Republican Lawmakers Express Doubts On Medicaid Expansion

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House Republicans expressed skepticism over Governor Bill Walker’s plan to expand Medicaid in a hearing Monday morning.

The subcommittee hearing of the House Health and Social Services Committee was the first chance for lawmakers to publicly question Health Commissioner Valerie Davidson on the subject.

Medicaid expansion is a complicated topic. Davidson and lawmakers dug into the details, like reimbursement rates in Alaska and efforts to combat Medicaid fraud.

An hour and a half into the hearing, subcommittee chair Dan Saddler, a Republican from Eagle River, was ready to ask a bigger picture question:

“Given the federal government’s debt load, that’s also projected to increase tremendously over future decades…. does it cause you any concern or to question the wisdom of expanding Medicaid?”

The federal government would cover Medicaid expansion at 100% until the end of next year, then that match gradually decreases to 90% in 2020. The money would pay for health coverage for mostly childless adults who are near or below the federal poverty level.

Davidson said they are mostly the working poor and she told Saddler she didn’t have a problem accepting federal funds to give them access to health care.

She pointed out that federal highway funds have a similarly generous match rate.

“We can build roads,” she said. “We can build all kinds of opportunities, but if we don’t have Alaskans who are healthy enough to participate in that economy, then we have done ourselves a disservice and so I am comfortable moving forward with expansion just as I am comfortable driving on roads that have the potholes replaced at those corresponding matches.”

Several other Republican lawmakers on the subcommittee were focused on the argument that the federal government would pull back on its promise to provide at least 90 percent funding for Medicaid expansion.

They wanted assurances that Davidson would drop Medicaid expansion if the federal match ever fell below 90 percent.

When Davidson told lawmakers that was the plan, Representative Lance Pruitt, a Republican from Anchorage, said ending expansion was unrealistic:

“We’ll have to have a discussion about are we also willing to take up the additional 90 or so million [dollars] after 2020 and have an honest discussion, because I don’t think we’re going to introduce something and ever strip it away whether we make legislation, whether we make law, whether we make regulation, it doesn’t matter, you’re not going to take away health care from Alaskans.”

Representative Bryce Edgmon, a Democrat from Dillingham, was frustrated the hearing didn’t focus more on the benefits of expansion- how it could reduce the state’s high rate of substance abuse, and help poor Alaskans access preventative medicine.

Edgmon doesn’t think it makes sense to spend so much time focused on whether the federal match rate will remain:

“The issue of whether the federal government pulls out and can’t hold their end of the bargain – I say this tongue and cheek – we have bigger issues in Alaska given that one third of our spending in this state is dependent of federal spending…on a whole range of programs we depend on the federal government.”

The budget Walker sent to lawmakers includes a line approving the receipt of federal Medicaid funds.

Representative Mark Neuman, a Republican from Big Lake, asked the administration to submit a separate bill on Medicaid expansion so it would be subject to the normal legislative process. The Governor’s office is not considering that option.

This story is part of a reporting partnership between APRN, NPR and Kaiser Health News.