Ahhh, nothing gets the day started like debating Medicaid expansion ...

As most readers know, another way I talk about and engage with interested Alaskans on oil, gas and fiscal issues is through a couple of open Facebook forums.  Increasingly, I find they provide a good opportunity to have a useful, open,"town hall"-like discussion on issues as they develop.  I know also that, while they don't often participate, many in Juneau follow along and, as a result, the exchanges provide a useful, if indirect means for exploring issues with them as well.

One engagement this morning in one of the forums -- "Thoughts on Alaska Oil & Gas" -- does a good job of capturing the heart of what is important to me, at least, in the Medicaid expansion debate.  The post is here if you want to participate.

Thoughts on Alaska Oil & Gas shared Alaska Health and Social Services's video.

39 mins · 

Medicaid is the state's second largest expenditure (behind K-12). Expansion without successful overall reform will increase those costs. While some argue that reform will come with (or better yet, "following") expansion, Alaska has a horrible track record of containing Medicaid costs. At a time when Alaska's fiscal health is already headed to the ER, the state needs to prove it can and will achieve the reforms first. Not just " demonstration" projects, actual results. Otherwise, this all sounds too much like the old cartoon character J. Wellington Wimpy's famous phrase, "I will gladly pay you Tuesday for a hamburger today."

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Alaska Health and Social Services

Expanding and reforming Medicaid will save lives and cut the number of uninsured Alaskans in half. It's the right thing to do.

• Paul Johnson Arguing over semantics while people die is inexcusable. Instead of sitting on the sideline bitching maybe you should lay down some concrete alternatives or solutions.

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  Thoughts on Alaska Oil & Gas Its not semantics; it's dollars and Alaska has less and less of them. They need to be spent wisely. If you have followed, you know that we have laid out alternatives -- reduce the scope of services covered by Medicaid (Alaska's is the most expansive in the nation, well above federal minimums), reduce eligibility levels (Alaska has the highest threshhold (above poverty line) in the nation, well above federal minimums), reduce reimbursement rates (Alaska's are the most generous in the nation, well above federal minimums and one of only two states where Medicaid reimbursement levels exceed Medicare reimbursement rates). The proposed expansion bill barely makes a dent in any of those and as a result, will increase Medicaid spending, reducing remaining funds available for K-12, University, revenue sharing and leading some in Juneau already to talk about implementing taxes and cutting the dividend -- i.e., increasing Government Take from Alaska's own citizens.

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