Opinions

Ideology, not reason, stands between Alaskans and Medicaid expansion

Like the four small-business owners who recently wrote a commentary in support of expanding Medicaid (ADN, Jan. 3), I too support expanding health care insurance to the 29,000 Alaskans who presently fall in a crack between the poverty cutoff required for qualifying for Medicaid and the $30,700 income threshold for federal subsidies under the Affordable Care Act. But I wanted to bring another perspective and some additional facts to this important discussion.

We live in a state that has named its largest airport after, and otherwise venerates, a former U.S. senator who creatively siphoned billions of federal dollars for Alaska projects, both large and small, some of dubious fiscal value, and often to the consternation of colleagues who railed against pork barrel spending.

Yet, while a majority of the states are readily accepting free federal money that provides health care coverage to millions of their citizens, Alaska (and 21 other states) has irrationally refused to accept the same federal benefit that would provide decent health care to thousands of hard-working families who are not so poor as to qualify for Medicaid, but not so well off to qualify for federal subsidies under Obamacare.

A few facts are in order.

The cost to the state of Alaska to provide decent health care to these wage-earning Alaska families over the short term is zero, and over the long term is miniscule. The federal government will pick up 100 percent of the Medicaid expansion costs through 2016, decreasing slightly annually thereafter until it dips to 90 percent in 2020 and all subsequent years. Over the next nine years, 93 percent of the cost of the expanded coverage would be borne by the federal government; Alaska's Medicaid obligation would grow by a mere 2.8 percent.

And even that small 2.8 percent increase overstates the actual cost since it would be significantly offset by savings to the state for funds that presently go for reimbursement of treatment for uninsured individuals.

As a lawyer who has represented not-for-profit Alaska hospitals, I have some idea of the costs involved in treating uninsured emergency-care patients, many of whom turn to the emergency room because they do not have health insurance. Why should Alaska's hospitals not receive the same federal support that hospitals receive in Vermont, or the other 28 states that have expanded their Medicaid coverage?

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As a lawyer who has defended medical malpractice lawsuits, I also know that the best protection against malpractice litigation is good medical results. And when people are forced to turn to emergency care because they don't receive regular medical care, there are more bad results, and more lawsuits.

Can you imagine someone driving past a neighbor's burning house and not calling 911 because he believed that fire protection services should be privatized? Yet that is an apt analogy to the ideologically driven refusal to accept federal funds that have already been appropriated for Alaska.

As the four business people rightly note, Medicaid expansion will be good for Alaska's economy. It will also be very, very good for thousands of Alaska kids and their families. It is time for state legislators to put ideology aside and to be both smart and humane in their consideration of Medicaid expansion.

Peter Gruenstein is an Anchorage attorney with the firm of Gruenstein & Hickey.

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, e-mail commentary(at)alaskadispatch.com

Peter Gruenstein

Peter Gruenstein is an Anchorage attorney.

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