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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).
     To minimize state costs under expansion, the state could also elect to implement expansion under a number of alternative design scenarios." (p. 3)
Summarizing Cost To Alaska if Medicaid Were Expanded:

    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.

    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)

Here's what I read in that:

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.
    “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."
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 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.
    “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."
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:


"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.

    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)

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.  

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:

  Lewin Final Report on Medicaid Expansion Alaska by Steve

[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.

An earlier version of this was posted at What Do I Know?
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Comment Preferences

  •  Why does that name "Lewin Group" sound familiar? (1+ / 0-)
    Recommended by:

    If I remember so correctly four years ago so many Republicans in Congress kept citing "a report from the Lewin Group".

  •  I watched the suits trying to decide (1+ / 0-)
    Recommended by:

    just how much to pay the other suits to take our oil. Haven't watched any tube since. I'm getting old enough to watch the blood pressure. Why do we need medical care for the elders anyhow? Climate change'll keep 'em warm. Thanks for the info, we appreciate you keeping us posted.

    “The basic tool for the manipulation of reality is the manipulation of words. If you can control the meaning of words, you can control the people who must use them.” ― Philip K. Dick

    by Wood Gas on Sun Nov 24, 2013 at 09:44:33 AM PST

  •  you said it yourself (1+ / 0-)
    Recommended by:
    One can't help but scratch one's head at how ideology can blind one to the obvious.
    What a terrible way to run our state.  This AND the oil giveaway...but maybe we will repeal the oil giveaway?  Maybe.  Then we are still left with higher costs for doing things to run with "ideology" instead of common sense, going with the medicaid expansion.

    Sigh.  Such a beautiful place to live.

    Run by people such as Parnell and his party's gerrymandering.

  •  So as a last resort for justifying his (1+ / 0-)
    Recommended by:

    declining Medicaid expansion, the governor of Alaska claims concern over the federal debt and deficit?  He would rather allow citizens of his state to go without access to regular health care than add to the federal debt?  That's the biggest load of nincompoopery I've heard in this whole ACA debate, and there has been truckloads of nincompoopery already dumped into the discussion.  I would ask how the people of Alaska could elect such a scoundrel to the governorship of the state, but I live in Texas, so I don't need an explanation.

    By the way, the Lewin Group is owned by United Health Care and is responsible for the study Republicans (and some Democrats) cited during the debate over the ACA in 2009 to kill the public option.  Back in 2009, the group published a study picked up by the Commonwealth Fund and the Heritage Foundation and disseminated with talking points to Republicans in the House and Senate.

    More specifically, the Lewin Group is part of Ingenix, a UnitedHealth subsidiary that was accused by the New York attorney general and the American Medical Association of helping insurers shift medical expenses to consumers by distributing skewed data. Ingenix supplied UnitedHealth and other insurers with data that allegedly understated the "reasonable and customary" doctor fees that insurers use to determine how much they will reimburse consumers for out-of-network care.

    In January [2009], UnitedHealth agreed to a $50 million settlement with the New York attorney general and a $350 million settlement with the AMA, covering conduct going back as far as 1994.

    "In this world of sin and sorrow there is always something to be thankful for; as for me, I rejoice that I am not a Republican." - H. L. Mencken

    by SueDe on Sun Nov 24, 2013 at 02:11:40 PM PST

  •  The Governor is really screwing AK hospitals (2+ / 0-)
    Recommended by:
    CanisMaximus, pvasileff

    The federal government makes something called Disproportionate Share Payments under the Medicaid program to hospitals that serve a disproportionate share of people who can't afford to pay their own bills and whose bills aren't paid through private insurance or government programs.  In FY 2011, the last year for which I could quickly find statistics, these payments nationally totaled approximately $11.3 billion.  As part of paying for the ACA, the payments will be reduced by $500 million in FY 2014, $600 million in FYs 2015-2016, $1.8 billion in FY 2017, $5 billion in FY2018, $5.6 billion in FY2019, and $4 billion in FY 2020.

    It was thought that the loss of these payments wouldn't hurt hospitals, because many more people would have coverage under the ACA, both through subsidized insurance and Medicaid expansion.  But for those states that rejected the Medicaid expansion, their hospitals that serve a disproportionate share of lower-income people are going to be really screwed.  In FY 2011, Alaska hospitals got in excess of $20 million under this program.

    Some of the states whose hospitals depend most heavily on this program are the very GOP-run states whose Governors refused to go along with Medicaid expansion and who are trying to interfere with the success of the ACA in every way possible.  Foremost among these are Texas and Louisiana, whose hospitals received approximately $957.3 million and $732 million respectively through this program in FY 2011. (NY and CA actually received somewhat more than that, but since they have Governors who accepted Medicaid expansion and are actively supporting the implementation of the ACA, their hospitals should be OK.)

    Bin Laden is dead. GM and Chrysler are alive.

    by leevank on Sun Nov 24, 2013 at 02:16:06 PM PST

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