Stances on Medicaid Factor Into Alaska Governor’s Race

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By Jill Burke

Alaska’s participation in Medicaid expansion is becoming a defining issue among candidates in a four-way gubernatorial race heading into the 2018 election.

Alaska Governor Bill Walker, an Independent, is banking on the benefits of Alaska’s participation in Medicaid expansion to help him get re-elected. Walker used his executive power to expand Medicaid starting September 2015, a move made in spite of the fact that the Alaska Legislature had declined to pass the legislation.

Two Republicans—former state Senator Mike Dunleavy and former Lieutenant Governor Mead Treadwell—along with former U.S. Senator Mark Begich, a Democrat, are after Walker’s seat. The GOP candidates face off in an Aug. 21 primary.

In spite of its historically red-state reputation, Alaska’s support for Medicaid expansion is understandable. The state depends heavily on federal spending, including Medicaid. Taking health care away now from a large block of Alaskans is a non-starter for voter support. So the conversation now isn’t about whether to scrap the program, but over who deserves it and how to pay for it.

“Those that want to take on Medicaid as some magic solution to the budget, they are not being truthful with the voters. I think they’re just using it for political fodder,” Begich told Bloomberg Law Aug. 3.

It’s Personal

Speaking to reporters in Anchorage on Aug. 1 from a health-care clinic that sees Medicaid patients, Walker said his prostate cancer diagnosis in late 2015 reinforced his desire to ensure all Alaskans had health care.

The expansion has given 43,000 more people access to health coverage, created 800 new health care jobs, brought in $73 million for behavioral health services, and boosted the state’s economy by bringing nearly $1 billion in federal funds to Alaska, according to the governor and his staff.

“It was quite an effort, and it just wasn’t going to happen if we didn’t step up and do it, and so we did,” Walker said during the press conference. “Alaska is a healthier, better place as a result of that and we will do all we can to make sure that continues.”

None of the candidates plan to scrap health care for needy Alaskans. But Walker’s challengers say they want reforms.

Controlling Costs

“I am just not sure that the way Medicaid has been carried out under Governor Walker is sustainable in the long run,” Republican candidate Treadwell told Bloomberg Law Aug. 1. “It has been much more extensive than anybody expected,” Treadwell said.

Dunleavy has criticized the expansion in campaign appearances, citing concerns about the growing cost of health care and associated costs to the state to keep coverage going for a widening base of enrollees.

“We certainly aren’t running a campaign on the notion that Medicaid expansion ought to just be rolled back. We have the program in place now so we have to look at how do we go forward in the most constructive manner that’s going to use the dollars most wisely, promote the best outcomes and provide the necessary access to medical care that people need,” Brett Huber, Dunleavy’s campaign manager, told Bloomberg Law Aug. 3.

Begich voted for the Affordable Care Act in late 2009 as the sole Democrat in Alaska’s delegation to the U.S. Congress and urged—unsuccessfully—that Walker’s predecessor sign Alaska up for Medicaid expansion.

“You bet I’m going to continue to support it. Over time the best way to deal with this issue of how many people are on it is to do everything we can to improve the economy,” Begich said.

Unexpected Growth

The recession, not Medicaid expansion, caused more people than expected to enroll in the program, members of Walker’s administration told legislators when explaining the supplemental appropriation request.

The program is expected to cost the state $691 million in 2019, providing coverage to more than 225,000 people, or nearly one in three Alaskans. That expense is controversial with fiscal conservatives.

Getting the budget into the black, and getting people into jobs that provide health care benefits are priorities the candidates share. If more Alaskans receive employer-sponsored health insurance, fewer will need Medicaid, the candidates say.

This spring, Walker sought nearly $100 million in emergency funding from the Legislature to keep Medicaid payments going through the end of the June. The Legislature approved $45 million.

Walker stands by his decision to implement Medicaid expansion. Not taking advantage of the federal government’s 90 percent match to the state’s 10 percent share would have been letting tax dollars slip away, he said.

“Alaskans pay an income tax to the federal government and we brought some of that money back to Alaska. I’ll stand behind that any day,” Walker said.

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