5 Things We’re Watching – Alaska, November 2013

Someone said to me last week “Many of us in healthcare have spent a lot of our careers trying to improve the system, but not making a lot of progress.  Today, regardless of your politics, there is more movement, more action, more dynamism in healthcare than at any other time in my 30-year career.  This is the time we’ve been waiting for.”

His was a powerful narrative on the “opportunity of now” in healthcare today.  It strikes me that even where a door closes on one idea, a few others immediately open.  And, so it is with the 5 Things We’re Watching this month in Alaska healthcare.

DJ Wilson - Host, State of Reform

1. Parnell:  Medicaid expansion “a hot mess”

It wasn’t a shock to see Governor Parnell decide against expanding Medicaid.  The politics of the issue are toxic given the failed roll out of Healthcare.gov.  But, the announcement wasn’t only a decision against expansion.  Parnell also announced the formation of a Medicaid Reform Advisory Group tasked with, in part, “uniting physical and behavioral health.”

Noteworthy was the release of the Lewin Group study on Medicaid, the subject of some gnashing of teeth over the year.  Also, in questions, Governor Parnell said he asked HHS Secretary Sebelius for flexibility on Medicaid and was told no.

2. “It’s what happens when you speak at State of Reform.”  

Two of our featured speakers from our 2013 event are getting new jobs.  Both are leaving state government.

Becky Hultberg, Commissioner for Administration, is stepping down.  While her new gig isn’t yet public, we hear she’ll stay very much in the mix.  In her resignation letter, she cited putting state employees’ and retirees’ health benefits “on a path to sustainability” as a highlight of her term.  Some outlets have noted that Hultberg is now the 4th commissioner to leave the Parnell administration in recent months.

Brett Kolb, Director of the Division of Insurance, also announced he is leaving his position with the state.  That departure is effective Dec. 19th.


3. The US Senate and Healthcare.gov  

With the 2014 elections around the corner, Democratic Senators have been pounding President Obama on the failure of Healthcare.gov.  Senator Begich has been chief among them.

With President Obama’s new deadline for a functioning federal health insurance exchange set for the end of the week, there has been a bit of a pause in that criticism.  However, if Healthcare.gov still isn’t ready for primetime, it’ll be interesting to see how Democrats respond with new policy bills and legislation – like Begich’s new bill, the “Expanded Consumer Choice Act” – ahead of the mid-term elections.  Republicans have already put a plan together to take advantage of the situation.

4. HC Commission: modify rules for provider payment   

One of the unique elements of Alaska’s health care marketplace is the creation of, essentially, a “floor” for provider reimbursement.  The Alaska Administrative Code says, in part, health plans or self-insured employers must pay providers an amount “equal to or greater than the 80th percentile of charges.”

It’s intended to help empower providers in order to attract them to come to Alaska.  It’s also helped drive the most expensive health care prices of any state in the country – with the most expensive health care system of any country in the world.

The Health Care Commission’s draft 2013 report recommends addressing the “unintended adverse pricing consequence” from the rule.  Expect the most active health policy discussion in the Legislature in years if that happens.


5. Enroll Alaska and United Way  

Some organizations were really out in front in terms of thinking through how to enroll folks on the insurance exchanges.  Enroll Alaska and the United Way were both at the top of that list – one as broker, the other as navigator.  Both have invested time, money and resources in helping drive enrollment through Healthcare.gov.  But, that plan depends on Healthcare.gov actually working.

If we assume for a moment that the site will be functioning at capacity this time next week, that gives Alaskans just short of a month to get enrolled before the Dec. 23rd deadline to have coverage in January.  And, for about 5,400 Alaskans with newly cancelled plans – as well as Enroll Alaska and United Way – that’s going to be a very busy, short-lived time.