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 Expansion:  19,900 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:

Lewin Final Report on Medicaid Expansion Alaska by Steve

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]

Four Alaskan Senators Point Out "Alaskans are among the least insured in the nation with 20.6 percent of our state living without health insurance" And Ask Governor What He Plans To Do About It

I reported recently that Alaska Senator Bill Wielechowski had sent a public records request to the Parnell administration requesting that the Lewin Group study of the impact of expanding Medicaid in Alaska under the Affordable Care Act be made public.  (It was completed in April.)

Today the Senator was joined by Senators Berta Gardner, Johnny Ellis, and Hollis French in a letter to the Governor asking him not only to release the report, but to get moving since the time for signing up for insurance has already begun.  Particularly, they note that Parnell's administration has abdicated any participation in the insurance exchange for Alaska, thus leaving it totally to the federal government with no Alaskan input. 

They also note Alaska's low level of health insurance coverage and a study by the Alaskan Native Tribal Health Consortium (ANTHC) that finds many benefits for Alaskans in expanding Medicaid. 


Here's the beginning of the Senators' letter:

Governor Sean Parnell
550 W. 7th
Avenue, Suite 1700
Anchorage, AK 99501
4 October 2013

Dear Governor Parnell,

Fall is upon us, and with it, the implementation of the Affordable Care Act. While many provisions of the Act have yet to take effect, one of the more important changes, the health insurance marketplace, has just come online October 1st of this year. With this deadline only recently passed, we believe now is the appropriate time for your administration to address a variety of questions Alaskans have regarding the state’s role in ensuring a smooth transition into a more affordable, efficient health care system. 

We’ve heard, mostly from media sources, that the exchanges have yet to be set up and that your administration decided not to participate in any decision-making processes that would have allowed for an Alaska-specific exchange. While we question the wisdom of giving up Alaska’s ability to have an exchange specifically designed for and adaptable to Alaska’s unique needs, that decision is past, and we hope to have a more public and open discussion about expanding Medicaid in Alaska.

According to a study by The Society of Actuaries, Alaskans are among the least insured in the nation with 20.6 percent of our state living without health insurance. The study found that, should you decide to accept the Medicaid expansion, the percentage of uncovered Alaskans would drop to just over 8 percent.

It is critically important for legislators, as well as the public, to have access to the information the administration is using to make its decision with regards to the Medicaid expansion. We ask that your administration finalize the Alaska DHSS sponsored Lewin Medicaid Expansion Recommendation Report so that Alaskans can more fully understand the issues and benefits. .  . 

The whole letter is here.

I would also recommend that the Senators, if they haven't already, look at 

the study the Lewin Group did for the State of New Hampshire.  (Phase I)

It shows huge advantages for the state in expanding Medicaid, far more than the costs.  I'm not sure what New Hampshire contracted Lewin to study, but my look at the Alaska contract with Lewin caused me to believe that they were basically asked to look at what it would cost and not how the state might benefit. 

Here's the Table of Contents for Phase II (January 2013) of the study: (Note, this is Phase II)

Table of Contents

EXECUTIVE SUMMARY ................................................................................................... 1

I.  INTRODUCTION ......................................................................................................... 11

II.  SUMMARY OF PHASE I ANALYSIS ..................................................................... 13

III.  PHASE II ANALYSIS AND RESULTS .................................................................. 15

   A.  Impact on Other State Programs ..................................................................................15

   B.  Impact on the Uninsured ............................................................................................. 19

   C.  Impact on Providers .................................................................................................... 24

   D. Economic Impact ......................................................................................................... 37

   E.  Impact on Commercial Market ....................................................................................41

IV.  METHODOLOGY......................................................................................................... 46

   A.  Impact of ACA on Medicaid DSH Payments ........................................................ 46

   B.  Health Systems ............................................................................................................ 47

   C.  Federally Qualified Health Centers ..............................................................................52

   D.  Community Mental Health Centers ........................................................................55

   E.  Cost-Shifting ...................................................................................................57

   F.   Economic Impact ..........................................................................................................58

I'm sure a lot of what it contains will be duplicated in the Alaska study.  At the very least, comparing the two studies should prove interesting.  How are they the same and how are they different and why?  Because the data are different, or because the instructions are different?

When Is A Bear Not A Bear? Face Saving Medicaid Review?

From yesterday's Alaska Dispatch:

The Alaska Legislature plans to hire a consultant to help lawmakers separate “fact from fiction” in the debate over expansion and reform of the public Medicaid health care program.
The Legislative Budget and Audit Committee, chaired by Rep. Mike Hawker, R-Anchorage, on Friday issued a request for proposals for what it called an “independent professional policy resource.”

While I try to step back here and look at things from all sides and present the facts.  But sometimes doing that seems disingenuous.   It's like saying, "There's a large four legged furry animal, bigger than most dogs with sharp teeth that stood up on its hind legs and sniffed the air.  Some say it is a bear and some said they couldn't see it well enough to tell."  The people who can't be sure are generally those who have a vested interest in their not being a bear.  Maybe it's because

• they've always believed there are no bears in the area, so it must really be a big dog.   Or  
• they told you flat out that there are no bears around, and it's hard to admit being wrong.  Or
• they have a vested interest in their being no bears - like they're being paid to keep bears away.

Medicaid expansion is the bear wandering around Alaska.  Republicans have believed it's bad since they first started calling it Obamacare.

• Some believed this through genuine belief that the market is the best way to do everything, despite the fact that the market was leaving millions of Americans uncovered, particularly people who really needed coverage. 
• Some were with Sen. McConnell who declared "The single most important thing we want to achieve is for President Obama to be a one-term president."  Anything the president wants, they oppose it and Obamacare, along with Medicaid expansion, has always been a key target.
• Some, with an eye toward national conservative PAC's that promise money for candidates who vote against Medicaid expansion and to defeat those who vote for it, Republicans (and Democrats) have a vested interest in preventing Medicaid expansion.

