COMMENTARY: Murkowskl Questions Health Care's Direction

Republican U.S. Sen. Lisa Murkowski wanted to talk. I heard from her spokesman last week, and we set up a time for a call. Murkowski said she'd read my commentary about the skyrocketing price of health insurance on the individual marketplace in Alaska, and had some thoughts to share. Our Q&A is below, with light edits and trims for clarity and brevity. I remain skeptical that journalism about America's health care system is capable of producing significant policy change. But I'm open to the idea of making some space for discourse on the subject in Northern Journal and happy to continue to hear feedback and ideas from readers; thanks to the many of you who have sent messages already.

Lisa Murkowski: I wish that I could tell you, you are so wrong, Mr. Herz - this is not what's happening out there. But you know, for me, it's kind of like deja vu all over again, from when we were going through the AC A (Obamacare, enacted in 2010). We were seeing everybody's health care costs high, and their insurance costs high - and in no place in the country was it as bad as Alaska.

Once again, we're going off the charts, and I'm worried about the current situation, because we've got some demographics that are working against us. As much as I like to think that I'm not getting any older, I do recognize that I am able to ski at Alyeska now with a senior ski pass - and that's great, because it's very affordable. But Alaskans are getting older, and our chronic conditions are just getting chronically worse, and these are factors that are driving things, in addition to all the external stuff. And so, it's just, we're not heading in the right direction here.

I don't know that I have all the answers, but this is something that I really care about. And I think we're going to jump into this, hopefully, in the new year on the HELP (Health, Education, Labor and Pensions) Committee, because we've got to get refocused. Nathaniel Herz: Were you surprised to read the specific numbers about premium increases in Alaska this year? Or did you already know?

Lisa Murkowski: I get visited by (insurer) Premera. I get visited by (insurer) Moda. I talk to the folks at the Alaska Division of Insurance. We're given the, 'Oh, Alaskans are going to see an X% increase.' But I think the thing that got my attention was the fact that, for the past three years, you've got cumulative increases that exceed 50%. I mean, it's one thing to say, 'Oh, it's going to be an 8% increase or it's going to be a 12%, increase even, or a 16% increase.' But then, when you say over 50% in just a couple-year time span, that's when it's kind of, you know, gut punching.

Nathaniel Herz: Do you have good sense of what is driving these huge increases in the individual and small group health insurance markets? Is it one thing in particular, or do you feel like that's something you need to spend more time to get to the bottom of?

Lisa Murkowski: Well, I think some of the things haven't changed since we were having the AC A debate. Even though our population has grown, even though we have more providers than we had, we still have limited competition. We just do. We've got limited competition when it comes to the providers, the specialists, but also with the insurance companies. Our primary is still Premera. And, you know, you've got Moda out there. But I mean, really, in terms of what we have available to us as options, it's not like Alaskans can kind of shop around. So, that is something that I think is a contributor. Then, you just have the pure logistics of health-care delivery in a huge state like Alaska, where your costs for everything - whether it's heating your clinic or moving doctors around, or the fact that you can't get certain professionals in your business without paying them a lot - I think you have some of those factors that are out there.

But you've also got some things that, I think, are areas where we can work to perhaps peel back some of this onion, and some of it lies with, just, transparency within the overall health care system. I went to my post office box a couple of days ago, and I got a bill from somebody who read a screening that I took back in April. I did this, what, three days ago? And it says, 'You now owe $105,' or something like this. And there's three separate charges on it. It was months ago; I didn't know that they were sending anything to a radiologist. And so, I get this statement, and there's nothing on it except a code. The code means nothing to me. I have no idea how much was originally submitted to my insurance. All I know is that now I'm being told, 'This is what you owe.' And I'm like, 'Well, okay, I can spend the time now to call these three different places and say, "All right, did you submit it to my primary?" Which is Medicare. "And my secondary?" Which is my state plan.' And, you know, basically give myself three hours to try to figure out whether or not all the steps were taken before I pay whatever the amount is.

