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Walker is out of line on Medicaid expansion; lawsuit right and likely

  • Author: Paul Jenkins
    | Alaska opinion
  • Updated: June 29, 2016
  • Published August 1, 2015

Gov. Bill Walker's dogged effort to unilaterally expand Alaska's Cadillac-class Medicaid program -- despite the Legislature's reluctance -- is being peddled to Alaskans with a massive propaganda campaign replete with misleading information and outright fibs.

Worse, he plans to pull it off -- to join 29 other states and the District of Columbia in expanding Medicaid -- while wading in legal quicksand; by pretending he can accept federal money and tell lawmakers to butt out because he simply would be expanding an existing program. It is malarkey. That's not me saying that; it's the Supreme Court.

There are only two questions Alaskans -- riding into a fiscal abyss on plunging oil prices -- should be mulling as Walker plods ahead. First, how much do we want to ante up in taxes to underwrite his ego? Second, what spending -- Education? Public safety? Transportation? -- do we slash if he succeeds?

Alaska's broken but ever-growing Medicaid system already boasts a state price tag of $700 million -- $1.5 billion with the federal share -- and covers 130,000 low-income children, pregnant women, families, elderly, blind and the permanently disabled.

It offers 27 optional services -- prescription drugs, chiropractic, adult dental services, for instance -- not offered elsewhere and has grown 250 percent in the last dozen years, eclipsing Alaska's K-12 education spending. With virtually no monetary limits, it offers recipients better care than the military's Tristar program, Medicare, the Veterans Administration or even that afforded state employees.

Over the years, Medicaid has been problematic. A 2014 legislative audit discovered severe financial management problems and violations of federal financial reporting rules. While the Walker administration promises to fix the mess, it continues efforts to expand the program, no matter what.

Walker is determined to add to Medicaid low-income, able-bodied, single adults between 19 and 64 years old, without children, at or below 138 percent of the federal poverty level. He predicts they will number about 20,000. That is about half of other, reputable estimates -- the Lewin Group, for instance -- effectively muddying the true costs. The Lewin Group was commissioned by the Alaska Department of Health and Social Services to study Medicaid expansion.

Alaska would not be the first to grossly underestimate expansion enrollment. A recent Associated Press analysis of more than a dozen Medicaid expansion states showed expansion enrollment far exceeded official projections. A Foundation for Government Accountability look at 17 states that expanded Medicaid found enrollment exceeded projections by an incredible 91 percent on average last year.

There are other discrepancies. Walker says costs will be less for able-bodied single adults, but the Lewin Group predicts each will cost $2,500 a year more than he estimates. Walker says expansion will save money, boost the economy, save beleaguered hospitals, bring 4,000 new jobs. None of that likely is true.

A devastating piece in Forbes.com's blog The Apothecary, "The Hubris of Gov. Bill Walker's Obamacare Medicaid Expansion in Alaska," by Josh Archambault and Christie Herrera, senior fellows at the Foundation for Government Accountability, puts the lie to Walker administration claims.

"Peer-reviewed research of previous Medicaid expansions to able-bodied adults shows that expanding Medicaid will diminish work, dampen earnings, reduce labor-force participation and hurt the economy," they write. "Those conclusions are supported by the independent Congressional Budget Office. ..."

"In Alaska, nearly 4,000 able-bodied adults could drop out of the labor force entirely, with many more reducing hours to avoid the welfare cliff."

Most troubling is Walker's tenuous claim about Alaska law allowing him to legally accept federal money without legislative approval for an existing program -- the Medicaid expansion -- if no additional state general funds are required.

His problem? The expansion would be a brand new program -- and he clearly needs legislative approval.

In National Federation of Independent Business, et al. v. Sebelius, 26 states, including the Frozen North, argued against mandatory Medicaid expansion under the Affordable Care Act, and won. The Supreme Court ruled such expansions would be optional, voluntary -- and entirely new, separate programs under Obamacare to distinguish them from existing programs.

As a further dodge around the Legislature, Walker plans to use $1.6 million in Alaska Mental Health Trust Authority money -- rather than general funds -- to cover the expansion's administrative costs.

Nothing about Walker's planned expansion, effective Sept. 1, makes sense. I'm no lawyer, but this nonsense -- usurping legislative authority, spending money illegally -- offers ample grounds for court challenge.

Walker must be stopped in his tracks if Alaskans are to be spared hundreds of millions of dollars in new taxes to pay for his ill-conceived Medicaid campaign promise.

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.

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