The irony is that states who refused to set up their own insurance exchanges are now facing the possibility of losing all federal Medicaid funding.  And they brought it own themselves.  They sued the federal government on a technicality.  The bill says there can be subsidies for people in states with a state exchange and they've argued those without a state exchange, using the federal exchange instead.  Their intent was to end the subsidies and thus kill Obamacare.  But now it's turning out that those states will be cutting off millions of citizens from affordable health care and huge costs will be shifted to those states.

They're charging Obama with not preparing for the possibility that the Supreme Court rules in their favor, which now they see as a catastrophe.  Obama, a constitutional lawyer, is just saying that he can't imagine the court ruling against Obamacare.   I'm sure behind that objective mask, he's got a big smirk as he thinks, "These guys brought this on themselves, let them squirm."

That's all some of the background behind yesterday's headline about the Alaska majority caucuses spending more money that they have repeatedly said we don't have, for a "report."

I'd just remind them that former Republican governor Parnell commissioned a study on Medicaid expansion from a conservative think tank.  He kept that study secret - even though it was paid for with public money - until the very last minute.

He kept is secret with good reason:  The facts contradicted his anti-expansion decision.

"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."

 I posted about this study and Parnell's decision on it in detail here.

The legislature doesn't need to spend more time on yet another study.  All they have to do is do their jobs.  Sit down and read the original study.  There are a number of legislators who, I'm sure, would have trouble understanding the study.  But Hawker, who's cited in the article, is a retired CPA.  He should be able to understand that study and know we don't need yet another study.  But he's also the legislator most responsible for the opulent redo of the Anchorage Legislative Information Office that everyone agrees is way above market value. 

The conclusion that makes the most sense to me (which doesn't mean its the right conclusion) is that another study could cite new evidence that would allow the Republicans to let the governor, on his own, expand Medicaid without any serious opposition from the legislators.   And if that is the case, then the already stressed Alaska budget will take another hit so the Republican majority's ego can be massaged.

This is really a bear.  But if that's what it takes to get Medicaid expanded in Alaska and adding health care coverage, many say, to 40,000 people, so be it.  But I hope the people of Alaska - particularly those who have given up on the process and stopped voting - realize how the Republican majority's talk of fiscal carefulness is belied by most of what they do.  The list of the legislators - particularly those from Anchorage and Mat-Su - who took excessive per diem during the special session is just yet one more piece of evidence of their lack of concern for the people of Alaska.

[Feedburner failure repost]

Public Records Act Says "Shall Give On Request" NOT "Shall Give When They Get Around To It"

I get press releases every day and I don't usually do anything with them, but this one appears to demonstrate a case of the Alaska Department of Health and Social Services refusing to obey the law on public records. 

According to part of the press release from the Alaska Democratic Party:

"The report, prepared with nearly $80,000 in State funds by the Lewin Group for the Department of Health and Social Services, has been complete since April 12, 2013.  Several individuals and organizations have requested release of the report, including at least one news organization, but the Department has refused to release it.  This refusal violates the Alaska Public Records Act, according to attorneys with the non-partisan Legislative Legal Services Division." 

The Alaska Public Records Act is pretty clear.  Here are the guts:

AS 40.25.110. Public Records Open to Inspection and Copying; Fees.

(a) Unless specifically provided otherwise, the public records of all public agencies are open to inspection by the public under reasonable rules during regular office hours. The public officer having the custody of public records shall give on request and payment of the fee established under this section or AS 40.25.115 a certified copy of the public record.

Note:  It says:  "shall give on request."   It doesn't say, "shall give when they get around to it"

So, what are the exceptions?  Read through them.  I think you'll agree that none of these apply here.  Then read the bolded section at the end.  It repeats the message above, but instead of staying 'request' it says 'demand.'

AS 40.25.120. Public Records; Exceptions; Certified Copies.

(a) Every person has a right to inspect a public record in the state, including public records in recorders' offices, except

(1) records of vital statistics and adoption proceedings, which shall be treated in the manner required by AS 18.50;

(2) records pertaining to juveniles unless disclosure is authorized by law;

(3) medical and related public health records;

(4) records required to be kept confidential by a federal law or regulation or by state law;

(5) to the extent the records are required to be kept confidential under 20 U.S.C. 1232g and the regulations adopted under 20 U.S.C. 1232g in order to secure or retain federal assistance;

(6) records or information compiled for law enforcement purposes, but only to the extent that the production of the law enforcement records or information

(A) could reasonably be expected to interfere with enforcement proceedings;

(B) would deprive a person of a right to a fair trial or an impartial adjudication;

(C) could reasonably be expected to constitute an unwarranted invasion of the personal privacy of a suspect, defendant, victim, or witness;

(D) could reasonably be expected to disclose the identity of a confidential source;

(E) would disclose confidential techniques and procedures for law enforcement investigations or prosecutions;

(F) would disclose guidelines for law enforcement investigations or prosecutions if the disclosure could reasonably be expected to risk circumvention of the law; or

(G) could reasonably be expected to endanger the life or physical safety of an individual;

(7) names, addresses, and other information identifying a person as a participant in the Alaska Higher Education Savings Trust under AS 14.40.802 or the advance college tuition savings program under AS 14.40.803 - 14.40.817;

(8) public records containing information that would disclose or might lead to the disclosure of a component in the process used to execute or adopt an electronic signature if the disclosure would or might cause the electronic signature to cease being under the sole control of the person using it;

(9) [See delayed repeal note]. reports submitted under AS 05.25.030 concerning certain collisions, accidents, or other casualties involving boats;

(10) records or information pertaining to a plan, program, or procedures for establishing, maintaining, or restoring security in the state, or to a detailed description or evaluation of systems, facilities, or infrastructure in the state, but only to the extent that the production of the records or information

(A) could reasonably be expected to interfere with the implementation or enforcement of the security plan, program, or procedures;

(B) would disclose confidential guidelines for investigations or enforcement and the disclosure could reasonably be expected to risk circumvention of the law; or

(C) could reasonably be expected to endanger the life or physical safety of an individual or to present a real and substantial risk to the public health and welfare;

(11) the written notification regarding a proposed regulation provided under AS 24.20.105 to the Department of Law and the affected state agency and communications between the Legislative Affairs Agency, the Department of Law, and the affected state agency under AS 24.20.105.

