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Alaska governor discusses decision to pursue Medicaid expansion

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JUNEAU, Alaska — Gov. Bill Walker said he believes his bill to expand Medicaid would have passed the Legislature if brought to a vote but that the legislation never seemed to be progressing toward that end.

Walker announced this month his intention to accept federal money to expand Medicaid, calling the move his "final option" after lawmakers had tabled his bill for further review.

In an interview Monday, Walker said that every day the state waits to expand Medicaid it is saying "no" to people who could be getting health care coverage. Estimates indicate that nearly 42,000 lower-income Alaskans would be newly eligible for Medicaid under expansion the first year and that nearly 21,000 would enroll.

Walker introduced expansion legislation with provisions geared toward containing and curbing costs within the Medicaid program in March, at the prodding of lawmakers who rejected his attempt to simply advance expansion as part of his budget proposal. The bill stalled in the House Finance Committee during the first special session in May; the Senate Finance Committee didn't take it up. Versions of the measure remain in both committees.

Walker said there was plenty of "process opportunity" during the regular and special sessions and that the administration answered the questions it was asked. "It just didn't ever seem to be progressing toward a vote," he said.

State law lays out a process by which a governor is to submit to the Legislative Budget and Audit Committee for review plans to accept and spend additional federal or other program funds. Even if the committee disagrees with the plan, the governor can proceed.

Once the plans are submitted, the law lays out a 45-day waiting period for the governor to move ahead, unless the committee earlier recommends the state proceed. If the committee holds a hearing and there's a vote by members, that would immediately trigger Walker's ability to pursue his plans, the committee's chair, Rep. Mike Hawker, has said.

The administration submitted its plans July 16, and has targeted Sept. 1 for the expansion rollout.

Hawker, R-Anchorage, has taken under advisement requests by at least two senators on his committee to hold a hearing on Walker's plan. But the panel by law is not supposed to be conducting policy hearings and has "absolutely no ability" to prevent Walker from accepting the Medicaid dollars, he said. It's more appropriate at this time for the committees sitting on Walker's Medicaid bills to hold any policy hearings they want to hold, he said.

Hawker said he's stuck in a tough spot. Some people want a hearing where they can "bash around" the governor and expansion but if that forum is allowed, the governor and expansion advocates would have to be given an opportunity to defend expansion, he said.

"And all it becomes is a cage match where no one wins because there will be no change possible in the policy outcome. That is, the governor can do what he has done, regardless of how big a kabuki theater I arrange in my committee," Hawker said. "I am not one to support theater. I want policy action."

Legislators and the public have to accept that Walker has the right to do what he's planning, and Walker has to recognize that there are legitimate concerns about the financial risks of expansion in Alaska, he said.

Hawker considers increasing access to health care one of the most pressing issues in Alaska. But he said he doesn't want the state to create "an inappropriate downside risk for our budget."

It's not too late to put parameters around expansion to help protect the state budget, he said.

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