Alaska Healthcare Journal Spring 2017 by Juneau Empire

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P U B L I S H I N G

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S P R I N G

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INSIDE: Alaska specialities reference Contributions from local specialists Alaska healthcare updates

301 Arctic Slope Ave. Ste. 350 Anchorage, AK 99518 P: 907-561-4772 F: 907-563-4744 www.alaskajournal.com Publisher Deedie McKenzie (907)335-1245 Deedie.mckenzie@morris.com Managing Editor Andrew Jensen (907)275-2165 editor@alaskajournal.com Advertising Director Jada Nowling (907)275-2154 Jada.nowling@morris.com Regional Circulation Manager Doug Munn (907)335-1232 doug.munn@peninsulaclarion. com Production Matthew Wilkinson (907)523-2233 matthew.wilkinson@morris.com Account Executive Ken Hanni (907)275-2155 Kenneth.hanni@morris.com Account Executive Ryan Estrada (907)275-2114 Ryan.estrada@morris.com

INDEX Specialties Audiology Chiropractic Family Medicine Hearing Aids Mental Health Obstetrics / Gynecology Optometry Massage Therapy

Page 10 11 11-13 14 14 15, 17 19 19

Specialties Page Pediatrics 20 Rehabilitation 20 Tinnitus 20 Vein Specialist 20 Bartlett Regional Hospital 23 Medical Services 24 SEARHC 25

Do you know what two of the most common phrases are that I hear in my office? “It’s not that bad, yet” or “I’ll just wait until it gets worse.” However, studies show that sooner, rather than later, is the time to address any hearing concerns. The ears are often overlooked, as hearing loss is a “silent disability.” We can’t look at someone and know they have hearing loss. We may notice the side effects of one’s hearing loss, often after it has been present for an extended period of time. Once a friend or loved one’s hearing loss is evident you might notice increased communication errors, frustration on both the listener and speaker sides of the conversation, reluctance or refusal of not wanting to attend social gatherings, and even cognitive decline. Did you know the auditory cortex, which performs the brain’s hearing functions, is like other muscles in our body and needs regular “exercise?” It is stronger and more effective when used regularly. Untreated hearing loss can shrink cortex size and weaken neural pathways, decreasing brain volume in key sensory areas. This directly correlates to the 25-year study which shows that untreated hearing loss is associated with quicker cognitive decline in older adults. The good news, is that by treating the loss, whether it’s a mild or a more significant loss, we can lessen the progression. We can lessen it so much so that there is no difference in cognitive decline between those using hearing instruments and those with normal hearing. As in all areas of health care, different parts of our body require specialization for the best quality of treatment and results. A Doctor of Audiology, like myself, provides the best in hearing loss care and treatment. We offer our professional knowledge, compassion, and highly personalized care to meet each individual patient’s needs. Today’s solutions are discreet and very technology focused allowing our patient’s ease of usage and access. Let us, Alaska Hearing & Tinnitus Center, learn more about the sounds of your life. We would love to help you continue hearing your friends and loved ones and enjoying the life you love it its fullest.

Emily McMahan Au.D. Doctor of Audiology (”Self-Reported Hearing Loss, Hearing Aids, and Cognitive Decline in Elderly Adults: A 25 25-Year Study”, 2015, October) This is a paid advertisement.

AUDIOLOGY

AUDIOLOGY DR. EMILY E. MCMAHAN Audiologist

The good physician treats the disease; the great physician treats the patient who has the disease.

1005 E. Dimond BLVD. Suite 3 Anchorage, AK 99515 907-522-4357 www.allearsalaska.com

William Osler

DR. PATRICIA G. CONNERS-ALLEN Chiropractic Physician 2354 Mendenhall Loop Rd. Suite 79 Juneau, Alaska 99801

ALASKA HEALTH OPTIONS

907-789-1613 aoffice@alaska.net

Thorough, careful and lasting treatment

Serving Juneau for over 30 years!

