Fixing Alaska’s health care and health insurance problems can’t be solved with a one-size-fits-all approach, the state’s director of the Division of Insurance Lori Wing-Heier told Senators on Wednesday, and taking away existing resources won’t help.
Wing-Heier testified along with four other state insurance directors in front of the Senate Committee on Health, Education, Labor and Pensions on Wednesday. The committee, which includes Alaska’s U.S. Sen. Lisa Murkowski, is holding two weeks of hearings on short-term fixes for the troubled individual insurance marketplaces across the country.
The insurance directors and senators broadly agreed on the need to add more flexibility in allowing states to regulate insurance markets and the need to ensure cost-sharing reduction payments are made. Those payments help cover out-of-pocket cots for low-income people purchasing health care on the individual marketplace. They are also one of the few levers Trump has with Obamacare, and he’s threatened to cut them off.
Trump has already cut funding for marketplace outreach from $100 million to $10 million and cut funding for navigators, non-governmental groups that help people understand and sign up for insurance. Wing-Heier said both programs are important to Alaska, with the navigator program being particularly important for the underserved parts of Alaska and asked they be protected.
“Please consider continuing and funding the navigator and assister programs,” she said. “In rural areas of Alaska, insurance brokers and consultants are hard to find. These programs reduce the number of uninsured citizens and maximize market participation. Media and public announcements are vital to public enrollment being successful.”
Part of the hearing’s focus was on the potential to create marketplaces that allow people to purchase insurance across state lines. It’s a move that Alaska has given some thought to, but a change that both Murkowski and Wing-Heier said is made particularly difficult by the existing problems facing Alaska’s marketplace. Alaska’s small, expensive and difficult-to-serve population doesn’t fit well with other marketplaces.
“As people have asked me, I’ve said, ‘We’re not attractive to anybody. We are high-cost, we are high-risk, why would anybody want to adopt Alaska into their pool?,'” Murkowski said and asked Wing-Heier to explain the problem.
Wing-Heier explained that Alaska has explored the possibility of creating a co-op or some other system that allows insurers sell health insurance plans across state lines with other rural western states, but said it’s difficult because Alaska is not an “attractive risk.”
“You’re exactly right,” Wing-Heier told Murkowski. “No one’s wanted us because of our cost of health care and what that translates then into insurance. We would be bringing the rest of the market down and that’s not a position we want to be in, it’s just a fact of being in Alaska. … There’s no magic answer for us, but certainly selling across state lines is something we can explore.”
Murkowski used the moment to make a point that Alaska’s small individual marketplace will likely never be totally sustainable. She said instead of trying to create a tiny, functioning marketplace, Congress should look at allowing people in difficult to serve areas to buy into existing federal health coverage programs.
“We cannot construct a market off of 18,000 people, so in Alaska we’ve been looking into where could they fit. I was pleased to read in the letter from the governors in suggesting maybe it might be a workable idea to have residents in underserved counties too buy into the federal employees benefit program,” Murkowski said to a smattering of applause. “I don’t know if that’s the place, I don’t know if it’s the state employees program or other programs we have out there. … Trying to construct something for 18,000 people to me just doesn’t seem like a measure that works.”