State of the State

Gov. Bill Walker delivers his third State of the State address to the Legislature flanked by Senate President Pete Kelly and House Speaker Bryce Edgmon on Jan 18, 2016. Walker called on the Legislature to work with him to address the state's budget woes. Matt Buxton/News-Miner

FAIRBANKS — Gov. Bill Walker is urging Congress to take its time to come up with a balanced replacement of the Affordable Care Act.

Walker shared his concerns and advice with congressional leaders in a letter earlier this month, noting that a repeal without a “workable alternative” would leave tens of thousands of Alaskans without coverage.

Walker wrote that 17,000 Alaskans are buying coverage through the individual marketplace. An additional 27,000 Alaskans, including nearly 3,000 in the Interior, are covered through the Affordable Care Act’s Medicaid expansion provision, which Walker enacted unilaterally after his election.

“The vast majority of these Alaskans would be unable to afford health care coverage without the current ACA provisions,” he wrote in the Jan. 13 letter. “To ensure the recent gains in health care access are not compromised, any changes to the existing provisions should maintain current access and funding levels.”

The letter was addressed to House Majority Leader Kevin McCarthy as part of a survey of governors about their concerns and priorities for the Affordable Care Act, known widely as Obamacare.

Walker said the 2010 health care act “has created both some challenges and opportunities for Alaska.” He advocated for keeping some parts of the law while updating or changing others.

“I am hopeful that adjustments are carefully evaluated and timed to allow for organized transitions to avoid negative impacts on individuals, health care delivery systems and industry stakeholders,” he wrote in the letter. 

“States like Alaska have invested significant resources on ACA compliance, and we are concerned that rapid changes without workable alternatives could have damaging long-term effects on the people of Alaska and our economy.”

The survey contained nine broad questions on the innerworkings of the legislation. In general, Walker requested changes that give states flexibility to implement the law and any impending changes to it. 

“My principal request is to move forward carefully and provide as much flexibility and support as possible for individual states to implement and/or maintain health care systems that meet localized needs,” he wrote. 

Among the biggest requests from the Walker administration is to preserve Medicaid expansion and its federal funding. Walker used executive authority to accept the expansion without the say-so of the Legislature. Thirty-one states have accepted Medicaid expansion funding, which is expected to be a key piece of repeal talks. 

A recent update on expansion showed that more than 27,000 Alaskans have signed up for coverage under Medicaid expansion. The same update says the system has paid out more than $300 million in claims, which are covered 100 percent by the federal government.

The letter explained that reversing Medicaid expansion would have negative impacts that would ripple far beyond the state’s health care system. Medicaid expansion was a key element of a major criminal justice reform bill that seeks to offer more drug treatment for offenders. He wrote it would have a significant impact on the state’s “ability to maintain criminal justice reform laws aimed at reducing criminal recidivism, homelessness and other health care issues.” 

Also on Walker’s list to keep are mental health parity regulations and protections for Alaska Natives, as well as provisions related to in-home care and primary care services for people with chronic health conditions.

A significant request for a change is to either repeal the co-called Cadillac tax on high-price employer insurance plans or to modify it to account for geographical cost differences. The Cadillac tax is set to kick in 2018 and has been of high concern in Alaska, where the cost of delivering health care is higher than in the Lower 48.

Other improvements suggested by Walker for the Affordable Care Act include reducing the workload placed on states for oversight audits and reviews.

Walker wrote that Alaska opposes the implementation of Medicaid block grants “due to unique access-to-care issues and travel costs that would disproportionately impact large, sparsely populated states like Alaska.” Block grants are included in President Donald Trump’s health care positions. 

He also called for provisions that would allow for national or local negotiations of drug pricing.

As of Tuesday, congressional Republicans and Trump had yet to find agreement on a replacement plan for the Affordable Care Act. Trump has pledged to have a replacement ready by the time his pick to head the U.S. Department of Health and Social Services, Rep. Tom Price, R-Georgia, is confirmed.

Trump on Friday signed an executive order directing the administration to “minimize the unwarranted economic and regulatory burdens of the Act.”

The Alaska congressional delegation has pushed for a repeal and replacement of the Affordable Care Act. In a statement released Tuesday, Rep. Don Young lauded Trump’s actions with the measure.

“There’s no question, the Affordable Care Act is broken,” he said. “In states like Alaska, the failures have been magnified through the loss of all but one provider, skyrocketing premiums and outrageous deductibles. As Congress begins the process to transition away from this law, I support giving Alaskan families and small businesses the relief from the law that they have demanded.”

Contact staff writer Matt Buxton at 459-7544. Follow him on Twitter: @FDNMpolitics.