State struggles to determine how many Alaskans lack health care access

Laurel Andrews

With the Affordable Care Act enrollment numbers in and the law's new regulations continuing to roll out, the state is trying to figure out just how many poor Alaskans still lack access to health care. The analysis is proving difficult, according to Department of Health and Social Services Commissioner William Streur.

"We thought it was going to be much easier than it is," Streur said. "It's tough; it's really tough."

The new analysis commissioned by Gov. Sean Parnell has tasked DHSS with analyzing who lacks coverage and exactly where state and federal money goes in providing health care to impoverished Alaskans. The analysis comes after the state decided to opt-out of a Medicaid expansion in November; by not expanding the program, a so-called "Medicaid gap" was created for childless Alaskans earning less than the federal poverty level -- $14,350 for an individual - who are not eligible for federal subsidies through, and are likewise not eligible for Medicaid.

Parnell's decision was contested by some organizations, including the Alaska State Chamber of Commerce and Alaska Native Tribal Health Consortium. The consortium commissioned two reports on the expansion that found it would bring an influx of jobs, $1.1 billion in new federal revenue, and health care coverage to around 40,000 Alaskans. The consortium was given a navigator grant to help sign Alaskans up, with hopes that Alaska Natives would enroll to offset health care costs at tribal clinics, which are only provided 50 percent funding from the Indian Health Service.

Others praised the decision, stating that Alaska could not afford to be left on the hook if the federal government decided to renege on the federal funding, and that the state can find better ways to address poor Alaskans' health-care needs.

The governor wants the state to "figure out who the population is that truly does not have access to health care," Streur said. DHSS doesn't know what this demographic looks like yet -- what uninsured Alaskans' ages are, or whether they live in urban or rural populations, for instance. "We need to fill in the gaps," Streur said.

Nailing down that number is difficult for several reasons. The state is using "estimates of estimates" to calculate who lacks access, deputy director Josh Applebee said.

A recent report that analyzed the impact of a Medicaid expansion in Alaska estimated that around 19,900 people earning $19,803 or less remain uninsured in the state.

Some of these people are eligible for federal subsidies under the Affordable Care Act. Alaska Natives included in that estimate have access to Indian Health Services, and veterans have access through the Department of Veterans Affairs. To determine the number of people who truly lack access, the state is using general population statistics to break down the numbers. Streur said their rough estimate is 10,000-12,000 people.

That number roughly mirrors the number of Alaskans who signed up for individual health insurance through the Affordable Care Act -- 12,890 Alaskans purchased insurance through, according to the Center for Medicaid Services.

Now, Streur is looking through state and federal budgets to figure out just how much money is spent providing access to poor Alaskans, who falls into this population, and what services they have access to. Streur said he was surprised by the amount the state spends every year on health care for the impoverished. He doesn't have hard figures yet, but said the number will be in the "hundreds of millions of dollars."

Streur is also going through lists of emergency room visits -- notorious for straining the health care system -- and talking with providers to find out who falls into the impoverished population and what services are available, or lacking, in various communities. One finding he noted is that non-tribal members living in the Bush have better access to specialty care than those living in urban communities. Tribal health clinics "tend to pick them up and treat them one way or another," he said.

Sometimes people have access but aren't aware of their options, Streur said. He referenced the Chronic and Acute Medical Assistance state program and Anchorage Project Access as two ways poor Alaskans can get health care, provided they know about the programs.

Applebee said he was surprised by "how many services are really out there" for poor Alaskans. Still, some types of specialty care -- including surgery, certain prescriptions and exams, and high-tech radiology -- are not available to the state's poorest populations, Streur said.

There's no deadline for the analysis to be finalized, Streur said.

The governor has also directed Streur to lead a Medicaid reform group to address how the existing system can be changed to work better for Alaskans, wrote Parnell's spokesperson Sharon Leighow. Currently, $1.5 billion dollars in federal and state money is spent on Medicaid in Alaska annually.

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