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Democrats' bid to extend Medicaid coverage of poor Alaskans rebuffed by Republicans

Pat Forgey

JUNEAU -- A new effort to persuade reluctant Alaska leaders to allow the state's working poor access to health care is running into stalwart opposition.

One Republican legislator is likening health care to a toy for a child, saying he doubts he and his colleagues would be willing to take the "toy" away if the day came when the state couldn't afford it. The politically charged proposal to expand Medicaid is part of the federal Affordable Care Act, the law known as "Obamacare," that Gov. Sean Parnell has bitterly opposed.

The federal government has offered to pay 100 percent of the cost for three years, while never dropping below 90 percent. That would expand coverage above the poverty line to 138 percent of the poverty levels and provide coverage to an estimated 40,000 Alaskans.

Parnell said he's confident that President Barack Obama will continue to support the program that unofficially bears his name, but doubts that promise of 90 percent funding will be maintained. He's not the only one with those doubts.

"Show me a (federally funded) program that hasn't had money taken away from it," said Rep. Mia Costello, R-Anchorage.

If the federal government reneges on its offer to pick up 90 percent of the cost of the expansion, that could leave Alaska with big bills it couldn't afford, said Rep. Lance Pruitt, House Majority Leader.

But Thursday, Democrats in the Alaska House and Senate went public with a new proposal to get Alaska to reverse course. In bills scheduled for introduction in the House and Senate this week, they're requiring Alaska to take advantage of the expansion funding, but with a twist.

"Congress made a generous offer to the states when it agreed to pay 100 percent of the expense for the first three years, and between 90 and 100 percent thereafter," said Sen. Bill Wielechowski, D-Alaska.

He listed several Republican governors who have accepted the Medicaid expansion, even while  opposing Obamacare.

"Conservative governors across the county have recognized this is the right thing to do and put the needs of their citizens above politics," he said.

The Democrats called their proposal "compromise" legislation, but they acknowledged that it would be filed without any Republican co-sponsors. The new twist in the new bill is a provision that automatically pulls Alaska out of the Medicaid expansion if the federal government backs out of its promise.

"Our bill authorizes the expansion for only as long as the federal government pays at least 90 percent of the cost," Wielechowski said.

That's when Pruitt likened health care to a "toy."

He said that he doubted that once Alaska expanded Medicaid it would be able to say "no" even if federal funds were no longer available. "Are we willing and ready to pay for it as a state when the feds yank it from us?" he said.

That would clearly put the state in an awkward spot that today's legislators say they don't want to put future legislators in -- taking away something to which the public had become accustomed.

"It's disingenuous to give people something and then turn around and take it away - that's not going to happen," Pruitt said. Then he likened providing health care to a low-income worker to giving a toy to a child. "You give them something, you give them a toy, you are not going to yank that out of their hand, and that's essentially what this is," Pruitt said.

But Rep. Andy Josephson, D-Anchorage, said it Medicaid coverage was a matter of life and death.

He cited a Legislative Research Agency report that said the lack of health care coverage for the additional Medicaid recipients would mean "scores" of additional deaths.

Sen. Berta Gardner, D-Anchorage, said that even temporary care for some would be a benefit. "A lot of people have pent up demands; they'll get caught up on that," Gardner said. "If they lose coverage that will be tragic and something we'll have to deal with, but the value, even if it is only for a short period, can be immense for individuals and families."

A study by the Alaska Native Health Tribal Health Consortium said the expansion would have a net cost of $24 million while bringing $1.1 billion of federal money to Alaska.

Contact Pat Forgey at pat(at)alaskadispatch.com.