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OPINION: Repeal of the 80th percentile rule is the change Alaska needs

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OPINION: Repeal of the 80th percentile rule is the change Alaska needs


To obtain change without changing is impossible.

For years, we’ve heard from Alaskans that health care costs need to change. They are too high. Nothing is being done about it. No one can stop this pricing spiral.

According to the Health Care Cost Institute (HCCI) June 2023 report, Anchorage ranks third in the nation for health care costs, with prices similar to those found in San Francisco.

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The repeal of the 80th percentile rule, which took effect on Jan. 1, 2024, is the type of change that can make a real impact on those high costs. The 80th percentile rule is intended to protect patients from surprise billing, which occurs when medical providers bill a patient for the difference between the amount they charge and the amount that the patient’s insurance pays.

When the 80th percentile rule was established in 2004, it stipulated that health plans must pay at the eighth highest rate out of 10 rates submitted, or billed charges if lower than the eighth highest rate. The higher the bill is, the higher the amount a health care provider is paid.

While the 80th percentile rule served its purpose in protecting consumers from surprise billing, it also meant providers could artificially inflate their rates in an endless chase to the top.

This is because there are no regulations that govern or place caps on what providers can submit to health plans for payment. Insurers like Premera were required to pay the 8th highest rate to non-contracted providers. So why, as a health care provider, would you contract with a health plan at all if you could handpick your reimbursement rate? For you, the sky’s the limit.

Now, I spent many years managing underwriting teams — the teams responsible for the complex calculations that determine insurance rates — so I’m a numbers guy. And what I can tell you is the numbers under the 80th percentile rule simply aren’t sustainable.

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One way we can measure the increase in cost is by using medical cost trends. Medical cost trend is how much we anticipate treatment costs will grow year-over-year and is one of the factors we use to set premiums. Our data shows the average medical service cost trend in Alaska for out-of-network providers under the 80th percentile is 4%, while it’s 1.8% for in-network contracted services.

When we look at our 2022 claims data, I’m shocked. Why should something like a mammogram cost $1,200 out of network in Alaska, but only $105 out of network in Washington? This is standard preventive care. Why should a COVID-19 antigen test come in at $139 out of network in Alaska but only $40 out of network in Washington? This is a simple, quick test.

The cost of living in Alaska is high, but to me, that seems preposterous. There is no regulation, ruling or governing body keeping health care costs in check. On the flip side, health plan rates are developed with both federal and Alaska Division of Insurance oversight.

Without the inflationary impacts of the 80th percentile rule, Premera:

• Filed a 2.5% reduction for 2024 employer premium rates

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• Worked with the Division of Insurance to establish new reimbursement rates for out-of-network providers at 185% of Medicare

• Committed to maintain all current in-network provider contracts until 2025

But since the repeal was announced, we’ve heard from providers across the state who claim this will result in such a drastic pay cut for them that they won’t be able to stay in business.

Let’s take a look at the numbers in a story we’ve heard several times in the news. One registered nurse says with the repeal of the 80th percentile rule, she will take a 70% pay cut. What that math tells us is that before the repeal, she was being paid at a rate that is at least 600% of Medicaid. Why should providers like that keep fattening their pocketbooks while Alaskans bear the brunt of their exorbitant costs?

We’ve also heard that patients are going to end up being hit with surprise bills from out-of-network providers. We contract with more than 80% of providers in Alaska to ensure our members have a robust list of in-network quality providers to choose from. We’re working hard to reach agreements with the remaining out-of-network providers so they can be paid at a rate higher than 185% of Medicare and our members are protected from high costs.

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You may be wondering what happens with those savings. It will go right back to our members and customers. Insurers are legally required to spend at least 80% of premiums on the cost of care for our members, so if prices drop, our members will see relief.

We understand there is a delicate balance between controlling costs for our members and ensuring providers are appropriately compensated. We don’t benefit from “chasing” health care providers out of Alaska by negotiating low reimbursement rates. Without a strong network of providers, we’re unable to offer our members our core service – providing access to quality care.

All of this again boils down to change. The status quo was simply not sustainable and required a major change for Alaskans to start to see lower health care costs. But providers who are fighting the repeal don’t want to change. And why would they when, under the 80th percentile rule, they could essentially set their prices as high as they wanted?

The numbers just don’t add up.

Jim Grazko is the president of Premera Blue Cross Blue Shield of Alaska based in Anchorage. The company and its predecessors have operated in Alaska since 1952.

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The views expressed here are the writer’s and are not necessarily endorsed by the Anchorage Daily News, which welcomes a broad range of viewpoints. To submit a piece for consideration, email commentary(at)adn.com. Send submissions shorter than 200 words to letters@adn.com or click here to submit via any web browser. Read our full guidelines for letters and commentaries here.





