Latest version of Graham-Cassidy reportedly includes Alaska carve outs to woo Murkowski

U.S. Sen. Lisa Murkowski.

It’s no secret that Alaska’s U.S. Sen. Lisa Murkowski is once again one of the most pivotal votes on health care, and Congressional Republicans’ latest overture to the moderate Republican is turning heads.

Under a rumored new version of the Graham-Cassidy bill, Alaska would essentially be spared from the deepest cuts put forward in the bill, be allowed to keep the Obamacare individual marketplace as is and even get more money for Medicaid.

The Independent Journal Review reported a summary of the new Alaska-centric provisions as described by a congressional aide familiar with the discussions. No updated version of the bill has been yet made public.

“This draft includes 3 separate provisions benefitting Alaska.

  1. Alaska (along with Hawaii) will continue to receive Obamacare’s premium tax credits while they are repealed for all other states. It appears this exemption will not affect Alaska receiving its state allotment under the new block grant in addition to the premium tax credits.
  2. Delays implementation of the Medicaid per capita caps for Alaska and Hawaii for years in which the policy would reduce their funding below what they would have received in 2020 plus CPI-M [Consumer Price Index for Medical Care].
  3. Provides for an increased federal Medicaid matching rate (FMAP) for both Alaska and Hawaii.”

The first provision is perhaps the most significant. The massive overhaul of the Obamacare health care system proposed by Graham-Cassidy seeks to pool federal funding that went to Medicaid expansion and individual insurance premiums—two things that vary wildly from state to state depending on Medicaid expansion and their success in enrolling people into marketplace insurance plans—and divide them up evenly per capita into block grants to states.

Initial projections of such changes would mean a lot of pain for Alaska, with estimates putting the lost federal funding as high as $2 billion through 2027 and 41,000 fewer people with health care coverage.

Gov. Bill Walker came out in opposition to the bill, and the overall math looked impossible to satisfy Murkowski’s long-running concerns about the impact repealing Obamacare would have on Alaska.

The above changes would go a long way to changing the game for Alaska. Leaving the premium tax credits in place amounts to more than $150 million for Alaska, as estimated by the Kaiser Family Foundation, with an average monthly subsidy being about $976 per person. (Full disclosure: Your humble Midnight Sun editor receives a roughly $450 monthly premium to buy an essentially useless insurance plan from the individual marketplace.)

It appears Alaska would also continue to receive its portion of the pooled federal health care funding.

All told it’d amount to a pretty substantial boon to Alaska, but Murkowski’s also said before that Alaska is not really insulated from the problems of the Lower 48 insurance system. Her comments from a July 13 Bloomberg article explores such a possibility.

“Let’s just say that they do something that’s so Alaska-specific just to, quote, ‘get me,’” Murkowski said in June. “Then you have a nationwide system that doesn’t work. That then comes crashing down and Alaska’s not able to kind of keep it together on its own.”

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