Opinions

Medicaid report delay reflects legislative posturing pattern

In January, the state Senate Finance Committee approved a contract with a former Alaska health and social services commissioner to provide expert advice on Medicaid expansion.

Among other tasks, the $45,000 contract called for Bill Streur to produce a "written report for committee use that presents strategies and options for Medicaid expansion" by the end of April. He was also to provide information on potential savings from Medicaid expansion and identify ways to change state operations to save money in one of the biggest programs in state government.

He never wrote the report, according to a staff member for Sen. Pete Kelly, co-chairman of the committee, because Streur spent all of his time talking to legislators, answering questions and examining budget information.

"Many legislators did not have the familiarity with the inner workings of Medicaid rules that was needed to fully engage and track the governor's Medicaid bills," said Heather Shadduck, an aide to Kelly.

There was much to talk about then and now. But that's no reason to abandon what should have been the most important part of the contract.

Streur, the commissioner of the Department of Health and Social Services under former Gov. Sean Parnell, has decades of experience in health care administration. While serving under Parnell, Streur defended the decision to oppose Medicaid expansion.

Eight of the commissioners who served before him, from 1984 until 2010 under both Democratic and Republican governors, have said they support the expansion of Medicaid. John Pugh, Myra Munson, Ted Mala, Margaret Lowe, Karen Perdue, Jay Livey, Joel Gilbertson and Bill Hogan all say it will help thousands of Alaskans who aren't protected by health insurance, largely paid for by the federal government.

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Parnell and Streur disagreed, but the executive branch changed course with the election of Gov. Bill Walker, who made expansion a priority. Walker has moved to expand Medicaid as of Sept. 1, following the refusal by the Legislature to vote on the matter. The administration has hired a consultant for $441,000 to redesign and expand the Medicaid program, with a three-year plan to reform the system due by next January.

Legislators who blocked an up-or-down vote on Medicaid expansion have taken to arguing that Walker was wrong for any number of reasons, ranging from legalistic to moralistic. That a childless "able-bodied adult" who is unemployed or works full time and earns less than $10 an hour would qualify for medical care strikes many as an extravagant waste. When they say "able-bodied adult," they mean "freeloader."

The handling of the Streur contract and the report he didn't write is in keeping with the legislative pattern of posturing and delay. The public deserves to see Streur's arguments spelled out in detail. That would advance the discussion and demonstrate accountability with public funds.

In April, Kelly and others on the committee revised the Streur consulting contract upward to a maximum of $105,000 and extended it until the end of the year. The former commissioner is receiving $2,000 a month, plus $750 a day when he works five hours or more.

Kelly and many other legislative leaders have opposed the expansion of Medicaid, but they didn't ask Streur to confine himself to the opposition option. That's a point they emphasized in January -- Kelly said he would be open to changing his mind if Streur provided evidence Medicaid should be expanded. Months of hemming and hawing ensued.

Kelly now says what the governor has done is "clearly irresponsible" and the Legislature wants solid answers from experts. He said that's why lawmakers are hiring additional consultants to review Medicaid. A new consulting contract is expected to be signed later this summer.

"These experts will pull from the best reform policies around the country to help us fix our Medicaid program so it is affordable, efficient and, most importantly, sustainable for our most vulnerable citizens," Kelly wrote.

Perhaps by the time their work is done, there will also be a written report from the expert his committee hired in January.

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.

Dermot Cole

Former ADN columnist Dermot Cole is a longtime reporter, editor and author.

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