It's an example. You're saying, 'You're not the expert.' I'm saying, 'I'm not the expert!' But we 're all consumers, so we all have our stories about what the hell's going on. You know: Why can't I get a straight answer about, 'what was it that you billed me for? How did my insurance company handle it?" Other than: 'You owe this now.' And I think that there is something that, both on the federal and the state side, we've got to be working on.

I think we're going to make some headway also with prescription drug pricing, more focused on making sure that generics have fewer barriers there.

But, you know, as I even say those things, it's like, 'Gosh, that sounds like such a drop in the bucket when you're you're dealing with the big drivers that we face.' Which are things like the medical cost inflation that I mentioned, the chronic diseases and the aging population. Some of these things are just issues that are going to continue to eat at us.

Nathaniel Herz: I feel somewhat reassured that, as a policymaker, you're experiencing some of these same frustrations that regular people do. But I also have the same kind of skepticism that these big picture problems are within your power to solve or make progress on.

Lisa Murkowski: I'm being careful in (not) saying, you know, 'We're going to fix this.' But I think that we can make some headway. You can argue back and forth about whether you think Trump's nominees in certain of these health agencies are the right people. It's very clear to me that the direction that he wants to move things on the health side are areas where there's more attention placed on prevention up front, and actually making us healthier, which is not a bad thing. If you're healthier, you have fewer health care costs. That's not a bad direction. I think that is long overdue. How that's going to happen, that remains to be seen.

But I do think that a focus on some of these chronic conditions, and more on the preventative side, is something that needs to happen. One of the things that I really didn't like about the ACA when we passed it was, it really didn't do a thing to lower health-care costs. What it did was, it worked to make health insurance more affordable for some. But we didn't really focus on prevention like I felt we should. Maybe we're going to start to be a little more aggressive in that area, and I think that that will be good for us.

Nathaniel Herz: On the specific issue of the enhanced tax credits for the premiums for the individual marketplace health insurance plans - it seems like there is a real question about whether those continue. What is your sense of where that's going in this new Congress?

Lisa Murkowski: There's a couple things going against it right now, with Republicans taking over. First of all, Republicans hated the American Rescue Plan (the Biden-era legislation that created the enhanced credits), and they hate, hate, hate the Inflation Reduction Act (the Biden legislation that extended the credits). And so, I worry a little bit that it's going to be one of these, 'We're just going to throw everything out. We didn't like those, and so we're going to let these expire.'

I look at this, and I would make the argument that you've got a lot of folks that have seen some real relief. These are middle income people who look at the increasing costs of their health care insurance for them and their families. They might not be seeing a three-year, cumulative increase of 50%. But it's significant, and it's making a difference, and it's what people are talking about - particularly this time of year, as you've got to re-up your plan.

Given the burden that families are still feeling in so many parts of the country when it comes to inflation - you think about this whole election in 2024, and so much of it was about, 'Hey, I'm paying so much more for everything.' So, health care is right in that bucket. And I think you're going to have real pressure coming on this administration and the Congress to continue these credits.

I'm looking at them really, really carefully. And I think Congress is going to have to have some more time to build out some of these more long-term solutions to work to reduce our overall health care costs. And I think we're going to need to continue these premium tax credits. And I think it's not just going to be the pressure that you're going to hear from Alaskans that are saying, 'Wow, this is not good.' But I think (expiration of the credits) has the potential to move us backwards, in terms of the progress that we have made in improving access to health care and affordability.

I think you're going to have a fair share of back and forth from those who say, 'It came about in a law that we didn't like, and we need to get rid of them, we shouldn't have subsidies.' But you tell me any place, any place in the country, where your health care costs or insurance are going down and making things easier for families. If it's happening, I'm sure not hearing it.

Nathaniel Herz: So, it sounds like fair to say that you're a yes, in isolation, on continuing the enhanced credits? Lisa Murkowski: For the tax credits to continue, yeah. I think we're going to have to. I don't know what that may exactly look like - whether it's just a straight extension, I don't know. But I think we're going to have to wrestle with this, and I think we're going to be hearing a lot from our constituents on it. Nathaniel Herz welcomes tips at [email protected] or (907) 793-0312. This article was originally published in Northern Journal, a newsletter from Herz. Subscribe at this link.