CHIROPRACTIC

FAMILY MEDICINE CHARLES AARONS, MD Family Medicine 2211 E. Northern Lights Blvd Anchorage, Alaska 99508 Phone: (907) 279-8486 Toll Free: 1-888-382-8486 www.mpfcak.com

TERRI BERNDT, PA-C

LISBETH BERGE, MD

2211 E. Northern Lights Blvd Anchorage, Alaska 99508

Phone: (907) 279-8486 Toll Free: 1-888-382-8486

www.mpfcak.com

FAMILY MEDICINE

TIMOTHY COALWELL, MD

BRIANA M. CRANMER, MD

Family Medicine

2211 E. Northern Lights Blvd Anchorage, Alaska 99508

Phone: (907) 279-8486 Toll Free: 1-888-382-8486

www.mpfcak.com

FAMILY MEDICINE

SLEEP STUDIES / FAMILY MEDICINE

MEDICAL FAMILY SERVICES MEDICINE DIRECTORY

FAMILY MEDICINE

KIEARA CONWAY, DO

T. NOAH LAUFER, MD

Family Medicine

2211 E. Northern Lights Blvd Anchorage, Alaska 99508

Phone: (907) 279-8486 Toll Free: 1-888-382-8486

www.mpfcak.com

FAMILY MEDICINE

JILL GASKILL, MD

JOHN GILLIS, MD Family Medicine

Family Medicine 2211 E. Northern Lights Blvd Anchorage, Alaska 99508

2211 E. Northern Lights Blvd Anchorage, Alaska 99508

Phone: (907) 279-8486 Toll Free: 1-888-382-8486

www.mpfcak.com

FAMILY MEDICINE

CLINICAL PSYCHOLOGIST

S. LYNN HORNBEIN, MD

MARIANA IVANOVIC, Ph.D

2211 E. Northern Lights Blvd Anchorage, Alaska 99508

Phone: (907) 279-8486 Toll Free: 1-888-382-8486

www.mpfcak.com

FAMILY MEDICINE

NATHAN KASUKONIS, DO

JEFFEREY KIM, MD

Family Medicine

2211 E. Northern Lights Blvd Anchorage, Alaska 99508

Phone: (907) 279-8486 Toll Free: 1-888-382-8486

www.mpfcak.com

FAMILY MEDICINE

JAMES LORD, MD

THOMAS WIGGINS, MD

Family Medicine

2211 E. Northern Lights Blvd Anchorage, Alaska 99508

Phone: (907) 279-8486 Toll Free: 1-888-382-8486

www.mpfcak.com

FAMILY MEDICINE

FAMILY MEDICINE MICHAEL REEVES, MD

Family Medicine

2211 E. Northern Lights Blvd Anchorage, Alaska 99508

Phone: (907) 279-8486 Toll Free: 1-888-382-8486

www.mpfcak.com

FAMILY MEDICINE

JULIE ROBINSON, MD

RAY ROBINSON, MD

Family Medicine

2211 E. Northern Lights Blvd Anchorage, Alaska 99508

Phone: (907) 279-8486 Toll Free: 1-888-382-8486

www.mpfcak.com

FAMILY MEDICINE

FAMILY MEDICINE R. MATISON WHITE, MD

JESSICA ROWLEY, PA-C

Family Medicine

2211 E. Northern Lights Blvd Anchorage, Alaska 99508

Phone: (907) 279-8486 Toll Free: 1-888-382-8486

www.mpfcak.com

FAMILY MEDICINE

PETER MONTESANO, MD

HEARING AIDS MENTAL HEALTH MEDICAL SERVICES DIRECTORY

HEARING DR. EMILY E. MCMAHAN Audiologist 1005 E. Dimond BLVD. Suite 3 Anchorage, AK 99515 907-522-4357 www.allearsalaska.com

Mental Health MENTAL HEALTH

North Star Behavioral Health

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OBSTETRICS/GYNECOLOGY

OBSTETRICS/GYNECOLOGY DR. NATALIA SAPRYKINA

DR. KENNETH MORHAIN

Board Certified OB-GYN, Novosibirsk State MEdical institure in Russia, recertification received from University of Kansas Medical Center

