AHCA, Juneau, Beth Johnson

These are “interesting times,” indeed. We focus this issue primarily on the AHCA, but we can’t overlook Juneau or thoughtful voices working towards innovation and collaboration in Alaska’s health care system.

It’s “What We’re Watching” in Alaska health care.

1.  Senate version of the AHCA is out

Here are a few things to know about the Senate’s health reform bill out this morning.  Four conservative Republicans are withholding their votes until changes are made. Senate Republicans can lose only two votes. Sen. Bob Casey (D-PA) has a simple run down of the major elements of the bill, though from a critical view.  Gov. Walker’s statement on the bill is here.

This bill is so different from the House version that a conference committee (assuming this passes, it may not) may come back with something altogether different, forcing members of Congress to vote on yet a third bill before it’s done.

If Republican members of Congress wanted to create a bill that its members could get behind, that might have endurance when the pendulum inevitably swings back towards Democrats, this does not appear to be the way to do it.



2.  Sen. Dan Sullivan on AHCA

“I will not vote for a bill that makes things worse for Alaskans.” That is Sen. Sullivan’s closing remark in a video he released yesterday. It’s a relatively prominent comment ahead of what will be a difficult vote for some members of the Senate.  For Sullivan, both a “yes” and a “no” come with significant consequences.

I’m told by Senate staff that Sen. Sullivan has been engaged behind the scenes working the bill, trying to get to a ‘yes’ vote but that he hasn’t been able to commit to that position yet.

I think voters – but particularly Alaskans – respect their elected officials when they explain their positions, regardless of whether they agree with the position. Explaining his thinking related to this vote in a video message to Alaskans deserves praise for his statesmanship, regardless of how one views his final vote.

3.  Sen. Lisa Murkowski and the AHCA

In yesterday’s newsletter from Sen. Murkowski, the pending health care vote was mentioned only in passing. However, she’s been pretty vocal since her March letter criticizing the House bill that she finds significant problems with the policy approach.

In comments last week, she got even more direct: “We’re setting ourselves up for the same criticism we waged against our colleagues on the other side.” From yesterday: “If it doesn’t work for Alaska, it doesn’t make any difference who is calling me.” This comment related to the impact of potential lobbying from the White House. She released this statement earlier today.

Assuming a phase out of Medicaid expansion stays in the Senate bill, it would be very hard to see how Murkowski votes for the AHCA based on her previous comments.  She’s staked out clear ground in support of Alaska’s Medicaid expansion and support for subsidies to exchange beneficiaries. It would be a shock to see that change during next week’s vote. The Hill has her listed as an “undecided” on this draft bill.

4.  Averting a government shutdown in Juneau?

It looks like the House and Senate are near a deal to keep government running, as reported by a few outlets (here, here). This afternoon, the Conference Committee working on the final fiscal plan removed any draw from the PFD to instead pull funds from the Constitutional Budget Reserve. That would leave $2.3bn in the CBR, a fund once at $10bn.

The deal now moves to the floor this afternoon. To draw from the CBR requires a 75% super majority in both chambers.  This means the legislature has effectively created a “grand deal” to fund all of the asks of both parties, while making significant cuts, but without a major revenue solution.

5. Video: Beth Johnson, Premera

Beth Johnson is the Senior Vice President of Health Care Delivery Systems at Premera Blue Cross Blue Shield of Alaska. She joins us in this edition of “What They’re Watching” to talk about the importance of building trust with providers during a time of intense change.

Candidly, Beth is one of the most well regarded executives on the west coast at building trust between plans and providers, and putting that together in a contract. She says the window is open now for innovation in Alaska. It’s unclear though if the turmoil around policy (DC) and finances (Juneau) might catalyze or obstruct that collaboration.