Health Care

Alaska’s “Polar Payoff”

Senator McConnell has a tight needle to thread. To pass TrumpCare, he can only afford to lose two of his members—and Senators Collins and Paul are looking like pretty firm no’s.

That means he has to pull out all of the stops to get everyone else on board. Hence, the Polar Payoff: a special provision that applies only for Alaska. It says any state with very high premiums relative to the national average gets extra money. Benefting only Alaska, it steers hundreds of millions of dollars the state’s way, to try to buy off Senator Murkowski.

But no special Alaska slush fund makes up for the destruction of this bill. Medicaid is decimated, even after revision: the expansion ends, and the program is transformed permanently into a system that caps coverage. Because the Cruz Amendment is included in the bill, insurance companies would once again be able to discriminate against people with pre-existing conditions. The bill is terrible for rural hospitals, in a state where 1 in 5 Alaskans work in the healthcare sector. The bill also totally fails people who need treatment for opioid addiction, even with a new pot of $45 billion added. Alaska’s share of $45 billion over 10 years divided by 50 states is far less than the state needs if Medicaid is destroyed and the ACA’s patient protections are ended.

Finally, it’s possible that Republicans won’t even be allowed to include the Polar Payoff in the final bill. That’s because it may violate the rules of the special reconciliation process Republicans are using to get TrumpCare through the Senate. A similar state-specific provision nicknamed the Buffalo Bribe, added by the House to get a handful of upstate New York Republicans on board, was stricken by the Senate Parliamentarian for violating the rules. The Polar Payoff could suffer the same fate.  


Caller: Hello! My name is [name] and I’m calling from [part of state]. Can you please tell me how Senator Murkowski  intends to vote on the Better Care Reconciliation Act?

Staffer: There is no vote currently scheduled on that bill.

Caller: Yes, but I’ve heard the Senate will have the first procedural vote as soon as tomorrow. How will Senator Murkowski vote on the bill?

Staffer: She hasn’t taken a position on the bill yet.

Caller: That’s terrible. Senator Murkowski needs to oppose the TrumpCare bill. She made her concerns known in a very public way. She said she wanted to see changes to the Medicaid sections of the bill. Well Mitch McConnell didn’t make any. She’s even said she wants to “set Medicaid off to the side.” That’s not what this bill does. This bill destroys Medicaid.

Staffer: The Senator still has concerns, but she is pleased there is a new provision in the bill that benefits any state that has premiums 75% higher than the national average, including Alaska. That is unquestionably good for our state.

Caller: That provision was included for the specific purpose of buying Senator Murkowski’s vote. It is not good enough for our state. The bill still destroys Medicaid—which Senator Murkowski said she cared about. And they may not even be able to include this provision in the bill, after the Senate Parliamentarian said other state-specific provisions broke the rules of reconciliation.

Staffer: There’s been no decision from the Senate Parliamentarian on this provision yet.

Caller: Well either way, no extra slush fund can make up for the rest of the bill. And it doesn’t do anything for people with pre-existing conditions that will be hurt by the Cruz Amendment, which is also included in the bill.  

Staffer: This bill protects people with pre-existing conditions.

Caller: That’s not true. The bill allows states to let insurance companies sell plans that don’t cover essential health benefits, meaning people with pre-existing conditions won’t be able to get the care they need. And the new proposal from Ted Cruz makes it even worse. The extra funding also doesn’t make up for the defunding of Planned Parenthood, which women and men rely for important health services. Senator Murkowski said she cared about that, too.

Staffer: The Senator is still undecided. I’ll be sure to pass along your thoughts.

Caller:  I expect Senator Murkowski to oppose this bill. Please take down my contact information so you can let me know whether she decides to stand with me or with Trump.