GOP Health Bill Steers Cash to the Home State of a Reluctant SenatorBy , , and
Alaska would benefit disproportionately from funding formula
Senator Lisa Murkowski has been a holdout on Republican bill
Call it the Polar Payoff.
Changes made to the Republican legislation to repeal large parts of Obamacare would send hundreds of millions of extra federal dollars to Alaska, whose Republican Senator Lisa Murkowski has been holding off from giving her much-needed vote to the bill. Under formulas in the revised legislation, only Alaska appears to qualify for the extra money.
The money comes from the legislation’s $182 billion in funding meant to help stabilize insurance markets and help states provide coverage. Under the formulas, states -- in this case just Alaska -- with disproportionately higher premiums would get extra funds from that account.
The legislation, called the Better Care Reconciliation Act, would repeal large parts of the Affordable Care Act. Republicans possess only a narrow margin in the Senate, and can only afford to lose two votes from their 52-vote majority. Murkowski had expressed concern about the legislation’s Medicaid spending reductions and lessened aid for people buying individual coverage. She also opposes a ban of at least a year on Planned Parenthood funding that was kept in the updated version of the legislation.
Questioned by reporters Thursday, Murkowski said she needed to read the bill before she decides how she’ll vote. Her office didn’t immediately respond to requests for comment, though last month she said she wasn’t interested in a special program for her state.
“Let’s just say that they do something that’s so Alaska-specific just to, quote, ‘get me,’” Murkowski said in June. “Then you have a nationwide system that doesn’t work. That then comes crashing down and Alaska’s not able to kind of keep it together on its own.”
Such legislative maneuvers aren’t uncommon. Senator Ben Nelson of Nebraska became the crucial Democratic vote for the Affordable Care Act after the inclusion of a provision that gave the state extra federal money for Medicaid, which is jointly funded by the federal government and states. Critics called it the Cornhusker Kickback, a reference to the Nelson’s home state.
Two related parts of the bill appear to specifically benefit Alaska.
In one, the state would get a larger share of money for health insurers meant to stabilize markets where people buy coverage. Under the formula, any state with insurance premiums 75 percent higher than the national average would qualify to get 1 percent of the $132 billion from a long-term insurance stability fund. Alaska appears to be the only state that qualifies, according to data from the U.S. Centers for Medicare and Medicaid Services.
Alaska only has about 0.2 percent of enrollees under the Affordable Care Act -- meaning it would benefit disproportionately. Under the formula, the state would get at least $80 million in 2019 from the fund, rising to $140 million per year in 2020 and 2021 and $192 million per year from 2022 to 2026.
Health plans in the state would also receive $150 million in 2018 and 2019 each, and then $100 million in 2020 and 2021 from the bill’s $50 billion in short-term assistance funds.
It’s possible that Alaska could later lose the benefit if its insurance rates changed relative to other states.
Another change in the revised legislation would benefit states that didn’t expand Medicaid under Obamacare, many of which are Republican-led. The bill changes the calculation for determining Medicaid payments to hospitals to assist with uncompensated care. It allots funds based on a state’s uninsured population rather than Medicaid enrollment as the original legislation did.
While Alaska expanded Medicaid in 2015, some other states did not. Florida and Texas are among those with high numbers of uninsured. Senator Marco Rubio, a Florida Republican, tweeted Wednesday that one of his priorities for changing the bill involved increasing those funds for hospitals in his state.
“On the actual confines of the bill, I think it’s made significant progress for my state, Florida, on the Medicaid side,” Rubio said Thursday. He plans to vote to move ahead with debate on the bill.
— With assistance by Zachary Tracer