What’s at Stake for Alaska in the Fight to Defend Health Care
The ACA extended coverage to millions of previously uninsured and improved affordability and quality of coverage for those who were already covered. Since passage of the ACA, the number of uninsured in Alaska has fallen 21 percent. Today, only 13 percent of Alaskans are uninsured. Hundreds of thousands more now also have critical protections against discrimination by insurers.
The ACA repeal bill passed by the House of Representatives, the American Health Care Act (AHCA), would threaten affordable coverage and care for thousands of Alaskans, strip residents of key consumer protections, and shift billions of dollars in costs to Alaska.
As the Senate debates the future of our country’s health care system, it is critical that they be reminded of the devastating human consequences of proceeding with the harmful policies included within the AHCA.
Here’s what Alaska stands to lose under the AHCA:
Thousands who are covered by DenaliCare could lose coverage and access to care
34,000 Alaskans would be at risk of losing health coverage through the Medicaid expansion. The Medicaid expansion has extended health coverage to lower-income Alaskans who hold down jobs that are the backbone of the state’s economy—from fast food workers to home care attendants to construction workers to cashiers. The AHCA would gut federal funding for the expansion and put the guarantee of this coverage in jeopardy for millions. According to the Congressional Budget Office (CBO), by 2024, only five percent of people with expanded Medicaid would still be enrolled—in Alaska, that means loss of coverage for 32,300 people.
Alaska would lose millions of dollars in federal funding for its Medicaid expansion. In 2023 alone, the AHCA would shift almost $67 million in costs to Alaska to cover people through the Medicaid expansion. This would increase state costs for the expansion by 346 percent.
Caps and cuts to federal Medicaid funding would translate to cuts in health care for the tens of thousands of Alaskans DenaliCare covers. Today, the federal government matches Alaska’s Medicaid spending. The AHCA would change that and cap funding for Alaskans in Medicaid. The caps are intentionally set to cut federal Medicaid funding more and more each year, and make no provision for increased need for nursing homes and other long-term care as the population ages. The caps are designed to pass costs on to Alaska: when Alaska’s costs exceed the cap the state’s taxpayers would be on the hook. CBO estimates that the combination of capping Medicaid and gutting the expansion would cut federal Medicaid spending by $834 billion over 10 years. Some of those cuts will hit Alaska and translate into health care cuts for the Alaskans who depend on DenaliCare, including:
Alaskans with private insurance could lose coverage all together or face drastically higher out-of-pocket costs
47,300 Alaskans with private coverage would end up uninsured. This includes 6,800 people with employer-sponsored coverage and 40,500 people who purchase coverage on their own.
Alaskans who get coverage through the health insurance marketplace would see their premiums and out-of-pocket-costs increase by thousands of dollars. The AHCA would drastically cut financial assistance to help lower income people afford premiums for private coverage and would completely eliminate financial assistance to reduce out-of-pocket costs, like deductibles. As a result:
- Marketplace enrollees’ premiums would increase $11,106, on average, after taking into account the reduced financial assistance provided under the AHCA.
The 13,128 marketplace enrollees who get financial assistance with premiums would see this financial assistance cut by $10,517, on average.
5,895 lower-income marketplace enrollees would lose all financial assistance to help lower deductibles, copays and other out-of-pocket costs.
- Marketplace enrollees’ out-of-pocket costs, like deductibles, copays, and coinsurance would increase $1,493, on average.
Older Alaskans would see their premiums increase the most. Marketplace enrollees between the ages of 55 and 64 would see the biggest increase in premiums and cuts to financial assistance under AHCA. For example:
- 60-year-old Alaskans making $30,000 a year would see their premium increase between $30,560, and $32,420, depending on where they live.
326,400 Alaskans with pre-existing conditions could be at risk of once again being discriminated against by insurers. The AHCA would give states permission to let insurers charge higher premiums to people with pre-existing conditions. Here is how much premiums could increase for Alaskans with five major health conditions if insurers once again charge more based on pre-existing conditions:
- Breast cancer: Premium increases $76,090
- Pregnant: Premium increases $45,960
- Major depression: Premium increases $22,550
- Diabetes: Premium increases $14,860
- Asthma: Premium increases $11,520
Alaskans could once again face a world where insurance plans routinely cap the most they will pay for someone’s health care in a year and in their lifetime. This used to effectively cut off coverage for the sickest individuals when they most needed it.
Roughly 237,000 Alaskans (including 64,000 children) had lifetime limits on coverage before the ACA banned these practices.