This story was originally published in the Alaska Beacon.
The Alaska Legislature has voted to urge the state’s congressional delegation to oppose cuts to Medicaid, as the state faces a potential annual loss of $194 million in federal spending and tens of thousands more uninsured residents.
The House passed Senate Joint Resolution 15 on Sunday by a vote of 27-13, and the Senate approved the final version 14-6 on Monday.
The joint federal-state program is the largest health care payer for lower-income Alaskans and a major source of nursing care for people with a wide range of incomes. The U.S. House of Representatives is considering making $625 billion in cuts over the next 10 years.
The health-focused foundation KFF estimated that Alaska would see a loss of federal payments under the current proposal equal to $194 million this year, or 19% of federal Medicaid spending in the state.
And state enrollment would decline by between 24,000 and 40,000, with a midpoint estimate of 32,000 fewer Alaskans enrolled in the program.
The Senate Health and Social Services Committee sponsored the resolution. Sen. Forrest Dunbar, D-Anchorage and the committee chair, noted roughly 1 in 3 Alaskans is enrolled in the program. He referred to his family history.
“My grandfather fought in World War II, and towards the end of his life, my mother moved him up to Fairbanks to get long-term care,” Dunbar said. “He had to have round-the-clock care; it was about $8,000 a month, which at the time was a lot of money — now it’s even more expensive. And the VA didn’t cover all of that care. We had to enroll him in the Medicaid program. And there are thousands of stories just like that.”
Under the current U.S. House proposal, the two biggest cuts would be the result of instituting work and reporting requirements for Medicaid enrollees and increasing the complexity of applying for and renewing Medicaid.
Dunbar noted that Medicaid pays for a significant share of revenue at major health care providers, citing estimates of 25% of payments to Providence Alaska and 41% of payments to the Alaska Native Tribal Health Consortium.
Sen. Löki Tobin, D-Anchorage, emphasized that the program enrolls most of Alaska’s children, including through school-based programs, and is a major source of health care for Alaska Natives.
The resolution asks U.S. Sens. Lisa Murkowski and Dan Sullivan and U.S. Rep. Nick Begich to oppose the proposed cuts “to protect the state’s health care system, communities, citizens, and economy.”
The resolution said “Medicaid plays a crucial role in supporting the state’s small businesses and entrepreneurs by providing access to affordable health care coverage for employees, which helps prevent illness, reduces absenteeism, and improves productivity,” and that “ by ensuring workers have access to necessary medical services, Medicaid enables small businesses to retain a healthier, more reliable workforce, ultimately contributing to economic stability and growth in the state.”
Rep. Genevieve Mina, D-Anchorage, led the effort to pass the bill in the House and questioned whether the state can afford to take on a greater share of Medicaid spending.
“Given our current fiscal situation, I don’t think that’s going to be realistic, in terms of delivering health care services for people who need it,” she said.
All 21 members of the multipartisan House majority voted for the resolution, along with six minority-caucus Republicans: Reps. Jeremy Bynum of Ketchikan, Bill Elam of Nikiski, Elexie Moore of Wasilla, David Nelson of Anchorage, Mike Prax of North Pole and Justin Ruffridge of Soldotna. The other 13 minority-caucus members voted against it.
One resolution opponent, Rep. Julie Coulombe of Anchorage, proposed an amendment to the resolution that supported “efforts to identify and eliminate waste, fraud and abuse within the Medicaid system.” Coulombe’s amendment passed.
When the amended version of the resolution returned to the Senate, Dunbar criticized the added language, which he described as a “red herring.” He also said that congressional efforts are not targeting waste, fraud and abuse, and could actually undermine some investigations of these issues. But he called for the Senate to pass it despite the added language, due to the overall goals of the resolution.
Twelve of the 14 Senate majority members voted for it, with Nikiski Republican Sen. Jesse Bjorkman and Fairbanks Democrat Scott Kawasaki the only majority members to vote no. Among minority-caucus Republican senators, four voted no, while Sens. Mike Cronk of Tok/Northway and James Kaufman of Anchorage voted for it.
While resolutions like these do not go before Gov. Mike Dunleavy, when the governor was asked about his view of Medicaid and other federal cuts at a new conference on Monday, he acknowledged that the federal government is facing a growing national debt.
“My concern is that Alaska may end up losing money in this process,” he said. “I would hope that whatever decision is made at the federal government, that the floor doesn’t drop out on states like Alaska — but if they’re going to decide to reduce things, that we’re given some time to adjust to that.”