(12) records that are

(A) proprietary, privileged, or a trade secret in accordance with AS 43.90.150 or 43.90.220(e);

(B) applications that are received under AS 43.90 until notice is published under AS 43.90.160 .

(b) Every public officer having the custody of records not included in the exceptions shall permit the inspection, and give on demand and on payment of the fees under AS 40.25.110 - 40.25.115 a certified copy of the record, and the copy shall in all cases be evidence of the original.

(c) Recorders shall permit memoranda, transcripts, and copies of the public records in their offices to be made by photography or otherwise for the purpose of examining titles to real estate described in the public records, making abstracts of title or guaranteeing or insuring the titles of the real estate, or building and maintaining title and abstract plants; and shall furnish proper and reasonable facilities to persons having lawful occasion for access to the public records for those purposes, subject to reasonable rules and regulations, in conformity to the direction of the court, as are necessary for the protection of the records and to prevent interference with the regular discharge of the duties of the recorders and their employees.

Why withhold documents?

Aside from the legally valid reasons, officials withhold information that makes them look bad.  Some examples:

• It refutes what they have told people.
• It doesn't support the position they espouse.
• It confirms what their critics have charged.
• It reveals incompetence or otherwise is embarrassing

Public records acts, in general, often have provisions that allow an agency to withhold documents while a policy is being formulated.  Section 11 above seems to be for that purpose and the link goes to the kind of information that would be exempted.  It's more about communication between the Department of Law or the Legislative Affairs Agency.

However, this is an independent report that is complete and will not change.  It's been paid for with State money.  The people have a right to see what it says.  If the Governor were really open to the best options for the people of Alaska he would share the report so it could be studied and its strengths understood and its weaknesses found. That's why the Public Records Act was written.  

I can't think of legitimate reasons for withholding such a document this long.  Yes, the agency is still working on its policy but that policy won't change this report.  

My guess is that the report doesn't support what the Governor wants to do.   [This accidentally got left out of the original post:  In 2009 The Washington Post quoted Lewin Group Vice President John Sheils

"Let's just say, sometimes studies come out that don't show exactly what the client wants to see. And in those instances, they have [the] option to bury the study -- to not release it, rather," Sheils said.

Except when they are a government that has public disclosure laws.] 

Who is the Lewin Group?

The Lewin Group, the company that did the report, is based in Falls Church, Virginia.

They tout their integrity and independence,  and they acknowledge they are owned by UnitedHealth Group:

"The value we place on accuracy, independence and objectivity is reflected in the trust our clients place in The Lewin Group. As such, The Lewin Group must safeguard its integrity, and address any appearance of conflicts that may stem from the organization’s relationship to other health care businesses owned by our parent company, OptumInsight, and its parent entity, UnitedHealth Group."

Sourcewatch writes:

Despite its corporate ownership, opponents of health care reform often cite the Lewin group as an impartial, non-partisan or independent source of information. House Rep. Eric Cantor (Virginia), has referred to it as "the nonpartisan Lewin Group." Republicans on the House Ways and Means Committee have called it an "independent research firm." Senator Orrin Hatch of Utah, the second-ranking Republican on the Senate Finance Committee, referred to the Lewin Group was "well known as one of the most nonpartisan groups in the country." They do not mention, however, that the Lewin Group is owned by UnitedHealth Group.
The Lewin Group has a reputation as the "go to" firm for beleaguered organizations in need of reports and research to support controversial positions and issues. In one example, in 2005 the American Hospital Association hired the Lewin Group to study the causes of skyrocketing health care costs. The study results blamed increased hospital spending on the rising costs of goods, a workforce shortage and greater demand for hospital services, but did not mention health insurance company profits, stock values, shareholder returns, etc. (Aug. 29, 2005, p. 8).^[3]

So, the Parnell administration went to a firm that is endorsed by Eric Cantor, a powerful House opponent of Obamacare.  He should expect a report that's favorable to his position and have no problem releasing it.  But they've held it since April.

We can guess that the report would have been released already if it concluded that the Affordable Care Act would be a disaster for Alaska - as the Governor has claimed:  

"The state of Alaska will not pursue unlawful activity to implement a federal health care regime that has been declared unconstitutional by a federal court,” Parnell told the Juneau Chamber of Commerce, to applause, Thursday."

But what if a company endorsed by Cantor said the Affordable Care Act would be ok for Alaska?  The Parnell administration wouldn't be able to blame the company's "liberal bias.' The Lewin Group's website has a summary of a study they did on expanding Medicaid in the State of New Hampshire:

The report they did for the State of New Hampshire concluded that while there would be a modest reduction in state spending over six years if the state did not expand Medicaid, if it did it would be a huge improvement in health care access for people in New Hampshire and it would bring billions in federal revenues to the state. 

"This report provides estimates on Medicaid enrollment and costs under the option of not expanding Medicaid compared to the option of expanding the program under various program design options. We find that if the state does not expand Medicaid, it could reduce state Medicaid spending by $66 to $114 million over the 2014-2020 period. However, expanding Medicaid would (1) reduce the number of uninsured in the state by an additional 22,300 people, (2) provide subsidized coverage for low income adults in the state, who would not have access without the expansion, and (3) increase federal revenues in the state by $1.8 to $2.7 billion over the 2014-2020 period."      

 If that's not clear, it says

• if you don't expand, you'd save around $100 million BUT
• lose 20 times that much in Federal revenues and
•  cut out 22,000 uninsured people. 