Board Certified OB-GYN, Creighton University

3976 University Lake Drive, Ste 300 Anchorage, AK 99508

(907) 222-9930 www.DenaliOBGYN.com info@DenaliOBGYN.com

OBSTETRICS/GYNECOLOGY

DR. TERYL ELAM

3976 University Lake Drive, Ste 300 Anchorage, AK 99508

(907) 222-9930 www.DenaliOBGYN.com info@DenaliOBGYN.com

Board Certified OB-GYN, University of Washington

Board Certified OB-GYN, University of New Mexico

OBSTETRICS/GYNECOLOGY

DR. MATTHEW LINDEMANN

DR. PETER ADAMS

Board Certified OB-GYN, University of Alaska

Board Certified OB-GYN, University of North Dakota

3976 University Lake Drive, Ste 300 Anchorage, AK 99508

(907) 222-9930 www.DenaliOBGYN.com info@DenaliOBGYN.com

OBSTETRICS/GYNECOLOGY

OBSTETRICS/GYNECOLOGY SANDRA MAHONEY, FNP

STEPHANIE McBRIDE, WHNP

3976 University Lake Drive, Ste 300 Anchorage, AK 99508

(907) 222-9930 www.DenaliOBGYN.com info@DenaliOBGYN.com

Board Certified Women's Health Nurse Practicioner Masters of Nursing, University of Cincinnati

Master of Science in Nursing from the University of Alaska, Board Certified Family Nurse Practitioner

OBSTETRICS / GYNECOLOGY

DR. TANYA PASTERNACK

K a t i e U l m e r , A N P M i g e l H a d l e y , A N P J e n n i f e r F e e n e y , A N P R h i a n n e C h r i s t o p h e r s o n , A N P

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Women’s Care of Alaska is an all-‐female medical practice, of Obstetrics and Gynecology that has been providing comprehensive care, to the women of Alaska, since 1994. Our group is currently composed of three physicians and four nurse practitioners. We recently moved into a new, much larger office, that was designed with the comfort of our patients, in mind; we created an environment that is warm and inviting not only for our patients, but for their families, as well. At Women’s Care of Alaska, we provide you with some of the best obstetrical care in Alaska. Our expertise encompasses both low and high risk pregnancies, starting with preconceptional counseling, all the way through post-‐partum care; in addition, we have in-‐office ultrasound and testing capabilities. Our obstetric care is tailored to individual needs and wants, while continually providing safe care for mom and baby. Our physicians are some of the busiest gynecologic surgeons in Alaska, especially when it comes to minimally-‐invasive and robotic procedures; all of our surgeons are robotically trained. We perform surgeries for evaluation and treatment of pelvic pain, bleeding issues, pelvic prolapse and incontinence, to name a few. We strive for a minimally-‐invasive approach in surgery, so our patients may have much faster recoveries, with less pain. Other services provided include the management of infertility, family planning, health maintenance annual exams, urinary concerns, sexual dysfunction, menstrual irregularities, and menopause. In addition to our medical services, our practice will also bill your insurance company. We are preferred providers with Blue Cross, Aetna, Cigna, Multiplan and Tricare. We are accepting new patients, and we look forward to providing Alaska’s women with the best medical care, we have to offer.

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OBSTETRICS/GYNECOLOGY

WYND COUNTS, MD, FACOG

WENDY CRUZ, MD, FACOG

2741 DeBarr Road, Suite C-205 Anchorage, AK 99508

(907)279-2273 wcakobgyn.com

Board Certified COEMIG Designee

OBSTETRICS/GYNECOLOGY

Board Certified

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2741 DeBarr Road, Suite C-205 Anchorage, AK 99508

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OBSTETRICS/GYNECOLOGY

MIGEL HADLEY, MSN, FNP-C

JENNIFER FEENEY, DNP, FNP-C

2741 DeBarr Road, Suite C-205 Anchorage, AK 99508

(907)279-2273 wcakobgyn.com

Advanced Nurse Practitioner

OBSTETRICS/GYNECOLOGY

RHIANNE CHRISTOPHERSON, MSN, FNP-C

Advanced Nurse Practitioner 2741 DeBarr Road, Suite C-205 Anchorage, AK 99508 (907)279-2273 wcakobgyn.com

