As a presidential candidate, Donald Trump repeatedly promised to “repeal Obamacare and replace it with something great.” Early this morning the U.S. Senate took an initial step toward repeal. As for the replacement, Alaska’s two senators describe something still in the formative stages.
The phones were ringing this week at Sen. Lisa Murkowski’s Washington office, with calls about Trump’s cabinet nominees and also the Affordable Care Act.
Murkowski said she’s well aware of the coverage the Affordable Care Act brought; more than 20,000 Alaskans now get their insurance through expanded Medicaid and 18,000 buy policies on the individual market, most of them subsidized.
“It’s a small number, but it’s a number that we need, to make sure that we’re listening to, that we’re responding to,” Murkowski said.
The specifics of that response aren’t yet clear. She didn’t directly say, for instance, whether she’s committed to keeping the expansion of Medicaid.
“It is absolutely a key part of this discussion,” Murkowski said.
She, like the rest of the Alaska delegation, wants to keep parts of the ACA, like the coverage for pre-existing conditions. She wants to dump the mandate that everybody get insurance. But Murkowski acknowledges that risks an imbalance, where only high-cost patients would buy coverage.
“We’re going to have to figure out where those pay-fors are, and how you can ensure that you get enough healthy younger people to participate,” she said.
How do you do that?
“Well, you make your healthcare more affordable in the first place,” Murkowski said.
One idea Murkowski has is to require price transparency, so patients can comparison-shop for knee surgery like they can for shoes or tires. She says each state will need different solutions.
“You ask the natural and easy question: ‘Well, what is the plan?'” Murkowski told reporters. “But I think if we get hung up on one plan -”
Murkowski moved from there to naming some of the topics under discussion, like expanding health savings accounts.
“What’s the plan?!?!” is actually the name of a campaign launched by University of Alaska Anchorage students. Political Science major Mark Simon said he’s alarmed that Congress is already taking steps toward repeal.
“We would like to know what the plan is to replace the Affordable Care Act, and ensure that there isn’t going to be a massive gap in coverage,” Simon said.
Sen. Dan Sullivan said he doesn’t think Congress will immediately change or drop the subsidies that help most people who buy insurance on the exchanges.
“We’re not looking to pull the rug out from people who have relied on this law, even though the law is not working,” Sullivan said.
As to whether the ultimate plan is to eliminate the subsidies…
“I don’t have an answer to that right now,” Sullivan said.
Sullivan said Congress has to make major changes, and soon. Sullivan points out that only one insurance company is now serving Alaska on the exchange and the cost of plans has shot up.
“To do nothing right now, to do nothing, is irresponsible,” Sullivan said.
The House is expected to vote Friday on the budget measure that starts the repeal. It instructs Senate and House committees to come up with repeal bills by Jan. 27. Earlier this week, Murkowski backed an amendment to extend the deadline until March. The sponsors dropped that amendment, but Murkowski said she’s been assured the timeline isn’t set in stone.
Liz Ruskin is the Washington, D.C., correspondent at Alaska Public Media. Reach her at lruskin@alaskapublic.org. Read more about Liz here.
