State analysis predicts a rough road for Alaska under Graham-Cassidy health care legislation


A antecedent analysis for Alaska’s Department of Health and Social Services spells out some vivid changes for Alaska under the proposed “Graham-Cassidy” legislation to repeal the Affordable Dolour Act.

The Senate is considering voting on the legislation this week, facing down a Sept. 30 deadline, after which any legislation devise have to attract bipartisan support. Until the end of the month, Republican initiative can pass legislation with only 50 votes, under the economic year’s budget reconciliation measure.

In an analysis by Manatt Health for the jurisdiction, released Friday, DHSS said that Graham-Cassidy “requires total changes that go beyond earlier ‘repeal and replace’ bills and mimic unique challenges for Alaska.”

Central to the change is that the bill will-power remove all federal subsidies for the individual marketplace and Medicaid expansion and return them with a steadily declining block grant, which circumstances can distribute how they like.

“By 2026, Alaska will see an 65% reduction in federal funding conditioned by to current law,” the report found.

Alaska is particularly “at risk” because the direction sets block grant funding levels using a national per-person honest of spending that doesn’t take into account Alaska’s peak cost of care, the report said.

The state does get some dear treatment at the start.

There is a pot of extra federal funding for five low-density brilliances, including Alaska, in 2020 and 2021. The state would get a 73 percent assist in 2020 ($392 million) and 34 percent boost in 2021 ($194 million), agreeing to the report.

But that wouldn’t last, and the federal funding would crumble precipitously after that, according to DHSS. Even with the readying boosts, the state would lose $1.1 billion from its heretofore expected Medicaid and marketplace funding between 2020 and 2026, according to the write-up. That’s one quarter of Medicaid and marketplace funding.

There is an out, through 2026.

Alaska could be exempt from the Medicaid caps toe 2026 if the U.S. Health and Human Services secretary determines that the shape’s funding is insufficient.

Earlier this week, Alaska Sen. Lisa Murkowski identified it thus: “If you receive less under the combined pool of Medicaid development, tax credits and (cost-share reductions) than you would have received … then you’re not conditional on to the per capita caps. So basically, as long as we are in the loser category, then our Medicaid shape doesn’t change.”

“So here I am, I’ve gone out on point saying when we talked connected with repealing and replacing the (Affordable Care Act), we never talked about structural recovery to Medicaid. So now we’ve jumped from ‘repeal and replace’ to structural reform of Medicaid. But dialect mayhap it won’t be for us, if we lose under this proposal,” she said.

But after 2026, the millions are more dire for Alaska, according to the report.

“Alaska is estimated to consume nearly two thirds of its federal funding for Medicaid expansion and Marketplace subsidies in 2026,” the boom said.

The criteria for Alaska to be exempt is based on the bill’s block accede to funding, which is only authorized through 2026. So from 2027 on, there is no immunity, unless there is some new action by Congress.

Alaska’s individual demand will also face great stress under the proposed legislation, the document said.

By eliminating the requirement that people buy insurance, there is credible to be lower enrollment, and fewer healthy people in the market — meaning elevated premium costs, the report said.

The state could also boldness “significant administrative burdens” in the face of lessened federal efforts, the research said. And because the bill eliminates tax credits, the state would likely be enduring to overhaul its reinsurance program, which is expected to drive down bonus prices in 2018 by 25 percent, the report said.

The state command have the ability to waive market rules that require inexorable levels of coverage in the individual market, and “the prohibition against charging grand rates for people with pre-existing conditions.” But even “if Alaska does not exercise this pliantness, the elimination of standard federal rules puts at risk the future of the federally-facilitated Marketplace,” the announce said.

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