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Juneau’s ninth Traditional Games welcomes international competitors

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Juneau’s ninth Traditional Games welcomes international competitors


Anchorage’s Matthew Chagluak performs an Alaskan High Kick during the 2024 Traditional Games in Juneau on Saturday, April 6, 2024. (Photo by Clarise Larson/KTOO)

The 2026 Traditional Games begin in the capital city on Friday. Around 200 participants from around the state and at least three other countries will compete through Sunday at Juneau Douglas High School: Yadaa.at Kalé.

The free event is co-hosted by the Central Council of the Tlingit and Haida Indian Tribes of Alaska and Sealaska Heritage Institute, with an opening ceremony featuring a parade of the athletes Saturday at 12:30 p.m.

KTOO’s Mike Lane spoke with coach, competitor and co-founder Kyle Kaayak’w Worl to learn about the importance of the games and what’s new this year.

Listen:

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The following transcript has been lightly edited for clarity.

Mike Lane: What exactly are the games? 

Kyle Worl: So the event has a collection of Indigenous games, and they’re mostly from the north, the Arctic. So you have the high kicks that are traditional Iñupiaq or Inuit games. We have stick pulls from the Interior Dene people. But this year, we’ve kind of broadened the perspective of traditional games and we are also including some traditional games in the form of workshops from our guests from New Zealand and Mexico. And then we have some canoeing activity as well, which is canoeing is one of our traditional forms of games here in Southeast as well. 

Mike Lane: How many events are there in total? 

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Kyle Worl: There are 12 competitive events where you can medal in. They hold cultural significance.

The seal hop is a game that is based on a hunting technique that was used in the Arctic to sneak up to seals laying out on the ice flow. And back when harpoons were used, you had to be able to get in range to hand throw that harpoon, and simply walking up to the seal wouldn’t work, you’d scare it off and it would jump back in the ocean. So the hunters developed a technique to hop like a seal to sneak up to the seal, and that’s what this game is based on. You’re in a like a push-up position on your hands and toes, and you have to hop for the greatest distance and the furthest distance places in the game, and it’s a game of both endurance and also pain tolerance. You’ll see the athletes, they’ll sometimes break skin as they hop on their their knuckles. It depends on the age groups — high schoolers, boys, they hop on their first knuckles, but the adults that compete have to hop on a closed fist. So we’ll see some pretty battered hands with broken skin as they go along the gym floor. 

Mike Lane: You’ve got people coming from all over the world to compete and also put on some workshops. 

Kyle Worl: Yeah. So this event has grown every year, and it’s, we always say, what can we do next year to bring it to the next level? And we wanted to bring a more international perspective to the games, because we know there’s there’s traditional games from all across the world. So we have teams from New Zealand and Mexico. Even Labrador in far eastern Canada is coming. So it’s very much a sporting event, but it’s also a cultural exchange, and that’s a really important aspect of this, is our sports are connected to our culture, and we want to make this an opportunity to learn from each other and learn about the variety of Indigenous games. So on Friday, we’ll have workshops with our Maori guests and our Mexican athletes. I know the Mexican workshop is an Aztec hip ball game where they have a, I think it’s like a 10 pound rubber ball that you hit with your hips. It’s been highlighted in movies like “El Dorado” and such, that’s where I first heard about it.

But it’s pretty cool to think that after all these years, we’re having these international guests come to our event, that it’s really grown into something pretty amazing. So we’re pretty excited. 

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Mike Lane: Who participates. I mean, is there an age range? 

Kyle Worl: The minimum age is 11, and we have three age categories. We have middle school — which is sixth, seventh and eighth — high school, ninth through 12th. And then we have an open adult category. 

Mike Lane: So 11 years old is the Youngest and what’s the oldest?

Kyle Worl: Because we have an adult division, some of the coaches of these high school teams also sign up. I’m not sure who the oldest is, but I’m sure there’s going to be a few people in their 40s, maybe older. 

Kyle Kaayak’w Worl smiles for a photo at KTOO on Tuesday, April 7, 2026. (Photo by Clarise Larson/KTOO)

Mike Lane: So there’s no ceiling?

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Kyle Worl: No upper age limit. You’re never too old to do the games. And I always say there’s a game for everyone. They’re not all about jumping and kicking, which may get harder with age. We have games like the Dene stick pull, which is a technique based game, and it’s based on grabbing a salmon out of the water. So it’s, it’s more about balance and technique. We have archery too, and there’s a lot of skill to it but it’s not something that’s going to hurt your leg. 

Mike Lane: And there’s artwork.

