Opinions

Alaskans are paying the premiums for party politics

Born and raised in Eagle River, I grew up being taught the ideals of hard work, generosity and being unequivocally candid. Briefly leaving the state for my undergraduate education, I came to truly appreciate the realness of our people, and that we "just do things differently in Alaska." That being said, I find the recent drama, distortions of reality, and "different" approaches in D.C. quite concerning as they muddy the water while our federal government is attempting poorly planned and harmful overhauls of Medicaid and our federal health insurance policies.

Make no mistake: The Affordable Care Act has weaknesses that must be addressed. But discussions surrounding the effects of these weaknesses and what solutions exist remain hindered and bemoaned by politics and anecdotal testimonies. As a medical student, I have been taught that the gold standard for things such as prescribing insulin, performing mastectomies and engaging in aggressive life-saving measures when one's heart stops beating are all derived from evidence-based medicine. When the evidence points to a better outcome, we Alaskans refer to this as common sense, not fake news. These ideas are where our discussions on health care policy should be founded and carried out.

[CBO: Senate GOP health care bill would leave 22 million more uninsured by 2026]

Three months ago, Sen. Lisa Murkowski wrote a letter to Senate Majority Leader Mitch McConnell detailing her concerns about the American Health Care Act's (AHCA) negative impacts on our state by ending Medicaid expansion. Together with three other senators, she wrote, "We will not support a plan that does not include stability for Medicaid expansion populations." In true Alaska fashion, she deviated from party lines and prioritized our health and well-being.

Since Gov. Bill Walker chose to expand Medicaid, more than 33,000 additional Alaskans have been covered by Medicaid (May 2017), and the uninsured rate has been reduced by 46 percent (2013 to 2015).

Why is this increase in coverage beneficial?  One notable example is that in the United States, we have a legal obligation to treat those presenting to an emergency department regardless of citizenship, legal status or ability to pay. Morally, of course, this makes sense, as one does not choose to be assaulted, or to have a heart attack or stroke. However, the caveat is that a large portion of the population unknowingly receives emergency quality care for non-emergent conditions, resulting in significant financial burdens placed upon patients, hospitals and, ultimately, taxpayers.

Putting aside the obvious public health benefits of increased insurance coverage and access to care, what these data show are a move to shift the cost burden, which will be present regardless of insurance coverage due to the results of this unfunded mandate. Primary care is more effective and less expensive, and the increase in coverage will foster a culture of preventive medicine that is effective both financially and emotionally.

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[Senate bill would undercut Alaska governor's authority over Medicaid expansion]

After a prolonged period of secrecy, lack of public hearings and exclusion of the majority of Republican lawmakers from the creation process, the Senate version of AHCA was finally released, known as the Better Care Reconciliation Act (BCRA). Sadly, it is not even a slight departure from its counterpart in the House, which was predicted by the Congressional Budget Office (CBO) to result in a loss of insurance for 23 million people. The CBO report for the Senate version says 22 million will lose their insurance.

Regarding the expansion, the BCRA moves to reduce funding, which will inevitably end the program as the cost will become too great for states to handle and eventually will increase the number of uninsured. Overall funding for Medicaid has a new proposed restriction through a per capita (i.e. per person) structure. Alaska has some of the highest health care costs in the nation, so as those costs continue to rise and federal funding fails to keep up, Alaskans will be footing the bill. Subsidies will be eliminated, making the cost of already high premiums and deductibles hurt even more to those who can't afford them. The list continues …

More than 50 organizations in the medical community, including conservative groups, were all united in opposition to AHCA (e.g. AARP, American Medical Association, American Hospital Association, etc.). These are organizations that know the health care system, care for patients in it and are concerned with having the best possible outcome for everyone. The fact that NONE of them supported the ideas put forth by the AHCA, ideas that are also present in BCRA, should give cause for grave concern. They are not anecdotal stories; these organizations represent expert recommendations based on evidence and compassion for the American people.

We need both Sen. Murkowski and Sen. Dan Sullivan to stand up for Alaskans and vote against BCRA. Both have stated that they do not support a bill that pulls care out from under Alaskans – this bill does exactly that.

The path our health care system is on is not sustainable, but the solution should be to critically evaluate ideas through respect of process, policy development and public discourse, not passing legislation that'll expedite a fatal hemorrhaging of our health care sector and potentially cost the lives of many of our citizens.

This bill is not good for the American people, it is especially bad for us Alaskans, and the stakes are too high to simply vote along party lines. Alaska is different — we are an outlier and stand to be hurt by this the most — and now is an opportunity for both senators to defend our rights and our health.

Mack Holmberg is a medical student at the University of Washington School of Medicine, Alaska WWAMI Campus, as well as volunteer and member of physician-led organizations dedicated toward health care policy development and patient advocacy. Graduates of Alaska's WWAMI (Washington, Wyoming, Alaska, Montana and Idaho) program comprise 14 percent of working physicians in Alaska, and the goal is to have nearly all members of the annual 20-student class return to practice in Alaska after finishing their education.

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