Six Alaska lawmakers from across party lines agreed on one thing at a conference Thursday in Anchorage: Medicaid expansion will arise as one of the most controversial health care issues during the upcoming legislative session.
But how the state will handle expansion -- part of the highly politicized federal Affordable Care Act -- depends heavily on which candidates Alaskans select in November to serve in the state Senate, House and governor's office.
Speaking on separate party-specific panels at the 2014 State of Reform Alaska Health Policy Conference, Republican legislators largely bucked expansion while the Democrats embraced it during 45-minute sessions in which a host of health topics were discussed, from primary care to Vitamin D to substance abuse.
Rep. Les Gara, D-Anchorage, argued that when Gov. Sean Parnell turned down Medicaid expansion in November, which would have extended the health care program to every Alaskan with an income up to 138 percent of the poverty level, he created a "doughnut hole" of more than 40,000 people.
"He left those people out in the cold," Gara said of the Alaskans who don't earn enough money to receive a federal subsidy, or discount, on their health insurance premium through the federally run marketplace but also don't qualify for Medicaid.
Gara sat at a table alongside Rep. Geran Tarr, D-Anchorage, and Rep. Andy Josephson, D-Anchorage, as speakers at the "Policy Leadership: Democrats" session.
Josephson said that Medicaid expansion was designed to be paired with the health insurance marketplace so "the two would work in conjunction with one another." He said he is trying to track if there is any linkage between Medicaid expansion and the hefty insurance rate increases announced recently in Alaska, though he noted it seems too early to tell and the data isn't there.
"But it seems commonsensical to me that if you have compensated care ... that would drive down costs for the hospitals and in turn those savings would get passed on to others," he said.
During "Policy Leadership: Republicans," Sen. John Coghill, R-Fairbanks, said Medicaid will emerge this legislative session as a "hot topic, there's no doubt about it."
Coghill said he has been a "strong no" on expansion but "is open to discussion." He said he is concerned about the price of expansion that the state and federal governments would pay compared to the value received, and he has not seen any pointed information on who falls into the coverage gap.
"It's borrowed money, so the next generation pays for it," Coghill said. "I'm not convinced it's going to be good value yet."
Under the Affordable Care Act, the federal government would pay 100 percent of costs for new Medicaid enrollees through the end of 2016, trimming that to 90 percent by 2020.
But varying estimates on what that means in actual dollars have provided different perspectives on just what kind of effects Medicaid expansion would have on Alaska.
The Alaska Native Tribal Health Consortium -- a proponent of expansion -- has estimated that Alaska would spend an additional $90.7 million in seven years but it would see at least $67.3 million in savings to the state budget. The federal government would pick up about $1.1 billion of the tab, ANTHC has said.
A state-commissioned study by the Lewin Group found that it would cost the state just more than $200 million over the same time frame.
Another point of contention is the number of Alaskans who fall into the coverage gap when Medicaid isn't expanded.
Gara cited more than 40,000 Alaskans, while Rep. Pete Higgins, R-Fairbanks, said during the session that only about 17,000 people would benefit from expansion. The difference largely depends on if Alaska Natives and American Indians who benefit from the federal Indian Health Service are excluded or included in the calculation. ANTHC has said IHS covers only 40 percent to 50 percent of the funding needed to provide health services.
Higgins said Alaska can't ignore IHS and the benefits it provides.
Gara said either number is too high.
Rep. Paul Seaton, R-Homer, also sat on the Republican panel at the conference, hosted by Washington-based Wilson Strategic Communications, a health care strategy and public affairs firm. The firm also hosts what it calls "nonpartisan, policy agnostic health care" events in Oregon and Washington.