Senators welcome delay on healthcare vote to lobby for Alaska

  • President Donald Trump talks with Sen. Joni Ernst, R-Iowa in the Cabinet Room of the White House in Washington, on June 13, alongside, from left, Sen. Rob Portman, R-Ohio, Sen. John Thune, R-S.D., and Sen. Lisa Murkowski, R-Alaska. Murkowski and fellow Alaska Sen. Dan Sullivan are key votes on the Senate’s healthcare bill and are using that leverage to lobby for improvements in the bill for the state. (Photo/Susan Walsh/AP)

A delayed vote on overhauling the U.S. health care system buys time for U.S. Sens. Lisa Murkowski and Dan Sullivan to negotiate on key provisions for Alaska over the July 4 recess.

Neither of the Alaska senators issued an official statement after Sen. Mitch McConnell, R-Ky., saw that he did not have the necessary 50 votes to pass his legislation repealing and replacing the 2010 Affordable Care Act.

Through spokesperson Karina Petersen, Murkowski called the delay a “good thing.”

“It’s a good step to take more time. She has said we need to do it right and not rush this. Now she can continue to vet the bill,” Petersen said, adding that her phone hasn’t quit ringing.

Murkowski’s moderate standing places her as a swing vote courted by both President Donald Trump and McConnell. The national media is clambering to know how Murkowski will vote, she said.

This also buys Murkowski negotiating credits — her vote in exchange for key changes.

“She is looking at the Medicaid portion — those with Medicaid and those who came in under Medicaid expansion — (wanting) that they continue to be covered and not have the rug pulled out,” Petersen said.

The Congressional Budget Office rated the Senate’s health care bill as potentially causing 22 million to become uninsured. About 15 million of those would be people who choose not to buy insurance because of the repeal of the individual mandate; others could lose coverage through loss of Medicaid eligibility or reduction in premium subsidies.

That is an important score, Murkowski says, but it’s not the only one she is considering.

According to the latest figures provided by the Alaska Department of Health and Social Services 185,139 Alaskans receive Medicaid services. That’s 25 percent of the state’s population. Previous to the Medicaid expansion funds accepted by Gov. Bill Walker, there were 33,945 fewer people covered that now are added to Medicaid rolls.

Keeping Alaska’s adjustment at 138 percent of poverty level is another must-have provision, Murkowski and Sullivan have said. Without that adjustment, fewer people will qualify for federal subsidies.

The bill, as currently written, also would phase out additional federal funding 31 states and Washington, D.C., receive, and Alaska is one of them. When then-Gov. Sean Parnell objected in 2010 to expanding Medicaid in Alaska through funds offered during the President Obama administration, he did so on the belief Alaska would be left holding the bag if the law ever changed.

That’s exactly what the Senate version does. It ramps down payments to states from 90 percent in 2020 to 50 percent by 2025.

“We want to keep what’s worked for some Alaskans under the ACA — keep coverage for preexisting conditions,” Sullivan said in a video statement.

But he’s also “relentlessly focused on educating leaders” about “how big of an outlier Alaska is as it relates to healthcare and insurance costs.”

The first of Sullivan’s three goals is to stabilize the market. One insurer on the individual market is not sustainable, he said. He wants to protect the “thousands who receive subsidies” but also the thousands who don’t “and they are being wiped out financially.” And thirdly, he wants to see a sustainable, equitable path forward.

In a statement issued June 27, Sullivan said he supports waiting until after the July 4 recess to vote. He also “appreciates being invited to the White House with my colleagues for a very productive meeting with President Trump and Vice President Pence” on June 27.

“Like most one-size-fits-all approaches from Washington, D.C., the Affordable Care Act is not working for many Alaskans,” he said. “Premiums and deductibles have skyrocketed for the middle class. The director of Alaska’s Division of Insurance (Lori Wing-Heier) said that our market is in ‘chaos.’ The current situation in the healthcare market in Alaska and nationally is not sustainable. Something has to be done, and it has to be done soon.”

Sullivan wanted to get rid of the employer or individual mandate, as well.

The Senate version does change how the mandate is handled. Insurance carriers have said they favor some kind of carrot to incentivize Americans not to wait to get coverage.

McConnell agreed to a penalty for Americans who let their insurance lapse for 63 days or more. Under the new provision, those who go without insurance will be “locked out” of getting coverage for at least six months after they sign up.

This “lockout period” would, in theory, create an incentive for people to have insurance all the time, instead of waiting until they’re in the ambulance.

Alaska’s only individual market insurer, Premera Blue Cross Blue Shield, favors moves that help with market stability. Premera Alaska President Jim Grazko expressed concern about the earlier draft that lacked any kind of mandate.

“We are encouraged that the Senate bill includes funding for reinsurance as well as more funding for subsidies than the House bill to help lower income families,” said Steve Kipp, vice president of corporate communications.

That’s important for Alaska because Premera’s rates climbed only 7 percent rather than 42 percent in 2017 because of a reinsurance program approved by the Legislature last year that included $55 million from the state collected through a levy on all plans sold in Alaska.

Grazko felt the Senate version offered “slight” improvements over the House. But income will be a big factor in determining subsidies, coupled with age. Premera’s criteria list is to ensure coverage for as many people as possible to increase Alaska’s pool and bring costs for all customers down. They also want people who can’t afford insurance to receive the subsidies for commercial health care coverage.

With so many variables still in the air, Premera must calculate its 2018 rates by mid-July and file with the Alaska Division of Insurance.

“We are currently working on those,” said Melanie Coon, Premera senior communications manager.

As of June 27, Division of Insurance Director Lori Wing-Heier said she was still analyzing the 140-page bill.

“At this point, it’s hard to say what impacts there will be to those in the insured market,” she wrote in an email. “We continue to work very closely with Sen. Murkowski and Sen. Sullivan on the intent of the bill and what its impact will be on Alaska.”

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Naomi Klouda can be reached at naomi.klouda@alaskajournal.com

Updated: 
06/28/2017 - 12:36pm

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