Alaska Medicaid expansion enrollees now nearly 50,000

Gov. Bill Walker’s experiment in universal health care coverage is expanding, and costing the State more each year. With the fiscal year 2018 ending on June 30, and a $100 million supplemental budget item needed to keep the program going, it was time to take a hard look at where Walker is leading. Some fast facts:

• Gov. Walker announced in July of 2015 that he would accept Obamacare Medicaid expansion in Alaska.
• Three years later, more than 30 percent of Alaskans — 219,734 — are enrolled in Medicaid, the federal- and state-funded program that pays for health care for Alaskans earning up to 138 percent of the federally established poverty level.
• Of the babies born in Alaska this year, 50 percent will have their prenatal, birth, and postnatal care covered by Medicaid.
• The total unduplicated “Medicaid expansion” enrollee population has grown to 49,719. These are able-bodied adults of working age, without children or disabled dependents, who are up to 138 percent of the federally established poverty level.
• Some Medicaid expansion enrollees are Alaskans being released from prisons. As the incarcerated are shown the exit, the State enrolls them in Medicaid as part of a plan for re-entry into society.
• The total number of enrollees — regular and expansion — is 21 percent higher than what Gov. Walker projected it would be in 2015, when he signed Obamacare Medicaid expansion into law by executive order.
• Three years ago, he announced that 20,000 people would sign up for Medicaid expansion the first year. The Lewin Group, advising the Department of Health and Social Services, projected the total expansion enrollment would be 41,000.

“Medicaid expansion would reduce state spending by $6.6 million in the first year, and save over $100 million in state general funds in the first six years. Every day that we fail to act, Alaska loses out on $400,000. With a nearly $3 billion budget deficit, it would be foolish for us to pass up that kind of boost to Alaska’s economy.” – Gov. Bill Walker, July 2015

COSTS BALLOON 

Foolish indeed. But those promised savings have not materialized.

In fact, the governor was off by $100 million in his Medicaid estimates for the fiscal year that ended on June 30.

To save the program from collapse this past fiscal year, the Legislature approved $73 million of the $100 million that Walker requested as a supplemental patch; the federal government came up with $27 million. The Medicaid program made it through June.

But although it survived, Medicaid cost the State of Alaska (including federal dollars) $2.34 billion this past year, once the supplemental funds are added. That’s $10,649 per enrollee, or about what it would cost to buy each of them a bronze plan in the Obamacare private health insurance exchange.

This was the second time the Legislature has kept the Obamacare program from collapsing. The first time was in 2016, when the Senate realized that with the departure of all but one health insurance company, it would have to jump in and save the individual insurance market from imploding.

The problem then was that Alaska lacks enough healthy people buying insurance on the individual market created by the Affordable Care Act to offset the high cost of chronically sick Alaskans.

The Alaska Senate passed a high-risk reinsurance subsidy that covers the sickest people. Some 500 individual Alaskans account for $53 million or more in health care costs that are now paid for by the State. This allows the rest of the 18,000 Alaskans who buy their insurance from Premera Blue Cross to have insurance.

Premera is still the only insurer offering coverage in Alaska’s individual market. The number of people enrolling in the individual market dropped 4 percent year over year, from 19,145.

BY THE NUMBERS

Prior to Gov. Bill Walker’s Medicaid expansion, 163,505 Alaskans were enrolled in the Medicaid health care program — many of them poor families with children.

Today, out of the total of 219,734 Alaskans enrolled, only 7,000 are “regular” enrollees of the very poor. The other nearly 50,000 are the expansion population of the able-bodied adults without children.