Senator Bill Wielechowki's most recent request to see this report was linked in the press release.  It's dated September 25, 2013, but it also refers to previous requests for the report - one in March and one in August.  It also goes into much more legal detail than I have.  You can read it here.

Here's the Department of Health and Social Services response to his August request.

From:  Hooley, Jason M (GOV) [jason.hooley@alaska.gov]

Sent:  Tuesday, August 20, 2013 3:34 PM

To:  Michelle Sydeman  [Wielekowski's staff]

Subject:  Re: Request for contract re: actuarial analysis of Medicaid expansion

Hi Michelle,

Thank you for your request for a copy of the contract with the firm completing the actuarial analysis of Medicaid expansion costs and effects.  A copy of the contract is attached.

Like many other states, Alaska looks to move cautiously and deliberately towards a decision on this issue. The Department of Health and Social Services (DHSS) has reviewed actuarial analyses of cost estimates and effects that sketch out what Medicaid could look like in expansion scenarios.

  

The report is not meant to advocate for or against a particular position, rather it will be used as one point of data as we develop our recommendation. DHSS’s actuarial study completed by the Lewin Group on April 12, 2013 entitled “An Analysis of the Impact of Medicaid Expansion in Alaska,”  is not yet available for distribution.

It will be made available once DHSS has completed its analysis and submitted its recommendations to the Governor.

Jason Hooley

|

Legislative Liaison

Office of the Commissioner

| Department of Health and Socia

l Services

3601 C Street (#902) | Anchorage, AK 99503

(o) 907.269.7806 |

(c) 907.341.7806

What about the language that says "Shall give on request?"  It's been available since April 12.  The key reasons I can imagine that it has not been released is to prevent Sen. Wielechowski from having enough time to review the data.  Or because the report is not favorable to the governor's position.  

If you go to Wielechowski's request, you'll see it spells out the specific legal reasons why the document should be released and shows why it doesn't qualify for any of the exceptions. 

It would appear that the State is illegally withholding information that the people of Alaska bought and paid for. 

Gov's Rejection of ACA Funds Like The Religious Couple Refusing Medical Care For Their Ill Child

 NPR (and others) reported in April 2013:

A faith-healing Philadelphia couple on probation after they refused to seek medical care for a son who later died has now lost a second child.

Instead of taking $2.9 billion in federal aid to expand medicaid (with a cost of about $250 million to the state over seven years) and taking about 20,000 Alaskans off the uninsured list, our governor instead relies on the "Invisible Hand" of the free market to take care of these people.

To me that's very similar to not taking your sick kid to a doctor because you believe in God's will.

How many Alaskans will suffer and die because of his refusal to take the ACA funding?

This is not to say that the free market doesn't make a very significant contribution to US prosperity, but unregulated, it also makes a huge contribution to the massive transfer of wealth to what's been popularly called the 1% from the rest. 

I've already posted about the study that the Governor himself commissioned that said expanding medicaid would cost the state  $240 million from 2014-2020
and gain the state $2.9 billion from the Feds.    And about 20,000 fewer Alaskans would be uninsured.

Instead the Governor's ideological beliefs in the miracles of the free market, apparently, have led him to not accept the Federal ACA funding to expand Medicaid in Alaska.

I have no doubt that many people will become unnecessarily ill, miss work, even lose their jobs, and many will die prematurely because of the governor's decision.  Just like this child in Pennsylvania died because of his parent's decision to let God, not modern medicine, save their child. 

I'm reminded of this because of  a new study by Chuck Burnham, Legislative Analyst from the Alaska Legislative Research Services  requested by Sen. Senator Bill Wielechowski.  It adds to the previous studies already showing the overwhelming benefits to the state of expanding Medicaid.   Here's the summary:

Summary  

Among the provisions of  the federal Patient Protection and Affordable Care Act (P.L. 111 ‐ 148), or ACA, when it was enacted is a requirement that states expand Medicaid programs to cover individuals with incomes of up to 138 percent of the federal poverty level. 1 Pursuant to the June 2012 U.S. Supreme Court decision in National Federation of Independent Business v. Sebelius , Medicaid expansion under the ACA became optional for the states. As you know, on November 15, 2013, Governor Parnell announced his intention to reject Medicaid expansion. Although this decision will have far ‐ reaching and, to some degree, unknown impacts, we confine this report to the specific questions you raised.

Mortality

Although we located no Alaska ‐ specific research on the possible impact on mortality of rejecting Medicaid expansion, a significant body of research shows that health insurance improves access to medical care and outcomes related to a wide range of serious illnesses and disease. Recently published research specifically on Medicaid expansion in other states suggests that rates of mortality decrease among those who are enrolled in the program as compared to the uninsured. Due to differences among populations and Medicaid eligibility thresholds, we believe applying specific numerical finding to Alaska’s uninsured population based on these results would be improper and problematic; however, it is reasonable to conclude that some of the specific benefits found elsewhere would generally accrue to newly enrolled Medicaid participants in Alaska.

Impacts on Healthcare Facilities

The ACA requires reductions in certain payments and reimbursement rates to hospitals. These reductions are more than offset, however, by the reductions in uncompensated care and increased revenues that are projected to occur through expansion of Medicaid. Nationwide, the net effect is estimated at $2.59 in revenues for every $1 in reductions. In Alaska, hospitals expect additional revenues of roughly $60 million per year and a reduction in uncompensated care of over 85 1 Text of the ACA can be accessed at http://www.gpo.gov/f dsys/granule/PLAW ‐ 111publ148/PLAW ‐ 111publ148/content ‐ detail.html . Portions of the federal healthcare overhaul are also contained in the Health Care and Education Reconciliation Act of 2010 (P.L. 111 ‐ 152), http://www.gpo.go v/fdsys/pkg/PLAW ‐ 111publ152/pdf/PLAW ‐ 111publ152.pdf .  L EGISLATIVE R ESEARCH S ERVICES , LRS 14.117 J ANUARY 8, 2014 — P AGE 2 S ELECTED I MPACTS OF R EJECTING M EDICAID E XPANSION percent. However, because Alaska declined to expand Medicaid, hospitals will absorb the reductions implemented by the ACA without the offsetting benefits.

