JUNEAU -- A bill that could open the way for Medicaid expansion in Alaska is expected to be introduced in the Legislature next week, but it will initially address only Medicaid reform, not expansion. And it will come from an influential Republican legislator, not the governor.
Legislative opponents of expanding Medicaid to thousands of lower-income Alaskans, possibly because of its role as part of Obamacare, stripped out of Gov. Bill Walker's operating budget elements related to expansion.
Those were largely cost savings that Walker says can be expected to come the state's way if it accepts the federally funded expansion.
But some legislative leaders said they'd be open to considering Medicaid expansion and have called on Walker to submit a stand-alone bill.
"It's the governor's responsibility, if he is wanting to make a major policy change, that he should introduce a piece of legislation," said House Speaker Mike Chenault, R-Nikiski.
Expanding Medicaid in Alaska would cost $145 million, which as part of the Affordable Care Act -- now generally called Obamacare -- would be fully funded by the federal government through 2016. The federal support would decrease after that, leading critics to raise cost concerns as well.
But Chenault and other legislators say that when former Gov. Sean Parnell sought important spending provisions, such as his request for $3 billion for the underfunded Public Employees' Retirement System and Teachers' Retirement System, he did so by introducing a bill, at least eventually.
Legislators last session stripped the $3 billion from Parnell's budget request, but they eventually approved it after Parnell submitted a stand-alone bill appropriating the money.
"If you go back and look at history, whenever a governor has made an issue like expansion, or more money into PERS-TRS retirement, or scholarship programs, whenever the governor has proposed a policy change, that has usually taken legislation," Chenault said.
But when legislators have a bill with which to work, that can open up the policy to significant changes. Sometimes those changes are needed to win passage of the bill through the political process.
When the Parnell PERS-TRS funding was sought, legislators amended Parnell's bill to make multiple changes to the state's retirement funding system. Those changes slowed payments to reduce the unfunded liability, took away from the Alaska Retirement Management Board the ability to set the amortization method, and added years to the debt payment period, which shifted billions in costs to local governments.
And when the legislators made changes to Parnell's scholarship plan, one was taking the name of his office off it. What was proposed as the "Governor's Performance Scholarship Program" won passage as the "Alaska Merit Scholarship Program" and was later changed to the current "Alaska Performance Scholarship Program."
But Senate President Kevin Meyer said a bill is needed if Walker wants to win support for Medicaid expansion, and that a bill Sen. Pete Kelly, R-Fairbanks, plans to introduce to reform Medicaid and reduce state costs could become the key to a Medicaid expansion deal.
That could take the place of a Walker bill, Meyer said.
"We've been waiting for him to do that, waiting for him to get engaged and say, 'this is really important,'" Meyer said.
But Kelly is co-chair of the powerful Senate Finance Committee, and his bill could also be the key to expansion for many senators, Meyer said.
"If we're going to go to expansion, in order to sell it to the rest of us, we've got to fix the existing program," he said.
Kelly was unavailable for comment on his proposed bill Friday, but Meyer said it would likely address cost-saving measures such as encouraging Alaska Native Medicaid beneficiaries to use federally funded health care, such as that available at the Alaska Native Medical Center, instead of alternatives such as Providence Alaska Medical Center that increase state costs. It may also address the ongoing issue with a troubled Xerox Medicaid payment system and other reforms.
While some legislators have suggested linking Medicaid reform to support for expansion, not everyone is comfortable with that, Meyer said.
"I think some would want to see the reform put in place first, give it a year or two to see just how much it really saves," he said. "A lot of times, when you project savings, they don't really happen."
But Meyer said that if the reforms look "solid," he could support both at the same time.
"In my case I might be more comfortable doing reform and expansion all in one bill," he said.
While there's no bill from Walker authorizing Medicaid expansion, Rep. Andy Josephson, D-Anchorage, a member of the minority Independent Democratic Coalition, has introduced such a bill.
But Rep. Dan Saddler, R-Anchorage, vice chair of the House Finance Committee, said that bill is inadequate.
"There's no reform that we all agree should happen, there's no cost containment," he said.
"This is the kind of thing that the administration has to bring forward," Saddler said.
But Meyer said a bill by Kelly, who has brought former Parnell Health and Social Services Commissioner Bill Streur on as a consultant, could also do that.
"If we get the reform done and done adequately on the existing program, this potentially could lead to expansion," Meyer said.