Governor right to act on Medicaid

This editorial originally appeared in the Friday edition of the Fairbanks Daily News-Miner.

On Thursday morning, Gov. Bill Walker announced Alaska will become the 30th state to accept Medicaid expansion under the Affordable Care Act. The governor’s unilateral move, taken after the Legislature declined to act during its regular session and two special sessions called afterward, won’t likely win him friends in the Alaska House and Senate majority caucuses. But providing a health care option for 20,000 of the state’s most at-risk residents is worth taking some political heat over.

After the Affordable Care Act’s adoption in 2010, states had the option to accept an expansion of Medicaid that would extend eligibility for the federal program to those earning as much as 150 percent of the federal poverty level wage. But if states chose not to expand Medicaid, it created a hole in the health care coverage the reform was supposed to provide.

Those earning less than poverty-level wages were already eligible for Medicaid, and those making wages of more than 150 percent of the poverty threshold had to pay for private coverage, but were eligible for subsidies to defray the cost of those plans. Those between 100 percent and 150 percent of poverty wages were caught in the void — without Medicaid and also without subsidies that would render private insurance affordable. In Alaska, there were more than 20,000 state residents in that position.

Gov. Walker campaigned on a promise to expand Medicaid, and brought it to legislators in January as one of his top priorities. But plans for expansion were stymied by the legislative majority caucuses, whose members slow-walked the issue to prevent its passage. …

But opposition from majority caucus legislators seemed to stem largely from partisan political divides, whether due to a fundamental philosophical opposition to legislation drafted by President Barack Obama, or differences with Gov. Walker. Rhetoric on the issue in legislative hearings was often distressingly similar to talking points distributed by national political figures.

Perhaps more disappointing was the utter lack of urgency given to the issue by state lawmakers who dragged their feet at every step of the process, speaking strongly against Medicaid expansion but offering no alternative that would provide any kind of assistance to the more than 20,000 Alaskans living without any way to pay for health care. Some Mat-Su legislators were front and center in that effort. Legislators who were only too happy to accept federal funds for other projects, suddenly became reluctant when those dollars were for health care instead.

If there’s a knock on the governor’s acceptance of Medicaid expansion, it’s that his unilateral move may widen the rift with leaders of the Legislature’s majority caucuses, who opposed the action. That could make dealings more difficult during next year’s legislative session, when the governor and legislators will have to make hard decisions about balancing the budget.

But Gov. Walker was more or less backed into a corner — Medicaid was one of his biggest priorities, and legislators had given him little hope they would act on the issue in any kind of reasonable time frame.

Most importantly, acting to secure health care for 20,000 Alaskans was the right thing to do, and good leaders shouldn’t hesitate to do the right thing because of the political consequences.