually concluded that, in some cases, people that would otherwise die without health care, will survive with this coverage. At issue, then, is the very life of some Alaska citizens.
Interestingly, because the authors of the Affordable Care Act did not believe the Supreme Court would conceivably reject that part of the ACA that called for a mandatory expansion of the Medicaid plan, the legislation leaves uncovered those individuals who might otherwise have been eligible to apply for coverage through the online marketplace (or required to do so, depending upon your political perspective). In short, these expanded Medicaid-eligible Alaskans are deemed too poor to reasonably purchase health insurance through the law.
I noted that there should be little serious dispute as to the question of Medicaid expansion. Conservative legislators have suggested that the federal government simply cannot afford the ACA, let alone the Medicaid expansion.
First, because of the Supreme Court's ruling, these are separate and distinct questions. Those who oppose "Obamacare" can continue to hold that position, and simultaneously see the obvious and clear wisdom in expanding Medicaid here in Alaska. This is precisely what tea party-supported Republican governors have done, including Gov. Jan Brewer in Arizona, Gov. Jon Kasich in Ohio and Gov. Dan Snyder in Michigan.
Second, it is disingenuous in the extreme to take a purist's philosophical stance and reject $1.1 billion in Medicaid revenue. This is especially obvious when one considers that no one -- including the most ardently conservative Alaska public official -- argues that Alaska should turn away the federal COLAs we enjoy, federal highway monies, or shutter our military bases. Any such suggestion would result in a significantly shortened political career, while being bad for Alaska's economy were those wishes to be realized.
The arguments in support of accepting additional Medicaid dollars, both economic and moral, simply swamp the arguments in opposition. If he wishes, the governor can genuinely take cover in continuing to oppose "Obamacare." The Medicaid expansion question, however, is a distinct and separate question.
I ask again, is paying $23 million for $1.1 billion a smart trade? I pray that common sense and wisdom will prevail and the governor will answer, "yes" by his mid-December deadline.
Andy Josephson, D-Anchorage, was elected to the state House of Representatives in 2012.