OBSTETRICS / GYNECOLOGY

KATIE ULMER, MSN, FNP-C

KRISTINA EATON, MD, FACOG

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OPTOMETRY

OPTOMETRY DR. ANTHONY MAKAR

DR. REBECCA MAKAR

Doctor of Optometry, Pacific University, College of Optometry, Forest Grove, Oregon

341 W. Tudor Rd., Suite 101 Anchorage, AK 99508

(907) 770-6652 www.makareyecare.com

DR. ELIZA SALVO

DR. ALYXANDRIA MOREY

Doctor of Optometry, Indiana University, College of Optometry, Bloomington, Indiana

Doctor of Optometry, Pacific University, College of Optometry, Forest Grove, Oregon

341 W. Tudor Rd., Suite 101 Anchorage, AK 99508

(907) 770-6652 www.makareyecare.com

OPTOMETRY

OPTOMETRY DR. ELIZABETH LANE, FAAO

DR. ROWENA RIVERA

Michigan College of Optometry Big Grand Rapids, Michigan Doctor of Optometry, Fellow of the American Academy of Optometry

Doctor of Optometry, Pacific University, College of Optometry, Forest Grove, Oregon 341 W. Tudor Rd., Suite 101 Anchorage, AK 99508

341 W. Tudor Rd., Suite 101 Anchorage, AK 99508

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DR. PATRICIA G. CONNERS-ALLEN Chiropractic Physician 2354 Mendenhall Loop Rd. Suite 79 Juneau, Alaska 99801 ALASKA HEALTH OPTIONS Helping our patients achieve a better quality of life.

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MASSAGE THERAPY

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PEDIATRICS

LATOUCHE PEDIATRICS, LLC 3340 Providence Dr., Suite A-452 Anchorage, AK 99508 (907) 562-2120 www.latouchepediatrics.com

REHABILITATIVE THERAPY DR. PATRICIA G. CONNERS-ALLEN Chiropractic Physician 2354 Mendenhall Loop Rd. Suite 79 Juneau, Alaska 99801

ALASKA HEALTH OPTIONS

907-789-1613 aoffice@alaska.net Serving Juneau for over 30 years!

TINNITUS DR. EMILY E. MCMAHAN Audiologist 1005 E. Dimond BLVD. Suite 3 Anchorage, AK 99515

