What the GOP health care plan means for Alaska and senators Murkowski and Sullivan

The Senate Republican’s health care repeal bill hit the public today after weeks of being drafted in secrecy. Separating the actual bill from the rumors will take some time and everyone, including Senate Republicans, are working to understand its impacts. Early analysis shows the bill is pretty similar to the widely unpopular measure that passed the House, with some significant differences.

Chief among them, the Senate bill protects coverage for pre-existing conditions. The House bill, in a move to win over right-wing conservatives, allowed states to opt out of the protection. The Senate hopes to win back moderates who, like Alaska Sen. Lisa Murkowski, panned the House version of the bill. The bill would still allow states to decide what constitutes essential services, meaning coverage for maternity care and mental health treatment could vanish.

There’s early suggestions, though, that this has already lost four conservative senators. Their opposition, it should be noted, is to the bill as currently drafted. The bill has been presented as a “discussion draft” meaning there will be changes before it comes to a vote as early as next week.

Republicans can only stand to lose two votes on this measure, and that’s not considering moderate members who’ve registered their concerns.

Pressure is big on the senators from Alaska, which has made headlines both for its insurance increases under Obamacare and for the forecasted hikes under a GOP repeal.

Highlights of the Senate health care plan

• The bill defunds Planned Parenthood for one year. Murkowski said defunding Planned Parenthood had no place in the repeal of the Affordable Care Act during her address to the Alaska Legislature. According to The Hill Maine Sen. Susan Collins, the two plan to introduce an amendment striking the Planned Parenthood language from the bill. As the story notes, the two tried the move in 2015 with no success, but Murkowski eventually voted for the bill anyways.

• Tax credits and subsidies for those buying insurance coverage on the individual market would be eliminated for people making between 350 and 400 percent of the poverty line. KTOO’s Andrew Kitchenman crunched the numbers on this, showing people single people making between $52,710 and $60,240 would be out in the cold. The annual subsidies this group would miss out on ranges from $3,381 per year to nearly $20,000 per year depending on age and income, according to the Kaiser Family Foundation’s marketplace calculator.

For Alaskans, this would be single people between $52,710 and $60,240, and a family of four between $107,625 and $123,000. https://t.co/4BRliCdwgo

— Andrew S. Kitchenman (@kitchenman) June 22, 2017

• The impacts on the changes to insurance subsidies are dramatic for older Alaskans, as illustrated by this tweet. Their out-of-pocket costs are already high with the subsidies and they’d be priced out if the Senate adjustment is accepted.

Make sure Senator Murkowski knows about this. She could be the deciding vote. pic.twitter.com/gzO9huMn44

— Topher Spiro (@TopherSpiro) June 22, 2017

• Most of the taxes are gone, except for the Cadillac Tax. The bill strikes many of the tax increases that were set to soon go into effect, except for the tax on high-cost health insurance plans. The tax levies a 40 percent tax on insurance premiums that exceed $10,800 annually for an individual or $29,500 for a family, which means it could hit a lot of Alaska’s plans. The tax would be delayed from 2020 to 2026 under the bill, giving Alaska’s delegation time to work out a deal.

• The official cost and coverage estimates of the bill are due out early next week by the Congressional Budget Office. The CBO score of the House bill found 23 million more people would be without insurance by 2026. The deficit under that plan would be reduced by $119 billion in the same time frame.

• The individual mandate to buy insurance is gone, as is the requirement businesses with 50 or more employees provide them with health insurance.

• Children can still stay on their parent’s health insurance plans until they’re 26. This popular piece of Obamacare is in both the House and Senate plans.

Impacts on Medicaid

• The repeal of Medicaid expansion would still happen, but a little slower. The Medicaid expansion has provided coverage to nearly 34,000 Alaskans since it was accepted in 2015 at a heightened federal reimbursement rate of 90 percent. Under the Senate proposal, the additional funding would be cut back and eliminated altogether by 2024. States would have to decide to continue funding for the expanded population with the regular 50 percent federal reimbursement.

• The rest of the Medicaid program would be transformed dramatically. The Senate bill would tie the growth of Medicaid rates to a different metric, causing it to grow much slower over the coming years. The states would also have to decide whether to receive the funds in a block grant or on a per capita basis, which raises concerns when combined with Alaska’s high health care costs.

