Thursday, November 21, 2013

Gov Parnell Rejects Medicaid Expansion Although Lewin Report on Alaska Expansion Says State Would Gain Bigtime

"Under our baseline participation assumptions, expanding Medicaid would cost the state $200.6 million more over the 2014 to 2020 period, compared to not expanding Medicaid, for a total increased cost of $240.5 million.  However, the state would receive $2.9 billion in additional federal funds and fewer individuals would remain uninsured.  Additionally, this new cost would comprise only 1.4 percent of total Medicaid costs from 2014 to 2020 (Figure E-4).
 To minimize state costs under expansion, the state could also elect to implement expansion under a number of alternative design scenarios."

Summarizing Cost To Alaska if Medicaid Expanded:
  • Cost to the state:  $240 million from 2014-2020
  • Federal $ to state:  $2.9 billion
  • Impact on population:  fewer individuals uninsured*

*How many fewer individuals, you ask.

Here's what it says on page 13:
"We estimate that there will be about 144,983  uninsured in Alaska in 2014 in the absence of the ACA. Taking into account all other provisions of the ACA, our estimates show that if the state expands Medicaid, the number of uninsured would be reduced to 60,435 — an 84,548 total decrease, or a 58.3 percent change ( Figure 7 ). However, if the state decides not to expand Medicaid, then the number of uninsured would decrease by a lesser amount — a 64,563 total decrease, or 44.5 percent change. This means that under the no expansion option, about 19,900 individuals will remain uninsured that would otherwise have coverage under Medicaid expansion.

Of the uninsured, it is those under 138 percent of FPL [Federal Poverty Level] who would primarily be affected under the decision to expand Medicaid . Those remaining uninsured will continue to strain the finances of other public health programs and safety net providers for their care, while likely forgoing or reducing necessary care and risking a drain o n personal finances." (page 13)
Here's what I read in that:

Without Medicaid Expansion19,900 more uninsured Alaskans than with expansion.  Though even with expansion there would still be 60,435 uninsured Alaskans. 

Here's what the Alaska Journal of Commerce reported
"Parnell said the additional federal dollars were “tempting” but that the expansion is not in the best interest of the state, for now, because the overall cost of the federal health care program will prove unsustainable and huge costs would fall back on Alaska at some point.
“The expansion of Obamacare will see skyrocketing costs and there is no guarantee this can be sustained. This is not ‘free money’. It’s being funded by debt and printing money,” on the federal level, Parnell said."
If things got as bad as Parnell says, there would be a problem for all the other states as well and adjustments would be made.  There's no way all the states would take the kind of hit that Parnell's folks suggest.  And I don't think he tells us where this data comes from.

The Journal went on to say the decision was against the advice of many in the business community.
"The governor’s decision has prompted an avalanche of criticism, including from business groups. In a statement, the Alaska Chamber (formerly Alaska State Chamber of Commerce) expressed disappointment.
“As a policy priority for chamber members, the expansion of Medicaid is an important part of our goal to reduce and contain the cost of doing business in Alaska,” said Rachael Petro, president of the chamber."
The State's Department of Health and Social Services' announcement on the governor's decision outlines the Parnell Administration's plan to take care of the uninsured:
"Recently, the Governor has been meeting with health care providers, large and small business organizations, and other stakeholders from across Alaska discussing recommendations for Alaskans who fall under 100 percent of the FPL and are the main users of Alaska’s safety net services.

It is imperative that we know more about the people who make up this category — who they are, their health care needs, and whether the current services available to them are being utilized or if different services need to be created. The state remains committed to funding the safety net of health care services and to improving the delivery of those services in the most efficient and cost - effective way.

The Department of Health and Social Services is in the process of developing an improved communications plan in the Division of Public Assistance directly targeted at those Alaskans who are the most vulnerable and who are in need of accessing the programs and services offered by the state and federal governments . In the months ahead, DHSS will execute the communications plan, and will strive to better identify and inform income - eligible Alaskans about the services available to them at little or no cost." (emphasis added)
So, the state isn't going to pay $200 million and get $2.9 from the Feds to take care of the problem.  Yet they remain committed to funding the safety net.  How can this, if they actually do it, not cost more than $200 million?  It can't.  And since the Governor has given $2 billion a year to the oil companies . . . what can one say?

But, rest assured, they will "execute a communication plan" to tell the poor how to get services that don't exist. "available to them at little or no cost."  I guess that means going to the emergency room and everyone else pays for their higher bills because they are forced to put off care until it becomes more serious and more expensive to treat. 

When I attended the confirmation hearing for then Attorney General Dan Sullivan, he outlined his plan for dealing with the Feds:  work with other attorneys general to fight the feds and to sue them if necessary.  The Parnell Administration has been following that strategy.  One can't help but scratch one's head at how ideology can blind one to the obvious.

The Lewin study which was finished back in January 2013 [and updated in April], was finally released a few days ago. (It's not dated on the DHSS site so it's not clear when. It's listed between items dated 11/8 and 11/15)  As I suspected, the results are a lot like their study for New Hampshire.  Here's the whole report:

If you'd like to compare the Alaska study to the Lewin Group's New Hampshire study on the same topic, you can find that study here.

At least they used different pictures on the cover.  And in New Hampshire they did an evaluation while in Alaska they did an analysis. 

[Feedburner update:  got to my email subscription in 2 hours, but it hasn't reached blogrolls yet 9 hours later.  Last few posts have gotten up in minutes. Grrr]

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