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Alaska health insurance

AK gains Medicaid expansion in 2015, big rate hikes for 2016

Many factors affect the overall health status of a state’s residents. Read this profile for a summary of public health rankings and healthcare reform initiatives in Alaska — The Last Frontier.

Alaska health ratings

Alaska ranks in the middle of the pack in several nationwide rankings of public health status. The state known as The Last Frontier placed 31st among the states and the District of Columbia in the Commonwealth Fund’s 2014 Scorecard on State Health System Performance and fell into the bottom five for health indicators related to prevention and treatment. Alaska was ranked 27th in the 2009 study. Review Alaska’s scorecard to see what factors are taken into consideration in determining these rankings.

America’s Health Rankings (2014 edition, which is the most recent) puts Alaska slightly higher at 26th, down one spot from 2013. Alaska gets good marks for low air pollution levels, low incidence of low birthweight, and public health funding Alaska’s public health challenges include a high violent crime rate, low immunization rates, and high levels of chlamydia infection – a sexually transmitted disease.

Another source for public health indictors and comparisons among the states is Trust for America’s Health. Check out its compilation of Key Health Data About Alaska.

If you want to take zero in on a particular area within Alaska, check out county-level rankings for Alaska. This data was compiled by the Robert Wood Johnson Foundation and the Population Health Institute at the University of Wisconsin.

Alaska and the Affordable Care Act

Alaska’s three-member U.S. Congressional delegation voted 2-1 against the Affordable Care Act, which was signed into law in 2010. Sen. Mark Begich, a Democrat, was alone in supporting the ACA. Sen. Lisa Murkowski and Rep. Dan Young, both Republicans, voted no. Former Gov. Sean Parnell opposed the overall ACA and spoke out strongly against a state-run exchange.

Sen. Dan Sullivan, a Republican who has talked about the need to repeal and replace Obamacare, defeated Begich in the 2014 election.

Alaska is the only state that did not to apply for the $1 million exchange-planning grant that was available from the federal government. State legislators considered a state-run exchange in the 2011 and 2012 sessions, but didn’t pass a bill either year. Parnell announced in July 2012 that the state would default to the federally facilitated exchange. Initially, Alaska did not adopt Medicaid expansion.

Obamacare’s impact on Alaska

While the ACA is credited with a sharp decline in the uninsured rate across the nation, the impact in Alaska has been more modest. Alaska’s uninsured rate dropped 2.8 percent during 2014 open enrollment, from 18.9 percent to 16.1 percent.

For comparison, the national uninsured rate dropped to 12.9 percent as of the fourth quarter of 2014 – the lowest quarterly average recorded by Gallup since 2008.

By mid-2015, Alaska’s uninsured rate dropped more dramatically to 10.3 percent – an improvement of 5.8 points for an overall change of 8.6 points from 2013 to 2015. In other states that only expanded Medicaid, only created a state/partnership exchange or did neither, the uninsured rate was 13.4 percent and decreased by 5.3 percentage points. Nationwide, the uninsured rate among all states fell to 11.7 percent.

Alaskans enrollment in qualified health plans

The Kaiser Family Foundation estimated in the fall of 2013 that about 78,000 Alaska residents would be eligible to enroll through the marketplace and that about 70 percent would qualify for premiums subsidies. However, just 12,890 people signed up for qualified health plans (QHPs) through Alaska’s health insurance exchange during the 2014 open enrollment period. Among those who did enroll in a QHP, 88 percent qualified for financial assistance, compared to 85 percent nationally according to the U.S. Department of Health and Human Services (HHS).

During 2015 open enrollment 21,260 Alaskans selected QHPs, and 52 percent of them were new to the exchange. Because some enrollees never paid their initial premiums and others cancelled coverage early in the year, effectuated enrollment was 19,380 by June 30, 2015. Of those enrollees, 88.8 percent were receiving advanced premium tax credits and 53.3 percent were receiving cost-sharing reductions.

Two carriers are offering 2016 health plans through Alaska’s exchange:

  • Premera Blue Cross Blue Shield
  • Moda Health

Average rate increases of nearly 40 percent were approved for both. Alaska’s average benchmark plan rate was the highest in the country in 2015—a year when the state’s health insurance rates increased an average of 31 percent. This year, the state’s average benchmark plan rate remains dramatically higher then the rest of the country.

New governor expands Medicaid

Alaska decided against Medicaid expansion for 2014, and a Kaiser Family Foundation study estimated 30,000 Alaska residents are excluded from coverage as a result. The same study estimated that 17,000 Alaska residents are in the Medicaid coverage gap – meaning they don’t qualify for Medicaid (e.g., they are a childless adult or exceed income threshold), yet they don’t make enough to qualify for federal subsidies that would help them purchase individual coverage through the marketplace.

Those left out of Medicaid coverage in 2014 faced brighter prospects in 2015. Gov. Bill Walker took office on Dec. 1, 2014, and made Medicaid expansion a priority in his first months. Walker’s administration is explored whether the governor could proceed through an executive order or if legislative action is needed to authorize expansion. Walker’s administration had set a July 2015 target for having Medicaid expansion in place. However, they faced budget challenges and problems with the state’s existing Medicaid systems technology. Lawmakers rejected Medicaid expansion in the state budget, and the 2015 legislative session ended without a vote on the Medicaid expansion bill.

On July 16, 2015, Walker used his executive authority to expand Medicaid on his own, noting that he had run out of options. Alaska Medicaid expansion took effect September 1. Within a month of the expanded guidelines taking effect, 2,000 people enrolled Alaska Medicaid.

There is currently a lawsuit underway that aims to retroactively block Alaska’s Medicaid expansion.

Visit the Alaska Department of Health and Social Services to learn about Medicaid and CHIP in Alaska.

Does Alaska have a high-risk pool?

Before the ACA reformed the individual health insurance market, coverage was underwritten in nearly every state, including Alaska. This meant that medical history was an important component in eligibility for a private individual plan, and people with pre-existing conditions often found themselves unable to purchase coverage, or only able to get a policy that excluded pre-existing conditions.

The Alaska Comprehensive Health Insurance Association (ACHIA) was created in 1993 to give people an alternative if they were unable to obtain individual health insurance because of pre-existing conditions.

As a provision of the ACA, all new health insurance policies became guaranteed issue starting on January 1, 2014. This reform largely eliminated the need for high-risk pools, but the ACHIA board has said that the pool will remain operational at least until the end of 2014.

As of August 2015, there were still 211 individuals enrolled in ACHIA coverage.

State-based health reform legislation

Here’s a summary of what’s happening at the state level in Alaska with regard to healthcare reform: Beyond the Alaska’s Medicaid expansion and associated lawsuit, there are no additional state-level updates at this time.

Alaska Medicare enrollment

Alaska Medicare enrollment reached 82,957 in 2015, which is about 11 percent of the state’s population. Nationwide, 17 percent of the population is enrolled in Medicare. Historically, 81 percent of Alaska Medicare recipients qualify for coverage based on age alone, whereas the other 19 percent are on Medicare as the result of a disability.

Medicare pays about $4,811 per enrollee in Alaska each year, and the state ranks 51st in overall spending with $553 million annually.

Alaskans that want additional benefits beyond what original Medicare offers can select a Medicare Advantage plan instead. Less than 1 percent of Alaska Medicare recipients make this choice, compared with 32 percent of all Medicare recipients.

However, 39 percent of Alaska Medicare enrollees also select Medicare Part D plans, which provide stand-alone prescription drug coverage. Of all U.S. Medicare recipients, 43 percent have stand-alone Rx plans.