Sen. Murkowski | Medicaid cost data | Thursday night

This is a big week in US health policy with a vote on the American Health Care Act scheduled for Thursday night. The impacts to Alaska could be extreme, based on reports below, which puts the congressional delegation committed to repealing Obamacare in a tough spot – one that could reverberate to the ballot box.

It’s part of what we’re watching in Alaska health care in March.

1.  Medicaid cost data: room for improvement

Milliman released actuarial data for all Alaska Medicaid claims for state fiscal year (SFY) 2015 and 2016. It’s a dense report, but some of the numbers are interesting. Appendix E says $105 per Medicaid member per month, or about 12% of the Medicaid spend, is “potentially avoidable cost.” They define those costs as avoidable through “best practice management.”

The same appendix shows Medicaid hospital readmission rates are 7.2%, lower than the average of 9.4% in other states, according to a recent study. However, baseline inpatient and hospital patient spending rose approximately 30% from SFY 2015 to SFY 2016, though the reasons for that increase were not identified in the report.

2.  US House votes Thursday on reform

Thursday is the 7th anniversary of the signing of the ACA. It’s also the day the US House is set to vote on their reform bill, the American Health Care Act. The bill is set to be amended in the Rules Committee on Wednesday.  You can read the Congressional Budget Office memo here.  It’s perhaps the most important read you’ll find for an objective analysis of the bill.

Ironically, a million more people will become uninsured under the AHCA than if Republicans simply repealed Obamacare, according to the CBO. It’s a bill that even Trump began to pan a bit in his Monday night rally in Kentucky. The ADN has a good write up on where Alaska’s delegation stands – a group that could become centrally important to the bill’s passage. As the Midnight Sun podcast implied, if Don Young thinks it’s ok to vote against the bill, it’s easy to see a number of other Republicans doing likewise.

3.  House reform’s impacts on Alaska

One analysis shows the AHCA would raise the net price (removing the subsidy but adding the tax credit) of an individual plan in Alaska by $10,243 per person. That would effectively collapse the state’s individual market of about 18,000 people. And in general, rural areas are hit particularly hard under this bill.

House Democrats break down the impact in Alaska by benefit, including employer coverage. Another analysis says 15,900 Alaskans could lose their current employer-based health benefits.

All three sources above are left of center. No similar right of center organizations appear to analyze impacts to states. Yet, the Heritage Foundation opposes the bill, the American Enterprise Institute says it’s not complete, and Cato says it’s “Obamacare-Lite – or worse.”

4. Video: Stephanie McBride

Stephanie McBride is a nurse practitioner at Denail OB-GYN. In this episode of “What They’re Watching,” McBride gives an authentic voice to the predicament some providers find themselves in while working in Alaska today.

“Patients are trying to do the right thing by paying these premiums, however outrageous they may be… and they are willing to pay more… if I tell (my patient) why it’s important, she will pay for it.  I feel like the insurance companies can be more transparent and help the lay person understand.”


5.  Murkowski and the fine line she walks

Senator Murkowski has staked out an Alaska-centric position on the AHCA, recognizing the mixed costs and benefits to Alaska. In a tight Senate, this is politically precarious where three votes lost mean the Republicans can’t move a bill. One can imagine a primary challenger might hit her with “casting the vote to save Obamacare” if the Senate doesn’t have the votes.

This week, she holds a Facebook Live town hall to discuss health care (you can RSVP here). In April, she’ll spend two weeks in the state. Sen. McConnell plans a vote in the Senate on the House bill just before that April recess, setting the stage for potentially contentious town halls.

Will these April town halls look like the August 2009 town halls where the then-rising Tea Party used a purposeful strategy to “rattle” and “shout at” legislators to “get them off their script?” We’ll see – but the stage will soon be set.