• The Senate bill includes money for an insurer stabilization fund, about $15 billion per year to stabilize the markets. States could apply for funds to help ease the transition in the insurance markets. Presumably, Alaska would get a decent chunk of this money because its rates look to change the most.

Murkowski was in the dark, still opposes defunding Planned Parenthood

Just as Republican U.S. Senators were heading into a briefing with leadership to get a briefing on the health care bill released this morning, Alaska’s U.S. Sen. Lisa Murkowski had some choice words for D.C. reporters.

Murkowski, who’s slammed the secrecy of the process, said she had still yet to see anything inside the bill, but noted that people outside of elected office seemed to know plenty.

“I am not a reporter, and I am not a lobbyist,” she told Haley Byrd of The Independent Journal Review. “So I’ve seen nothing.”

Since these exchanges, details have emerged on the bill and it appears to be at conflict with positions staked out by Murkowski.

What is clear is the Senate bill intends to defund Planned Parenthood for one year. Murkowski said this is a no-go for her. She told the Alaska Legislature earlier this year that defunding Planned Parenthood had no place in the ACA repeal. Reporters, who have been chasing Murkowski around this morning, asked her about it.

Just asked Murkowski about defunding @PPFA.

“I support Planned Parenthood.”

The bill defunds it for a year.

“I do not support defunding.”

— Sahil Kapur (@sahilkapur) June 22, 2017

Later in the day, Murkowski released a pretty bland statement on the bill. She’s gotta crunch the numbers before making a decision.

Now we have the full text of the Senate’s bill, I will do my due diligence and thoroughly review it. I will be working closely with the state over the next several days to analyze the text and crunch the numbers. It’s no secret that healthcare needs to be reformed, but it needs to be done right. So know that I remain committed to ensuring that all Alaskans have access to affordable, quality healthcare and will vet this bill through that lens.

Sullivan: “I will not vote for a bill that will make things worse for Alaskans.”

U.S. Sen. Dan Sullivan is often left out of the health care debate, assumed to be a shoo-in GOP vote, released a video statement laying out his positions on Wednesday. In it he said he won’t vote for a bill that “makes things worse for Alaskans.” Sullivan, however, is operating on the belief that Obamacare is a disaster for Alaska so the metrics to judge the new bill are a little fuzzy. Though the criticism is true: Insurance premiums have gone up by more than 200 percent and reduced the individual marketplace to one provider since it was passed.

Still, it’s a strong statement that can likely bring him and Murkowski to the bargaining table as the Senate can’t afford to lose both their votes. Whether or not it can be leveraged into some change or exemption for the 49th state is yet to be seen. The legislation contains pots of money that could be used to offset some of the biggest impacts to Alaska surrounding hikes in the individual insurance marketplace.

Two senators from Alaska – where Obamacare premiums are sky high – are in the Sen Majority Leader's office right now.

— Jennifer Haberkorn (@jenhab) June 21, 2017

His main goals, as outlined in another statement, include “stabilizing the Alaska insurance market, reversing the trend of dramatically increasing costs, and providing a sustainable and equitable path forward for Medicaid.”

Walker weighs in

Alaska Gov. Bill Walker, an independent, released a statement concerned about the Senate health care bill in short order this morning. His chief concern is how the bill doesn’t take into account Alaska’s high health care costs.

He’s likely particularly concerned about the Senate proposal to transform Medicaid into not-great-for-Alaska systems in 2020. According to the analysis by PBS, “Starting in 2020, under the Senate bill, states must choose between accepting one large, capped, block grant or accepting a predetermined amount of funding per recipient.”

Walker told Congress that neither system would work for Alaska, with its highest-in-the-country health care costs.

“My team and I are analyzing the newly-released discussion draft of the Senate Republican health care bill,” he said in a statement. “Given the population size, vastness, and remote location of Alaska, I am deeply concerned about the potential effects of a one-size-fits-all approach. However, I am confident that Senators Lisa Murkowski and Dan Sullivan will do all they can to fight to protect Alaskans and our unique health care needs. My team and I will continue to work closely with members of our Congressional delegation to ensure Alaska’s voice is well-represented in upcoming negotiations.”

Follow @mattbuxton