With health care, not all Alaskans are as lucky as the attorney general

I’m glad that Attorney General Kevin Clarkson, who has good health care coverage as a state employee, received the emergency medical attention he needed after he suffered a heart attack.

“I now have two stents in my heart to keep the coronary artery open and I currently get around a little slower,” Clarkson wrote in the guest opinion column that has appeared in newspapers across the state.

“So what are the lessons to be learned? Take care of your heart. Get checked regularly by your doctor,” he said.

I agree with his advice. But I can’t pass it along without mentioning the serious contradiction here with the Dunleavy administration effort to reduce the level of health care to many thousands of low-income Alaskans who aren’t as well fixed as state employees.

Gov. Mike Dunleavy plans to cut more than $700 million from Medicaid, including about $465 million in federal funds. No one has been able to explain with that will mean to low-income people who need to take better care of their hearts.

Dunleavy, health commissioner Adam Crum and other administration officials met with Anchorage doctors and other health care professionals last week in a contentious session that touched on many unanswered questions. The video has been posted on Facebook and is worth watching.

The governor is comfortable with his budget talking points, but he is unable to give a good reason why Alaska plans to refuse hundreds of millions in federal money that provides health care to low-income Alaskans.

One doctor said he couldn’t understand why the state would refuse the money, except perhaps that it is “easier to cut stuff from poor people.”

“That’s not my intent to cut from poor people. I mean that’s not the intent,” Dunleavy said. When audience members said that is the result, Dunleavy said “I understand, that’s not the intent though.”

His intent is irrelevant. All that counts is the impact of his policy.

An emergency room physician said that people with serious illnesses will suffer and lose health care access. “I resent the implication that because that’s not the intention it doesn’t matter. It does matter. It matters to me and it matters to my patients,” the doctor said.

Another doctor mentioned a fisherman in the Aleutians, let’s call him Tom, a man with HIV who is still alive because of Medicaid expansion.

The doctor mentioned that he could use Dunleavy’s help when the cuts go through and Tom has to be told “that I can no longer be his physician and he can no longer access life saving care and may die.”

Dunleavy said, “that’s a tough one” and retreated to his usual line about sustainability.

A moment later, Crum said the state never said it would cut Medicaid expansion and “How would a 5 percent rate cut to you make you stop seeing Tom"?” (The Dunleavy administration has never explained what services would remain after the $714 million cut.)

There was a strong reaction from everyone in the room to Crum’s comment. This may be a sign that Crum is unaware that Medicaid rates to doctors have dropped by more than 20 percent over the past five years.

The doctor said this is not about his fee, but other costs. He mentioned cuts to housing and transportation that allow Tom to get to Anchorage for treatment. He also said the HIV medications cost $3,000 a month. “I’m not worried about my income. This is not the issue. I’ll see Tom for less money. Tom’s got to come and be able to get to see me. He’s got to get here. He’s got to have housing. He’s got to have medications.”

“I can go with a 5 percent cut. I just want my patients to be healthy and alive for the coming years,” he said.

A little while earlier, another doctor said the trend to lower reimbursement is putting his practice at risk. He said that in his 30-year career his philosophy was always to treat whoever came through the door, but in the past year things have taken a turn for the worse. Lower payments and rising costs have him worried to death.

“I will tell you that if this trend continues, it’s gonna break me. It’s gonna collapse me. I think a lot of people in this room are probably in the same situation.”

Let’s celebrate the attorney general’s recovery, but recognize that the Dunleavy plan to put less fortunate Alaskans at risk is dead wrong.