If Gov. Sean Parnell is truly serious about improving health care access for low-income Alaskans, his administration will have its work cut out as it tries to find holes in the state's safety net.
A recent national study by Georgetown University's Center for Children and Families highlights the challenge and complexity of the issue. Released just days after Gov. Sean Parnell refused to expand Medicaid, it showed that Alaska had the biggest percentage increase of uninsured children of any state.
The executive director of the research group, Joan Alker, said that's because Alaska has one of the "stingiest" programs for children of low-income families in the country. In fact, Alaska nearly has the nation's tightest eligibility rules for children and teens to receive Medicaid. Only North Dakota is stricter.
But factor in the generous income exemptions allowed by Alaska, and the state's help for low-income children and teens moves it much higher in the national rankings, said Margaret Brodie, director of the state's Health Care Division.
Also, the findings of the Georgetown University study come with important limitations.
Alker said Alaska's small population makes it difficult to have full faith in the numbers, which were taken from the U.S. Census Bureau. But she said that in general, the results don't look good for how Alaska, compared to the rest of the nation.
"It's clear that Alaska is not getting better while many states are," she said. "At best, Alaska is stagnating."
Thirty-nine states and the District of Columbia saw more children insured between 2010 and 2012.
Nationally, the number of uninsured fell by 2.1 percent since 2008, thanks to streamlined enrollment and eligibility expansions in Medicaid and the Children's Health Insurance Program, according to the study.
But Alaska saw a 1.7 percent increase in uninsured children between 2010 and 2012, the study said.
Alaska had 3,114 more uninsured children in 2012 than in 2010, boosting the overall number to 25,957. Overall, 13.9 percent of Alaska children are uninsured, the second highest percentage in the nation, behind only Nevada, the study said.
One question is how many of the uninsured children are Alaska Native, who in reality have access to care at no cost through the federally supported Indian and Native health care network.
Alker blamed the state's eligibility thresholds for children. In Alaska, children whose families earn up to 175 percent of the poverty level are eligible for Denali Kid Care. The program provides coverage for low-income pregnant women and children and teens through age 18.
Parnell could have expanded coverage for children in 2010, by supporting a $3-million boost to Denali Kid Care that was broadly supported in the Legislature. The proposal would have expanded eligibility to 200 percent of the poverty level, helping another 1,300 children.
But Parnell rejected it, partly because the program funds medically necessary abortions as a result of a court order.
Now, only North Dakota's eligibility threshold is lower, at 160 percent. However, the national median is much higher, at 235 percent, Alker said.
"Alaska is very low," she said.
But Brodie, Health Care Division director, said the state has long allowed generous income exemptions, known as "disregards." For example, the income of siblings isn't counted in household income, the state allows essentially a $90 write-off, and the Permanent Fund Dividend isn't counted.
Those exemptions make it appear as if family income is lower than it actually is. When you count those disregards, the state ends up about in the middle of the nation for providing Medicaid to uninsured children, Brodie said.
"We're more generous that way than other states," she said.
One point of agreement: The issue is complex.
When Parnell rejected Medicaid earlier this month, he wanted to know who are the people falling through the cracks, what are their health-care needs and are their needs being met?
Parnell said he'd create an advisory group to recommend reforms to the state's Medicaid program, and he'd have Streur develop a report to help better understand the state's safety net.
Time will tell what will come of that.
Contact Alex DeMarban at alex(at)alaskadispatch.com