5 Things Alaska: Bills we’re watching, Budget update, Anna Brawley

It was 10 years ago this fall that we hosted our first State of Reform event in Anchorage. It seems like a lifetime ago that we had keynotes from DHSS Commish Bill Streur and HHS Regional Director Susan Johnson. The kind of bi-partisan, policy agnostic convening that State of Reform attempts to host was important then.

And, as we head into a bitter 2020, with recalls, conventions, and a general election, I hope the sort of “safe table” that State of Reform tries to provide will be just as important to you in 2020 as it was in 2011. It’s a role we’re honored to play.

As always, let us know how we’re doing – and thanks for reading our stuff.



With help from Emily Boerger



1. Oil prices and a big March revenue forecast

Last week, spot prices for Alaska North Slope fell to their lowest point since Sept. 12, 2017 – about $52 per barrel. Gov. Dunleavy’s budget was predicated on $59 per barrel, before the fall off in demand from the coronavirus.

While House Finance Committee recently worked through amendments to the budget, this shortfall leaves the legislature with big questions about revenue assumptions. The updated March revenue forecast is always important, but with this size of a drop between December and March, it could be one of the more consequential revisions in recent sessions.

2. Health bills we’re watching

A handful of new health-related bills have been referred to the House and Senate health committees this session. While there are several health bills carried over from the 2019 session still in committee, we’ve compiled a list of some of the newly-filed pieces of legislation we’ll be watching as session progresses.

The list includes two bills (HB 238 & SB 179) that look to add Alaska to the interstate nursing compact, making it easier for nurses to continue practicing when moving between participating states. Another bill would require existing health education requirements to include a mental health curriculum in K-12 classrooms, and this bill would make changes to Alaska’s health care price transparency laws.

3. Lessons from the coronavirus

The coronavirus has transfixed me these last few weeks, causing me to have a range of conversations with folks about our ability to respond to the outbreak here. I’ve learned about a central paradox in public health: we probably aren’t ready for a pandemic, but being honest with the public about not being ready may cause more harm than good. So, it’s better to convince ourselves we’re ready, I guess, and not ask tough questions in public. (?!)

In the Washington State case, we learned that anti-viral drugs first developed to ward off AIDS appear to have efficacy. We have learned that it’s increasingly possible we’ll just live with the coronavirus, as we do with influenza, and that we’ll start to catch pneumonia like we catch the flu. From Hong Kong, we’ve learned to expect a run on toilet paper if the virus hits here. And, kids face very little impact from this at all, with only 100 confirmed cases among 75k.

The flu has already killed 10,000 Americans this year alone, but that new threats are scarier than existing threats, even if mortality rates are the other way around.


4. Video: Anna Brawley, Agnew Beck Consulting

Anna Brawley is a Senior Associate at Agnew Beck Consulting, a multidisciplinary consulting firm based in Anchorage. She joins us in this edition of “What They’re Watching” to discuss the cost of health care and the potential policy discussion around determining an acceptable amount that people pay for care.

“I don’t think we’ve had a policy discussion about what’s an acceptable amount that people pay for health care — so that’s insurance premiums, cost of care…It’s not an easy question to answer and say it’s the same percent for everybody. But I think that that’s a really important conversation that we need to have. And so, then a lot of policies would flow from that, whether it’s controlling cost on the provider side, whether it’s reforming the insurance industry, whether it’s having more subsidies the way that we do with Medicaid and Medicare.”


5. Capretta: “Healthy Adult Opportunity” initiative

Some of the biggest health news in recent weeks came from CMS’s release of the “Healthy Adult Opportunity” initiative, or what many are calling a “block grant” model. Our State of Reform columnist Jim Capretta of the AEI breaks down the new proposal. He takes a complex proposal and explains the impact and its component parts.

The approach offers some meaningful options for being smarter about care coordination and system reform. But, it’s not a good option for rolling back coverage. In fact, as Capretta argues, the net result will probably be an expansion of coverage under the Trump proposal. So, even in a “block grant” situation, from a president committed to ending the ACA, the opportunity requires a thoughful approach to improving care and lowering cost trend for more Alaskans than in the current system.

That is good news if you’re worried about containing costs and improving care. It’s not good if you’re looking for easy, ideologically-driven solutions.