Opinions

Don't expand Alaska's Medicaid system until it's been reformed

As the state stares down the barrel of perhaps a $4 billion budget deficit, it is beyond baffling that anybody -- even a liberal clinging desperately to freebie medical care as some sort of talismanic human right -- could justify adding even one person to Alaska's Medicaid rolls, much less 40,000, as Gov. Bill Walker wants.

Walker is hectoring Republican lawmakers at every turn to expand a program already plagued by fraud, abuse and lack of controls. It must be reformed simply to survive -- much less be expanded. Forget the touchy-feely nonsense the left is peddling. Alaska cannot afford Medicaid expansion.

Alaska's ever-growing program, sporting a state price tag of $700 million -- $1.5 billion when you add the federal share -- already covers about 150,000 low-income Alaskans. It has blossomed by almost 150 percent over the past decade and already eclipses K-12 education in overall spending. It is in disarray, with poor accountability and lousy records.

State expenditures for Medicaid are up 300 percent since 2000 and someday will overwhelm the budget. Add to that, nagging billing and cost-control problems, and any reasonable person would think it wise to get the current nightmare under control before piling on hundreds of millions more in new spending.

The state, it turns out, has done precious little to fix Medicaid. Alaska, the Kaiser Foundation points out, is one of only three states with no risk-based managed care or primary care case management for its Medicaid population to control skyrocketing costs. Under such arrangements, states contract with organizations to deliver care through networks -- avoiding the costly emergency room as necessarily the first stop -- and to pay providers.

Alaska's Medicaid program is -- and let's be kind here -- broken, and while Walker would add 40,000 recipients, nobody is sure how many actually would join. Apparently, free medical care draws people out of the woodwork.

Under Obamacare, millions were enrolled in an expansion of Medicaid, providing free health care for low-income, able-bodied, single adults between 19 and 64 years of age. Today, 29 states and the District of Columbia have expanded Medicaid. Every state that has expanded Medicaid has adopted a new tax to pay for expansion. Alaska will be no different, increasing costs for large providers and small.

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Gov. Sean Parnell resisted expansion, saying he did not trust the federal government to keep its word to pay 90 percent of the costs for the first few years -- and who could blame him? -- but Walker injected the issue into his election campaign for the state's top post, saying it would bring 4,000 jobs and zillions of federal dollars to the state. It was blue sky, of course, but it paid off on Election Day.

Many Medicaid questions are hard. Will the federal government change the rules unilaterally? It can. Will Alaska have to pay more in the future? How much? The federal government, if we buy into the expansion, is in the driver's seat and gets final say on future expansions. If we opt in, can we ever opt out? Unlikely.

Some questions are easier: Does expansion make sense if we cannot get a grip on what we already are doing? Do we want to expand a program that pays doctors 130 percent more than Medicare pays for senior citizens or Tricare pays for military families and veterans -- programs, by the way, both groups pay for -- pushing them to rear of the line, behind those getting free medical care?

The big question is whether there will be any doctors left to see them. Some already are having problems getting paid and a provider tax will not help. Those same practices, already at risk, face increased costs and burdens by being buried in continual audits, pre-authorizations and a snarl of regulations.

With expansion, none of that gets better. A 2014 legislative audit found severe financial management problems and numerous violations of federal financial reporting rules, including "incorrect and untimely reimbursement for services." To "mitigate" all that, the state issued "cash advances to providers totaling approximately $143 million in FY 14" to pay for its mismanagement and oversights.

How bad is it? The audit found "program integrity staff was unable to complete investigations and pursue collections of potential overpayments from providers due to unreliable system data."

Reading the audit leaves one conclusion: The system now in place is so screwed up, so out of control, that nobody really knows how screwed up it is.

How can anybody in good conscience advocate expanding such a program before top-to-bottom reform?

Paul Jenkins is editor of the AnchorageDailyPlanet.com, a division of Porcaro Communications.

The views expressed here are the writer's own and are not necessarily endorsed by Alaska Dispatch News, which welcomes a broad range of viewpoints. To submit a piece for consideration, email commentary(at)alaskadispatch.com.

Paul Jenkins

Paul Jenkins is a former Associated Press reporter, managing editor of the Anchorage Times, an editor of the Voice of the Times and former editor of the Anchorage Daily Planet.

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