Effects on Health Insurance Premiums

Research suggests that in 2009 uncompensated care added roughly $257 to premiums per privately insured individual Alaskan, or about eight percent of total private insurance premiums. We are unable to isolate the impact of rejecting Medicaid expansion on insurance premiums; however, implementation of the ACA’s health insurance exchanges coupled with Medicaid expansion in Alaska has been projected to result in savings that could reduce the premium increases associated with cost shifting from $301 in 2014 without the ACA / Medicaid expansion to $45 with the healthcare act fully implemented.

Job Creation

One study estimates that additional Medicaid spending under the ACA would result in the creation of over 1,500 jobs in 2014 with annual increases through 2020 when 4,000 new positions are expected. In that year, these jobs could provide approximately $220 million in wages.

Federal Funding

Three studies on Medicaid expansion projected resultant additional federal funding in “mid ‐ case” enrollment scenarios at between roughly $1.1 billion and $2.9 billion in aggregate for the years 2014 to 2020. Increases in state spending in the same projections ranges from $79 million to $240 million. All three reports estimated federal to state spending ratios under expansion would be over $12 to $1

Reading Brooks' Bests and Reexamining What We Know

How do people know what happened?  Even things they've seen themselves.  How does what other people say affect what they 'know?'   We really don't know that much about these things.  Kevin L. Leahy, an attorney who has defended corporations against asbestos personal injury claims writes about the memory of witnesses:

Cognition specialists discuss memory as a process that has three primary stages: (1) encoding; (2) consolidation and storage; and (3) retrieval. (Id.) Each step involves biological efforts within our brains to ensure that an eyewitness account is accurately retained. (May 2003 issue of HarrisMartin’s COLUMNS-Asbestos.)

He goes on to say that unlike artists or story tellers, who can fill in the details after the fact, and not necessarily accurately,

eyewitnesses have no license to stray from their understanding of past events during trial. Our system expressly demands that witnesses “tell the truth, the whole truth, and nothing but the truth.” Once the bailiff and judge forbid conscious manipulation of testimony, however, the remaining instructions are generally silent about the accuracy of the witness’ recall.

So, you might ask, where is this coming from and where is it going?  David Brooks, in the Friday, Dec. 25, 2009 NY Times gives out his Sidney Awards to the best magazine essays  of 2009.

One of his choices is a lengthy story about Todd Willingham, an unemployed auto mechanic, who was put to death in Texas for killing his three daughters by burning his house down.  All the expert witness arson evidence pointed to Willingham.  And so did the eyewitness evidence.  But a friend who came to know Willingham when he was on death row, decided to  recheck the evidence.  And what she found suggested that  some of the details the eyewitnesses gave, was revised later on, after they were exposed to what the 'experts' thought.  From the New Yorker artcle,  "Trial by Fire"   by David Grann:

The witnesses’ testimony also grew more damning after authorities had concluded, in the beginning of January, 1992, that Willingham was likely guilty of murder. In Diane Barbee’s initial statement to authorities, she had portrayed Willingham as “hysterical,” and described the front of the house exploding. But on January 4th, after arson investigators began suspecting Willingham of murder, Barbee suggested that he could have gone back inside to rescue his children, for at the outset she had seen only “smoke coming from out of the front of the house”—smoke that was not “real thick.”

An even starker shift occurred with Father Monaghan’s testimony. In his first statement, he had depicted Willingham as a devastated father who had to be repeatedly restrained from risking his life. Yet, as investigators were preparing to arrest Willingham, he concluded that Willingham had been too emotional (“He seemed to have the type of distress that a woman who had given birth would have upon seeing her children die”); and he expressed a “gut feeling” that Willingham had “something to do with the setting of the fire.”

Dozens of studies have shown that witnesses’ memories of events often change when they are supplied with new contextual information. Itiel Dror, a cognitive psychologist who has done extensive research on eyewitness and expert testimony in criminal investigations, told me, “The mind is not a passive machine. Once you believe in something—once you expect something—it changes the way you perceive information and the way your memory recalls it.”

Certainly anyone who is married knows that spouses can remember something that just happened very differently, and both are sure they are right.  And as Democrats and Republicans and everyone in-between or beyond makes claims about health and other policies, I  wonder what causes people to be so sure about things they can't possibly know too much about.  If eyewitnesses have trouble remembering what they saw in the past, how can we possibly know for certain things that haven't yet happened (the effects of carbon on the environment, the impact of health reform, etc.)  I'm not saying we can't make educated guesses based on the facts we do know.  I'm really referring to the people who are absolutely certain, who have no doubts, who can't see any possibility that perhaps their opponents may actually be right.

[Update, Saturday afternoon:  The New Yorker Fire article is 17 pages long and I'd only read part of it when I first posted.  The real issue in this article about knowing is that the arson experts based their findings on myth.  They didn't know:

In 2005, Texas established a government commission to investigate allegations of error and misconduct by forensic scientists. The first cases that are being reviewed by the commission are those of Willingham and Willis. In mid-August, the noted fire scientist Craig Beyler, who was hired by the commission, completed his investigation. In a scathing report, he concluded that investigators in the Willingham case had no scientific basis for claiming that the fire was arson, ignored evidence that contradicted their theory, had no comprehension of flashover and fire dynamics, relied on discredited folklore, and failed to eliminate potential accidental or alternative causes of the fire. He said that Vasquez’s approach seemed to deny “rational reasoning” and was more “characteristic of mystics or psychics.” What’s more, Beyler determined that the investigation violated, as he put it to me, “not only the standards of today but even of the time period.” The commission is reviewing his findings, and plans to release its own report next year. Some legal scholars believe that the commission may narrowly assess the reliability of the scientific evidence. There is a chance, however, that Texas could become the first state to acknowledge officially that, since the advent of the modern judicial system, it had carried out the “execution of a legally and factually innocent person.”[emphases added]]

And, as I remind readers now and then, this blog is fundamentally about examining what I know.  

