AUDIE CORNISH, HOST:
As we just heard, Alaska Republican Lisa Murkowski is among those lawmakers with reservations about the direction of the Senate's health care bill. Alaska is a deeply red state, but many of its rural residents depend on Medicaid for health care.
Governor Bill Walker was a Republican. He now identifies as an independent. He expanded the state's Medicaid program under Obamacare, and he's worried about what will happen next. I ask Governor Walker to describe his concerns with the legislation being crafted in the Senate.
BILL WALKER: We're concerned about many things up here. One is that we haven't seen the bill, and it's hard to prepare and respond back to something that we have not seen yet. So that's certainly a major concern to us. Being that I'm an independent and nonpartisan governor, the only one in the nation, I look at it not from the - there's no partisan side to health care. It's only taking care of Alaskans, and that's what my job is. So we're very concerned about how this could impact our residents.
CORNISH: Are you afraid you're going to have to boot people off of Medicaid?
WALKER: Well, and that certainly is a potential, and we hope not. You know, when I accepted Medicaid expansion, you know, it was a huge help to not only just those that need health care - also on the opioid issue. I declared a declaration of disaster on the opioid epidemic in Alaska, and we set up an incident command system. And so we're attacking it as the emergency that it is.
CORNISH: So your concern is about coverage for addiction treatment as well that would usually come under the health care - Affordable Care Act bill as it is right now.
WALKER: That's correct.
CORNISH: You say that - in a letter you've written to House Republicans that a lot of your concern is about the timing of how whatever changes will happen will happen and whether they'll be orderly or not. Does this situation - does it look like it's a mess to you?
WALKER: Well, and that gets just back to the fact - my concern is we race for a deadline that is perhaps expedited beyond what is best for those that are served by Medicaid and Medicaid expansion. Alaska is very - I mean every state is unique. There's no question about it. Our uniqueness come from the fact that 82 percent of our communities are not connected by roads. So we don't take a $300 ambulance ride to the hospital. We take a $50,000 to $150,000 medivac. That's a significant difference for - in Alaska. Our costs of health care are certainly the highest in the nation.
CORNISH: Now, Alaska is also different in that you were able to come up with a plan to hold down premiums essentially using some state budget money to prop up insurance costs for the sickest citizens - without going into too much detail, a kind of reinsurance program. I know some other states are looking at copying this, but is it sustainable. I mean is it a Band-Aid on a bigger problem?
WALKER: Well, I think it is. We only have one carrier here in Alaska, so that's a concern - a major concern that we have. So...
CORNISH: Meaning one insurer left in the Affordable Care Act exchanges.
WALKER: That's correct. We'd like to see more, you know, carriers in Alaska, not - obviously you can't get much less than one. So it's a stability that is needed for that to - and, you know, bring other carriers to our state.
CORNISH: So how are you planning? How are you thinking about the next year?
WALKER: Well, I mean first things first. We want to find out what we're doing with the Affordable Care Act, how that's going to change, how that's going impact Alaska, certainly working with the carrier we do have in making sure that that carrier remains in place. And in fact, I was in a call this morning with some of our health care team on this issue. So it's a high - it's one of the highest priorities we have.
CORNISH: So in the end, what's your chief concern I mean to the lawmakers who may be hearing this in Washington?
WALKER: Well, our biggest concern is there will be changes that will disproportionately shift the costs onto the states. And that is something that would be - if it was on a block grant or something of that nature, it would be very harmful to us because if - not all states are the same as far as the costs of health care. So it's definitely a - you know, no one size fits all. And if we attempt it that way, Alaska will be sorely damaged in the process.
CORNISH: Governor Walker, thank you so much for speaking with us.
WALKER: Thank you very much. Transcript provided by NPR, Copyright NPR.