VEIN SPECIALISTS

907-522-4357 www.allearsalaska.com

VEIN SPECIALIST

DONALD IVES, MD

JESSE SANDOVAL, DO

American Board of Venous & Lymphatic Medicine certified

2550 Denali Street, Suite 1307 Anchorage, AK 99503

907-375-8787 www.dynamiclegs.com

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Insurance officials hope federal waiver will cover reinsurance costs State officials and insurance companies in Alaska say they are encouraged by positive receptions so far from President Donald Trump’s administration on an application for federally-backed health “reinsurance” program for individual health insurance policies sold in the state that have been hit hard with losses. If the proposal is accepted, federal funds could replace a $55 million, one-year backstop put in place by the state in 2016, in House Bill 367, to prop up the individual health insurance market. The funding expires at the end of this year. Trump administration officials are interested in Alaska’s reinsurance program, and want to nurture it, because it represents the kind of state-led innovations in health care the new administration wants to encourage, Alaska Insurance Division Director Lori Wing-Heier said. This assumes that the basic structure of the federal Affordable Care Act remains intact, with health insurance subsidies paid through “metallic” plans offered on insurance exchanges. It appears for now that the ACA will continue roughly in its present form, although Republicans in the U.S. House and Trump have renewed a push for a repeal and replacement of the ACA with something structurally different. For now, however, the Alaska experiment in reinsurance is being watched closely by the new federal administration and by several states including western states with small, dispersed populations like Alaska’s, with similar problems with affordable health care. However, Minnesota and Iowa are also watching Alaska closely, Wing-Heier said. Jim Grazko, president of Premera Blue Cross Blue Shield of Alaska, said in a March 30 interview with the Journal that, “Alaska is developing a reputation for innovations. No other state has the small population and very small insurance pools like Alaska. There’s also an urgency here in tackling the problem, that hasn’t been felt elsewhere. A lot of states are watching Alaska.” Premera is now the sole insurer in the individual health insurance market after Moda Health was briefly suspended from operating before it departed last year citing financial losses. In 2014 before the ACA went into effect, Alaska had five companies in the individual market. Last year the state faced an emergency with the individual health insurance market with Moda’s impending exit and a possible 42 percent rate hike on the table from Premera, and the state administration and Legislature acted fast to create a temporary backstop by using assessments collected from every policy sold in the state. Alaska has had reinsurance for years, a subsidy for health insurance coverage for individuals with serious medical problems who couldn’t get coverage, under the state-created Alaska Comprehensive Health Insurance Association, or ACHIA. Insurance companies who sold health policies in Alaska paid fees to the association for the high-risk premium subsidies. Individuals with those policies contributed to the premium, and it wasn’t cheap for them, but coverage was at least available. When the Affordable Care Act passed, insurance companies could no longer deny coverage because of preexisting conditions. Most of the Alaskans in the ACHIA program — there were

Insurance officials for the state and Premera Blue Cross Blue Shield of Alaska are hopeful that Health and Human Services Secretary Tom Price will grant a waiver to the Affordable Care Act that would allow for the federal treasury to cover a state reinsurance program created last year for the members of the individual market who fall into a small high risk pool.

several hundred — dropped it and signed up in the newlycreated individual insurance exchange, taking their serious medical problems with them. The Alaska individual insurance market, which numbered about 20,000 last year (it has since dropped to about 18,000) wasn’t big enough to absorb the costs, however. Washington state’s individual market numbers about 300,000 in comparison. Events last year coincided with two insurers pulling out of the Alaska health individual insurance market, Moda Health and Aetna, leaving Premera Blue Cross/Blue Shield as the sole company remaining selling individual policies. “We were the last guys left standing,” Grazko said. The result was predictable – huge losses for Premera. Grazko said his company has posted a $7.7 million in losses in the Alaska individual market over three years. The company lost $25 million in 2014 and 2015 but did have an $18 million profit in 2016, which reduced the three-year loss total and triggered an examination of the company’s financials. In a statement, Alaska’s Division of Insurance said 2016 profit may have been boosted due to delayed payments under the ACA’s risk transfer programs for 2014 and 2015 that were delayed, and showed up in 2016 in the company’s books. Adjusting for that, Premera’s profit and administration expenses show nothing unusual for 2016, the division said in its statement. State officials are still inspecting Premera’s three-year financial reports to verify information the company made available, insurance division director Wing-Heier said. By law, the Insurance Division must ensure companies’ returns are adequate but not excessive, she said. The losses projected last year, however, were enough that Premera initially filed a rate request for a 42 percent premium increase in the individual market, which prompted the state to

step in with its reinsurance. That allowed the company to lower its 2017 rate increase to 7.5 percent. Grazko said the actuaries who crafted the revised rate anticipated fully drawing the $55 million available in the reinsurance program. What the state did, Grazko said, basically was to “repurpose” ACHIA by extending it to cover costly medical problems among people in the individual market, mostly those who had migrated from the former reinsurance program. The differences were that the new subsidy was paid through a fee on all insurance sold in Alaska, property and casualty included, rather just on health insurance policies as was previously the case. Also, the program was organized to pay costs for 33 specific high-cost medical procedures rather than costs experienced by individuals. The Legislature authorized the program at a $55 million funding level, which was the amount of losses for the high-risk people estimated at the time. Although this did not involve state general funds, the Legislature must still authorize state program expenditures even if paid for by others. How this is actually working out in 2017 won’t be known for a while, Grazko said in the Journal interview. Premera operates on a calendar year (compared with the state’s July-to-June fiscal year) and was only able to start drawing funds, paid by the fees, on Jan. 1, he said. It’s still too early to know what the costs will actually be for 2017, whether the $55 million authorization by the Legislature will be enough, or if the expenses don’t reach $55 million whether some of the authorization can be rolled in 2018. That means, however, that Premera will have to file a proposed individual insurance rate for 2018, due in May, based on just a few months of actual data. Also, it will likely still be unknown at that time whether the federal government can step in under the state waiver