Anyway, Brooks' recommendations are worth a look.  Besides Grann's reexam of the arson evidence,  Brooks has several more suggestions.  He mentioned, but because it was published in the New York Times (where he himself writes) did not include it,  David Rohde's  series on being a Taliban captive that I pointed out in October.

His other choices include:

1. Atul Gawande’s piece, “The Cost Conundrum,” in The New Yorker, was the most influential essay of 2009, and
   
   
2. David Goldhill’s “How American Health Care Killed My Father,” in The Atlantic, explained why the U.S. needs fundamental health reform.
   
   
3. Jonathan Rauch’s delightful essay, “Fasten Your Seat Belts — It’s Going to Be a Bumpy Flight,” in The National Journal. Rauch described what the airline industry would look like if it worked the way the health care industry works.
   
   
4. Matt Labash of The Weekly Standard['s] . . . piece, “A Rake’s Progress” was a sympathetic and gripping profile of Marion Barry, the former Washington, D.C., mayor, crack-smoker and recent girlfriend-stalker.
   
   
5. S. Frederick Starr’s “Rediscovering Central Asia,” in The Wilson Quarterly, is an eye-opening look at what once was. A thousand years ago, those mountains [around Afghanistan] were the intellectual center of the world. Central Asians invented trigonometry, used crystallization as a means of purification, estimated the Earth’s diameter with astonishing precision and anticipated Darwin’s theory of evolution.

(While I've added numbers, I've kept Brooks' own descriptions above)  All the articles challenge our notions of what we know, if you are looking with that in mind.

Atul Gawande does a case study to see if looking at the most expensive town in the US can give him new insights.

The question we’re now frantically grappling with is how this came to be, and what can be done about it. McAllen, Texas, the most expensive town in the most expensive country for health care in the world, seemed a good place to look for some answers.

 Goldhill's article on his dad's hospital caused death immediately made me rethink the level of risk of different activities just by how he placed statistics side-by-side:

My dad became a statistic—merely one of the roughly 100,000 Americans whose deaths are caused or influenced by infections picked up in hospitals. One hundred thousand deaths: more than double the number of people killed in car crashes, five times the number killed in homicides, 20 times the total number of our armed forces killed in Iraq and Afghanistan. Another victim in a building American tragedy.

Jonathan Rauch’s article, gives us another way to 'know' the health care system.  He imagines booking an airline ticket as though the airlines were run like health care.  It causes us to 'know' the issues differently than before.

May I have your flight-insurance information, please?"
"Millennium Travel Care, group number 068832, ID number RS-3390041B."
"I'm sorry, sir, we're not in Millennium Travel Care's provider network."
"You're listed on their website. It says you accept Millennium."
"We did until last week. If you like, you can pay out of pocket for your ticket."
"How much would that be?"
"Yes, sir, I'll be happy to get that price for you. That would be $17,885.70."
"What? For a flight to Chicago? Does anyone actually pay that?"
"I'm sorry, sir, I wouldn't know. I can tell you that different clients and insurers pay different rates. For individuals, the rate is $17,885.70."
"Oh."

[Update Jan. 8, 2009:  Phil Munger put up this video of a version of the Rausch airline/health piece on Progressive Alaska.]


I'm having some trouble seeing a different way of knowing in the Matt Labash article.  It's a rip roaring article that reminds me of Tom Wolfe.  Brooks calls it sympathetic, I'd say it's more like damning with very occasional faint praise.

Barry is by now transported himself. He gets up and joins the mosh pit of ululators, swinging his arms like a child readying himself for the standing broad-jump at a school track meet. When asked afterward what part of the sermon spoke to him most, he says, "All of it," then starts throwing some Bible himself. "It says, 'Greater is He that is in us than he that is in the world,' " Barry says, adding his own interpretation: "Greater than devils, and evil-doers, and haters .  .  . Barry critics."
It's a tad ironic that while all but Emperor-for-Life in Ward 8, Barry didn't make his bones as mayor by standing up for "the last, the least, and the lost," as he has spent the post-Vista half of his career rebranding himself in these parts. While his signature summer-jobs program for youth insured that you can swing a cat in a local black neighborhood and hit five adults for whom Barry provided their first gig, his primary accomplishment was riding '80s-era real-estate-boom market forces.
Barry threw the city open to development the likes of which D.C. hadn't seen before. He was so proactive that old staffers tell how, early in his mayoral tenure, he used to have weekly brainstorming brown-bag lunches with architects and developers and would fast-track formerly glacial construction-approval processes with Post-it notes saying "Good idea, do it!" When he assumed office in 1979, whole quadrants of the city were ghost towns, and there were streets untouched since they were torched in the '68 riots.

It's not so much about knowing something differently as adding more data to what we know. Though at one point we do see Barry having an insight about his behavior:

Both Barry and Linda talk freely about how much he cared for Effi, which prompts me to ask how he could put her through what he did: the infidelity, the public humiliation. Linda covers for him: "He's not doing it out of disrespect, or less love for the person he's committed to at that time."
Barry takes this in, meditatively chewing on a pineapple slice. "I haven't thought about it much," he confesses. "First of all, I love people. Attractive women. They're all attractive to me if they're female." We laugh.
"No, really," he insists:

But I guess part of what happens in life is you are what you see. Growing up without a natural father, I didn't see these one-on-one relationships. I'm just thinking about it for the first time, quite frankly. I mean I've thought about it, but not in this depth. .  .  . I think there ought to be fidelity between a man and a woman. .  .  . But you are what you see. And when I was growing up, I didn't see men who were one-woman men. So I guess it sort of got caught in my personality. I'm not rationalizing it. It is what it is. [Emphasis added]

S. Frederick Star's "Rediscovering Central Asia" gives us a number of ways to rearrange what we 'know.'  Most obvious is filling in the gaping holes in our knowledge about that part of the world where our military is most visibly engaged.  Many of us think about it as a backward land of ignorant people.  That isn't true today, and Star tells us that it certainly wasn't true in the past.

