- Associated Press - Tuesday, April 7, 2015

JUNEAU, Alaska (AP) - One of the big questions with less than two weeks left in the scheduled 90-day legislative session is whether lawmakers can reach agreement on a package to expand and reform the state’s Medicaid program. The following is a look at some of the debate:

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WHAT IS MEDICAID EXPANSION?

Under the federal health care law, states can expand their Medicaid programs to provide health care coverage for people with incomes up to 138 percent of the federal poverty level. For states opting for expansion, the federal government is to pay 100 percent of the costs of the health-care costs of newly eligible beneficiaries through the calendar year 2016. The federal contribution is to step down after that, to 90 percent by 2020.

The federal contribution rate for the current Medicaid program is 50 percent, according to the state health department.

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WHO WOULD BE COVERED?

Adults between the ages of 19 and 64 who are not disabled, caring for dependent children or pregnant and who meet income guidelines. For a single adult, that is an income of up to $20,314 a year; for a married couple, up to $27,490 a year. A report commissioned by the department indicated that about 44 percent of those in the expansion population in 2012 and 2013 were employed, while about 30 percent were unemployed, a category that includes people looking for work.

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WHY IS EXPANSION NEEDED? WASN’T THE FEDERAL HEALTH CARE LAW SUPPOSED TO PROVIDE COVERAGE?

To qualify for a federal subsidy to buy private health insurance on the federally run online insurance marketplace, people must earn between 100 percent and 400 percent of the federal poverty level.

The law as passed required states to expand Medicaid to receive Medicaid funds. But the U.S. Supreme Court made expansion optional, ruling in 2012 that the federal government cannot require states to accept it. As a result, those earning less than 100 percent of the poverty level in states that do not expand Medicaid fall into what has been referred to as the doughnut hole and are not eligible for Medicaid or a health-insurance subsidy.

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WHAT IS THE DEBATE?

Medicaid makes up about 60 percent of the state health department budget and is a driver of the state operating budget. The current program is widely seen as unsustainable.

Some legislators worry about the impact of expanding Medicaid and adding thousands more people to a system that they say is broken. They also worry about whether the federal government will live up to its end of the bargain in providing match funds.

Supporters of expansion say the state hasn’t refused federal transportation dollars with similar match rates for fear the federal government will pull out, and Gov. Bill Walker’s administration has said the state will not participate in expansion if the federal match falls below 90 percent.

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HOW MANY PEOPLE WOULD BE COVERED?

The numbers have varied. A 2013 report by The Lewin Group projected that about 40,000 of an estimated 65,000 Alaskans eligible for enrollment in 2016 would enroll; the Alaska Native Tribal Health Consortium, in a 2013 report, projected expansion enrollment around 35,000 for 2016. Evergreen Economics, in a report released earlier this year, estimated about 42,000 Alaskans would be eligible to enroll in fiscal year 2016 and about 20,000 would. Evergreen Economics estimated the number of new enrollees would grow to nearly 27,000 by 2021.

Even if all the roughly 42,000 Alaskans identified as eligible for expansion by Evergreen Economics enroll for the coming fiscal year, which begins July 1, the state would realize savings of about $4.6 million, according to the health department. That takes into account the expectation that the Alaska Mental Health Trust Authority will pick up the first-year administrative cost of about $1.6 million. The savings come from the federal government picking up costs otherwise covered by the state, including some inmate health costs.

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