5 Things We’re Watching – Alaska, March 2013

There is so much going on in health care, our conference attendees have asked us to keep them posted “with what’s most important in health care today.”

Rather than make a judgment on what’s “most important,” given the diversity of attendees at State of Reform, we offer this approach:  five things we are watching when it comes to Alaska health care that we think are worth keeping an eye on.

If you have something to add to the list, please let us know!

1. “Changes of this magnitude are beyond my authority”

The Indian Health Service is feeling the pain of the sequestration acutely, with impacts in Alaska both diverse and wide ranging.  SEARHC, southeast Alaska’s largest employer, is bracing for a $3.5 million cut, for instance.  The impacts to the IHS are even starting to turn heads in the national media.

With focus now on competing budget propositions from the House and Senate, there is less talk on addressing these cuts.  What this means for the safety net in rural Alaska moving forward is an open question.

2. Innovations in Medicaid expansion – via the exchange

The devil is in the details, and these two markets won’t be entirely the same, but we’re seeing a trend of homogenization between Medicaid and the exchange as states  innovate to transform Medicaid.

In Washington state, the Apple Health Plus program allows exchange plans to easily opt-in to become Medicaid plans. Governor Rick Perry in Texas is looking to a block grant model to support Medicaid beneficiaries purchasing benefits, likely on the federal exchange.  Arkansas Gov. Mike Beebe wants to expand the exchange subsidies to newly eligible Medicaid beneficiaries rather than increase the size of Medicaid itself.  Even Florida and Idaho are looking to fundamentally change Medicaid into a more private market.


3. AlaskaCare proposals are in

One of the most potentially impactful things in Alaska health care in 2013 may be the result of the state AlaskaCare RFP.  Proposals are now in, after extensions of the deadline.  I’ve been told that the state has not awarded the contract to the incumbent vendor – ever.

One long time Alaska health care leader told me recently that “If Premera wins this contract, they might get enough critical mass in the market to actually bring about meaningful cost reductions over trend.”

Lots of eyes are watching this one.

4. “Alaskans will be the healthiest people in the nation.”

“What does the Health Care Commission have planned for 2013?”  I hear that question often and for good reason.  They have a tendency to highlight key issues in health care ahead of the rest of state government and the marketplace.

It’s for this reason we always pay attention to key documents they produce, like this recent document “Transforming Health Care in Alaska: Core Strategies and Policy Recommendations.”


5. Senate Finance committee critical of Medicaid innovation

Last month, I highlighted how the Senate Finance committee dressed down the leader of the federal insurance exchange effort.  This month, Chairman Max Baucus (D-MT) used kids’ gloves, but was critical of the Center for Medicaid and Medicare Innovation.

“What can you tell us that’ll make us more comfortable that we’re actually going to get demonstrable results here so that this whole effort is worthwhile.  It sounded good in the act, now we’re trying to find out whether in practice it actually makes sense.”  (32:30)

Bottom line:  This committee is re-engaging deeply in health policy and isn’t very comfortable with what it’s seeing out of the ACA lately.