to receive funds from Washington, D.C. On a per capita basis, literally no other state benefits as much as Alaska
when it comes to collecting federal funds -- the state takes in nearly twice the national average.
But on Friday afternoon, Gov. Sean Parnell (R) apparently made the rare discovery of federal funds Alaska doesn't want: Medicaid expansion
Expansion would have benefited 40,000 or more Alaskans, many of them low-income adults without children who currently have no health insurance. It also would have helped hospitals and doctors by reducing the amount of uncompensated care they have to write off and would have brought billions of federal dollars into the Alaska economy. But Parnell, a Republican running for re-election next year, described it as one of many troubled parts of health-care reform. "I believe a costly Medicaid expansion especially on top of the broken Obamacare system is a hot mess," Parnell told reporters at a news conference in Anchorage called to announce his decision.
The governor didn't explain why he thinks the Affordable Care Act "system" doesn't work -- Republicans do realize that websites can be fixed, don't they? -- or why his administration would deliberately put Alaska at a financial disadvantage.
The move was immediately panned by the state Chamber of Commerce, state AARP, Alaska Native organizations, local hospitals, and prominent religious organizations, each of whom said Medicaid expansion is a great deal that shouldn't be rejected out of partisan spite. Making matters slightly worse, the Alaska Dispatch noted
that many involved in the debate "blasted the administration for keeping secret a state-commissioned report on the topic."
There's clearly a preferred Beltway narrative when it comes to health care: what matters is turning implementation issues into a national scandal and presenting a sliver of the population that will pay more for better insurance as if it were a widespread crisis. But I continue to believe Republican governors rejecting Medicaid expansion -- leaving struggling families behind for no reason -- is the far more serious scandal
that much of the political world seems wholly uninterested in.
Similarly, the New York Times reports
today that while most governors have made a decision on Medicaid expansion one way or the other, Tennessee Gov. Bill Haslam (R) can't seem to make up his mind. The well-being of about 400,000 low-income constituents hang in the balance, but so, too, does the state economy.
In Tennessee, opposition to expanding Medicaid has come largely from Republican officeholders and conservative groups. Arrayed on the other side are the Tennessee Hospital Association and other medical groups, the Tennessee Chamber of Commerce and Industry and local chambers across the state, several antipoverty organizations and the Democratic opposition. Recent layoffs at a few Tennessee hospitals have focused attention on their plight — and complicated Mr. Haslam's decision. David McClure, senior vice president for finance at the state hospital association, said that failing to expand Medicaid would have a devastating effect on the state's 165 hospitals, leading to layoffs and the closing of some facilities. "In every community that has a hospital, we are typically the biggest or one of the biggest employers," Mr. McClure said. "I don't want to be Chicken Little and say the sky is falling, but there will be some hospitals that will close."
So the argument in favor of Medicaid expansion is that it helps low-income families, helps state finances, helps state hospitals, and helps the state economy. On the other hand, there are Republicans who don't like the president.
This, apparently, is a tough call in Tennessee, and a decision that went the wrong way in Alaska.