Is that a $2 billion bonus or a $1 billion bonus for Alaska buried in the latest version of the secret Republican health care bill in the U.S. Senate?
The lower figure is probably closer to reality, but neither one changes the math for Alaska, which would still be a multibillion-dollar loser under the Senate health care bill.
This can get lost if you look simply at what was added to the bill and forget about the billions already subtracted in the version that surfaced in late June.
The end of the Medicaid expansion would mean a loss of $3.1 billion in federal Medicaid funding from 2020 to 2026, while about 34,000 people would lose coverage, a state consultant found. People who would remain on Medicaid would be at an increased risk for funding reductions.
The decline would accelerate in the decade after that, the Congressional Budget Office predicts, with a 35 percent reduction by 2036.
The Senate bill released Thursday did not make substantial changes to this proposal.
Sen. Lisa Murkowski staked out a clear position early this year against the provision now included in the Senate bill.
"So as long as this Legislature wants to keep the expansion, Alaska should have that option — so I will not vote to repeal it," Murkowski told legislators Feb. 22.
Sen. Dan Sullivan has not taken a position in public on whether he would vote to end Medicaid expansion, which probably means he would.
This could be the largest stream of federal money to Alaska ever opposed by a member of Congress from Alaska, a distinct change from the normal practice of getting every dollar possible for the 49th state.
Murkowski and Sullivan have not announced whether they intend to vote for the Senate bill, but its Republican proponents can't afford to lose either one.
That confusion exists on the sweeteners aimed at getting Alaska's senators to support the bill reflects the poor process of the past few weeks.
The Senate goal is not to cobble together a plan to improve the health care system, but to find 50 votes. As Murkowski has warned, the price of doing it this way could mean many more years of bitter partisan debate.
In addition, the insertion of provisions that benefit Alaska at the expense of other states carries an inherent risk that they will be repealed and replaced as soon as other senators say, "Where's mine?"
That could happen in a year or two when members of Congress or the administration look for budget cuts and see percentages out of proportion to the state's population and costs.
"Let's just say that they do something that's so Alaska-specific just to, quote, 'get me,' " Murkowski said in June. "Then you have a nationwide system that doesn't work. That then comes crashing down and Alaska's not able to kind of keep it together on its own."
In a public process, with the give and take essential to creating good policy, we should be able to get the right numbers and find any hidden flaws before the vote. But not when you operate in secret.
The Associated Press reported Friday: “One of the provisions in the latest version of the Senate Republicans’ health care bill appears to benefit only the state of Alaska. And to the tune of $2 billion in federal money.”
Newspapers across the country headlined this with some version of, "Alaska scores sweet deal in health care bill."
Other reports said it was a $1 billion bonus or less.
Alaska would get 1 percent over time of a special fund expected to total $182 billion. That is about $1.8 billion.
But $70 billion of that fund is designated to help insurance companies deal with the problems created by an amendment from Sen. Ted Cruz, who wants to allow the sale of cheap insurance policies with no coverage requirements.
Alaska getting 1 percent of the money from the Cruz amendment, $700 million, to fix problems created by the Cruz amendment, is not a bonus. So subtract $700 million from that $1.8 billion.
"The revised bill's extra funding for Alaska is much less than it appears," wrote Aviva Aron-Dine, a senior fellow and senior counselor at the Center on Budget and Policy Priorities.
It would be nice to have the numbers out in the open and fully examined, given that the Senate plans to vote on the complicated bill next week, but Congress hasn't opted for any vetting.
Columnist Dermot Cole can be reached at dermot@alaskadispatch.com.
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