Budget Consideration Sparks Medicaid Debate

As of 6pm, debate on the state’s operating budget was underway in the Alaska House of Representatives. Democrats have proposed 22 amendments, and discussion of the bill is expected to last into the late hours. The minority opened with an effort to restore Medicaid expansion to the budget. APRN’s Alexandra Gutierrez reports.

It’s often said that a budget is a moral document, an exercise where lawmakers literally spend money on the things they value. With that in mind, the House minority caucus traditionally offers a series of changes that promote their platform, but that are rarely adopted. At the top of the current priority list is expanding the state’s Medicaid program.

Rep. Andy Josephson, an Anchorage Democrat, offered language to accept federal dollars for that purpose.

“I think there is a moral imperative,” said Josephson. “So I would ask that we expand Medicaid, and I think this can be done. And I think the economy would be better. People would be better. People would be healthier.”

The amendment, which failed on caucus lines, would have allowed the state to accept $145 million in federal funds so that Alaskans near the poverty line can get health care through Medicaid. Expanding Medicaid has been a major priority of Gov. Bill Walker, and the budget he sent to the Legislature included a line to do just that. But the House Finance Committee removed the language, with some members saying the budget was not the appropriate vehicle for expansion.

The Medicaid debate highlighted some of the fractures on the issue not only in the Legislature, but within the Republican majority caucus. Some Republicans, like Rep. Shelley Hughes of Palmer, categorically oppose Medicaid expansion on ideological grounds.

“In the coming years, it’s time for communities to pull together. It’s time for churches to step up,” said Hughes. “We can be kind as people. It’s not the government’s place to be kind. We need to be kind as people.”

But others, like Rep. Dan Saddler of Eagle River, rejected the amendment on the basis of process. If the Legislature is going to consider expanding its Medicaid program, Saddler said the action should be done through a larger reform bill.

“This amendment, sir, has no cost control provisions. It has no over-utilization control for emergency room visits. It has no provision for health savings accounts,” Saddler listed.

In response, Democrats spent nearly an hour touting the economic and health benefits of expansion. As part of the Affordable Care Act, the federal government pays the entire cost of expansion in the first years, and then covers 90 percent after 2020.

Amendment sponsor Andy Josephson said it was unusual for Alaska to go out of its way to reject federal money, invoking the name of the late Sen. Ted Stevens, who aggressively brought funding to Alaska during his tenure in Congress.

“I think that Sen. Stevens, if he were here would, unless he just turned 180 degrees, he’d say, ‘What are you doing? Why don’t you reap the benefit of $1.1 billion? 4,000 jobs?’” said Josephson.

The amendment failed 11 to 26. Even though it was an up-down vote, the issue of Medicaid expansion may come up again in the Legislature. Members of the House Health and Social Services committee are taking part in a Medicaid working group, and a reform bill is in the works in the Senate.

The operating budget spends $4.1 billion from the state’s unrestricted general fund, and cuts $273 million in agency operating funds compared to the budget passed last year. Even with the cuts, the state is facing a deficit in excess of $3 billion.