Opinions

State should drop secrecy on Medicaid expansion report

FAIRBANKS--It must be easier to register on the Obamacare website than to get people excited about an $80,000 assemblage of charts, graphs and statistics, but the Parnell administration has accomplished the impossible. It has created public interest in a consultant's report on Medicaid.

Bill Streur, the commissioner of the Department of Health and Social Services, performed this miracle by treating the Lewin Group report on Medicaid as if it is more sensitive than the stuff Edward Snowden swiped from the NSA.

His formula for generating publicity is to withhold public access for no good reason and watch as a campaign to release the report from the vault of state secrets takes shape, a sideshow that distracts from the larger question.

A year ago the state hired the Lewin Group at $144 per hour, for a total cost of up to $79,920, to report on what Medicaid expansion would cost the state of Alaska.

While we remain in the dark about this Lewin Group report on Medicaid spending, we can read another Lewin Group report, a 33-page treatise on "The Impact of Medicaid Expansions and Other Provisions of Health Reform on State Medicaid Spending."

Granted, the 2010 report deals with all 50 states, but it covers the basics. The underlying framework has not changed, with the federal government agreeing to pick up nearly all of the cost. The full report and many others are available on the Lewin Group website.

Under the Affordable Care Act, states have the option of expanding health coverage so that single people who make up to about $20,000 a year and families of four making twice that amount would qualify for Medicaid.

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The Lewin Group said that more than 17 million Americans could be added to the Medicaid rolls, 46,000 of them from Alaska.

For Alaska, the increase in state Medicaid spending would be 1.6 percent, which would be lower than all but 14 states, the Lewin Group said.

The added cost to the state of Alaska would be about $73 million from 2014-2019, while the extra cost to the federal government would be about $1 billion.

Nationwide, from 2014-2019, there would be a $421 billion increase in Medicaid spending, with $17 billion of that paid by the states.

The Lewin Group said that expansion of Medicaid would have a "major impact on uncompensated care and safety net programs."

"Public hospitals and clinics would see increased revenues from newly insured patients that will now be covered by Medicaid or privately insured patients," the group said.

In Alaska, the number of uninsured people would drop by about half with Medicaid expansion, according to the Alaska State Hospital & Nursing Home Association.

Gov. Sean Parnell has rejected Medicaid expansion so far, but has said he might reverse course in his next budget, to be released in December. It comes down to whether the state will support extending health care coverage for 40,000 to 50,000 Alaskans, financed largely by the federal government.

The numbers in the 2010 Lewin Group report are close to those in other studies released over the past year, one of which says that for every $1 from the state, the federal government would spend $12. There is no reason to think that the report Alaskans are not allowed to read contradicts the other estimates available to the public.

The secret report looks at part of the health care equation, driven by an administration looking for reasons to oppose Medicaid expansion. In its instructions to the contractor, the state limited the scope to the costs, not to the benefits of having tens of thousands more Alaskans with health coverage.

Complete or not, it remains an important element of what should be a public process. The document was paid for with government funds and should be released so all Alaskans -- including those who would otherwise not be interested -- can find out what we paid for.

Contact Dermot Cole at dermot(at)alaskadispatch.com. Follow him on Twitter @dermotmcole

Dermot Cole

Former ADN columnist Dermot Cole is a longtime reporter, editor and author.

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