Vice President for Health Policy
Alaska would experience significant harm from Republican efforts to repeal the Affordable Care Act (ACA), as we’ve explained. But the risk to its Medicaid expansion, which has provided health coverage for more than 30,000 Alaskans and especially benefited Alaska Natives, would be especially serious — and would begin as early as 2020.
Among other harmful provisions, both the Senate and House health bills would effectively end the ACA’s Medicaid expansion. Specifically, the Senate bill would phase down federal funding for the expansion from 2021 to 2023, increasing Alaska’s cost to maintain its expansion five-fold by 2024. Alaska, which has faced persistent budget problems in recent years, would almost certainly find it fiscally unsustainable to continue its expansion, as would many or all other states.
But Alaska’s expansion, in particular, would be at grave risk beginning in 2020 — even before the federal enhanced match would start phasing down in 2021 under the Senate bill and long before it would fully phase out in 2024. That’s because, under the Senate bill, Alaska’s Medicaid expansion could be subject to a legal challenge that’s likely to succeed.
Alaska Governor Bill Walker expanded Medicaid by executive order, relying on a state law that requires Alaska to cover all groups that states must cover under federal Medicaid law, usually referred to as mandatory coverage groups. Despite the U.S. Supreme Court decision allowing states to decide whether to expand Medicaid, the Medicaid statute continues to list expansion adults as a mandatory group, so Governor Walker followed Alaska law and took up the expansion. A court challenge to Governor Walker’s executive order was rejected on the grounds that Alaska law requires the state to cover all mandatory coverage groups.
Both the House and Senate bills would change the Medicaid statute, however, by repealing the mandatory coverage group for expansion adults and substituting a new optional coverage group beginning in 2020. That would put Alaska’s expansion at grave risk of being overturned if, for example, any member of the Alaska legislature were to again bring suit to challenge the Governor’s authority to expand. Under Alaska law, the legislature must authorize the addition of an optional Medicaid coverage group, which would be unlikely, especially in the face of declining federal funding for the expansion. Thus, while the Senate bill threatens coverage for all 11 million people who have gained Medicaid coverage under expansion, it poses an especially immediate and grave risk to Alaskans.