Alaska Legislative Democrats and Republicans lay out health policy priorities

Seven state lawmakers gathered this week to discuss the health care and fiscal policy teed up for Alaska’s 2021 legislative session. The conversations took place between two separate panels – one featuring Democrats and the other featuring Republicans – during the 2020 Alaska State of Reform Virtual Health Policy Conference.

The Democrats panel featured Sens. Tom Begich, Bill Wielechowski, and Scott Kawasaki, along with Reps. Ivy Spohnholz, and Sara Hannan. Sen. David Wilson and Rep. Mike Prax offered their perspective on the Republicans panel.

Below are highlights from the wide-ranging discussions that took place in both panels.


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Policy Leadership: Democrats

  • Rep. Spohnholz, Vice Chair of the House Health & Social Services Committee, says heading into 2021, health policy and reform falls into a couple of different buckets: Medicaid budget and reform, behavioral health, and transparency related to health care spending and outcomes. 
  • As for Medicaid, Spohnholz says across the board rate cuts and cutting services aren’t solutions. She says the state should instead look to value-based reforms
  • Spohnholz also says behavioral health reforms – such as investments into addiction treatment capacity and finding ways to divert individuals away from the criminal justice system – will be key to improving health and reducing crime. 
  • She says she and Sen. Natasha von Imhof will continue working on moving legislation to create an all-payer claims database
  • Sen. Begich focused his comments on the importance of pre-K and early education. Last year, Begich put forth legislation to offer universal voluntary pre-K in Alaska, but the bill didn’t pass due to COVID. He says he will focus on legislation that supports early education, as well pre- and post-natal care. 

“Those young people that go through pre-Kindergarten actually have greater health outcomes, less engagement in the juvenile justice system, and less opportunity to become addicted to substances. These are all critical components in our long-term health care costs,” said Begich. “Education as a critical component of health care can’t be ignored.” 

  • Sen. Kawasaki says the discussion in the legislature this year will boil down to the budget. He says with a $2 billion budget shortfall heading into session, funding Medicaid will be a major discussion point. Adding a layer of complexity to this discussion is the fact that Medicaid enrollment in Alaska has increased by more than 5%, mostly due to the impacts of COVID. 
  • Kawasaki says the implications of the upcoming elections are also critical in determining what the legislature will look like, who is in leadership, and what decisions are made at the federal level. 
  • Tribal health and telehealth will also be important conversations, says Kawasaki. 
  • Similar to Spohnholz, Sen. Wielechowski points to the connection between crime and behavioral health as an important conversation for the 2021 legislative session. 

“If we want to get crime in this state under control, you’ve got to provide substance abuse treatment, you’ve got to provide beds, and you’ll see big pushes for that I think from us,” says Wielechowski.

  • He also says the confirmation of the next Supreme Court justice and the Court’s decision on the Affordable Care Act could have significant impacts on Alaska. 
  • Alaska has some of the highest rates of suicide for young adults, says Rep. Hannan. For that reason, mental health and behavioral health need to be a top priority. She says the state needs to focus on early interventions and addressing Adverse Childhood Experiences (ACEs) to improve the lifelong health of Alaskans. 


Policy Leadership: Republicans

  • Rep. Prax says his focus will be on trying to contain the cost of health care. Alaska is facing about a $1.3 billion budget shortfall [in the just-ended fiscal year] and Prax thinks that reality necessitates clear decision making: We’re at the point now where if we want something, we have to say what of something else we don’t want.”
  • Prax said the any that the substance of policy solutions to the ongoing public health and economic crises are contingent on the makeup of the Legislature next session
  • Sen. Wilson said the year ahead would be challenging for several reasons, among them that states don’t have very many options to contain Medicaid spending:

“States really can’t cut the enrollment eligibility just because we have to continue to provide coverage to enrollees due to the maintenance requirements.” WIlson is concerned about lack of room to make cuts and realize savings. 

  • Wilson wants to take a closer look at state-based regulations that have been suspended and decide whether suspensions would be worth making permanent.
  • Alaska has been a leader on tele-health and collaborating with tribes, said Wilson.
  • On the state potentially getting rid of the 80th percentile rule, Wilson said he would hate to see the loss of a consumer protection rule but that a lot of “bad players’ have been able to take advantage and engage in price inflation: “The 80th percentile rule probably needs to go, but I’m not sure how or what we would replace it with yet.”
  • Prax said the 80th percentile rule establishes a perverse incentive and has not worked out as expected. With Alaska being a small market, Prax said the state has monopoly players among both providers and payers. He continues by saying the Legislature should take steps to develop the market or combine with other market areas that might bring more players into the fold. 

“I would love to see more competition in our state,” said Wilson as he discussed his controversial bill to repeal the certificate of need. “I think we need to do something to increase competition in our state. I understand that we may not have the payer mix to make it profitable for every entity to come into every market within our state, but we know where the hub is.”

  • Alaska is one of 12 states that does not have a Managed Medicare Plan. Wilson would like to see more of a managed care system implemented for older utilizers.
  • Wilson is attempting to obtain data on how COVID has halted medical tourism in Alaska.
  • Rep. Prax is concerned that many people are looking outside of the state for health care options. If the state doesn’t reduce the cost of care, the medical industry will lose customers. “People will not even bother with Fairbanks and just go to Seattle.”