WASHINGTON — Alaskans' health insurance comes from a wide variety of sources — some federal and some not.
As the debate rages on in Washington, D.C., over how the federal government should involve itself in health insurance, here's a look at just how Alaskans are insured.
Despite the current political focus on individual health insurance coverage and Medicaid, about half of Alaskans actually get their health insurance from their employers.
Under the Affordable Care Act, companies with more than 50 employees must provide "affordable" coverage that includes various baseline care, like pediatric and dental care. Employers usually pay about 75 percent of the plan's cost, according to Alaska Business Monthly.
Health care is expensive in Alaska.
The state had the nation's highest growth in per-person health care spending from 2010-2014, at 4.8 percent per year, according to new trend data from the federal government. The national average growth rate was 3.1 percent.
During that time, Alaska also had the highest spending for private health insurance per enrollee — $5,958. That figure was 31 percent above the national average, according to the Centers for Medicare and Medicaid Services.
More than 184,000 Alaskans are covered by Medicaid — 25 percent of the state's population. That includes 14,400 adults who gained coverage when the state expanded its Medicaid base to include people living just above the federal poverty line.
Nearly half (48 percent; 88,915) of the Alaskans on Medicaid are children, but most of the state's Medicaid spending (55 percent) goes to people with disabilities and the elderly.
Most older adults are on Medicare, but 15,100 of them (21 percent) receive supplemental funding from Medicaid. That accounts for 27 percent of Medicaid funding, according to a new report by the Kaiser Family Foundation. (Nearly 80 percent of Alaska's nursing home residents are covered by Medicaid, which costs roughly $150,000 a year.)
Medicaid is also the spending conduit for the Indian Health Service, by which many Alaska Natives receive health insurance. More than one quarter of Native adults are covered by Medicaid, and two-thirds of Native children, according to the Kaiser Family Foundation.
The rest of Alaska's Medicaid population is made up of 1 percent disabled children (2,455), 8 percent disabled adults (14,871 people) and 20 percent poor adults (36,883).
The number of Alaskans who have gained coverage on the federal exchange is relatively small — 19,145 people in 2017, about 2.5 percent of the state population.
According to the federal government, 16,937 — 88 percent — received subsidies to help pay for their premiums.
Likely because of the high cost of marketplace plans for those who do not receive subsidies, the individual market has not done as much to reduce the number of uninsured Alaskans as it has in some other states.
The number of people on the exchange has dropped each year, as have the number of insurers. Premera is now the only available provider in Alaska.
In 2016, there were 23,029 people enrolled, so the market took a 17 percent hit in just one year. That's one of the largest declines in the country. There was a 5 percent decline in enrollments nationwide for 2017, according to healthinsurance.org.
Uninsured: There are still plenty of uninsured people in Alaska, but the number has dropped. In 2013, the uninsured rate was 18.9 percent. That fell to 10.3 percent in 2015, according to Gallup.
The uninsured rate went back up a bit in 2016, to 11.7 percent, according to a report commissioned by the state Department of Health and Social Services. The national average uninsured rate in 2016 was 10.9 percent.
Small businesses: Alaskans who work for a business with fewer than 50 employees can sometimes use the Small Business Health Options Program, a pooled coverage option. That covered 21,645 people in 2015, though many of those people also received insurance elsewhere, according to healthinsurance.org.
Other programs: Medicare, the federal health insurance plan for people over the age of 65, covers 11 percent of Alaskans. The U.S. Department of Veterans Affairs and the military's Tricare cover 17 percent of Alaskans, according to the University of Alaska Anchorage.