Alaska's independent Gov. Bill Walker has put his state on track to become the 30th state to expand Medicaid under the Affordable Care Act. He announced Thursday he would use his executive power to extend eligibility to as many as 40,000 low-income residents.
Walker unsuccessfully attempted to persuade the Alaska Legislature to expand the program, first through the state budget process and then with a freestanding bill.
"This is the final option for me, I've tried everything else,” Walker said during a news conference. He promised during his campaign last year to expand the program, which helped him beat incumbent Republican Gov. Sean Parnell.
State officials estimate Alaska would draw $1.1 billion in additional federal funds over the next six years under the Affordable Care Act by raising eligibility to residents with incomes up to 138% of the federal poverty level.
To go around the Legislature, Walker is turning to the state's Legislative Budget and Audit Committee, a group of bipartisan lawmakers that has the authority to review requests for Alaska to accept federal money when the Legislature is not in session.
The panel has 45 days to review Walker's proposal but he could move forward with the plan even if the committee decides not to support it.
The mechanism has been employed seven times in the state's history, Walker said, adding that the Legislature could derail the effort by reconvening during the 45-day review period.
But there's some reason to believe that won't happen.
Governors in Kentucky, Ohio and West Virginia all circumvented their legislatures to expand Medicaid, and none of those states has subsequently reversed course, according to Laura Snyder, senior policy analyst with the Kaiser Commission on Medicaid and the Uninsured.
Walker is proposing a straightforward expansion rather than pursuing a complex waiver from the CMS as several other conservative-leaning states have done, such as Indiana and Montana.
“It's pretty significant, as it means they can start getting people enrolled pretty quickly,” said Judith Solomon, vice president for health policy at the liberal Center on Budget and Policy Priorities.
Several states have used the expansion waivers for controversial provisions such as imposing premiums and cost-sharing on people below the poverty level, which policy experts fear will dampen enrollment.
Ron Pollack, executive director of the advocacy group Families USA, said he was relieved Walker chose not to pursue an alternative model.
Opposition to Medicaid expansion in Alaska, as in other states, got support from Americans for Prosperity, a conservative advocacy group financed by the billionaire Koch brothers. The organization mounted an aggressive campaign in Alaska, arguing that the state would be on the hook to pay for the new coverage after the federal match drops below 100% for the newly eligible population.
“At a time when the state is facing a $4 billion deficit, we think it's a bad idea to add 40,000 people to the program,” AFP Alaska State Director Jeremy Price said. He said it's unclear at this point if state lawmakers will come out of recess to challenge Walker.
Either way, the move is likely to have consequences for the governor, said Edmund Haislmaier, a health policy expert at the Heritage Foundation, a conservative think tank.
“Generally, when a governor goes around the legislature, you're going to create institutional friction which could spill over into other things,” he said.
Other Republican-led states that may expand Medicaid include North Carolina, Utah and surprisingly, Louisiana, according to Adam Searing, a senior research fellow at Georgetown University's Center for Children and Families.
Louisiana's Republican Gov. Bobby Jindal is on his way out because of term limits, and gubernatorial candidates from both political parties have signaled they are open to expanding Medicaid, Searing said. That state's Legislature also passed a law in June that would make expansion easier by dictating that hospitals would pick up the tab for any costs not covered by the federal government.
“[Medicaid expansion] is still alive,” Searing said.