Last week Alaska's Governor Sean Parnell announced he would NOT expand Medicaid under the ACA.
The long secret state funded Lewin study which was finished back in January 2013 [and updated in April], was finally released too.
From the Lewin Report (Executive Summary):
"Under our baseline participation assumptions, expanding Medicaid would cost the state $200.6 million more over the 2014 to 2020 period, compared to not expanding Medicaid, for a total increased cost of $240.5 million. However, the state would receive $2.9 billion in additional federal funds and fewer individuals would remain uninsured. Additionally, this new cost would comprise only 1.4 percent of total Medicaid costs from 2014 to 2020 (Figure E-4).Summarizing Cost To Alaska if Medicaid Were Expanded:
To minimize state costs under expansion, the state could also elect to implement expansion under a number of alternative design scenarios." (p. 3)
Cost to the state: $240 million from 2014-2020
Federal money to state: $2.9 billion
Impact on population: fewer individuals uninsured
"Fewer" is a bit vague. How many fewer individuals?
Here's what it says on page 13:
"We estimate that there will be about 144,983 uninsured in Alaska in 2014 in the absence of the ACA. Taking into account all other provisions of the ACA, our estimates show that if the state expands Medicaid, the number of uninsured would be reduced to 60,435 — an 84,548 total decrease, or a 58.3 percent change ( Figure 7 ). However, if the state decides not to expand Medicaid, then the number of uninsured would decrease by a lesser amount — a 64,563 total decrease, or 44.5 percent change. This means that under the no expansion option, about 19,900 individuals will remain uninsured that would otherwise have coverage under Medicaid expansion.Here's what I read in that:
Of the uninsured, it is those under 138 percent of FPL [Federal Poverty Level] who would primarily be affected under the decision to expand Medicaid . Those remaining uninsured will continue to strain the finances of other public health programs and safety net providers for their care, while likely forgoing or reducing necessary care and risking a drain on personal finances." (page 13)
Without Medicaid Expansion = 19,900 fewer insured Alaskans than with expansion. Though even with expansion there would still be 60,435 uninsured Alaskans.
Here's what the Alaska Journal of Commerce reported
"Parnell said the additional federal dollars were “tempting” but that the expansion is not in the best interest of the state, for now, because the overall cost of the federal health care program will prove unsustainable and huge costs would fall back on Alaska at some point.If things got as bad as Parnell says, there would be a problem for all the other states as well and they would demand that appropriate adjustments be made. And I don't think he tells us where his data come from.
“The expansion of Obamacare will see skyrocketing costs and there is no guarantee this can be sustained. This is not ‘free money’. It’s being funded by debt and printing money,” on the federal level, Parnell said."
The Journal went on to say the decision was against the advice of many in the business community. [More on this and the state DHSS 'solution' after the break]
"The governor’s decision has prompted an avalanche of criticism, including from business groups. In a statement, the Alaska Chamber (formerly Alaska State Chamber of Commerce) expressed disappointment.The State's Department of Health and Social Services' announcement on the governor's decision outlines the Parnell Administration's plan to take care of the uninsured:
“As a policy priority for chamber members, the expansion of Medicaid is an important part of our goal to reduce and contain the cost of doing business in Alaska,” said Rachael Petro, president of the chamber."
"Recently, the Governor has been meeting with health care providers, large and small business organizations, and other stakeholders from across Alaska discussing recommendations for Alaskans who fall under 100 percent of the FPL and are the main users of Alaska’s safety net services.So, the state isn't going to pay $200 million and get $2.9 from the Feds to take care of the problem. Yet they remain committed to funding the safety net.
It is imperative that we know more about the people who make up this category — who they are, their health care needs, and whether the current services available to them are being utilized or if different services need to be created. The state remains committed to funding the safety net of health care services and to improving the delivery of those services in the most efficient and cost - effective way.
The Department of Health and Social Services is in the process of developing an improved communications plan in the Division of Public Assistance directly targeted at those Alaskans who are the most vulnerable and who are in need of accessing the programs and services offered by the state and federal governments . In the months ahead, DHSS will execute the communications plan, and will strive to better identify and inform income - eligible Alaskans about the services available to them at little or no cost." (emphasis added)
How can they do this for less than the $200 million the state would pay if Medicaid were expanded? They can't. And since the Governor has given $2 billion a year to the oil companies . . .no, let's not go there now.
But, rest assured, they will "execute a communication plan" to tell the poor how to get services
that don't exist "available to them at little or no cost." I guess that means going to the emergency room and everyone else pays their bills, which will be higher because they will be forced to put off care until it becomes more serious and more expensive to treat.
When I attended the confirmation hearing for then Attorney General Dan Sullivan, (now US Senate candidate) he outlined his plan for dealing with the Feds: work with other attorneys general to fight the feds over everything and to sue them if necessary. The Parnell Administration has been following that strategy. One can't help but scratch one's head at how ideology can blind one to the obvious. That may sound like snark, but the Governor chose a company favored by conservatives to do the study and the contract itself seemed geared to find problems with expanding Medicaid and yet the facts of the study show Alaskans would be better covered at little cost to Alaska. And the Governor comes up with another reason to reject it.
Now that we can see the report, finally, as I suspected, the results are a lot like their study for New Hampshire.
Here's the whole Alaska report:
[NOTE: I tried to embed this scrollable Scribd document here, but I can only make a link to it. If someone knows how to do this, please let me know.]
If you'd like to compare the Alaska study to the Lewin Group's New Hampshire study on the same topic, you can find the New Hampshire study here.
At least they used different pictures on the cover. And in New Hampshire they did an evaluation while in Alaska they did an analysis.