JUNEAU -- Staunch legislative opponents of the Affordable Care Act may have lost their last chance at blocking the expansion of Medicaid to the working poor in Alaska with the U.S. Supreme Court's ruling upholding subsidies in June.
A ruling against the program could have thrown "Obamacare" in disarray, but the court's decision doesn't ensure Medicaid expansion, supporters said.
Gov. Walker has scheduled an announcement for Thursday on his plans for Medicaid expansion. His options could include another special session on the topic, possibly in the fall, or taking unilateral action without legislative support.
Walker's press secretary Katie Marquette said it is "in our interest to ensure more Alaskans have access to health care -- expanding Medicaid is the obvious next step."
Some legislators said last session they thought Medicaid expansion could pass through both houses if a straight up-or-down vote was allowed, but Republican opponents of the program held key leadership positions that prevented Walker's expansion bills from moving through the legislative process.
At the end of the regular session, the then-pending Supreme Court case, King v. Burwell, was cited as a factor against expansion by opponents such as Rep. Steve Thompson, R-Fairbanks.
The case challenged the legality of subsidies for health insurance purchased from federally run health care exchanges in states like Alaska that declined to establish their own exchange -- a kind of insurance marketplace.
That decision "could severely impact Alaskans who have signed up for health insurance through the federal exchange by costing them their assistance," Thompson said in a speech delivered to the House Finance Committee he co-chairs, as it abruptly adjourned in June without taking action on expansion.
House Rules Committee Chair Craig Johnson, R-Anchorage, made similar comments at the end of the regular session, calling expansion "a billion-dollar gamble" and said no action should be taken with the issue in flux.
"Is it prudent for us to do it now and just have it undone depending on the Supreme Court?" asked Johnson, whose committee controls the flow of bills to the House floor.
Both Johnson and Thompson declined repeated interview requests in the weeks after the court's ruling.
Supporters of Medicaid expansion, including members of Alaska Faith and Action Congregations Together, want Walker to implement expansion on his own, even if the Legislature won't.
"AFACT has been in unqualified support of Medicaid expansion, however it happens," said the Rev. Julia Seymour of the Lutheran Church of Hope in Anchorage.
Following the decision, the court's action can no longer be used to oppose expansion, said Rep. Paul Seaton, R-Homer, chair of the House Health and Social Services Committee and one of the Legislature's moderate Republicans who favor expansion.
"I think that argument is gone," Seaton said.
But that doesn't mean easy approval for expansion.
"The people who cited that as a reason for delaying, I'm not sure that meant they were committed to saying 'yes' if it got decided the way it got decided," Seaton said.
Rep. Cathy Munoz, R-Juneau, said Walker can now expand Medicaid on his own following the ruling.
"My personal feeling is that Medicaid expansion will eventually happen. It may happen administratively, or it may happen with the support of the Legislature, but it will happen," she said.
Munoz said expansion should occur as soon as the Department of Health and Social Services is confident the once-troubled computer system that manages the entire Medicaid program is ready to handle it.
There is no longer an argument the ACA will soon go away, Marquette said.
"While the King v. Burwell decision has no direct impact on Medicaid expansion, it does tell us that the Affordable Care Act is here to stay," she said.
Walker's expansion bills each passed through their first committee of referral in the last session, in each case the Health and Social Services committees of the House and Senate. They then stalled in finance committees controlled by Medicaid opponents.
They also included language in the must-pass state budget blocking expansion, though attorneys for both the Legislature and the Department of Law say that prohibition was unconstitutional and has no legal effect on Walker.
The prohibition on Medicaid expansion was added to the operating budget after legislative leaders concluded Walker had the power to accept expansion on his own. House Speaker Mike Chenault, R-Nikiski, told the Alaska Dispatch News in March he believed Walker had that authority.
"Can he do it? My guess is probably they can finagle some way to do it," he said at the time. "Would he do it? That's up to the governor," Chenault said.
The speaker said he didn't know whether the Legislature had any options to stop expansion, but there could be consequences for Walker in next year's legislative session.
When legislators return to Juneau for next year's regular session, they'll have "a better idea what, if any, the consequences would be," Chenault said.