The U.S. Senate battle over Obamacare repeal put Alaska Gov. Bill Walker in the center of a political storm last month. He hopes to use the position to develop a national solution.
Walker said President Donald Trump and former President Barack Obama both called to lobby him for and against legislation to repeal the Affordable Care Act, as did House Minority Leader Nancy Pelosi and Sens. Lindsey Graham and Bill Cassidy, the sponsors of the bill.
Vice President Mike Pence called many times — more than anyone else — and asked Walker to visit Washington to work on the issue. Walker instead took a planned trip to China for meetings on his Alaska natural gas pipeline project.
But the governor sent a team of seven to work with the White House to assess the impact of the bill on Alaska. They spent six hours at a meeting that included Tom Price, then secretary of Health and Human Services, and Seema Verma, administrator of the Centers for Medicare and Medicaid Services.
Walker said he also worked on the issue by phone from China, with a 12-hour time difference. On one call, after midnight, he fell asleep while talking with Alaska's two senators, waking up three hours later.
Walker's opinion mattered because Sen. Lisa Murkowski, a swing vote in the narrowly divided Senate, remained noncommittal on the Graham-Cassidy bill, which would have channeled federal health spending into block grants for each the state.
Murkowski said she would rely on the state's evaluation of the bill's Alaska impact. Walker's team was never able to provide those numbers, so she remained on the fence until the bill died Sept. 26.
Lori Wing-Heier, director of the Alaska Division of Insurance, who attended the White House meeting, said the Trump administration could not provide firm financial details for the Alaskans to work with. The bill was changing too fast.
Numbers did come after the proposal collapsed, but the state didn't bother to analyze them, Wing-Heier said.
Walker and Murkowski each contacted me over recent weeks asking for my advice on Alaska health care reform. I met Walker in his office and Murkowski in a coffee shop, each for around an hour.
It's not my job to give politicians advice, and I am not a health care expert, but we agreed that the off-the-record conversations would be followed by recorded interviews. We did those interviews Tuesday.
By then events were moving again. Murkowski called just after Sens. Lamar Alexander, R-Tennessee, and Patty Murray, D-Washington, announced a compromise bill to continue Obamacare subsidies temporarily while allowing more flexibility for states and individual policyholders.
More states could get federal waivers like the one Alaska used to create a program that is reducing individual policy premiums with an infusion of state and federal money. Alexander called the provision, "Alaska for all."
Murkowski said she served as an intermediary between Alexander and Murray, a role akin to shuttle diplomacy. The ADN's Erica Martinson reported much of that conversation in her article yesterday.
Walker signed a letter with 10 governors of both parties Wednesday supporting the bill Murkowski helped negotiate.
Walker said he signed an earlier letter opposing Obamacare repeal after a governors-only meeting at the National Governors Association. Presented with a draft, he edited out partisan language, he said, and that new, softer version brought Republican governors on board to sign.
The experience convinced Walker that his status as an independent could help him bridge the partisan divide to come up with a national health care solution. He hopes to convene a bipartisan group of a dozen governors in Denver before the end of the year to work on a plan.
But Walker doesn't have a solution for health care reform at the state level. With the most costly health care in the nation, Alaska experts haven't gelled around big ideas.
Murkowski said Alaska must address costs. I agree.
Murkowski helped stop legislation that would have hurt Alaska, and that incidentally also would have reshaped an industry comprising more than a sixth of the U.S. economy. But she rightly questions attempting to tailor a federal solution around Alaska's tiny individual market, with its 18,000 people.
"We have a system that is not sustainable," she said. "We are going to have to have some hard discussions about what is sustainable and we're probably going to have it sooner than later."
She expects the Obamacare repeal debate to re-emerge within six months.
But state solutions are moving much slower, or not at all.
A group of key legislators and officials from the health industry and Walker administration met all day Wednesday in Midtown Anchorage to begin working on a plan for how to create a plan. When I left about 50 people were breaking into small groups to talk about broad goals.
Becky Hultberg, president of the Alaska State Hospital and Nursing Home Association, and a member of the steering committee for the effort, told the group major changes to Alaska's system would take at least five years.
Walker and Wing-Heier are studying a proposed Alaska Health Care Authority, which would consolidate government employee health plans, potentially reducing costs. They said the authority might also allow nonprofit organizations and small businesses to buy into its coverage.
But their approach remains cautious and slow. Wing-Heier is still considering the unique Alaska regulation that many observers believe drives up Alaska physician payments by requiring insurance companies to pay 80 percent of customary charges — which some physician groups themselves control.
After more than a year of strong public interest in the 80th percentile rule, she is still studying it.
A strategy focusing only on the federal level is a bet that Alaska can keep bringing in a disproportionate amount of free money rather than dealing with the factors that are causing our higher costs.
Perhaps Alaska will stay lucky and that strategy will continue to work. But it doesn't look like good gamble to me. The stakes are too high.
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