Sample letter to Senators Murkowski

Dear Senator Murkowski (and valued staffers),

I am writing again today to share my concerns about how the Better Care Reconciliation Act (BCRA) would disproportionately harm the state of Alaska and the pediatric patients I serve every day. I continue to sincerely appreciate your thoughtfulness in evaluating each issue’s potential to impact Alaskans and your ethics in using your vote to “do the right thing.” This is why I feel that it is so important that I now share with you some specific data points on how Alaska could be harmed under this bill.

As with the House bill, Alaska may be the single most harmed state under the Senate bill’s policies. That’s because the bill still reduces tax credits more deeply for Alaskans than for people in any other state while also still effectively ending the Affordable Care Act (ACA)’s expansion of Medicaid; still cutting Medicaid funding for seniors, people with disabilities, and families with children (in fact, cuts it even more deeply than the House bill); and still eliminating key benefits for Alaska Natives. All told, both bills would create a “perfect storm” of detrimental impacts that could hit Alaska harder than any other state.

As you know, Medicaid covers one in four people in Alaska—more than 185,000 individuals, nearly half of whom are children. Last month, the Alaska Department of Health and Social Services released a report finding that the House-passed health bill would cut Alaska’s federal Medicaid funding by $2.8 billion between 2020 and 2026, or 27 percent. The effect of the Senate bill would be even more severe. The report also concluded that “nearly 34,000 expansion adults could lose coverage entirely, and the remaining children, seniors, people with disabilities, and other adults covered by Medicaid are at increased risk for cuts.” In addition, “the magnitude of the federal cuts are such that they may well affect Alaska’s ability to finance other State priorities such as education and infrastructure.” Even worse, the federal funds available to Alaska under the per capita cap will not be known until after each year ends, creating substantial uncertainty for the state as it makes key decisions, decisions that will likely affect the children I treat.

Like the House bill, the Senate bill would convert virtually the entire Medicaid program to a per capita cap. That means that rather than rising with need, federal Medicaid funding would be limited by a cap that would cover a falling share of a state’s actual costs over time. Cuts under a per capita cap would be deepest precisely when need is greatest, since federal Medicaid funding would no longer rise automatically in response to public health emergencies like the opioid epidemic. And the Senate bill would make the cuts even deeper by reducing the growth rate for the per capita cap beginning in 2025.

The Senate bill would still end Alaska’s Medicaid expansion, and it would likely cut total federal Medicaid funding for Alaska more than the House bill by 2026, and by several times as much in the subsequent decade. A recent CBO analysis shows these additional cuts to Medicaid between 2026 and 2036 that would further the damage to Alaska’s neediest populations. Under the Senate bill, Alaska’s cost to maintain its expansion would rise by 50 percent compared to current law in 2021, 100 percent in 2022, and 150 percent in 2023, and would be five times its current law cost — an increase of $83 million per year — starting in 2024. Alaska, which has faced persistent budget problems in recent years, would almost certainly find it fiscally unsustainable to continue its expansion, which has helped reduce the state’s uninsured rate from 18.9 percent in 2013 to 11.7 percent last year.

Many of the individuals who gained coverage under the expansion in Alaska are parents of the patients I treat every day. It is important to note that the health status of parents can have a direct impact on the health and well-being of their children. Coverage of screening of and treatment for maternal depression, for example, can impact the health of an infant. Additionally, coverage of parental substance use disorder may greatly impact the health and well being of children. Thus, ending the Medicaid expansion will have disastrous effects on children in Alaska.

I am also particularly concerned about the impacts to the Alaska Native population, as there is a common misconception that they do not benefit from the Medicaid program. In 2014, before Alaska implemented its Medicaid expansion, 37 percent of non-elderly Alaska Natives were uninsured, second only to South Dakota for the highest uninsured rate among American Indians and Alaska Natives. The ACA’s Medicaid expansion has enabled Alaska to provide many more Alaska Natives with coverage. Today, while Alaska Natives make up 15 percent of the state’s residents, they comprise nearly 40 percent of its Medicaid enrollees, and, while updated data are not available, their uninsured rate has almost certainly fallen significantly.

Further, Natives with Medicaid can use their coverage to receive care at Indian Health Services (IHS) and tribal operated facilities or with other providers who take Medicaid. Medicaid also pays the full cost for travel to such facilities, which is a critical benefit for rural Alaskans. The millions of new federal dollars that the Medicaid expansion has brought into Alaska have helped tribal facilities improve care and offer more services. Ending the expansion, as the Senate bill would almost certainly force Alaska to do, would thus disproportionately harm Alaska Natives.

Please protect Alaska children’s health care coverage and oppose any funding cuts or caps to Medicaid in any health care bill you consider.

Please feel welcome to contact me if I can provide you with more information, or help in any way as we work to craft a more effective health care system for America.

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