This is from the Vox website:
Buried in Senate Republicans new health care bill is a provision to throw about
$1 billion at states where premiums run 75 percent higher than the national
average.
Curiously, theres just one state that meets this seemingly arbitrary
designation: Alaska.
That state also just so happens to be represented by Sen. Lisa Murkowski, a
crucial Republican swing vote who has spent months threatening to torpedo the
entire Obamacare repeal effort over her concerns about Medicaid cuts.
Nobody believes this special fund was created to give Alaska alone a big boost
through sheer coincidence. Reporters on the Hill have taken to calling the
carve-out to help Alaskans the Polar Payoff, the Kodiak Kickback, and even
the Juneau Jackpot a special gift to the state, inserted by Senate Majority
Leader Mitch McConnell to win Murkowskis vote.
They really, really, really need Lisa Murkowski to vote for this, and theyre
thinking this may help, said Timothy Jost, a health care expert and a professor
emeritus at Washington and Lee University.
The big question right now is whether the approximately $1 billion in additional
health spending for Alaska will be enough to win over Murkowski to a bill that
would gut Medicaid and result in about $1 trillion less health spending for
America overall.
How the Kodiak Kickback works
The Kodiak Kickback is responsive to a very real problem for Murkowskis
constituents in Alaska: extraordinarily high premium rates in the state.
As Voxs Sarah Kliff has documented, Alaska in the past struggled with high and
rapidly increasing premiums that put the states Obamacare exchanges on the
verge of entering a death spiral. To avert it, the state started paying back
insurers for especially high claims. Premiums stabilized, and the Trump
administration just decided to let Alaska spend the savings.
But premiums in its Obamacare marketplace are still high, and the current
Republican health bill would make subsidies for most low-income people much
skimpier. A midlevel plan in the states Obamacare marketplace cost $905 in 2017
partly because Alaskas isolation makes it difficult to get patients to
specialty doctors, and partly because such a large percentage of its population
uses health insurance provided through the Bureau of Indian Affairs.
Its because they have a very small market and because health care is very
expensive in the state, Jost said. The Alaskans in the individuals markets is
a pretty small group of people, and when you have a really small risk pool it
doesnt take many high-cost cases for premiums to soar for everybody.
Senate Republicans newest bill includes a special $182 billion fund that will
give the Department of Health and Human Services broad latitude to help
stabilize the Obamacare markets. This fund, which has increased as the vote on
the bill draws near, is intended to reassure moderate Senate Republicans worried
about its impact on the individual markets.
But to make sure it helps Alaska and, perhaps, its moderate senator
lawmakers added a new clause to that special fund this week that will require at
least 1 percent of it be spent on states where premiums run 75 percent higher
than the national average. One percent may not sound like a big number, but
were talking about Alaska, which only has 700,000 people. The state is still
set to receive nearly $2 billion over 10 years.
One percent of a multibillion-dollar fund could be very helpful for Alaska,"
Sen. Dan Sullivan (R-AK), Murkowskis Senate counterpart, told the Alaska
Dispatch News.
Murkowski could determine the fate of the entire bill
Right now, as Voxs Dylan Scott explains, Senate Republicans can afford to lose
zero additional votes on their health care bill. All Democrats oppose it, as do
two Republican senators Rand Paul (R-KY) and Susan Collins (R-ME).
In other words, Murkowski alone could kill the bill when McConnell brings it to
the floor on Tuesday on a motion to proceed vote. But so far, she isnt
revealing her planned vote one way or another.
In an interview last month with Bloomberg, Murkowski insisted that she wouldnt
be swayed by any effort to buy her off if she still opposed the overall bill.
Lets just say that they do something thats so Alaska-specific just to, quote,
get me, she said in June. Then you have a nationwide system that doesnt
work. That then comes crashing down and Alaskas not able to kind of keep it
together on its own. Its worth noting that Murkowski ran for Senate over
McConnells wishes in 2010 and doesnt owe him much by way of her political
success.
Nothing else, though, has changed in the bill. Murkowski has primarily expressed
opposition to the bills Medicaid cuts, but McConnell has preserved those steep
cuts. And as the Center for American Progresss Topher Spiro points out, the
bill would still have devastating impacts on Alaskas 185,000 Medicaid
recipients despite the Polar Payoff:
Republicans health care bill will cost Alaska Medicaid recipients about $3
billion. In exchange, theyre trying to buy off Murkowski with far less in
funding for the Obamacare exchanges. Well know soon if it worked.
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Bonnie L. Sherrell
Teacher at Large
"Then do not be too eager to deal out death in judgement. For even the very
wise cannot see all ends." LOTR
"Don't go where I can't follow."
We gave the Goblin King control of our nation!
