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Rep. Les Gara
A Note from Rep. Les Gara

Begich Quietly Earns A Shout Out:
Joint Work Gets Major Alaska
Medicare Fix In Health Reform Bill

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Dear Neighbors,

         While millions of Americans focused on the hot button issues of the national health care debate, Senator Mark Begich was doing some unnoticed work to improve the ability of Alaska’s seniors to find a doctor.  He hasn’t asked for credit, so I’ll force it on him – for passing an important amendment to provide what could be the most important Medicare improvement for Alaskans in a decade.   For it to work, the governor and Legislature will have to pitch in, but this is the best news on the Medicare front we’ve seen in years in Alaska.

         The reform is one we presented to his and Sen. Murkowski’s office a year ago.  Last summer I and Rep. Lindsey Holmes sat down with Senator Begich to talk about it again, and since then we’ve been plugging away (with his office taking the lead!!!).  In November he found an angle in the health care bill, while other people were calling each other Nazis for their health care positions, and arguing about Death Panels that didn’t exist.  Apparently, no one told Senator Begich that Senate freshmen aren’t allowed to write major Medicare reforms. 

         Here’s the issue, and what the amendment does.

         Currently, thousands of seniors in Anchorage, the Mat-Su Valley, Fairbanks, and a growing number of other communities are being turned away by their doctors.  I’ve written about this problem, and our efforts to solve it, in the past.

         The federal Medicare program, while it works fairly well in most states, uses a formula that – in Alaska and a few other places - under-compensates doctors, nurses and other medical providers for the care they provide.  As a result, many physicians have stopped taking Medicare patients.  Medical insurance that doctors won’t take isn’t medical insurance.  And seniors who have worked their lives for Medicare coverage should be able to find a doctor when they are ill.

         Federal law doesn’t allow states or patients to supplement the Medicare payment.  So, if a doctor won’t see you, there’s nothing you can do to change their mind. 

         So, what’s the solution?

         Plan A: The best solution is to raise the federal reimbursement rate, but our congressional delegation hasn’t been able to get the support to do that.  Former Senator Ted Stevens made some progress in raising this rate in the past, but because of opposition from senators in states where Medicare works fine, he never was able to raise the federal rate enough to fix the problem.  In November, Senator Begich’s bill (he’s a co-sponsor) to raise the reimbursement rate was blocked from the floor for a vote.  As you know, the atmosphere in Washington, D.C., these days is partisan and toxic.  His effort had the support of roughly 45 Democrats, but opposition from roughly 10 Democrats and every Senate Republican.  He needed 60 votes to bring it to the floor for a vote.

         Plan B: Last year we tried to get around the federal ban on supplemental state payments with legislation we filed, that would have offered a state bonus to doctors who saw 200 or more Medicare patients in a year.  While Senator Begich’s office worked with us to try to get federal approval of this approach, in the end federal regulators said this violated the Medicare ban on supplemental state payments.

         So – we sat down with Senator Begich to look for a “Plan B” – to allow states to supplement the Medicare payment in areas where the reimbursement rate is too low for patients to secure medical treatment.  In the fall, Senator Begich found an angle and added this provision to the health care bill.  But at the time, and until a week ago, it wasn’t clear whether the language would survive in the bill.  Through great work by him and his staff, it’s now law.

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         So – today, the state has the option to provide supplemental payments to physicians, nurses, and other medical providers.

         Is this a perfect solution?  No.  The perfect solution would be a better Medicare reimbursement rate, which Senator Begich says he’ll keep pushing.  It will cost some state funds.  That’s not great.  But if we have to choose between a state where seniors can’t get medical care, or making a modest contribution so they can, I’ll choose the latter. 

         This effort, added to the efforts many of us have launched to spur the creation of more Medicare clinics (which would be more likely to succeed with a state supplemental payment), will serve our seniors well.  I’ll have to apologize to the Governor and my legislative colleagues that we now have a decision to make.  I hope there’s enough time to make it before the legislative session ends in 30 days.  But if not, I hope the public will tell us, this summer, to come back in January and take advantage of the Senator’s good work.

         As always, let us know if you have any questions. 

         My Best,

[signed] Les Gara

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