Independent Bill Walker, who won election last month in a governor’s race so tight the results weren’t known a week after the voting was over, campaigned on the promise that he’d expand Medicaid as one of his first orders of business. To make good on that, he’ll have to face Alaska’s Republican-controlled legislature that hasn’t been willing to even consider the idea.
But for Walker, it’s a no-brainer. Around 40,000 low-income Alaskans — mostly childless adults — would receive health benefits under Medicaid expansion. The federal government would pay 100 percent of the costs until the end of 2016. After that, the state’s share would slowly increase to 10 percent by 2020. Plus, he says, Alaskans already pay taxes that fund the expansion.
“I always will default back to what is best for Alaskans, and it’s best for Alaskans to have the health care coverage we’ve already paid for,” says Walker, who took office Dec. 1.
The Alaska Chamber of Commerce, the Alaska State Hospital and Nursing Home Association and the Alaska Native Tribal Health Consortium all support expansion. So far 28 states have expanded Medicaid, and Laura Snyder with the Kaiser Family Foundation says most of those governors have had legislative support. (KHN is an editorially independent program of the foundation.)
“There have been a few states where the governor has acted on his own through executive authority,” she says, “but most states have generally incorporated it into state budgets which usually require legislative sign off.”
Walker will probably need the legislature to fund part of the expansion because the state has to pay administrative costs that would add up to as much as $10 million per year. Those millions could be a tough sell for the Republican legislature. Republican State Sen. Anna MacKinnon says Walker will have to make a strong case.
“It will be a lively debate, but I look forward to work with him to the best of my abilities within the financial constraints that this state is currently facing,” she says.
To help his case, Walker has appointed Valerie Davidson as health commissioner. She’s been a leader in the Alaska Native health care system and a determined advocate for expansion since the health law passed. She says she’ll rely on a cooperative work ethic as she negotiates with lawmakers over expansion. Davidson is confident Alaska can get it done.
“It may not be something everyone’s 100 percent happy with, but we may be able to find middle ground that we can all live with,” she says. “I think that’s what makes Alaska so great. We don’t back down just because things get difficult. If it’s 40 below we go about our day and get things done. That’s just what we do. And we do that with policy issues as well.”
Beyond the legislature, Alaska faces big technical hurdles before Medicaid expansion can work. The state’s payment and enrollment systems aren’t functioning properly right now and Davidson wants to address those issues before any expansion.