5 Things Alaska: Deferred care, Alaska Native mortality rates, ACA ruling in context

While DJ is out trying to get in a well-deserved vacation, I’ll be bringing you this edition of 5 Things We’re Watching. I’m the managing editor here at State of Reform where I have my eye on health care and health policy in Alaska and a number of other states.

Feel free to email me any feedback or tips on what you think we should be covering!


Emily Boerger
State of Reform

1. The ACA ruling in context

This week, the US Supreme Court found that states arguing for the repeal of the ACA lacked standing. In what DJ describes as “a stroke of unintended irony,” by zeroing out the individual mandate, Congressional Republicans undermined the case by Republican AGs. With the penalty at zero, Justice Breyer writes “Neither logic nor evidence suggests that an unenforceable mandate will cause state residents to enroll in valuable benefits programs that they would otherwise forgo.”

This marks the third edition in the “trilogy” of cases brought to repeal the law, each perhaps a uniquely creative ruling. The NFIB case in 2012 said the penalty was not a penalty but a tax, therefore within Congress’s power. It also re-wrote policy to make Medicaid expansion voluntary rather than required. The King v Burwell case said the federal government was really like a state, so it too could deliver marketplace subsidies otherwise expressly reserved for the states. And in this case, Texas v California, the Court chose to set aside questions of Constitutionality by stopping at the procedural step of standing.

The ACA has at least three lives, having dodged (most of) each of these threats. We’ll see if there is a fourth test to come.

2. Alaska Native mortality rate 51% higher than US average

The Alaska Native Mortality Report finds the mortality rate for Alaska Native people was 51% higher than the overall US rate from 2014-2018. During this time, Alaska Native people had significantly higher rates of all ten leading causes of death including cancer and heart disease (the two leading causes of death), and alcohol abuse, where the Alaska Native morality rate was 8 times the rate of the US average.

Alaska Native people also experienced an average 26.8 years of potential life lost, with unintentional injury being the biggest contributor to years lost. The report also details regional differences in Alaska, with the Anchorage-Matsu region experiencing higher mortality rates for all causes compared to the rest of the state, while Bristol Bay and Southeast saw lower rates.


3. Impacts of deferred care

By June 2020, over 40% of adults reported having delayed or avoided medical care – including emergency care and routine care – out of concerns about COVID-19. Though long-term implications of delayed care are still unclear, leaders at the Alaska Dept. of Health and Social Services say they’re already seeing increases in hospitalizations and mortality rates for certain conditions.

Dr. Anne Zink says in 2020 they saw increases in mortality from cancers, neoplastic diseases, and cardiovascular disease. “The concern there is people aren’t getting screened and they’re not getting diagnosed, which means that they’re waiting until things advance to a more kind of critical stage before they’re getting [a] diagnosis and treatment,” says Ashley Minaei, Public Health Specialist and Program Manager at DHSS.


4. Q&A: Jerry Jenkins, ABHA

Jerry Jenkins has served as the Alaska Behavioral Health Association’s chief operating officer since 2018. In this Q&A, Jenkins reflects on the behavioral health challenges faced by Alaskans during the past year and shares lessons learned from the pandemic.

Jenkins says Alaskan’s resilience and adaptability give him hope during this time, but he says it’s important to recognize that there are profound and lasting impacts from trauma. He says the road to recovery is a slow one. “I just think it’s recognizing that we need as much time to recover as it took us to get through the pandemic — as much as 18 months.”


5. Davidson’s past comments on health reform

The Alaska Native Tribal Health Consortium Board of Directors last week named Valerie Nurr’araaluk Davidson as its new president. Davidson was the state’s first Alaska Native woman to serve as Lieutenant Governor, and previously served as Commissioner of the Alaska Department of Health & Social Services.

Davidson has offered remarks at the Alaska State of Reform Health Policy Conference on several occasions over the years including this keynote speech where she discussed the future of health policy in Alaska, and this 2015 video where she reflected on the importance of collaboration in moving health reform conversations forward.