It is one thing to draw a circle on the map, but quite another to explain why this region, call it Greater Central Asia, should have produced such a cultural flowering. Booming cities provided the setting for cultural life. A traveling Arab marveled at what he called the “land of a thousand cities” in what is now Afghanistan, Tajikistan, and Uzbekistan. The ruins of mighty Balkh, once the capital of this region, still spread for miles and miles across the plain west of modern Mazar–­i-­Sharif in Afghanistan. In its heyday Balkh was larger than Paris, Rome, Beijing, or Delhi. Like all the great regional centers, it had running water, baths, and majestic palaces—and solidly built homes of sun-dried brick for non-palace dwellers.

It was also richer, thanks to continental trade. Merchants from Balkh and other Central Asian commercial centers journeyed to the Middle East, Europe, China, and deep into India. Traders from those lands brought goods to the sprawling commercial entrepôts in Greater Central Asia. Since slavery thrived throughout the Muslim world and beyond, the bazaars also included large slave markets. Gold, silver, and bronze currency from these thriving hubs of commerce traveled all the way to Gotland in Sweden and to Korea and Sri ­Lanka.

And for most US citizens who think of their country as the world's cultural leader today, it's sobering to remember the fate of such leaders of the past.   There's an opportunity for a little rearranging of our mental maps in this article, if one is open to that sort of activity.

Leahy - you remember him, the asbestos lawyer mentioned at the beginning of this post - used three cognitive steps to frame his discussion of eyewitnesses' ability to accurately report what they had seen in the past.  We shouldn't just be adding facts to reinforce our old stored beliefs.  We should be rearranging everything know and then to see whether that affords us a more effective view of the world. 


David Brooks recommends people forgo watching "It's a Wonderful Life" once again and read these articles instead.  (He has still more recommendations coming Tuesday.)  And given that in today's world, you don't have to go to the library or bookstore to read these, I'd nudge you to give at least a couple a look.  And remind yourself how much you can actually expand what you know with a couple of hours of reading good stuff. 

Was Lewin Contracted By Alaska To Find Fault With Medicaid Expansion Under Affordable Care Act?

I posted the other day about Sen. Bill Wielechowski's unsuccessful attempts to get a copy of the Lewin Group's completed report on the impacts of Alaska expanding Medicaid under the  Affordable Care Act.  It was finished last April but, apparently in violation of the state's public access laws, the Parnell administration has not released copies of the report.

The original press release that alerted me to this, did, however, have a copy of the contract the state had with the Lewin Group.

As I read this contract, I only see them being asked to identify the potential problems, not the benefits of expanded Medicaid in Alaska.   Look for yourself:


[Sorry, the PDF was in a format that didn't allow copying text.  These are screen shots - rather than writing it all out.  You can see the original contract here.]

You can click on the images to enlarge them considerably

 

(A) through (I) ask for costs.  

(E) is particularly cynical.  It asks for the costs of people who will lower their income to become eligible.  I do know a few folks who are forced into keeping their income low to stay qualified.  One is a graduate student at UW who was paralyzed from the waist down in a motorcycle accident and has other accident related problems.  His parents are not alive.  He's pretty much on his own.  He had to turn down a job because it would put him at an income level that would make him ineligible for Medicaid and his medical expenses are huge.  The job didn't offer insurance, but would have made him ineligible.  

I also know an FAS kid who has some serious deficits  which make living a normal life difficult.  But he also has some great skills which means he can hold down a low level job, which he has done for a number of years now.  But he has to watch how much he makes or will lose his Medicaid eligibility which would end any health care.  

Maybe I'm wrong.  Maybe they're just trying to calculate the costs of this sort of person.  But I have a hunch they believe there are all these welfare cheats out there who love being poor so they can live on government handouts.  I know such people exist, but most people would love to have a good paying job that had health coverage.  

There's only one item in the list of deliverables - #8 - that looks for positives.  #8 is cost savings due to reduction or elimination of existing programs.


As I mentioned in the previous post on this, the Lewin Group's study on the same topic for New Hampshire lists the costs to the state of New Hampshire to be around $100 million.  BUT it then goes on to explain that New Hampshire will get about 20 times that much (about $2 billion) in Federal revenues to the state.   It also says that 22,000 fewer people in New Hampshire will UNinsured.

This Alaska contract doesn't seem to call for these positives.  It doesn't ask for how much federal money will come in or how many people will become eligible for Medicaid and sign up.  Well, that's not exactly true.  It does ask for different categories of folks who will likely sign up - but the focus of the contract is not on the benefits of more people being covered.  Rather it seems to be on the liabilities to the state of more people being covered by health care.  My sense is they see people who have Medicaid as deadbeats. 

I always try to acknowledge that I might be missing something.  I might, so if my thinking here is overlooking key points, I hope readers will point that out to me.  But from what I see of the contract, the Parnell administration was contracting for a report that would support their position against the state expanding Medicaid under the Affordable Care Act.  An honest study would look at the costs AND the benefits and then determine the right policy. 

Homelessness In Anchorage - Thoughts On What I've Been Told In OLE Class

I've been to five 75-minute classes on Homeless in Anchorage offered through OLÉ.  The class is facilitated by Nancy Burke, the Mayor's homelessness point person.  Friday's class was presented by Thea Agnew Bemben, M. A.,  who works for a consulting company on mental health.  She gave us the results of studies on ways to improve how the civilian and forensic (criminal) mental health population are served.


