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William Streur: Alaska's 'Medicaid gap' not as big as claimed

William J. Streur
OPINION: Access to health care is a serious concern. A new report from the Alaska Department of Health and Social Services shows that gaps in Alaska's health care safety net exist, but they are more limited than what has been reported in the media or claimed by political advocacy groups. 401(K)2013 / cc via flickr

One of Gov. Sean Parnell’s priorities is to help vulnerable Alaskans access necessary health care services. In November 2013, when the governor announced that he would not be seeking Medicaid expansion in 2014, he asked me to analyze Alaska’s health care safety net. This analysis is the first step in finding an Alaska solution to the health care challenges for this population. Gov. Parnell wanted to identify coverage gaps for Alaskans whose income falls between eligibility for Medicaid and the subsidized federal Health Insurance Marketplace. Last week, my team completed the analysis and made it available to the public online.

The report defines the population in the gap, gives an overview of current safety net services, and provides a brief description of funds supporting these services, as well as the existing gap in services.

Reviewing the health services available across the state is a reminder of just how unique, diverse, comprehensive, and complicated our health care delivery system is. Through a combination of tribal health organizations, community health clinics, and federally qualified health centers, public health centers, and hospitals, Alaskans without health insurance can access comprehensive care in more than 200 Alaska communities. Gaps exist, but they are more limited than what has been reported in the media or claimed by political advocacy groups.

For this analysis, the population in the coverage gap is those individuals between the ages of 18 and 64, with no health insurance, who are not eligible for Medicaid, and are not covered under another health care system providing benefits for members (e.g., tribal health beneficiaries), who do not have dependents, who earn less than 100 percent of the federal poverty level, and who are not disabled.

Between 10,000 and 12,000 Alaskans meet these criteria. However, many still have access to a wide array of health care services.

Generally, the gaps in access to primary care and most preventive care are small because of an extensive in-state network. The extent of primary care services available, regardless of community size, is made possible largely through a combination of tribal health organizations and their Community Health Aide programs, community-based public health nurses, and the highest number of community health centers and federally qualified health centers per capita in the country. We counted more than 150 such service sites across the state.

In 2010, total public and private spending on health care services in Alaska was $7.5 billion — more than $10,000 per resident annually.

By now we expect that cost to have increased. It is a sign of the dysfunction and inefficiency of the health care system when we spend more than $10,000 per Alaskan, per year, but there remain gaps in services for some. Other barriers, aside from government and taxpayer funds, have an important role to play in the discussion surrounding service gaps, access, and utilization that we need to better understand in order to identify appropriate and sustainable solutions.

Late last year, Gov. Parnell called for the creation of the Medicaid Reform Advisory Group, which will meet regularly over the next several months to review the existing Medicaid program and provide recommendations. The governor’s intent was to seek reform through an Alaska solution, rather than simply putting more dollars into a bloated system.

The gap analysis completed by the Department of Health and Social Services will inform the group’s deliberations. I expect their work and recommendations will further our understanding of opportunities to provide coverage for gaps identified in the report. I recognize that with a topic this large, providers and other subject matter expects bring valuable experience and perspective to the conversation. Comments may be submitted to

Access to health care is a serious concern. Like Gov. Parnell, I remain committed to the safety net of health services already available to Alaskans who do not qualify for Medicaid yet cannot afford private insurance. In addition to the Medicaid Reform Advisory Group, this analysis will play an integral role in the department’s FY 2016 budget development. It will also add support to the upcoming legislative agenda, as we further define how to better promote the health and well-being of Alaskans today and into the future.

William J. Streur is commissioner of the Alaska Department of Health and Social Services.

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