The Alaska impact of ACA repeal bill? Depends where you look

Protestors at the U.S. Capitol in May. Photo by Liz Ruskin.

Sen. John McCain has announced he will vote “no” on the Republicans’ latest health care repeal attempt  That appears to sink the bill. But anti-repeal activists aren’t taking any chances. They organized a protest in front of Sen. Lisa Murkowski’s Anchorage office again Friday, urging her to vote no. Murkowski said her position on the bill will hinge on data showing how Alaska would fare under the bill, and that could depend on where she looks.

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Alaska is a tough state to treat, medically and politically, in a health care bill.

Sen. Lindsey Graham, R-S.C., said he understands that.

“Alaska is a third the size of the United States, with 750,000 people,” Graham told reporters at the U.S. Capitol this week. “It is a bedeviling problem.”

It’s unclear whether Senate leadership will put his repeal bill, Graham-Cassidy, to a vote now, but a hearing is scheduled for Monday. If Murkowski is still trying to make up her mind, she might read the reports of think tanks and consulting firms. Their calculations of the Alaska impacts of Graham-Cassidy vary wildly.

On the high end, the consulting firm Avalere said Alaska would lose about $1 billion over seven years, 2020-2026, compared to what it gets under current law.

But the Kaiser Family Foundation finds Alaska’s loss would be just $275 million over those same seven years.

And the Center for Budget and Policy Priorities says Alaska would lose $255 million in a single year.

The authors of three different reports see the divergent numbers are unimportant. The bottomline:

Photo via Avalere

“Under this bill, we found that Alaska is at risk of losing money,” Chris Sloan of Avalere said.

But $1 billion vs. $275 million?

“Well part of it is, you know, our number is rounded .. to the billionth,” Sloan said.

That’s right: they’re rounding their dollar figures to the nearest billion. (It’s a national report, not solely focused on Alaska.) Another difference among the reports: how they treat special allowances in the bill that would help Alaska.

For instance: One of the things the Graham-Cassidy bill would do is change funding for the 50-year-old Medicaid program. The bill would have the feds pay states a set amount per person, starting in 2020. But the bill has an exception for certain low-density states. That boils down to Alaska and Montana. The bill allows them to delay the change until 2027.

Sloan said Avalere assumes Alaska will not get that allowance, or others in the bill that would help Alaska but depend on the health secretary certifying eligibility.

“We didn’t want to predict what the secretary is going to decide, so our analysis … includes the per capita cap for Alaska,” Sloan said.

Avalere’s report was sponsored by the Center for American Progress, a liberal advocacy group.

Kaiser Family Foundation VP Larry Levitt. Photo via KFF.

The non-profit Kaiser Family Foundation, on the other hand, assumes Alaska will delay the
Medicaid payment cap. That’s part of the reason Kaiser’s report shows Alaska’s loss as much lower. But KFF Vice President Larry Levitt says Alaska would still have significant losses, because the block grants the bill provides aren’t as generous as Alaska’s benefits under the Affordable Care Act.

“The (Graham-Cassidy) block grant tries to equalize funding across states,” Levitt said, “not based on whether they’ve expanded Medicaid or not, or how high premiums are, but how many low-income people live in the state. And by that formula Alaska ends up losing a substantial amount of money, almost $300 million.”

That’s over seven years.

Another left left-leaning group, the Center for Budget and Policy Priorities says Alaska would lose almost that much just in 2026.

“The difference is the baseline,” CBPP Senior Fellow Aviva Aron-Dine said. She worked on implementing the Affordable Care Act in the Obama administration.

Aviva Aron-Dine of the Center for Budget and Policy Priorities. Photo: CBPP.

Aron-Dine said all of these reports compare what the bill would do relative to current law. So you have to make assumptions about the path we’re on now, like: how many Alaskans will be on the Medicaid rolls in 2026? What will insurance cost five years from now?

“The truth is, reputable well-intentioned analysts can just disagree about what it’s reasonable to assume,” Aron-Dine said.

Aron-Dine said a firm called Manatt may be best on take on these Alaska factors, because it does research for the Alaska Department of Health and Social Services. Manatt’s latest report was made public on Thursday.

Its prediction of the seven-year impact: $1.1 billion.