With the meter set to expire soon on the Legislature’s 90-day session, the big question around the state capitol: Is there enough time left to get a Medicaid expansion and reform bill passed? Or, will lawmakers be forced to go into overtime to finish work on a bill that seems to have popular support.


A March poll from Ivan Moore Research shows the governor had a 60 percent approval rating in March, with 65 percent support for Medicaid expansion, compared to about 22 percent in opposition.


Those numbers are lower in a Dittman Research poll, commissioned by the Republican Majority — but they still show strong support for Gov. Bill Walker and Medicaid expansion.


In the Dittman poll, also conducted in March, Walker has a 54 percent approval rating. Only 13 percent of the respondents had a negative view of his performance.


These numbers put the governor in a good position to be in the bully pulpit for Medicaid expansion.


Of those surveyed in the Republican Majority poll, 60 percent said they want Medicaid expansion, compared to 31 percent who don’t.


Despite those numbers, House Majority leaders say they’re in no hurry to expand Medicaid.


“It’s really a billion-dollar gamble,” said Rep. Craig Johnson, chairman of the Rules Committee.


Johnson says lawmakers should weigh this decision carefully.


“So, how much time should we take? And my answer to that, is, as long as it takes to make sure we’re doing due diligence,” Johnson said.


House Speaker Mike Chenault says he wants to know more about the Medicaid system’s computer problems and how they got so far behind in payments to medical providers that some have had to declare bankruptcy.


If the state accepts $145 million in federal money to expand Medicaid, more than 40,000 uninsured Alaskans would be eligible for health care.


Chenault isn’t ready to sign on to expansion unless there are assurances the system can absorb new people without being overwhelmed.


Chenault says he has too many questions.


“How do we try to rein in those costs?” he asks. “What’s it going to take to fix it? And what’s the actual cost of expansion? That causes concern. It’s like writing a blank check and hoping it works out right.”


Sen. Bill Wielechowski, a Democrat and an advocate for Medicaid expansion, says lawmakers shouldn’t make their decisions based on polling — but in this case, they do show that they need to pay attention to their constituents.


“Let’s go ahead. Pass something. If we need to come back in special session or next session and tweak it, let’s do that,” Wielechowski said. “The time is now. I think we need to act and not let the perfect get in the way of the good.”


Throughout the week lawmakers have heard about the benefits of expansion.


On Thursday, two Kenai Peninsula hospital administrators told lawmakers Medicaid expansion will make more money available to improve health care for all the patients they serve — because there will be fewer charity cases turning up at the emergency room, which require some of the most expensive care.


Becky Hultberg, head of the Alaska State Hospital and Nursing Home Association, says hospitals in the state spend over a $100 million a year in what they call “uncompensated care” — treatment for people who can’t afford it.


“We’re all paying for that. We pay for that, because hospitals still have to cover their fixed costs,” said Hultberg, who also points out that the Central Peninsula Hospital in Soldotna and the South Peninsula Hospital in Homer are community hospitals, so in a sense, everyone in the region pays.


The same is true for Bartlett Regional Hospital in Juneau, Hultberg said.


“Bartlett estimates they would have an additional million dollars in revenue coming in with Medicaid expansion,” Hultberg said.


She says an extra million dollars could go a long ways toward improving care in a small community like Juneau.


Hultberg also says the backlog of Medicaid payments to medical providers are gradually getting caught up, so this shouldn’t be an argument against expansion anymore.


But she says the emphasis Medicaid opponents place on reforming the system is good, but their approach is wrong.


Hultberg says lawmakers need to understand reform is complicated and can’t be accomplished in one big bite.


“We need to start the process — and starting the process is looking at some of the bills right now and moving forward with Medicaid,” Hultberg said. “We could wait for years talking about reform. Reform is not a destination. Reform is a journey. We need to be doing it every year.”


Hultberg said reform can begin with pilot programs, as well as savings that will occur when Medicaid expansion covers some of the costs the state is now paying for, such as the health care for prison inmates.


Medicaid expansion, she says, will create opportunities for hospitals to improve health care overall.


“Because what is required to accelerate innovation is capital investment,” Hultberg said. “And right now, many hospitals don’t have the financial investment cability to innovate.”


Lawmakers, as they wrestle with a $4 billion budget gap for the current fiscal year, are hesitant to put the state at more risk. They say it’s possible in the next week to pass a Medicaid bill, but with everything else in the backdrop, the odds are against it.


Medicaid expansion is likely to be a bargaining chip in the end-of-session game, along with education funding — especially in the House, where the Republican Majority will need votes from Democrats to reach the required three-quarters majority to tap one of the state’s main savings account, the Constitutional Budget Reserve, which is needed to cover some of the state’s multibillion-dollar deficit spending.


On Saturday, starting at 1 p.m., the public will have one of its last chances to weigh in. The House Finance Committee will take statewide testimony on the governor’s Medicaid legislation, House Bill 148.


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