Health care is complex and hard, because it is both deeply personal and expensive. As a society, we unite behind the belief that we must take care of people. We’ve already crossed that bridge, because anyone can go to the hospital emergency department regardless of their ability to pay. We are also obligated to take care of them in a way that is fiscally sustainable.
As a country, we must do better at both of these things. This requires big thinking, real analysis, painful compromise and a glidepath that assures a better future without crashing our existing health care system. It does not involve rolling back Medicaid expansion, an action that would risk the future of our health care system, hurt Alaska’s economy and harm the lives and health of almost 47,000 people.
Those who advocate repealing Medicaid expansion rely on misinformation. If we are serious about reforming the health care system, strengthening the economy, treating addiction, reducing crime and maintaining our hospitals and health care providers, state leaders would be well served by relying on data and understanding why these myths are just that — myths.
Myth 1: Medicaid expansion blew up the budget
Fact:Medicaid expansion is a tiny fraction of the total state Medicaid budget, and actually saves the state money. Under federal law, the state will never pay more than 10 percent of the program’s cost. For Alaska, that percentage is closer to 6.5 percent because the federal government pays the full cost of Indian Health Service beneficiaries. In fiscal year 2018, the total cost of expansion was around $418 million, but the state general fund cost was only $14 million, or 3.3 percent. However, the state avoided $15.8 million in other costs because of expansion, saving the state $1.8 million.
Myth 2: Medicaid expansion enrollees are all able-bodied adults who should just get jobs
Fact: According to the Kaiser Family Foundation, nearly eight in 10 non-disabled, non-elderly adults on Medicaid live in working families, and a majority are working themselves. Many Medicaid expansion enrollees are working at low-wage jobs for employers that don’t offer health insurance. Others may be out of the workforce temporarily for an illness or injury (like a cancer diagnosis) but will return to the workforce.
Myth 3: Alaska offers a “Cadillac” Medicaid plan, and should offer the “Chevy” version instead
Fact: Medicaid offers mandatory and optional services. Many optional services, like pharmacy, aren’t truly optional if the goal is to keep people healthy. More than two-thirds of U.S. states offer the optional services in Alaska’s Medicaid program. We recognize that Alaska faces hard choices about utilization, services and reimbursement, but it is important to recognize that the current Medicaid plan is mainstream.
Myth 4: Medicaid is a drag on Alaska’s economy
Fact: Medicaid expansion has provided a huge economic boost during a recession, injecting over $1 billion federal dollars into the economy at a time when health care was one of the few industries growing. Eliminating Medicaid expansion will harm an economy struggling to recover.
Myth 5: Hospitals are making a lot of money off of Medicaid expansion
Fact: Hospitals get paid what it costs to provide services to Medicaid enrollees, but no more. Our most vulnerable hospitals — those in smaller communities — have low or negative margins, which means that eliminating expansion could jeopardize hospitals in communities with limited health resources and support systems.
Myth 6: This doesn’t affect me
Fact: Rolling back expansion adds to the cost of health care for everyone. Newly uninsured patients will seek care through the emergency department and hospitals will have to absorb those costs. In fiscal year 2017, Medicaid expansion reduced hospital uncompensated care by $173 million. Eliminating expansion means that costs increase dramatically for hospitals, which means higher health care costs and insurance premiums for everyone.
Discussions about how to provide health care and sustain budgets must be informed with facts, they must be transparent, and they must provide a vision for a better future. Repealing Medicaid expansion meets none of those tests, and it will hurt people and slow down Alaska’s economic recovery. We urge the governor and Legislature to retain Medicaid expansion. It is in all Alaskans’ economic interest to do so.
• Becky Hultberg is the president and CEO of the Alaska State Hospital and Nursing Home Association. My Turns and Letters to the Editor represent the view of the author, not the view of the Juneau Empire.