Health insurance in Alaska
- Alaska opted to use the federal health insurance marketplace for exchange enrollment.
- Open enrollment for 2019 coverage in Alaska ended on December 15, but enrollment is still possible for Alaskans who have qualifying events.
- Short-term health plans in Alaska can now have initial plan terms up to 364 days.
- A single insurer – Premera – offers on-exchange coverage.
- About 18,000 residents enrolled in 2018 coverage through the exchange.
- Alaska adopted the ACA’s Medicaid expansion in 2015.
- Alaska defaults to federal short-term health insurance rules.
- About 97,000 Alaskans were enrolled in Medicare at the end of 2018.
Alaska’s health insurance marketplace
Alaska was among the 26 states that opted to use the federal health insurance marketplace. The state refused federal funding to evaluate and implement a marketplace, and was one of the first states to announce it would leave responsibility for its marketplace in the hands of the federal government.
Enrollment in 2019 plans through HealthCare.gov ended on December 15, but enrollment is still possible for Alaskans who have qualifying events.
During open enrollment for 2018 coverage, 18,313 people signed up for coverage in Alaska’s exchange. That was about 4 percent lower than the 19,145 people who enrolled in coverage through the Alaska exchange during the prior year’s open enrollment period.
Read more about the Alaska health insurance exchange.
Gov. Bill Walker expanded Medicaid
Alaska decided against Medicaid expansion for 2014, and a Kaiser Family Foundation study estimated 30,000 Alaska residents were excluded from coverage as a result. But Gov. Bill Walker took office on Dec. 1, 2014, and made Medicaid expansion a priority in his first months.
On July 16, 2015, Walker used his executive authority to expand Medicaid on his own and Alaska Medicaid expansion took effect September 1. Within a month of the expanded guidelines taking effect, 2,000 people enrolled Alaska Medicaid.
Through July 2018, the state has seen an increase of more than 87,000 Alaskans covered by Medicaid/CHIP.
Read more about Medicaid expansion in Alaska.
Short-term health insurance in Alaska
Alaska does not have state-specific regulations pertaining to the duration of short-term health insurance plans, so the state defaults to new federal short-term rules. Insurers are allowed to offer short-term plans with initial terms up to 364 days and the option to renew for a total duration of up to 36 months.
Read more about short-term health insurance in Alaska.
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 started out more modest. Alaska’s uninsured rate dropped 2.8 percent during 2014 open enrollment, from 18.9 percent to 16.1 percent.
However, the state soon made up for its slow start. By late 2015, Alaska ranked 7th among the 10 states with the greatest reduction in uninsured. In 2013, Alaska’s uninsured rate was 18.9 percent; by 2015, it was 10.3 percent – down 8.1 percentage points. In the same timeframe, the nation’s uninsured rate fell to 11.7 percent.
Alaska expanded Medicaid in September 2015, nearly two years after many other states had implemented Medicaid expansion. By December 2016, more than 25,000 people had gained coverage under Alaska’s expanded Medicaid.
The AHCA calls for Medicaid expansion to be frozen as of 2020, so enrollment would decline from that point forward. The bill also calls for Medicaid funding to switch from the current open-ended federal matching program to a per-capita allotment. This could leave states holding the bag (and low-income people ultimately losing their coverage) as Medicaid costs increase.
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, so the state’s entire U.S. Congressional delegation is Republican. All are opposed to the ACA, but Senator Murkowski has expressed reservations about voting for the AHCA, due to the bill’s cuts for Planned Parenthood funding. Murkowski also disapproved of an earlier leaked draft of a GOP bill that would have eliminated Medicaid expansion (the AHCA keeps Medicaid expansion through 2019, but then freezes enrollment as of 2020 and switches Medicaid to a per-capita funding system, rather than the current open-ended federal matching program).
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. Governor Bill Walker, an Independent, took office on December 1, 2014, and announced his intention to expand Medicaid within his first 90 days in office. Though it took a little more time, he succeeded and the state expanded Medicaid on September 1, 2015.
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 pool is still operational as of 2017. But funding that used to be sent to ACHIA is now used to fund the Alaska Reinsurance Program.
Medicare enrollment in AK
Alaska Medicare enrollment reached 97,195 in 2018, about 13 percent of the state’s population. Nationwide, over 18 percent of the population is enrolled in Medicare.
In Alaska, 84 percent of Medicare recipients qualify for coverage based on age alone, whereas the other 16 percent are on Medicare as the result of a disability. These numbers match national averages.
Medicare spending per enrollee in Alaska – $6,846 on average – was the second-lowest in the nation in 2016.
Alaskans seeking additional benefits beyond what original Medicare offers can select a Medicare Advantage plan. But in Alaska, there are no individual Medicare Advantage plans for sale. Just 1 percent of Alaska’s Medicare beneficiaries had Medicare Advantage plans as of 2017.
However, about 40 percent of Alaska Medicare enrollees select Medicare Part D plans, which provide stand-alone prescription drug coverage. Of all U.S. Medicare recipients, 45 percent have stand-alone Rx plans.
Alaska health insurance resources
- AK Health Reform – An initiative providing research, data and analysis regarding the state of health care in Alaska.
- Denali KidCare
Alaska Comprehensive Health Insurance Association – created by the Alaska State Legislature to provide access to health insurance coverage to all residents of the state who are unable to obtain individual health insurance.
State-based health reform legislation
Here’s a summary of what’s happening at the state level in Alaska with regard to healthcare reform: