Access to care is improving for Alaskans. We shouldn’t go backward.

Access to care in Alaska is a fragile issue. While we have seen great strides in many areas, the persistent gap in access to care for Medicare patients is a cautionary tale that the state should seriously consider — especially now, as insurance companies work to undermine important patient protections like the 80th percentile rule.

As more doctors and health care providers have come to Alaska, we've seen a dramatic increase in "in-network" participation. Alaskans have more options than ever before at home for care, and we believe this has encouraged fairer prices and greater transparency. Doctors, health care providers, and patients want to keep building on the progress we've made, but big insurance companies are working to roll back these gains, putting profits ahead of patients.

A colleague recently told me about a patient referred to him for "heart failure" who very obviously had cirrhosis from hepatitis C with massive accumulation of fluid and swollen legs. He had no problems with his heart at all, yet wound up being treated by a cardiologist. Why? Because he was a Medicare patient, and couldn't access the right specialist or primary care doctor.

Unfortunately, this isn't a unique story. There are more than 84,000 Alaska seniors on Medicare, and access to care for these patients is a persistent issue across the state. At the same time, 208,000 Alaskans are on Medicaid and CHIP. While it's a priority for doctors to provide care to these vulnerable populations, Medicare and Medicaid grossly underfund reimbursement of the full cost of care for our patients.

To ensure that our Medicare patients have adequate access to care, some physicians have taken matters into their own hands. Seven years ago, providers in Anchorage opened a special Medicare clinic for seniors. Even though it only had to cover operating expenses, the clinic could not sustain itself on Medicare payments. The clinic is now solely subsidized by Alaska Regional Hospital. Prioritizing patient care over profits, providers continue to absorb the gap between Medicare reimbursement and the actual cost of care, so that patients don't always end up back in the hospital. Yet clinics can have up to eight-week wait times — they're overrun, as Medicare patients have few other options.

Politicians in Washington, D.C., set Medicare and Medicaid rates, and they have nothing to do with the actual cost of care or local market issues that affect real people in Alaska. A recent Health Affairs report notes that between 2001 and 2014, general U.S. inflation increased 33.4 percent, while Medicare rates only went up 2.9 percent. The report recommends increasing Medicare payments to solve access to care and quality issues for senior populations. But Alaska is doing the opposite. For Medicaid patients, who face similar challenges, the state recently decreased reimbursements to providers by 10 percent.

At the same time, big health insurers operating in Alaska have been working to protect their profits, fighting against existing patient protections. For more than 10 years, the state has had a rule in place that protects patients from out-of-network bills. This rule ensures that insurance plans cover their patients and pay providers directly for out-of-network care — keeping out-of-pocket costs down for patients and ensuring access to emergency and specialty care across the state. Insurance companies now want to push legislation that bases physician reimbursement off  inadequate Medicare rates — the same politically driven rates that have left so many seniors without access to care.

Eliminating the 80th percentile rule would mean big insurance companies could now spend less on care for patients, making patients pick up more of the cost, plain and simple. Doctors, nurses and patients know better. Protecting patients from high costs by requiring fair coverage from insurers has led to more doctors and specialists in every field of care. When more patients can get treated in state, this means better patient outcomes and lower costs.

Before the 80th percentile rule was enacted, the Division of Insurance in Alaska consistently received complaints from patients that insurance companies were not covering the cost of their care and they were still being balanced billed for medical services. Currently, this doesn't happen to patients, because insurers are required to pay claims for services based on the 80th percentile.

Insurance companies want to get rid of the 80th percentile rule to cut their costs and increase their profits, but this is dangerous for patients and wouldn't necessarily save Alaskans any money. It would only increase patient costs and decrease what insurers pay. We all like to have choices for care, and patients now have more options for specialists and emergency care because of the 80th percentile rule. Allowing insurance companies to eliminate this important consumer protection and skip out on their obligation to patients would be a grave mistake. Let's remember what's happening with Medicare and Medicaid right now. Doctors and patients are committed to fighting this false narrative and ensuring that all Alaskans have access to quality care and are protected from surprise medical bills.

Dr. Peter Lawrason, M.D., is an obstetrician-gynecologist in Fairbanks, Alaska and is affiliated with Fairbanks Memorial Hospital. Dr. Lawrason has been practicing in Alaska for more than 30 years and is the immediate past president of the Alaska State Medical Association.

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