With the state forgoing any role in a health insurance marketplace, federal officials and Alaska nonprofits are scrambling to fill the void by Oct. 1.
That's the first day of open enrollment under the Affordable Care Act, and the date by which each state is supposed to have an insurance exchange where the uninsured can shop for coverage.
"There are people very, very committed to making sure Alaskans have the opportunity to take full advantage of what the law can provide," said Michele Brown, president of United Way of Anchorage.
The United Way is one of two Alaska organizations each receiving a $300,000 federal grant to hire "navigators" to help Alaskans find their way around Obamacare. The other is the Alaska Native Tribal Health Consortium.
Sue Brogan, United Way's vice president for income and health, said Friday she just received authority from the federal government to begin hiring and training navigators. Two will be stationed in Anchorage -- one at Providence Medical Center, the other at the office of a nonprofit to be determined later. Juneau and Fairbanks will each have one. Volunteer navigators will also be trained, she said.
Karen Pollitz, a senior fellow at the Kaiser Family Foundation in Washington, D.C., and an expert in the implementation of the health care law by the states, said Congress provided an almost unlimited pool of money for the states to create their own marketplaces. If states didn't take action, though, the law put the burden on the federal government. Congress assumed the states wouldn't forgo the opportunity to localize the federal law and didn't leave much money for federally managed exchanges, Pollitz said.
As it turned out, 27 states refused to set up marketplaces.
"It's all stretched thin where the federal government is having to do it for so many states, because they just didn't think they'd have to," Pollitz said. "The federal government has to do everything. They have to take the complaints, they have to operate the call center, they have to review the plans, establish a website, do the outreach and enrollment -- it's a lot of work. And there's some economies of scale, but just because you signed up a plan in Florida, that doesn't mean it's going to help anybody in Alaska. Lots about health insurance markets are local."
Alaskans are among the least insured in the nation. The Society of Actuaries, an insurance related organization, said in a recent study that 20.6 percent of the state's population is without health insurance, a proportion exceeded by only five other states. If the health care act is fully implemented in Alaska -- and so far, Gov. Sean Parnell is resisting the biggest part, the federally funded expansion of Medicaid -- the percentage of uncovered Alaskans would drop to just over 8 percent, the study said.
The insurance marketplace is one of the key components of the law, passed by Congress in 2010. It's where uninsured individuals and small-business owners can shop and apply for policies that conform to the federal law. Websites associated with the marketplace will provide side by side comparisons of different policies using a standard set of criteria. Low-income Alaskans will also be able to learn about subsidies for their premiums in the marketplace.
While the U.S. Department of Health and Human Services will run Alaska's marketplace, as it's doing in 26 other states, state law has required Alaska's Division of Insurance to get involved. The division has approved two health insurance providers for the marketplace: Premera Blue Cross and Moda Health, based in Portland, Ore.
Insurance Division Director Bret Kolb said in an interview Friday that state law requires him to review the Obamacare policies just like any other health insurance plan. Kolb said his staff reviewed the plans being offered by Premera and Moda -- the only two applicants for the marketplace -- and both conform to the Affordable Care Act, he said.
The exact cost, the number of plans and the features of the plans won't be available until Oct. 1, Kolb said.
Parnell, who frequently criticizes the federal government for "overreaching" in Alaska, said Friday he has no regrets for abandoning the marketplace to Washington.
"I had to act with the information I had at the time," Parnell said in an interview. "What I had at the time was that the federal government had no fixed standards for what design or implementation would be approved by them, so we had the problem of moving goalposts and targets to hit."
But Parnell, who led Alaska into the losing lawsuit challenging the law's constitutionality, didn't take advantage of federal money set aside to study the marketplaces, also called exchanges.
The U.S. Centers for Medicare and Medicaid Services says Alaska was the sole state to not apply in 2010 for a health insurance exchange establishment grant. The only other parts of the United States to not apply for such a grant were four of six U.S. Pacific island territories: Palau, the Northern Mariana Islands, the Marshall islands and the Federated States of Micronesia, the CMS said. Guam and America Samoa applied for the grants.
Parnell said he was also concerned that once the federal government's grants dried up, the state would be on the hook to operate the exchange.
Pollitz, from the Kaiser Foundation, said it's true the grants will end in 2015. But the law allows states to collect a portion of premiums to operate the exchanges, she said. The federal government is planning on taking 3.5 percent, but states could opt to take less, she said.
Parnell said he was unaware "of that specific detail."
Alaskans haven't been hurt by his decision, he said. "I think they're actually more hurt by losing their freedom and being compelled to pay for health insurance," he said.
The first open enrollment period for people without group insurance through their employers extends from Oct. 1 thorough March 31, with insurance coverage beginning Jan. 1.
Reach Richard Mauer at firstname.lastname@example.org or 257-4345.
By RICHARD MAUER