Reform unsustainable Medicaid program before expanding

Total Medicaid spending exceeded $1.6 billion in fiscal year 2015 and will grow to $2.8 billion by 2025 — even without expansion. Medicaid in its current form is unsustainable and is the biggest cost driver in state government. The governor should work for real reform instead of instituting Alaska’s version of “Walkercare” which has the potential to sink the system we already have.

Good intentions aside, those who insist on expanding Medicaid willfully ignore the fatal flaws that make expansion an irrational decision at this time.

1) The Medicaid system at current levels is so very broken it simply cannot deliver anything that resembles quality healthcare to an expanded population.

2) There is no workforce development plan that describes where all the doctors, nurses, phlebotomists and techs to handle all these new people will come from. Dumping more people into the system does not create the healthcare workers to handle them and wait times to see doctors will necessarily increase.

3) We cannot afford this. We are facing billions in shortfalls for the next several years. The legislature is deeply cutting the budget in an attempt to keep up with these multi-year, multi-billion dollar deficits and it is ludicrous to expand when we are sinking in red ink.

4) Contrary to expansionist rhetoric, the feds are not going to pay for this. They say they will, but they can’t — they’re broke.

There is no principle of economics at play here, nor is there any federal mandate that will create savings. Expansion will, by design, increase prices because it will increase demand without any corresponding increase of supply i.e. doctors, nurses, clinics etc.

That means higher prices for everyone except the able-bodied, childless recipients who are the beneficiaries of expansion. Oh you weren’t aware that’s who the expansion population is? Alaska already provides the most extravagant healthcare plan in the United States for the most needy, the elderly, families with dependent children, pregnant women, and the disabled.

The expansion population is mainly, but not entirely, made up of able-bodied, childless adults. What? You thought it was for the most vulnerable among us? Think again.

There are many other reasons not to expand Medicaid, but let’s just talk about the most obvious. This is a public policy debate that needs to be debated, not decreed, and the debate needs to include reform. 

The legislature is committed to sound Medicaid reforms. That is why our Legislative Budget & Audit committee went out to procure experts to provide the critical information we’ll need to have a reasoned discussion on the topic. These experts will pull from the best reform policies around the country to help us fix our Medicaid program so it is affordable, efficient, and most importantly, sustainable for our most vulnerable citizens.

Then, when Medicaid is no longer a mess, we can think about expanding it. To be honest, we may not expand it even then, but it is clearly irresponsible to do it now.

We in the Senate Majority began the process to reform Medicaid in the last legislative session. I, with the consent of my colleagues, sponsored a sweeping Medicaid reform bill (Senate Bill 74) and it has worked its way through most of the Senate process. It includes provisions to reduce unnecessary emergency room visits, absurd travel expenses and costly self-referrals to specialists.

It puts recipients on a health management plan, incorporates telemedicine and initiates privatization to create a much higher level of accountability.

Expanding the mess of Medicaid without fixing it first is irresponsible. The governor’s bill has been given a fair shot in the legislature. In fact, his bill has been given deference over our own bill and sits in Senate Finance awaiting continued action when the session reconvenes. Unfortunately, Walker prefers to end run the legislative process and like Obama, act by fiat.

That should not surprise us. Obamacare was inflicted on this country by sidestepping the democratic process. Remember the passage by proclamation nonsense in the U.S. Senate? Or, the now famous remark by House Speaker Nancy Pelosi, referring to the Obamacare bill: “You have to pass it to find out what’s in it.”

Medicaid expansion is simply another piece of Obamacare and as such it should be no surprise that it is inflicted on the people of Alaska in the same way.

If Walker truly cares about the people of Alaska, and I have no reason to doubt he does, he should work to reform the system we have.

Sen. Pete Kelly, R-Fairbanks, is co-chair of the Senate Finance Committee.

Updated: 
11/20/2016 - 2:57pm

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