Just weeks after Gov. Sean Parnell said he'd maintain Alaska's opposition to letting the federal government provide expanded Medicaid health care to Alaskans, there was discussion at a legislative committee of new possibilities of making that happen.
Commissioner of Health and Social Services Bill Streur said his department and a newly appointed Medicaid committee are looking at where the most critical health care needs are in Alaska and what programs might fill those gaps.
That could involve looking at examples from states such as Iowa, Arkansas or Georgia that have implemented non-standard Medicaid expansions that might be replicated in Alaska.
"We continue to look at those options should you all at the Legislature come back and say 'we want to do a Medicaid option,'" Streur told the House Finance Committee's subcommittee reviewing his department's budget Tuesday.
Streur said that despite Parnell's recent statement that he would not include Medicaid expansion in his budget proposal for next year, scheduled for release next week, some version of expanded health care could be included when the governor's supplemental budget is released in late January.
The rejected Medicaid expansion would have been fully funded by the federal government initially, but that contribution was later scheduled to drop to 90 percent, though Parnell expressed concern it could be reduced even further. That would have covered 43,000 uninsured Alaskans, though Streur said that because many get coverage elsewhere, that number would actually be closer to 19,000.
After the U.S. Supreme Court said states could not be required to expand Medicaid, Republican opponents of the Obama administration have used that to block one of the key provisions of the Affordable Care Act -- popularly known as Obamacare -- that would provide coverage to many uninsured Americans.
Frequently, states rejected the expansion in a confrontational manner, and the federal government stood firm on how Medicaid should be expanded.
But lately, Streur said, the federal government has become at least slightly more willing to let states design their own expansions.
"The feds have become less stringent and more willing to talk," he said.
It was only two weeks ago that the feds approved an innovative expansion in Arkansas that might provide a model for others, he said.
"We continue to look at a lot of options," Streur said.
That got the attention of Committee Chair Rep. Mark Neuman, R-Big Lake.
"Did I hear an opening?" Neuman asked.
Would that mean that if the Legislature on its own decided to support expansion, that the Parnell Administration would consider going along?
Streur was noncommittal.
"I don't have enough power to consider. That goes to the governor," he said.
Parnell spokesperson Sharon Leighow said the governor had addressed the question about whether he'd support a legislatively-inspired expansion at his press conference two weeks ago.
"The governor said he would need to see a change in circumstance or facts that he hasn't already considered," Leighow said.
There are some recommendations that Parnell is looking forward to, she said.
"The governor is focused on reforming the state's Medicaid program -- and will consider recommendations from the Medicaid Reform Advisory Group," she said.
Streur said that group would likely take 11 months to provide recommendations, so it is unlikely they'd be ready by January, when the Legislature reconvenes.
If the Legislature moves to expand Medicaid without Parnell's approval, Rep. Bill Stoltze, R-Chugiak, said that could set up a situation similar to the time former Gov. Sarah Palin rejected money from the 2009 federal stimulus. Legislators included it in the budget anyway, and when Palin vetoed it they called themselves into special session for a veto override.
"That seems like a logical dynamic," Stoltze said.
Later, Streur's health care policy adviser Josh Applebee cautioned that just because Streur had discussed the timeline for a supplemental budget for a possible Medicaid reform or expansion, that was no assurance that there would be such reforms.
Contact Pat Forgey at pat(at)alaskadispatch.com
CORRECTION: Bill Streur heads the state Department of Health and Social Services.