What happens to grandma when the state doesn’t pay its bills on time?

The state Department of Health and Social Services missed a rental payment the first of the month this month. Alaska doesn’t really have a state health infrastructure, regardless of what any other commentary piece published in recent weeks may have told you; rather, they lease it from several hundred barely-functional 501(c)(3) not-for-profit organizations throughout the state via state grant payments out of general funds. Let me draw the comparison of that of the interstate system, where one could drive or go by bus from NYC to Miami via I-95; that, my friends, is a health system. Whereas in Alaska, we are broken out into separate little pieces of island, like that of the Aleutians, where each element of our health system exists practically as islands on to themselves.

Well, on July 1, Alaska failed to pay their rent on time. Those grant payments were not made to any of the publicly funded mental health treatment agencies, substance use treatment agencies, local and municipal public health nursing clinics, and more than likely there was also disruption in grant payments to primary care clinics, hospitals, and probably a laundry list of pass-through monies to secondary and tertiary elements of a health care framework, such as public safety elements and maybe even volunteer fire department medic response teams.

This was in part because it took the Legislature two special sessions to pass a budget, but it was also due apparently to the state rolling out a new IRIS accounting system. And why should you care? Because the Alaskan health care “system” is made up of so many fragile agencies and providers that there is no telling how many of them are so dependent upon these state grant monies that they could be unable to make payroll for their staff or pay their own rent by July 1 or 15, let alone even to mention the possibility that grant payments may still not be paid by Aug. 1.

And if it does become the situation that all of these islands unto themselves can no longer make payroll, then this will inevitably cause a disruption in health service delivery throughout this state when workers decide that they will not work for free. It gets interesting when your grandma’s personal care attendant, or your kid’s nurse isn’t there to take care of the people you love. Not even to mention if it is your sister or cousin who is now in search for more work because their employer wasn’t able to make payroll.

Because the Alaska Department of Health and Social Services didn’t pay their bills on time.

And some of my prose herein may read as quips and jokes, and they are, because joking about it is often the only way that I can open my mouth without screaming. Because we all saw this tragedy coming; Rasmussen, Foraker, the Alaska Mental Health Trust Authority, and DHSS have all, for years, helped perpetuate islands on to themselves by funding an immense number of small, unsustainable 501(c)(3) not for profit organizations to recreate the wheel time and time again instead of getting these people to somehow learn how to live, work, and play nicely together in the sandbox.

Because our health system in Alaska comprises more of a group of agencies who behave like a bunch of four year olds who have taken their ball and gone home than an actual team of adult professionals who understand that, in health care, the needs of the many outweigh the needs of the few, and that service above self means that you make sure that your staff get paid at the first of the month.

And so I know much of the news these past several days was regarding how Walker will be acting unilaterally to expand Medicaid. But what of those workers and patients who are suffering today? These are your friends and neighbors who have their own rent and mortgages to pay. And what of those agencies for which they work for who are so exceptionally failed and broken that they may not be able to make it through the month of August, let alone to Sept. 1 when Walker states that Alaska will receive those Medicaid Expansion monies?

I hope you can explain this to grandma when she asks why that nice young girl who helps her take a shower has stopped showing up to work.

John C. Laux lives in Anchorage.