I've been wondering if the nursing home industry would oppose the bill
because from what I can gather, it cuts Medicaid in such a way that the
elderly won't have it to fall back on for nursing home care. But so far, I
haven't read or heard a thing about that.
Miriam
-----Original Message-----
From: blind-democracy-bounce@xxxxxxxxxxxxx
[mailto:blind-democracy-bounce@xxxxxxxxxxxxx] On Behalf Of Bonnie L.
Sherrell
Sent: Sunday, July 16, 2017 2:01 AM
To: Blind Democracy <blind-democracy@xxxxxxxxxxxxx>
Subject: [blind-democracy] The Kodiak Kickback
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, there's 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 Murkowski's vote.
"They really, really, really need Lisa Murkowski to vote for this, and
they're 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 Murkowski's
constituents in Alaska: extraordinarily high premium rates in the state.
As Vox's Sarah Kliff has documented, Alaska in the past struggled with high
and rapidly increasing premiums that put the state's 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 state's Obamacare marketplace cost $905 in
2017 - partly because Alaska's 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.
"It's 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 doesn't 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 we're 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), Murkowski's Senate counterpart, told the Alaska
Dispatch News.
Murkowski could determine the fate of the entire bill
Right now, as Vox's 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 isn't
revealing her planned vote one way or another.
In an interview last month with Bloomberg, Murkowski insisted that she
wouldn't be swayed by any effort to buy her off if she still opposed the
overall bill.
"Let's just say that they do something that's so Alaska-specific just to,
quote, 'get me,'" she said in June. "Then you have a nationwide system that
doesn't work. That then comes crashing down and Alaska's not able to kind of
keep it together on its own." It's worth noting that Murkowski ran for
Senate over McConnell's wishes in 2010 and doesn't owe him much by way of
her political success.
Nothing else, though, has changed in the bill. Murkowski has primarily
expressed opposition to the bill's Medicaid cuts, but McConnell has
preserved those steep cuts. And as the Center for American Progress's Topher
Spiro points out, the bill would still have devastating impacts on Alaska's
185,000 Medicaid recipients despite the "Polar Payoff":
Republicans' health care bill will cost Alaska Medicaid recipients about $3
billion. In exchange, they're trying to buy off Murkowski with far less in
funding for the Obamacare exchanges. We'll know soon if it worked.
----
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!
