As the U.S. Supreme Court heard oral arguments in a court case challenging Affordable Care Act subsidies, Alaska legislators on Wednesday heard a presentation attacking another component of the ACA: Medicaid expansion.
A representative from the Florida-based Foundation for Government Accountability traveled to Alaska this week to give presentations in Wasilla on Tuesday and Juneau on Wednesday opposing Medicaid expansion.
Senior fellow Christie Herrera of the conservative foundation met a mostly friendly crowd in Wasilla and more resistance in Juneau.
Herrera said in Wasilla that she wanted to show the "other side of the story" — "some of the real horror stories that have happened in the states that expanded Medicaid," Herrera said.
Her visit to Alaska comes as Medicaid expansion is being hotly debated in Alaska. Former Gov. Sean Parnell opposed expansion, calling it a "failed experiment."
But Parnell was defeated by Gov. Bill Walker, who ran on an election platform that included Medicaid expansion as one of his top priorities. However, he must first convince Alaska's skeptical Republican-controlled Legislature.
Medicaid expansion was one of the tenets of the Affordable Care Act, designed to be implemented in every state as a way to ensure that low-income Americans would get health care. It was a funded mandate -- Congress agreed to pay for nearly all the additional costs to the states.
But a 2012 U.S. Supreme Court ruling made expansion optional. Twenty-eight states have chosen to expand Medicaid thus far.
Herrera has traveled to Alaska before, holding town hall meetings before Parnell rejected Medicaid. Herrera's Foundation for Government Accountability later took credit for Parnell's decision.
Herrera was formerly a director of the Health and Human Services Task Force with the American Legislative Exchange Council. ALEC model legislation in Alaska in past years would end collective bargaining rights for public employees and turn Alaska into a "right-to-work" state.
The town hall was co-sponsored by another conservative group with national ties, Americans for Prosperity's Alaska chapter. AFP Alaska says it aims to limit government growth and promote free markets.
Americans for Prosperity is backed by Charles and David Koch, the billionaire industrialists who have spent fortunes backing conservative candidates and ideas.
During Herrera's presentation Tuesday, she noted several times that much of the newly eligible population would be childless, non-disabled, low-income adults, since low-income families with children and disabled adults generally qualify for Medicaid already.
"There's no incentive for people to lift themselves out of poverty" under the expansion, Herrera said afterward.
Much of Herrera's presentation focused on three states -- Arkansas, Arizona and Maine.
Arkansas implemented a Medicaid expansion program called "private option." The program has cost far more than anticipated, and now Arkansas lawmakers are considering a repeal.
When asked after the presentation how Arkansas' situation compares to Alaska, Herrera said, "It doesn't, but I know that a lot of folks ... (are) looking at red state Medicaid expansion."
Arizona and Maine had far greater enrollment in Medicaid than anticipated, Herrera said, and thus greater costs, with little drop in uninsured rates.
While Herrera held out Arizona and Maine as examples of Medicaid expansion gone wrong, they had little to do with Obamacare. According to the Kaiser Family Foundation, Arizona and Maine expanded Medicaid to childless, non-disabled adults roughly a decade before the Affordable Care Act passed Congress. Herrera said she chose those states because they offered 10 years of information.
"A lot of these Medicaid expansion states, we just don't have (data)," Herrera said.
However, Arizona and Maine are only two of numerous states that expanded Medicaid to mostly childless adults in prior decades. New York, Pennsylvania, Vermont, Washington, Wisconsin and Indiana all expanded their Medicaid programs before the Affordable Care Act went into effect. New York has been providing Medicaid coverage to extremely low-income childless adults since 1966, according to Kaiser.
When asked the following day about her assertion that there was little information outside of the examples she picked, and the fact that other states besides Arizona and Maine have had reforms for decades, Herrera acknowledged "the data exists, but it takes a while to compile."
On Tuesday, when an audience member asked whether she was aware of any states benefiting under Medicaid expansion, Herrera replied, "I don't know."
Her foundation is working on a research paper that examines all the states, Herrera said.
The FGA gave the same presentation to legislators in Juneau on Wednesday. Sen. Mike Dunleavy, R-Wasilla, sponsored the "informational lunch and learn."
At Herrera's presentation in Juneau, more than 60 legislators and staff members packed a Capitol hearing room, with turkey and cheese sandwiches provided by Americans for Prosperity. Reactions to her talk were mixed, with some conservative Republicans like Sen. Cathy Giessel, R-Anchorage, and Rep. Wes Keller, R-Wasilla, nodding as Herrera went through her talking points, while Rep. Andy Josephson, D-Anchorage, shook his head no.
After Herrera finished presenting her slides, she fielded sharp questions from several Medicaid expansion advocates in the audience, including Rep. Les Gara, D-Anchorage, state health commissioner Valerie Davidson, and Becky Hultberg, president of a trade group that represents Alaska hospitals and nursing homes.
Davidson said in an interview afterward that she's "a fan of free speech" but argued that Herrera's presentation "wasn't completely accurate" and contained "disingenuous" information.
Meanwhile, the Alaska Department of Health and Social Services is engaging in a social media campaign on Twitter and Facebook to convince Alaskans of the benefits of Medicaid expansion. DHSS says it has spent $2,530 on the information campaign through March 1.
Sen. Peter Micciche, R-Soldotna, attended the Wednesday's presentation. Afterward, he said his "skepticism meter" for the FGA's presentation and DHSS data was "somewhat equal for someone who has a desired outcome without taking the time to understand unintended consequences."
"I'm not sure either side is stepping back and make sure they have all the information available to make the best decisions. And I'm trying to do just that," Micciche said.
Reporter Nathaniel Herz contributed to this story from Juneau.