Lisa Murkowski

U.S. Sen. Lisa Murkowski, R-Alaska, gestures before a public television debate on Thursday, Nov. 3, 2016, in Anchorage, Alaska. She faces three challengers in Tuesday’s general election. (AP Photo/Mark Thiessen)

FAIRBANKS — Sen. Lisa Murkowski of Alaska and three other Republican senators warned Senate Majority Leader Mitch McConnell this week that they will not support a replacement of the Affordable Care Act if it does not protect people who gained insurance coverage under the law’s Medicaid expansion provision.

In the Monday letter to McConnell from Murkowski and Republican Sens. Rob Portman of Ohio, Shelley Moore Capito of West Virginia and Cory Gardner of Colorado, they said, “Medicaid covers more than 72 million Americans and is the core of the health care safety net for individuals across the country.”

Medicaid is a federal-state health care program for low-income people who are disabled, pregnant or caretakers of dependent children.

The four senators each represent states that chose to expand Medicaid eligibility under the Affordable Care Act. Republicans hold 52 seats in the Senate, so the four senators could have leverage in the GOP’s effort to replace former President Barack Obama’s Affordable Care Act if they are not satisfied. 

Murkowski is a member of the Senate Health, Education, Labor and Pensions Committee.

“We are concerned that any poorly implemented or poorly timed change in the current funding structure in Medicaid could result in a reduction in access to life-saving health care services,” according to their letter. “The Medicaid population includes a wide range of beneficiaries, many of which cycle on and off Medicaid because of frequent changes in income, family situations and living environments.

“The Department of Health and Human Services reports that nearly one-third of individuals covered under the Medicaid expansion have a mental health or substance use disorder,” it reads. “As the largest payer of mental health and substance use services in the United States, it is critical that any health care replacement provide states with a stable transition period and the opportunity to gradually phase-in their populations to any new Medicaid financing structure.”

The letter was sent the same day that House Republicans unveiled their long-awaited legislation to replace the Affordable Care Act, known generally as Obamacare.

The bill’s Medicaid provision would phase out the program beginning in 2020, at which time states will continue to receive the federal payments for people covered by the expansion but will receive less funding for new enrollees. It would also affect the states by basing payments on enrollment and costs in each state rather than using the open-ended financing under which states are guaranteed at least $1 in federal funds for every $1 in state Medicaid spending. 

The four senators indicated that some Medicaid reform is needed, however.

“We believe Medicaid needs to be reformed, but reform should not come at the cost of disruption in access to health care for our country’s most vulnerable and sickest individuals,” they said in the letter.

The letter concludes with “we will not support a plan that does not include stability for Medicaid expansion populations or flexibility for states.”


in Alaska

Gov. Bill Walker in August 2015 made Alaska the 29th state to accept federal funds to expand Medicaid in Alaska through a coverage program named the Healthy Alaska Plan. The Legislature sued Walker, claiming it and not the governor had the authority to determine Medicaid eligibility. A Superior Court judge ruled against the Legislature, which eventually dropped the lawsuit.

Walker wrote in January of this year to House Majority Leader Kevin McCarthy of California urging Congress “move forward carefully” on changes to the Affordable Care Act. Walker was responding to a health care reform survey of governors and state insurance commissioners by McCarthy and other members of Congress.

In his response, Walker noted that the health law itself and the expansion of Medicaid in particular have brought health insurance coverage to thousands of Alaskans. “The vast majority of these Alaskans would be unable to afford health care coverage without the current ACA provisions,” he wrote.

Walker opposes changing how Medicaid funding is directed to the states, one of the key Medicaid provisions in the House bill. Yet he also proposed, in his survey responses to McCarthy, changes such as reducing federal oversight audits and reviews and giving states added flexibility in administering Medicaid programs and services.

The state Department of Health and Social Services, in a February 2015 document, said Medicaid expansion would bring health insurance to 26,500 Alaskans by 2021, with an estimated 5,800 of those living in Interior Alaska.  

The U.S. Department of Health and Human Services in mid-December, five weeks ahead of the installation of the Trump administration, touted the benefits of Medicaid expansion in Alaska. It stated in a report that 17,000 Alaskans have gained health coverage because of the state’s decision to expand Medicaid eligibility.

Murkowski, in previously unpublished comments from a Feb. 4 interview with the News-Miner, noted Medicaid expansion has been positive for Alaska. She made the comment while explaining the status of the health care debate in the House and the Senate.

“Medicaid is something, obviously; you have those states that have moved forward with expansion and we’ve clearly seen the benefit of that here,” she said.

Contact News-Miner Editor Rod Boyce at 459-7585.