Senate bill would undercut Alaska governor’s authority over Medicaid expansion

WASHINGTON — Alaska's Medicaid expansion would likely not survive another legal challenge if the Senate's proposed health care bill passes, according to experts.

The way the bill adjusts spending on Medicaid expansion, "like other provisions of the bill, makes Alaska worse off than other states," said Judy Solomon, vice president for health policy at the Washington-based Center for Budget and Policy Priorities, a left-leaning think tank.

Alaska Gov. Bill Walker expanded Medicaid under the Affordable Care Act ("Obamacare") using an executive order. He based his authority on a provision in Alaska law that says the state must cover Medicaid populations that are listed as mandatory under federal law.

Members of the Alaska Legislature sued over the governor's action, but an Alaska court sided with Walker. Though the U.S. Supreme Court ruled that states didn't have to comply with the ACA Medicaid expansion or risk federal funding, it is still listed in the "mandatory" section of the Affordable Care Act. So Alaska law requires inclusion of the group in its Medicaid coverage, the Alaska Superior Court ruled.

[The Senate health care bill hands big costs to Alaska]

Under the ACA, states were allowed to extend Medicaid coverage to people making up to 138 percent of the poverty line ($15,060 annual salary for a single Alaskan and $30,750 for a family of four). In Alaska, that ultimately added 33,945 Alaskans to Medicaid.

March 1, 2016: Judge dismisses Alaska Legislature's lawsuit over Medicaid expansion]


The Senate bill would allow expansion states to continue getting Medicaid funding for the larger population, but starting in 2020 would move the expansion group to another list in the law — for optional services.

"Under Alaska law, whether to cover an 'optional' group is at the decision of the Legislature," Solomon said. While it's not clear exactly what would happen on "day one," it is "certainly clear that a court challenge … would likely be successful," Solomon said.

"The (Medicaid) expansion is at risk in all the states that have it, but the risk is heightened and comes into effect sooner in Alaska than other states," she said.

Erica Martinson

Erica Martinson is a former reporter for the Anchorage Daily News based in Washington, D.C.