application. Based on that, Premera’s initial rate filing may cause some sticker-shock for Alaskans with individual health policies. Grazko said the 2018 premium filing can be revised later in the year when it becomes known what the federal government will do on the state’s waiver application. Meanwhile, Wing-Heier expects the waiver application to be approved, based on comments so far from the U.S. Department of Health and Human Services. The state does have to enact a statute change to comply with the federal waiver requirements, mainly in making contingency state appropriations multi-year. Those changes are now in a section of the state operating budget which is pending in the Legislature but it sure to ultimately be enacted. “The application (for the waiver) was filed on Jan. 3. We received notification that the waiver application has been deemed complete on Jan. 17. Secretary (Tom) Price issued a letter acknowledging our waiver and reinsurance program,” Wing-Heier wrote in an email. The waiver application totaled 183 pages and included an analysis by the University of Alaska Anchorage’s Institute of Social and Economic Research that the federally-backed reinsurance appropriation would be “budget neutral,” or not resulting in added costs to the treasury that would not otherwise occur. “Once the state budget is passed (with the required language) we expect that CMS (federal Centers for Medicare and Medicaid Service) will approve our waiver rather quickly,” she said. Even with federal backing the state would have to provide some general fund support, however. That would be $11 million in fiscal year 2018 and increasing gradually to $14.1 million in fiscal year 2022, according the information given to the Legislature’s finance committees by the Insurance Division. Tim Bradner is co-publisher of Alaska Legislative Digest and a contributor to the Journal of Commerce. He can be reached at timbradner@gmail.com.

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Alaska senators take input, share thoughts on fixing Obamacare By DJ Summers

Alaska U.S. Sen. Dan Sullivan speaks to members of the Alaska Chamber on Feb. 22 at the Petroleum Club in Anchorage, where he heard their concerns about the Affordable Care Act, also known as Obamacare. Repealing and repairing the law has become a challenge for congressional Republicans after years railing against the law as they try to preserve popular parts while fixing what isn’t working for states like Alaska. Alaska’s senators know the Affordable Care Act has not lived up to its name in the state, but they aren’t willing to toss the baby out with the bathwater just yet. In February, Sens. Lisa Murkowski and Dan Sullivan addressed lawmakers and business leaders about the controversial healthcare provision, taking a softer tone of “repair” rather than the hardline call of “repeal” some of their Republican fellows take. Sullivan dropped by the Petroleum Club in Anchorage on Feb. 22 to talk about his intent to follow Republicans in voting to repeal the Affordable Care Act, or ACA, but not to the extent many of them might want. Alaska’s exorbitant health costs drive the discussion as much as anything. Sullivan highlights Alaska’s size and remoteness, its relatively small number of providers, the lack of transparency of medical procedure prices and overall pharmaceutical prices as issues he wants to find ways to address. “It’s not a one-size-fits all thing,” Sullivan said. “What I’ve been doing since I’ve been home is meeting with as many stakeholders as I can, literally hundreds and hundreds of Alaskan, some people who think the ACA is great, others who think it’s horrible, and some are somewhere in between.” The meeting was packed mostly with the people who think it’s

