No rational Alaskan can believe Medicaid expansion is a good idea

As Gov. Bill Walker's campaign promise to expand Medicaid in Alaska without the pesky Legislature's approval chugs along, it only gets curiouser and curiouser.

There are reasons galore to question the program's fait accompli expansion as of Sept. 1: We are broke and may get broker; Walker could be breaking the law; the idea stinks as public policy; expansion without the Legislature presents a separation-of-powers thingy; it could shred the economy; arguments supporting expansion are questionable; it hoses the elderly and military families; and, perhaps worse, it could threaten education, pensions and other critical spending. That is just for openers. Alaskans could find themselves doing without a Permanent Fund dividend -- and paying a snarl of taxes to pay for the new, improved, expanded program.

Underpinning all those very good reasons to have the heebie-jeebies, however, is a more central question: How insane would we have to be to trust the federal government, especially this particular federal government? EPA? King Cove? Closing off North Slope drilling? ANWR? Pebble? NPR-A? Any of that ring a bell?

Earlier this year, Walker gave Medicaid expansion under Obamacare his best shot. Why is anybody's guess. (A long list of supporters on his website who would profit from expansion should tell you all you need to know.) He offered two bills. Lawmakers desperate to makes ends meet did not buy in. He tried a little of this; a little of that. He bombed. Then, he waited until the Legislature adjourned, announced he was expanding Medicaid anyway -- and the Legislature? Well, it was welcome to pound sand. Ta-da!

Proponents assure us the federal government's pledge to pick up at first 100 percent of the expansion, and then 90 percent -- and eventually, who knows? -- is as good as gold; that Alaska could walk away if it goes south. In whose dream? One of the reasons our previous governor -- and governors of several other states -- balked at expanding Medicaid is a distinct, well-grounded lack of faith in our if-you-like-your-doctor federal overlords.

All with good reason. During the budget negotiations in 2011, Barack Obama proposed cutting federal funding for Medicaid expansion by $100 billion over 10 years -- with states picking up the difference. Then, there is Congress. "The notion that the federal government is going to keep matching Medicaid spending at this level is a notion that is just a faulty premise," then-House Budget Committee Chairman Paul Ryan said in 2013, according to Watchdog.org. "It's going to get cut."

Oh, c'mon, that could never happen, proponents say; the feds, would never do that. We can trust them forever and ever, despite $18 trillion in red ink.


Somebody should have warned the nine states -- Florida, Texas, Tennessee, California, Massachusetts, Arizona, Hawaii, Kansas and New Mexico -- Obama decided to hold hostage over billions of dollars in federal funding for hospitals that treat low-income patients. Expand Medicaid under the Affordable Care Act -- or live without federal Low-Income Pool money, the feds told those states, leaving ragged, smoking, billion-dollar holes in state budgets. The pool pays hospitals for care rendered to uninsured patients.

Florida was among the first threatened. The Miami Herald reports U.S. Centers for Medicare and Medicaid Services Acting Director Vikki Wachino told Florida's Medicaid director earlier this year, "... the state's expansion status is an important consideration in our approach regarding extending the LIP program."

Florida House Speaker Steve Crisafulli, R-Merritt Island, was steamed. "It is unthinkable that they would leave our state on the hook for over a billion dollars simply because they want a specific policy outcome," he said.

It is unthinkable he was surprised, but then, most states have not had the cozy, hot-breath-on-your-neck relationship with the federal government that Alaska has enjoyed. It is not at all difficult to believe the feds would -- in an attosecond -- leave Alaska holding the bag if there were something it wanted and Alaska even thought about balking.

You also could ask Florida Gov. Rick Scott about the trust issue.

"(Centers for Medicare & Medicaid Services) has a program, LIP, for low-income families ... and they are walking away from it," Scott told the Herald. "Why would we put taxpayers on the hook for something when we can't trust the federal government to fulfill a program they already started?"

There are two immutable truths in the expansion argument: We cannot trust the Obama administration; we cannot afford to expand our gold-plated, broken Medicaid program to cover perhaps 40,000 -- or more -- low-income, able-bodied, single adults.

Who in their right mind could believe otherwise?

Paul Jenkins is editor of the AnchorageDailyPlanet.com, a division of Porcaro Communications.

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, email commentary(at)alaskadispatch.com

Paul Jenkins

Paul Jenkins is a former Associated Press reporter, managing editor of the Anchorage Times, an editor of the Voice of the Times and former editor of the Anchorage Daily Planet.