So after this much, here's my sense of things:

1. Berkowitz's administration is better organized and on top of things than I thought
1. At least in the data gathering aspects of homelessness
1. They're part of a couple of national models for handling data and using the data to reduce homelessness
2. Gathering data is important because it gives a picture of 
1. how many homeless there are
2. what categories the fit in
3. what services they use
4. how long they've been homeless
5. best ways to use resources
2. The Muni's data gathering system is up and running, though the sense I have is that it's a fairly recent phenomenon and it still has more to do
3. Homelessness models identify three categories of homeless on a 1-10 scale
1. 1-3 folks basically need help finding social services resources and can get themselves back into housing - these are people who have been housed and through an unexpected event (lost job, health emergency, etc) lost the ability to pay rent or mortgage
2. 4-6 moderate problems,
3. 7-10  problem homeless - mentally ill and or substance abusers that cost the city the most in police and health  and the most expensive to take care of
4. The third category is about 50% of the homeless in Anchorage
4. So, the most important way to deal with the 50% who have serious problems is to have better ways to deal with mental health in the community.  To increase the number of providers and beds available for the people with the most serious mental health problems
1. Right now both on the civil side (hospital emergency rooms, API) and the forensic side (jai/prisons), we're failing woefully.  
1. People get minimal treatment and sent back out onto the streets on the civil side.
2. On the forensic side, people wait in jail until they  can be evaluated to see if they are fit to stand trial, if they aren't, they sit in jail.  They are off the streets, get fed, get some medical treatment, but not what they should get.  And they could be in jail for months before even going to trial.  
2. A serious obstacle to enough beds is Medicaid rules that restrict payments to facilities with about 16 beds or less.  
5. Despite all the Mayor's attention to homelessness, without improving mental health access early on, the part of the homeless problem people are most upset about isn't going to go away.  And getting money for improved mental health care for the indigent is going to be hard.
6. The $40 million fund to help the homeless in Alaska will help
1. The MOA is using several different national models - including Housing First - which seems to have an immediate effect on reducing lots of the other problems homeless people have.  And getting housing that's accompanied with social workers is an important factor. 
2. There's concern that the State will cut funding because of this new source of financial help for the homeless.  

OK, that's my take on this off the top of my head after five classes.  There are two more 3 more classes, but I'll miss the last one.  

------------------------------------------------------------
The chart below comes from the Executive Summary of the Alaska Behavioral Health Systems Assessment commissioned by the Alaska Mental Health Trust with other health co-sponsors.  Thea Agnew Bembem - the presenter Friday - was part of the study team.  The Executive Summary is short and has good visuals.  I recommend a visit.  The whole study is much longer and requires a serious commitment.

I would point out the numbers and percentages of people with problems compared to the numbers and percentages of people who get help.  It's an impossible gap and probably explains not only a lot of our homelessness problems, but also accounts for dysfunctional families which create a population of kids with serious issues.  (The chart format is different in the original, but I think all the data are there.)

YOUTH

Grant Funds in State Fiscal Year 2013

Risk Behaviors 1                               
Approximately One in Five
4,641 traditional high school students had a moderate or high-risk behavior for substance use.
• The prevalence of this behavior was similar for male
and female students (20.3% compared to 16.4%)
Mental Health Issues 1, 2         
Approximately One in Four
7,214 traditional high school students experienced a mental health issue in the past year.
• The prevalence of mental health issues among female
students was higher than among male students (37.8%
compared to 19.4%)
Among 9 to 17 year olds, 5,550 (6%) were estimated to have had a serious emotional disturbance in the past year.

Youth Clients Served 4     
Approximately One in Nine
12,147 unique youth clients were served with support from state Medicaid and/or behavioral health grant funds.
Breakdown of Youth Served
By diagnosis category:
• Substance Use Disorder: 1,324 (11%)
• Serious Emotional Disturbance: 9,350 (77%) • Mild or Moderate Mental Illness: 2,215 (18%) • Co-occurring Disorders: 482 (4%)By gender:Male: 7,129 (59%) | Female: 5,018 (41%)

ADULTS

Total Prevalence 3         
Approximately One in Four
145,790 adults needed treatment for illicit drug or alcohol use and/or experienced a mental illness in the past year.
Alcohol & Illicit Drug Use 3    
Approximately One in Nine
62,815 adults needed treatment for an illicit drug or alcohol problem.

• Estimated need for treatment among low income
  adults was higher than among adults above 138% of the
  federal poverty level (16.7% compared to 11.5%)
• Estimated need for treatment among adult males
  was higher than among adult females (15.5% compared
  to 7.5%)
• About one-third of those that needed treatment
  (22,990 adults) also experienced a mental illness in the past year
  Mental Illness 3                    
  Approximately One in Five   
  105,966 adults had a mental illness in the past year.

• 61,176 adults (11.2%) had a mild mental illness, 23,487 adults (4.3%) had a moderate mental illness and 21,302
  (20%) had a serious mental illness
• Estimated mental illness among low income adults was
  higher than among adults above 138% of the federal
  poverty level (23.8% compared to 19.4%)
• Estimated mental illness among adult females was

higher than among adult males (24% compared to 15%)

Adult Clients Served 4              
Approximately One in Twenty
27,728 unique adult clients
were served with support from
state Medicaid and/or behavioral health grant funds.
Breakdown of Adults Served
By diagnosis category:
• Substance Use Disorder: 14,442 (52%)
• Serious Mental Illness: 16,841 (61%)
• Mild or Moderate Mental Illness: 2,061 (7%) • Co-occurring Disorders: 3,690 (13%)By gender:Male: 11,480 (41%) | Female: 16,232 (59%)

Behavioral health services in Alaska are funded through a mix of Medicaid, state and federal grants, Indian Health Service Compact and other Tribal funds, private insurance, self-pay and uncompensated care so the utilization data analyzed tells only part of the story. Nonetheless, the report’s findings reinforce what we heard from stakeholders: the behavioral health needs of many Alaskans are going unmet resulting in higher costs and poorer health outcomes.