Chris Ashenbrenner, Alaska's new Medicaid expansion project director, quit her job as a fisherman in 1981 because of a problem familiar to thousands of Alaskans: she needed health insurance.
"So I took a state job," Ashenbrenner, a lifelong Alaskan, said Monday. "I liked the work and I liked having health insurance, so I just kept going."
More than 30 years later and with decades logged in the public health sector, Ashenbrenner, 65, has come out of retirement and accepted the role of Medicaid expansion project director, a new position created under Gov. Bill Walker. In the coming months, she is expected to carve out the state's path toward extending health care coverage to some of Alaska's lowest-income residents.
"If you have a certain income, you have a hard time getting health care and you end up going to the emergency room, and that impacts everybody," she said. "It impacts you because you're always hitting bottom. It impacts uncompensated care. It's part of a real vicious circle."
Ashenbrenner started in her new, temporary position about two weeks ago, soon after Walker took office. Once the state has firmly established a plan to start enrolling individuals in the expanded Medicaid program, she said she will resume retirement.
Valerie Davidson, commissioner of the state's health department, said she expects enrollment to begin sometime in July, confident the state will successfully expand Medicaid and noting Walker's commitment to the project.
Walker made Medicaid expansion one of his key talking points during his recent campaign against former Gov. Sean Parnell, who bucked expansion under the Affordable Care Act, saying it was too costly.
Under the health care law, expansion would extend Medicaid coverage to all Alaskans who earn up to 138 percent of the poverty level or about $20,120 annually. The federal government assumes 100 percent of Medicaid costs for the newly covered individuals through 2016, then support gradually shrinks, until 2020 when it settles at 90 percent.
Before Medicaid expansion can happen in Alaska, Ashenbrenner will have to work through a series of hurdles that include the state's Medicaid eligibility and payment systems which have been plagued with defects, as well as talking with legislators who must agree to accept and spend federal funds on expansion as well as allocate state dollars on infrastructure to handle the expanded program.
Originally, Ashenbrenner said, she planned to complete her work on Medicaid expansion by king salmon season, but since better assessing the task at hand, she said, "now I'm saying, 'How about hunting season?' "
On Monday, she said she was reading through a 2-foot-tall stack of papers at her Juneau desk, sifting through information on how Medicaid expansion has worked in other states.
Davidson said she created Ashenbrenner's position because "we needed someone who could come on board who could focus exclusively on Medicaid expansion."
"We knew we needed someone with a proven track record for bringing on pretty heavy projects; pretty transformational projects to the state," she said.
When Ashenbrenner first took a job with the state in 1982, she worked as a clerk in the Division of Public Assistance, eventually rising to the role of director in 2001. Her focuses included implementing Denali KidCare and welfare reform. Most recently, Ashenbrenner served as the executive director of the Alaska Council on Domestic Violence and Sexual Assault before retiring in 2009.
In late August of this year, she said, she began "working pretty hard" on Walker's campaign after listening to a debate on the radio in which the gubernatorial candidate pledged to expand Medicaid. Ashenbrenner would eventually work as part of Walker's transition team before joining the state health department as the only employee with a full-time focus toward expansion.
Sarana Schell, a public information officer with the state health department, wrote in an email that Ashenbrenner's new position is a long-term, non-permanent job, funded half by the state and half by the federal government. Ashenbrenner's salary totals nearly $8,000 a month.
The department is not holding any specific position vacant to fund Ashenbrenner's job, Schell wrote.
"The Governor's top priority is Medicaid expansion/reform; we're still determining exactly what the staffing needs will be," she wrote.