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Alaska health insurance

ACA impact in AK modest so far; hope for Medicaid expansion in 2015

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

Alaska health ratings

Alaska ranks in the middle of the pack in several nationwide rankings of public health status.

Alaska is 31st among the states and the District of Columbia in the Commonwealth Fund’s Scorecard on State Health System Performance 2014. 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 (2013 edition, which is the most recent) puts Alaska slightly higher at 25th, down one spot from the 2012 edition. Alaska gets good marks for low air pollution levels, low incidence of low birth weights, an improving high school graduation rate, and a drop in binge drinking. 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-D 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.

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.

ACA impact in 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 2.7 percent during 2014 open enrollment, from 18.9 percent to 16.2 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.

Alaskans enrollment in QHPs

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 Alaskan residents signed up for qualified health plans (QHP) 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 2014 open enrollment, Alaska residents could choose from among 34 plan options from two medical insurance carriers: Premera Blue Cross Blue Shield of Alaska and Moda Health, which was formerly known as ODS Health Systems of Oregon.

New governor pushing for Medicaid expansion

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 face brighter prospects in 2015. Gov. Bill Walker took office on Dec. 1, 2014. He’s made Medicaid expansion a priority for his first months in office. Walker’s administration is exploring whether the governor can proceed through an executive order or if legislative action is needed to authorize expansion. Walker’s administration has set a July 2015 target for having Medicaid expansion in place. However, budget challenges and problems with the state’s existing Medicaid systems technology make that date questionable.

While seeking medical insurance coverage during the 2014 open enrollment period, about 4,200 Alaskans people qualified for Medicaid or the Children’s Health Insurance Program (CHIP) under existing eligibility criteria. Enrollment in Medicaid and CHIP continues throughout the year.

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.

Members can shop for new coverage in the exchange when open enrollment begins in November. Especially for members who are eligible for premium subsidies in the exchange, there may now be a private option that provides a better value than the risk pool coverage.

If ACHIA ends up terminating coverage at the end of 2014, members will need to enroll in a new plan through the exchange by December 15 in order to have seamless 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: