Critiquing Dunleavy’s first year on health care

This week, Governor Dunleavy released a “Report to Alaska” listing some of the accomplishments of his first year in office.

In the section titled “Supporting Alaskans in Need,” the post includes the following seven highlights.

  • After years of neglect, the Alaska Psychiatric Institute has regained federal compliance
    and on a successful track
  • Created a statewide opioid action program
  • Initiated the process to reform our Medicaid system
  • Reduced backlog of applications for public assistance
  • Addressed ~3,000 Child in Need of Aid cases
  • Improved veteran healthcare access
  • Secured millions of dollars of new funding to combat homelessness

I’m certainly not familiar with everything this administration has done on health policy.  And, I certainly don’t want to quibble over minor details.


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That said, it does seem a bit of a stretch to say this administration “initiated the process to reform our Medicaid system.”  In fact, one could argue this administration has halted the process, or perhaps re-directed the process.  One could argue this was done as a result of community feedback or the like.

But the process to reform Medicaid was kicked off in 2016 with the passage of SB 74.  In fact, then-Sen. Mike Dunleavy voted for that legislation.

Now, implementing that legislation didn’t quite go as swimmingly as it could have.  There were delays and missteps that former Walker administration officials will privately admit.  Nevertheless, in the hand off from Walker to Dunleavy, Alaska was on the cusp of moving to a Medicaid system that would fundamentally reform and redesign care across both physical and mental health.

Yet, under Gov. Dunleavy, most of those efforts have been abandoned (like United’s care coordination work) or stalled indefinitely (like Optum’s BH-ASO work).

Now, there may be good reasons to do this.  Perhaps those were the wrong initiatives in place.

But, the notion that this administration has “initiated the process to reform our Medicaid system” is simply false.

I know it is trying to figure out a strategy, and should get credit for exploring some creative options at the department level.  But that’s different than what this says.

Likewise, the opioid action program was an initiative designed, proposed and approved via, in part, an 1115 waiver which started under Walker as a result of the 2016 legislation.

And, I’m sure the Walker administration would argue that it addressed significant parts of the backlog for public assistance as well – though that clearly was not completed under the previous administration.

The takeaway here for the Dunleavy administration on health care is probably this:  be careful not to overstate the progress made on health reform.  You’ve got a tough task here.  Focus on consensus as much as possible.

As what happened in SB 74, which took two sessions to pass, consensus takes time to build, but once built, it can be lasting and meaningful.