Ever since the Affordable Care Act passed without bipartisan support, it has been one of the most dividing political issues of our time. Republicans generally oppose it and Democrats almost universally embrace it. When an issue inspires such political passion, it's a challenge to step back and think rationally. It's far easier to construct, grasp at and, yes, even make up facts to support our positions.
It is in this context that we continue to debate Medicaid expansion in Alaska. Unfortunately, it's hard to have a debate based on facts in such a politically charged environment. However, both health care and our fiscal situation are too important to do otherwise. To support the furtherance of reasoned discussions on health care and Medicaid expansion, I want to respond to several statements made by Frank McQueary in his Aug. 29 ADN commentary.
First, McQueary got several facts wrong about provider taxes. As CEO of the Alaska State Hospital and Nursing Home Association, I've followed the provider tax discussion closely. My members have more financial interest in this issue than any other provider group in Alaska. The federal Centers for Medicare and Medicaid Services has identified 19 different classes of providers that can be taxed under this complex system. However, provider taxes are almost always levied on hospitals and nursing homes, not on physicians or other provider groups. He's also incorrect in stating that nonprofit hospitals would not be subject to provider assessments. Tribal providers would likely be exempt from the tax, but other not-for-profit providers would pay. Provider taxes are much more complex than portrayed, so complex in fact that they require specialized consulting help to design and implement.
Second, McQueary states Medicaid expansion will "further damage elderly clients of Medicare," because Medicaid reimburses physicians better than Medicare. There is no clear evidence to support this speculation, but should the worst come to pass, hospitals would likely step in to fill a provider shortage. Several years ago, Anchorage Medicare patients had difficulty finding primary care physicians that accepted Medicare. Providence Alaska Medical Center opened a senior care clinic to help fill this need. A state-financed private clinic also opened. With state funds running out, Alaska Regional Hospital has stepped in, so hospitals now run both clinics.
McQueary asserts "the current system is broken" as justification for not expanding Medicaid. Specifically, he refers to the botched rollout of the Medicaid payment system. It is true to characterize the system's rollout as no less than a debacle, which had severe and significant impacts on providers. Problems with the system, however, were related to design and implementation issues, not the volume of claims flowing through the system. Current claims are paying timely and accurately, so adding new Medicaid beneficiaries should have no impact.
Reasonable people can disagree. In a public policy context, disagreement can be healthy and can improve the process, forcing people to think differently and to compromise. Our public policy debates, however, must be informed by good information, not speculation. Health care presents a tremendous fiscal challenge to our nation and our state. It's a complex issue that does not lend itself to sound bites, but it nevertheless demands our attention. It's time to move forward, which we can do if we set aside speculation and rhetoric and focus on working together to find solutions.
Becky Hultberg is CEO of the Alaska State Hospital and Nursing Home Association, and previously worked at Providence Alaska Medical Center and in the administration of Gov. Frank Murkowski.