By Jonathan Ingram and Josh Archambault. Mr. Ingram is research director, and Mr. Archambault a senior fellow at the Foundation for Government Accountability.
In July, Alaska Governor Bill Walker (I) announced his intention to unilaterally implement Obamacare’s Medicaid expansion. Walker’s expansion would shrink Alaska’s economy, discourage work, crowd out resources for truly needy patients and ultimately put funding for education, pensions and other critical services at risk.
But Gov. Walker’s unilateral Obamacare expansion isn’t just bad policy, it’s also likely illegal.
Alaska Legislators Beginning To Challenge Gov. Walker
Earlier this year, Gov. Walker lobbied unsuccessfully to expand Medicaid under Obamacare. Seeing that his efforts had failed, Gov. Walker waited until after the legislature had adjourned and announced that he would expand Medicaid without legislative approval.
Now that Gov. Walker has announced his intentions, state lawmakers are beginning to stand up and demand answers. Alaska Senate Majority Leader John Coghill, for example, recently questioned the legality of Gov. Walker’s actions in the Alaska Dispatch. Representative Liz Vazquez circulated a memo to her colleagues covering similar ground.
Their arguments are pretty straightforward: Alaska law prohibits the governor from expanding Medicaid to any “additional groups … unless approved by the legislature.” This means that Gov. Walker could only expand Medicaid to a new class of able-bodied childless adults if this coverage group was already authorized by state law.
The governor can only provide Medicaid to two classes of people:
(1) individuals that the federal government requires Alaska to cover in order to participate in the Medicaid program; and
(2) individuals who belong to one of 15 specific optional eligibility groups.
Because Obamacare’s Medicaid expansion group fits neither class, Gov. Walker’s proposed Medicaid expansion is likely an illegal power grab.
Obamacare Expansion Is Not Required By Federal Law
If federal law requires Alaska to expand Medicaid in order to keep participating in the Medicaid program, Gov. Walker would be authorized to expand eligibility under existing state law. The only problem?
Federal law does not require Alaska to expand eligibility to a new class of non-disabled adults without dependents.
Although Obamacare originally called for a mandatory Medicaid expansion, the Supreme Court made that expansion optional in NFIB v. Sebelius. The Court ruled that a mandatory expansion would be unconstitutional and then prohibited the Obama administration from “withdraw[ing] existing Medicaid funds for failure to comply with the requirements set out in the expansion.”
The Court held that states must be given a “genuine choice whether to accept” Obamacare expansion, giving them the opportunity to either “voluntarily sign up” for the expansion or “choose to reject the expansion.”
Because NFIB made Obamacare’s Medicaid expansion optional, Alaska law does not authorize Medicaid expansion as a mandatory coverage group.
Gov. Walker Admitted Obamacare Expansion Was Optional Earlier This Year
Gov. Walker has already admitted that Medicaid expansion was optional. Earlier this year, he proposed House Bill 148 and Senate Bill 78. Both bills would have authorized the ACA’s Medicaid expansion by adding a new optional eligibility group in Alaska law. The Alaska Legislature rejected both bills.
In fact, Gov. Walker frequently touted a letter from HHS Secretary Sylvia Burwell while lobbying the legislature to expand Medicaid. In her letter, Burwell states there is “no requirement for a state to maintain coverage for the new adult group” under the Obamacare.
Obamacare Expansion Is Not Otherwise Authorized Under State Law
Alaska law also provides Medicaid eligibility to 15 specified optional eligibility categories. These optional eligibility groups include, among others:
- Individuals eligible for but not receiving SSI or TANF benefits;
- Children in foster care;
- Certain individuals living in institutions;
- Pregnant women below a specified income level who are not otherwise eligible;
- Certain children with special needs;
- Certain individuals with disabilities;
- Children below a specified income level who are not otherwise eligible;
- Certain women diagnosed with breast or cervical cancer.
Notice anything missing?
Obamacare’s Medicaid expansion is nowhere to be found. Gov. Walker recognized this fact when he attempted to amend state law to make Obamacare expansion the 16th optional group authorized by state law.
Time For Alaska Lawmakers To Stand Up To Gov. Walker
Alaska policymakers held numerous hearings on the Medicaid expansion issue. After careful consideration, they flatly rejected Gov. Walker’s proposal.
Instead of rethinking his position on the issue, Gov. Walker has decided to do an end-run around the legislature and expand Obamacare unilaterally. Walker’s proposed expansion isn’t just bad policy, though; it’s also likely illegal.
It’s time for lawmakers to remind Gov. Walker that Alaska has more than one branch of government. Legislators were right to turn down Obamacare’s Medicaid expansion. Now they must prepare to do whatever it takes to block Walker from illegally implementing a policy they rejected.
TWITTER: @JoshArchambault and @ingramlaw , and follow The Apothecary on Facebook. Or, sign up to receive a weekly e-mail digest of articles from The Apothecary.
