WASHINGTON — The three members of Alaska's all-Republican congressional delegation are looking for big changes before voting "yea" on the House-proposed Affordable Care Act repeal-and-replace bill.
There will be changes introduced this week, when the bill to repeal and replace the Affordable Care Act goes to the House Rules Committee Wednesday. The full House of Representatives is expected to vote on a bill Thursday.
Alaska Rep. Don Young said Monday that he won't vote for the bill unless he can secure changes that would provide equity for Alaska. As the bill was originally written, Alaskans who buy health care on the exchange would take a major hit in terms of cost — by far the largest in the nation.
The bill would also peel back Medicaid funding, and Sen. Lisa Murkowski has said she won't support a bill that causes many Alaskans to lose their health care.
The bill moving through the House is not a full repeal of the ACA — it touches only on tax and budget-related provisions. By moving the bill as part of the "budget reconciliation" process, Congress won't have to face down a filibuster by Democrats in the Senate. The once-a-year measure only requires 51 votes, the same number of Republicans that are in the Senate. Other bills require 60 votes to pass the Senate's filibuster hurdle.
"Right now where the House is, the impact to our state and what it would do to us is something that I don't think is sustainable, and I am very concerned," Murkowski said in an interview late last week. She said she would be "looking pretty critically" at whatever legislation ultimately comes out in the House this week.
If on Thursday the legislation has "fair equitable treatment to Alaskans, I'll probably vote for the bill. But if it's not there, I'll probably vote against the bill, because it's really not the repeal of Obamacare as we originally said we were going to do," Young said in an interview Monday.
Young would like to see Republicans employ a bit more leverage: Use the budget reconciliation to repeal, but not replace, the tax and budget portions of the ACA starting in 2020. Then, take some time and write a comprehensive replacement bill, using the drive of impending repeal to get everyone to the bargaining table.
But for now, "I remain committed to improving this legislation in areas that it falls short," Young said.
"Health care is broken as it is today. We've seen the numbers — skyrocketing premiums, soaring deductibles and the loss of all but one insurer in the state of Alaska," Young said.
"Ultimately, I support efforts to repeal and replace the Affordable Care Act, but I also recognize that it's very difficult to put 'the toothpaste back in the tube,' " Young said.
All three members of the delegation support holding on to some remnants of the ACA: protections for people with pre-existing conditions, allowing people to remain on their parents' plans until they are 26 years old, and lifting the limits on lifetime insurance spending caps.
And Young said that all three members of Alaska's congressional delegation are working to address Alaska-specific issues in the legislation: "the high cost of care, skyrocketing premiums, lack of competition, our remoteness and the many challenges we face due to our lack of infrastructure … We remain the highest-cost state for health care and therefore — at times — we require a different approach than the Lower 48," Young said.
"But right now, given the direction that they've taken on the tax credits, for Alaskans, this is really a hard kick to Alaskans who have been receiving any level of subsidy," Murkowski said. "We take the hardest hit of any state out there," she said.
"Under this proposal, on average each Alaskan in the individual market will lose $10,500 in premium support. And that's just in the individual market — with 18,000 people in Alaska," Young said.
When it comes to Medicaid, Young said he wants to see Alaska get a greater amount of funding to cover its high-cost health care. A variety of changes are under discussion, "but I'm not going to put the burden back on the state," Young said.
Sen. Dan Sullivan has been the least critical of the House bill of the three, but only in relative terms. "The senator is pleased that the bill in its current form repeals the individual and employer mandates, works toward reducing costs, provides flexibility to states, protects the Indian Health Care Improvement Act, and continues to provide coverage for those with pre-existing conditions as well as young adults on their parent's insurance," said Mike Anderson, Sullivan's spokesman.
But Sullivan is also worried about the high costs Alaska could face compared to the rest of the country. The senator has pressed the issue with House and Senate leadership, as well as Trump administration officials, Anderson said, noting another planned discussion with Health and Human Services Secretary Tom Price scheduled Tuesday.
Murkowski said last week she spoke to Price about how the tax credits in the House bill "simply do not take into account just the geographic disparity, the cost disparity, the low population, all of the factors that make Alaska Alaska," as well as the hit the state would take on Medicaid expansion.
Asked if she would vote for the House bill unchanged, Murkowski would only say, "I can pretty much tell you that the Senate would not put that bill up."