In Alaska, Governor's Move on Medicaid Expansion Is in Eye of Beholder

To hear Alaska Governor Bill Walker tell it, his announced plan to accept federal money to expand Medicaid is his “final option” after the legislature tabled a bill that would have given lawmakers a voice in the move.

In talks with reporters in the state capital of Juneau, Walker says he isn’t going to wait any longer than necessary for those without health coverage to get it, and he plans to roll out expansion on September 1, 2015.

But for critics of the move, Walker is going back on an earlier agreement to hold off on Medicaid expansion until 2016; as recently as last month he had reached an informal agreement to do with Alaska’s legislative leaders.

Laws in each state are different, which have allowed some governors who support Medicaid expansion to those earning up to 138% of the federal poverty line to expand the program under the Affordable Care Act (ACA), despite opposition of their legislatures. Walker claims that a quirk in Alaska law allows him to move forward because no new state funds are required for expansion, at least not for now. Critics aren’t sure they have run out of options to block him.

On Saturday, during the evening session of the National Governor’s Association with HHS Secretary Sylvia Mathews Burwell, Walker referenced the acrimony over his decision when she called on the remaining expansion holdouts to work with her department to craft waivers unique to state-level needs.

Walker’s move comes amid declining oil revenues and he sees it as a way to expand healthcare with funds his state does not have. But a scathing review in Forbes by contributor Josh Archambault saw otherwise last week. He wrote that Medicaid expansion in Alaska would reduce economic growth and discourage work among the able-bodied. Archambault also predicted that many more would sign up for the program than projections foresee; if this happens, it would be consistent with what has happened thus far in many other states under the ACA.

Walker is 1 of 4 governors to expand Medicaid despite opposition from the legislature. The other three include Kentucky Governor Steve Beshear, a Democrat who leaves office next year due to term limits, and Ohio Governor John Kasich, a Republican who is now running for president. As in those state, Walker is betting that a successor will be unwilling to roll back benefits once they are in place, and his political survival—he is no longer a Republican but an independent—may be a separate matter from the healthcare he leaves behind.