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WASILLA, Alaska — In the small town that birthed the political career of Sarah Palin, the debate over the future of health care has taken on an urgency unlike that playing out in much of the lower 48 states.
That’s because Alaska currently has the second-highest per capita spending on health care in the country, with plans costing two and a half times the national average, according to the Kaiser Family Foundation.
Both the House’s American Health Care Act and the Senate’s delayed vote to roll back the Affordable Care Act stand poised to drive those costs even higher.
While Palin has been one of Obamacare’s loudest critics, falsely warning that the law would lead to the creation of death panels, many residents of Wasilla seem unsure about the effort to replace it.
And while some in the town of just 7,800 residents say they want change, many out this week running errands at a local hardware store or taking kids to recreate at Wasilla Lake expressed frustration at the state’s high cost of care. Others were reflexively against new proposals that would drive premiums even higher and leave potentially more neighbors, co-workers — perhaps even themselves — uninsured.
“Health care up here is so expensive,” said Brittany Ward, who gets health insurance through her Army veteran father. “It makes me hopeless. … I can’t afford [care], and I need it.”
Ward has schizophrenia, which landed her in the hospital recently and saddled her family with a $68,000 bill.
The ongoing debate among politicians on the issue is so frustrating, Ward said, she could not bear to watch the news.
“They don’t understand health care for the middle and lower class,” Ward said.
Ron Taber said he signed up on the insurance exchange but that the cost was still higher than was feasible for him to pay. After going to the hospital with chest pain, he said his deductible was still $7,000.
“It’s not something that should ruin people,” he said.
Across town, Craig Pell manages one of the most Alaskan of businesses, the Chimo Gun Store. He said he’s lucky to have coverage through his wife, who works for the Matanuska-Susitna School District.
Still, perched in front of a rack of hunting rifles, Pell, who voted for Donald Trump, said he thought there should be a way to make health care cheaper and that lawmakers in Washington were needlessly complicating the matter.
“There has to be a way to level it out so a poor person pays as much as I do,” Pell said. He added that his message for his senators, Republicans Dan Sullivan and Lisa Murkowski, was “keep it simple, stupid.”
A wide range of factors contribute to the expensive cost that faces residents in Wasilla and across the state. These range from a high cost of living to a dearth of medical professionals, as well as long trips from far-flung towns to access the few doctors who reside here.
The sheer scale of the state — the biggest in the union as well as its least densely populated — makes it difficult to deliver health care, according to Becky Hultberg, president of the Alaska State Hospitals and Nursing Homes Association.
“We have the same challenges you face everywhere else, they’re just magnified here,” Hultberg said. “We have the challenges of cost of health care delivery. It’s just the geography and market magnifies that.”
No matter the cause, Alaskans feel they are paying too much for care, something that analysts say would only increase with the proposed Republican alternatives to the ACA. While only 19,000 Alaskans use the state’s health care exchange, more than 90 percent receive subsidies in the form of tax credits in an effort to make their care more affordable.
The Senate health care plan would tighten the eligibility of middle-class Americans to receive those subsidies from 400 percent of the federal poverty line to 350 percent — a problem for Alaska given the high cost of living in the state. In addition, older Alaskans would have to contribute more of their income toward premiums.
The current exchange has struggled in recent years, with Primera being the only remaining insurer offering coverage since last year. In an effort to bring stability, the state Legislature opted to pass a bill taxing all insurers in the state to try and help subsidize the most costly patients.
Even though state Sen. Mia Costello, a Republican, said the reinsurance program has worked, she noted it was not a permanent solution to problems with the ACA. Costs, she said, can “be as high as a person’s mortgage.”
“That was putting out an immediate fire that had to be put out, and we had a situation where something had to be done,” Costello said.
The Center on Budget and Policy Priorities estimates that 69,000 Alaskans could lose coverage under changes to the ACA and that health costs, even for those not in the public exchange, would rise. Both Sullivan and Murkowski have remained noncommittal on the Senate repeal bill and have said they will not vote against the interests of Alaskans.
“I don’t have enough data in terms of the impact to my state to be able to vote in the affirmative,” Murkowski said.
But care in Alaska is so expensive its citizens often have to look elsewhere for services. In an effort to escape pricey treatments, Alaskans will often travel to Seattle or Portland, where even nonemergency procedures can be significantly cheaper.
State Senate Democratic leader Berta Gardner said this would only increase if Congress took action.
“Even if you have insurance, you can save money by going somewhere else,” Gardner said. “I need to take care of a procedure that I have to do but is nonemergency, and one of the things on my to-do list is to call around and see where I should go to have it. … But the medical costs are much cheaper there than here. So even though I have coverage for 80 percent of it, even just on the other 20 percent I’d save money.”
Not all Alaskans have that option — including those who could lose coverage if the state’s Medicaid expansion were rolled back. Gov. Bill Walker, an independent, opted to expand the program in 2015 over the objection of the Republican-controlled state Legislature.
Both the AHCA and the Senate proposal would roll back Medicaid spending, capping the amount of money states can receive and eventually rolling back the expansion of the program, which was one of the ACA’s signature pieces.
Gardner said that, given budget difficulties, the state would have trouble stepping in to support the 30,000-plus Alaskans who were supported by the Medicaid expansion.
“Even with the best efforts, there will definitely be people left behind,” she said. “And this is in a state with the highest, or among the top, rates of domestic violence, sexual assault, child abuse, suicide, substance abuse. We have staggeringly high levels of all adverse social indicators. And losing health care and losing funding for therapies will definitely impact us in a huge way.”
Hultberg said cuts to Medicaid would drive up rates for all Alaskans and could result in the loss of facilities in less populated areas.
“It’s going to affect the entire market in the state, and it could result in the loss of nursing homes and [smaller] hospitals,” she said.
In Anchorage, a group of several dozen residents crowded outside of Murkowski’s office downtown, buoyed by news that Senate Majority Leader Mitch McConnell, R-Ky., pushed back a vote on the health care bill until after the July 4 recess. When both Murkowski and Sullivan return home, they will face many constituents like Jennifer Brosnan, who takes off an hour from her clerical job each week to protest. An Alaska Native, Brosnan said fighting the bill was about ensuring her granddaughter, who accompanied her to the demonstration, could have care going forward.
“Alaska was the land of my grandmother, and it is the land of my granddaughter, and this is not the future I want for her,” Brosnan said.
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