ACA repeal could complicate Medicaid reforms

Valerie Davidson, commissioner of Alaska’s Department of Health and Social Services in 2015. She’s concerned about the effect of an Affordable Care Act repeal. (Photo: Skip Gray/360 North)

State health leaders say a federal repeal of the Affordable Care Act could make it difficult to implement reforms to Medicaid. That could cost the state the tens of millions of dollars that lawmakers are counting on.

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Many of the reforms the Legislature included in the Medicaid law it passed last year depend on parts of the Affordable Care Act.

State Health Commissioner Valerie “Nurr’araaluk” Davidson said medical providers have told her they hope to receive federal funding that was included in the law.

“If Medicaid expansion went away, if that authority went away, that would really impact their ability to participate in some of those reform opportunities, because it provides them with a little bit of cushion for them to be able to do things creatively,” Davidson said.

A state plan to increase the amount of services that people with disabilities receive in their homes and communities depends on a part of the federal law. And a Division of Insurance reinsurance program that’s gained national attention also depends on the ACA.

Some members of Congress have discussed replacing the current system that guarantees federal payments for Medicaid to one where states receive a set amount of money each year, known as “block grants.”

Davidson said these proposals favor states with lower medical costs and low transportation costs.

“We really see the block grants as really a mechanism to be able to shift that federal responsibility to states,” Davidson said. “The proposals that we have seen so far to do Medicaid block grants do things that do not favor Alaska.”

More than 27,000 Alaskans receive Medicaid due to an expansion that Gov. Bill Walker supported. Another 18,000 residents receive health insurance through the ACA’s individual and family marketplace.

Senate Health and Social Services Committee Chairman David Wilson, a Republican state senator from Wasilla, asked Davidson if she’s preparing for a repeal of the Medicaid expansion.

“Has the administration or the department come up with contingency plans for those type of scenarios, those worst-case scenarios?” Wilson asked.

Davidson said the department is trying to plan, but the proposals could affect the state in hundreds of ways. She’s asked members of the state’s congressional delegation to ask for long-term estimates of state expenses for proposals to repeal the federal health law.

Gov. Walker said on Talk of Alaska on Tuesday that if the federal government stops funding the Medicaid expansion, it still would have benefited Alaskans.

“If we can’t afford to fund the federal portion – which I think would be very, very difficult given our fiscal situation – we’ll just have to be pleased with those whose lives were improved, those lives that were saved as a result of taking that step to expand Medicaid,” Walker said.

Republican U.S. Sen. Lisa Murkowski has said Congress should replace the Affordable Care Act at the same time it repeals the law.

Andrew Kitchenman is the state government and politics reporter for Alaska Public Media and KTOO in Juneau. Reach him at

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