In early November the U.S. Supreme Court agreed to hear a case that could profoundly hurt Alaskans who purchase private health insurance. Currently, the Affordable Care Act (ACA) provides subsidies to individuals, based on their taxable income, to help defray the cost of insurance premiums. For a state like Alaska, where health insurance premiums are two to three times more expensive than in other states, subsidies can reduce the cost of insurance by thousands to tens of thousands of dollars per year. Depending on how the Supreme Court rules on this case, these subsidies could be taken away and Alaskans forced to pay much higher insurance premiums.
The case in question, King v. Burwell, attempts to twist the language of the ACA in such a way that citizens of states that have not set up health exchanges cannot receive subsidies for their health insurance. We live in such a state; when given the opportunity and the funding to set up an Alaska health exchange several years ago, Gov. Parnell failed to do so and instead preferred that Alaskans use the federal exchange (healthcare.gov). Though that website is working well now, Parnell's failure to establish a state-based exchange has created a new threat that could make health care even more expensive.
Alaska politicians love to complain about federal overreach, but thanks to federal overreach, the number of Alaskans potentially affected by this decision is actually less than in other states. We have a high percentage of citizens who have health care guaranteed and subsidized in some fashion by the federal government. This includes military and ex-military personnel, Alaska Natives and the many federal government employees and retirees in our state. The Supreme Court decision will have no effect on these people; they can thank federal overreach for their protection and their low insurance premiums. In contrast, the people most at risk are those who purchase heath insurance on their own. A particularly galling aspect of this problem is that some people who themselves benefit from federal subsidies for their health care -- our new senator-elect, for example -- are eager to disallow these subsidies for other Alaskans.
One obvious solution to this problem is for the incoming Walker administration to establish an Alaska health insurance exchange. This would guarantee that the Supreme Court could not use a technicality to take away affordable health care from Alaskans, and would also create an exchange more focused on Alaskans' needs. Gov. Walker has already advocated expansion of Medicaid, a policy long blocked by Gov. Parnell; creating an Alaska exchange would correct the second of the ex-governor's egregious blunders in implementing the ACA.
But it is also important that the cost of the premiums themselves be addressed, not just the subsidies. These high costs are often blamed on the small pool of patients here in Alaska, and it certainly is true that the bargaining power of patients is increased when coverage is spread out over more people -- that is why the single-payer plans present in most other developed nations provide better care at lower cost than here in the U.S. Rather than just sitting back and accepting business as usual, lawmakers and insurance regulators should seek out new insurance models that reduce the vulnerability of those of us in small-population states like Alaska. To do otherwise threatens the health of our citizenry and the economic viability of businesses that must provide insurance for their employees.
Randall Plant is a doctor who lives in Anchorage.
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