Compass: Alaska can only gain by Medicaid expansion

By JOHN RILEYDecember 30, 2013 

Mr. P is 45 years old and works as a janitor. Mrs. P is 49 years old and has several chronic medical problems including diabetes, depression and rheumatoid arthritis. She is able to work a few hours per week as a hotel maid. The number of hours Mrs. P can work is dependent on her arthritis and depression symptoms. The arthritis is no longer controlled with generic medications, and she needs more expensive brand name drugs to control her symptoms and allow her to work. However Mrs. P is uninsured and unable to afford them.

Mr. and Mrs. are my patients at a community health center in Anchorage. Mr. and Mrs. P qualify for sliding fee medical services due to their income. Unfortunately while community health centers are able to provide a wide range of family practices services, they do not provide specialty care or hospital services. Uninsured patients are on their own to pay for the high cost of ongoing specialty care, medications and hospital services. Mr. and Mrs. P get assistance with food from the Food Bank and their church. Mr. and Mrs. P don't qualify for Affordable Care Act health insurance because their income is below the Alaska poverty level. They were supposed to be covered by the expansion of Alaska Medicaid to include the "invisible poor," those below the poverty level who don't have dependents and are not disabled. However, the State of Alaska recently chose not to expand Medicaid services to cover the 43,000 low income Alaskans like Mr. and Mrs. P.

I have worked for 25 years in community health centers. Many of my patients struggle to provide for themselves and their families. Every one of them is pursuing their version of the American Dream. But despite our iconic belief in equal opportunity, not all of us have equal access to upward mobility. Those who began their lives in poverty tend to stay in poverty. Those with access to resources have the door propped open for them to succeed.

A gulf in understanding has developed between the haves and have-nots. Those who were born with resources are unfamiliar with the reality of the energy and time required to meet the basic needs of housing and food that the rest of us take for granted. Unfortunately we have entered a phase in our culture where this lack of familiarity has led to blaming those in need and the belief that helping them fosters dependence. Compassion has become a cultural casualty.

I propose a different perspective. I propose that assisting people like Mr. and Mrs. P is an investment that permits our fellow Alaskans to improve their chances to succeed and will help rebuild our shrinking middle class.

Our Alaska policy makers are currently discussing future capital and infrastructure investments including $10 billion in state ownership of a LNG pipeline and hundreds of millions to publicly fund the Knik Arm Bridge, both projects with significant risk.

The governor's Lewin Medicaid report estimates the average annualized state cost to expand Medicaid to 43,000 Alaskans would average $35 million per year over the next seven years. I submit that this is an affordable investment in Alaska's human capital and social infrastructure with a lower risk and a higher payoff.

We are now in the holiday season and have the opportunity to reflect on our past and future through the lens of our values as Alaskans. Our Alaska constitution is one of the few that explicitly provides for the promotion and protection of public health. I invite Alaska's health policy makers to visit their community health centers around Alaska and join us in the trenches for a day. I think it will become crystal clear that we don't need to pay for another study to see the value of making health care coverage available to Alaskans most in need.

John Riley is a physician assistant who works in community health in Anchorage. He teaches at UAA and is the board chair of the Alaska Center for Public Policy.

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