5 Things Alaska: Sen. Giessel, Dunleavy budget, ACA ruling

This month, we complete our 7th year of bringing you this newsletter on Alaska health policy and health care.  To the 6,500 of you on our Alaska list, it’s been an honor to have you read our stuff.  Thanks for helping us build a new model for health care journalism and coverage in this digital age.

I hope you can enjoy this holiday season with those most important to you, and that you are safe and warm with those you love for Christmas.

DJ 5 Things SignatureWith help
from Emily Boerger,
Marjie High and Sara Gentzler.


1. Administration says the budget is bad, but it might be worse

To comply with the December 15 guideline for the governor to submit a budget to the legislature, Gov. Dunleavy submitted the budget prepared by his predecessor. But, he described the budget’s assumption that oil will sell for $75 per barrel between July 2019 and June 2020 as an “unrealistic projection.” Instead, Dunleavy says a more realistic price is $64 per barrel.  According to the administration, that price level results in a $1.6 billion deficit that Dunleavy will have inherited.

Even that might be optimistic. The federal government projects oil prices will be about $54 late next year.  Oil futures are currently trading at around $49 per barrel for the latter half of 2019.

That means that, for all of the cutting and work to reduce government in the last four years, Alaska may still be facing a $3bn budget deficit in 2019, or about a 26% shortfall on an $11.5bn budget for FY2020.


2. Blanket waivers in place post-earthquake

As Alaska recovers from the magnitude 7.0 earthquake that hit on November 30, CMS announced several blanket waivers to aid providers in continuing patient care. The waivers aid in a variety of ways, including expediting processes, extending deadlines for paperwork, and allowing for exceptions to some rules (like allowing Medicare coverage for certain prescription refills if medication has been “rendered unusable” because of the quake). Sara Gentlzer has an overview of the blanket waivers and other resources that CMS and Alaska DHSS are offering in the post-earthquake space.

CMS was given the legal authority to announce waivers like these after President Trump issued an emergency declaration for the state and U.S. Secretary of Health and Human Services Alex Azar declared a public health emergency in Alaska that was retroactive to the day of the quake.

3.  The timeline for deciding the ACA ruling

Friday’s decision invalidating the ACA drew two responses: one that claimed victory, and one that said this ruling will get overturned. Here’s what I think we know about this process based on the 2012 NFIB v. Sebelius case, which was the landmark ruling on the ACA.

First, the timeline for a decision will be some time, but not that long.  Marjie High and Sara Gentzler on our team researched this question and estimate a decision possibly as soon as June 2020. Like 2012, that would be like setting off a political bomb in the middle of the presidential election. It’s also a fool’s errand to suggest anyone knows how the Supreme Court will ultimately decide this. No one foresaw the Roberts decision in NFIB in 2012 – I was wildly off the mark – and few will probably predict (correctly) how this court will react in 2020.

4.  Video: Sen. Cathy Giessel

Senator Cathy Giessel is a member of the Senate Health and Social Services Committee in the Alaska State Legislature. More importantly, Giessel was recently elected Senate President for the next session. She joins us in this edition of “What They’re Watching” to discuss controlling healthcare costs.

I’m working on a rule – it’s not something that the legislature passed, it’s a rule that was put in place by the bureaucracy in Alaska early in the 2000s. It’s called the 80th percentile rule. It sets the reimbursement for health care, that’s outside of an insurance network, very high. And it actually incentivizes prices to incrementally go up…We need to ramp this back so that families can afford to live here and businesses can afford to work and do business here.”

5. AK ranks 32nd in annual health rankings report

America’s Health Rankings recently released their 2018 Annual Report, breaking down the state of the nation’s health on a state-by-state basis. Based off measurements covering determinants of health and health outcomes, Alaska ranks 32nd overall in the nation, falling three spots since last year’s report.

For health-related behaviors, community/environment, and policy measurements, Alaska ranks poorly at 45th and 46th. However, Alaska’s overall ranking is boosted by a high score for clinical care (2nd in the nation). In this category, Alaska’s number of dentists and mental health providers per 100,000 population, along with the rate of preventable hospitalizations, all rank in the top 10. The full data set for Alaska is summarized here.