My good friend and former state Sen. Gretchen Guess often reminds me that life is about choices.
In public policy, our choices can enhance or destroy people’s lives, so we have a moral obligation to understand their consequences. Good choices involve a decision-making process. What problem am I trying to solve? What are my options? What information or data do I have to evaluate these options? What stakeholders might have information I missed?
In his rush to craft a state budget, Gov. Mike Dunleavy and his team missed most of these decision-making steps, jeopardizing our economy and health.
Case in point is the governor’s Medicaid cuts, which the governor’s administration says will not reduce Medicaid eligibility or services and thus won’t impact the lives of Alaskans. In fact, many of these decisions were made with virtually no analysis or consultation with stakeholders and could have a dramatic impact on the health care system, people who rely on it and small Alaska communities. As the governor makes these choices, Alaskans should understand the consequences.
One of the most damaging budget proposals is to reduce Medicaid rates for nursing homes. These facilities, which house the medically vulnerable, are 75-100 percent Medicaid-funded. Medicaid pays what it costs to provide services, so cutting rates means that some nursing homes will be paid less than cost. You can see that this won’t work for long in a vulnerable facility that relies 100 percent on Medicaid. The consequences of the governor’s decision for some nursing homes will be reducing the quality of care for elders or closing and sending medically fragile Alaskans out of state.
The governor’s administration continues to falsely claim that the budget won’t hurt small hospitals. In fact, most small hospitals are co-located with a nursing home, sharing costs and staff. The nursing home revenue is often greater than the hospital revenue and helps keep the facility afloat. Cutting nursing home rates is more damaging to small hospitals than cutting hospital rates. The consequences of the governor’s choice? Dramatically reducing access to health care in some small communities or closing small independent hospitals.
In addition to making cuts that directly affect people’s lives, the governor proposes to drastically alter how larger hospitals and all nursing homes are paid, with no analysis of the impact of these changes. Consultants know a lengthy process and significant analysis is required to make informed changes of this magnitude without adverse impacts, but the governor wants to make them by Jan. 1.
It is impossible to quantify the impacts without analysis, but the governor is pushing cuts without that information. Some of Alaska’s larger hospitals are not financially strong. How will this affect hospitals in Fairbanks and Juneau? How will it impact small nursing homes? We simply don’t know, but we can’t assume they will be fine.
The governor’s team also claims that budget cuts will not affect children, when in fact there is no data upon which to make this assertion. It is true that eligibility for Denali KidCare, the Medicaid program for children, is not impacted. However, access to health care has two parts — having a way to pay for it (insurance coverage) and having providers willing to see you. The department is cutting physician reimbursement rates an additional 5 percent on top of recent rate cuts. While pediatricians are exempt from this rate cut, other pediatric providers are not.
How will this cut affect the small number of pediatric specialists serving kids in our state? How will it affect physical therapists, speech therapists, psychologists and other providers of health care for children? We simply don’t know, because no analysis has been completed.
Life is about choices, and as the governor makes choices, Alaskans deserve to understand their impacts. We can have reasonable conversations based on full information, even if we disagree, but masking or ignoring the impacts of choices does Alaskans a disservice.
Alaska’s hospitals and nursing homes want to collaborate with the administration to improve health care and reduce cost growth, but that must be done in an environment of full transparency about actions and their consequences.
• Becky Hultberg is the president and CEO of the Alaska State Hospital and Nursing Home Association. She lives in Anchorage.