horrible, while outside the Anchorage Petroleum Club protestors picketed Sullivan’s semi-closed meeting. Members of the press were only to report on the condition that they not identify audience members by name to facilitate an “open discussion.” For a state in a recession, officials say ACA is putting a chill into business owners at a time when the state needs growth. Among other problems, the room full of business owners talked of a general feeling of fear — of not being able to provide insurance for employees or of not being able to make insurance requirements pencil out for their bottom lines. “What we’ve heard is more general,” explained Lori WingHeier, director of the Alaska Division of Insurance. “Businesses are afraid to hire people. They’ve probably laid more people off. In starting up a business one of their concerns is with cost of healthcare. What are some of the impacts if you’re to start a business?” Though the business crowd had concerns, Sullivan addressed the larger theme of how unaffordable health care is in Alaska under the Affordable Care Act. “Doing nothing on this right now would not be responsible,” Sullivan said. “The Alaska market is in chaos, ground zero for failure, because of the ACA. Premiums have tripled, deductibles are at $12,000, $13,000, for a family of husband and wife with two kids making $75,000 a year. Some people are literally having to fork out $30,000…that’s not affordable care.” Alaska’s new Medicaid enrollees are already costing more than what economists predicted they would. Centers for Medicare and Medicaid Services reported to Congress that Medicaid expansion enrollees cost $6,366 per person for fiscal year 2015 (ended last Sept. 30), about 49 percent higher than estimated. Like many other rural states with sparse populations, Alaska’s results from the ACA have been mixed at best. What has worked better for high population states like New York and California has had poor results in Montana, Wyoming, Alaska and other places where there simply aren’t enough people to evenly spread the expense of high-cost enrollees. The ACA has had other unintended consequences for Alaska. In May 2016, the Legislature bailed out insurance provider Premera Blue Cross Blue Shield of Alaska with a $55 million reinsurance bill. Wing-Heier said the law also known as Obamacare hasn’t been all bad for the state. “You’ve got to look at the ACA in entirety,” she said. Like Sullivan, Wing-Heier points to the expanded coverage class as a benefit. Around 26,000 Alaskans now have access under Medicaid expansion. “The number in the individual market with the high cost claims, probably 600 to 700 people in the entire market that if we were underwriting today wouldn’t be able to get insurance,” she said. “They have a cancer, they have preexisting conditions. For that population, it’s been a success.” That population affects the conversation. Nationally and in Alaska’s delegation, ACA reform comes in two flavors: outright repeal, or a more targeted, piecemeal approach that keeps some of the benefits — a strategy Sullivan favors. “I’m going to press to retain certain things,” he said. “Staying on parents’ insurance until the age of 26, coverage for people with pre-existing conditions. That’s why I’m referring to this as

‘repeal and repair,’ not replace.” Sullivan’s stance reflects that of Murkowski, who told the Legislature on Feb. 22 that she wouldn’t vote on broad or poorly thought out ACA repeal process. Like Sullivan, Murkowski acknowledged that coverage for children under 26 and for people with preexisting conditions was a boon to the state, and wouldn’t support measures that would strip those parts of the ACA. She also told the Legislature she would support Medicaid expansion if it did. To this end, Wing-Heier said the Division of Insurance is holding extensive talks with Sullivan and Lisa Murkowski and Rep. Don Young about the several pieces of ACA-related law being introduced in Congress by reform-minded Republicans. “All three of them realize that there’s impacts to replace and repeal, and have gone more to a repair,” she said. “What’s the impact to Alaska, yea or nay, good or bad.” Wing-Heier said the Division of Insurance thoroughly analyzed the proposals of Sens. Bill Cassidy, R-La., and Susan Collins, R-Maine, and House Speaker Paul Ryan. The Cassidy-Collins bill makes more structured reforms, while Ryan’s bill approaches a repeal, which Wing-Heier said does not suit Alaska’s needs. President Barack Obama’s Affordable Care Act, or ACA, expanded Medicaid eligibility in 2014. More than 4.3 million additional Americans now qualify, for a total of 64 million. By 2024, state and federal governments will spend $920.5 billion on the program, at which time 77.5 million people will get coverage. The expansion covers 41,910 low-income Alaskans from 19 to 64 years of age who were previously not eligible for Medicaid — those not caring for dependent children, not disabled or pregnant, and who earn at or below 138 percent of the Federal Poverty Level, or FPL, for Alaska.