Kyle Worl: Yeah. So we’re really lucky that Corinne James agreed to design our 2026, shirts, and she did a formline design of Nalukataq, which is the blanket toss from the Iñupiaq people. And she did her interpretation in formline. It’s a really beautiful design. It’s going to be on all of our shirts. We have a pin made of it. So we’ve been really lucky to get really amazing Southeast Tlingit, Haida, Tsimshian artists to provide us art each year. 

Mike Lane: Kyle, thanks for your time. 

Kyle Worl: Thank you.

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Opinion: The $70 million engine most Alaskans aren’t talking about

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Opinion: The  million engine most Alaskans aren’t talking about


The Northern Hawk factory trawler docked in Dutch Harbor. At left is the Matson Tacoma container ship. (Loren Holmes / ADN)

Many statewide candidates talk about putting Alaskans first, ahead of Outsiders. The problem is most of them are just putting some Alaskans ahead of others. We need more candidates in the mold of Ted Stevens and Don Young, leaders who weren’t willing to divide us, urban versus rural, just to win an election. Ironically, neither the Indiana-born Stevens nor California-native Young were originally from Alaska. It makes you wonder how our state’s most honored and beloved politicians would fare in today’s electoral environment.

This “me-first” populism dominates modern Alaska issue campaigns, too. It’s no accident that Outside groups promote “trawl bycatch” as the root of all evil when it comes to today’s fish wars: No one trusts science anymore (thanks, Joe Biden), and the pollock fleet has demonstrable ties to Seattle, making trawlers easy targets.

Of course, pollock and seafood are no different than Alaska’s other natural resource industries — all of which rely on capital and labor from Outside. If your flight back to Alaska happens during a shift change, you’ll share the plane with plenty of Lower 48-based roughnecks and miners, not just fishery workers.

But are the pollock trawlers really all that “Outside”? Stevens and Young didn’t think so. They had a clear vision for the Bering Sea’s role in Alaska’s economic future. Their legislative genius was to create mechanisms that “Alaskanized” our state’s natural resource wealth. They gave land to the regional Native corporations, which used their oil, minerals and timber to develop local economies and workforces and pay dividends to Alaskans.

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Stevens and Young tackled seafood in a two-step move: First, they claimed the Bering Sea away from the Soviet and Japanese fleets and made it available for American fishermen (yes, most of them were in Seattle at the time). But the Seattle fleets delivered their catch to processors in Alaska, creating jobs on shore. Then Stevens and Young created the Western Alaska Community Development Quota program so Western Alaska villages could build wealth and eventually buy up the Seattle fleets, especially the large factory trawlers.

Today, those villages control more than a third of the Bering Sea pollock fleet and major elements of the crab, cod and flatfish fleets. Unless we let Outside groups shut it down, the Alaskanization of the Bering Sea will continue, just like Uncle Ted and Don intended.

CDQ is the rural economic engine few know about, but we should all be talking about. The program generates more than $70 million annually for economic development and social programs in 65 Bering Sea villages — including in the very poorest parts of Alaska. In many villages, the local CDQ group is the largest or the only private sector employer. And unlike government programs, CDQ doesn’t rely on federal largesse — it’s off-budget and self-sustaining, costing taxpayers nothing over the last 35 years.

CDQ groups fund a wide variety of programs, doing things government programs cannot do in places other businesses would never invest: They buy fish, creating markets for local fishermen; they give out heating oil in late winter, when other supplies run low; they provide scholarships and job training where few others do; and they operate local companies, including boat builders and mechanic/welder shops, putting local employment ahead of profits. That’s real economic activity that never leaves the state, despite what you read on social media.

Unfortunately, the attacks on trawl might just pull down CDQ, too, because most CDQ revenue comes from the pollock factory ships. Anti-development “charitable” foundations are the real outsiders in this debate. They have poured more than $30 million into Bering Sea policy fights since 2021, hoping to put another resource industry scalp on their wall. Disclosures are shady at best, but a lot of that money goes to Washington, D.C.-based New Venture Fund (aka SalmonState) and myopic Native groups that aren’t part of CDQ.

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With that much chum in the water, other Alaska groups are taking up the anti-trawl crusade and pivoting from their traditional causes, like Kenai River habitat conservation or public lands access. Be sure to thank them if rural Alaska loses thousands of jobs and the cost of everything goes up because we don’t backhaul seafood out of Alaska anymore. If the outside interests and their allies win and pollock trawling gets shut down, the Stevens-Young vision for Alaska’s seafood industry dies, too, along with tens of millions spent annually across the state and hundreds of millions invested by Alaskans in the fishing industry.

Rick Whitbeck is a veteran of resource development advocacy and a 40-year Alaskan by choice. He currently serves as the director of strategic engagement for CVRF, a CDQ organization for 20 Y-K area villages. The views here are his own and not his employer’s.

• • •

The Anchorage Daily News welcomes a broad range of viewpoints. To submit a piece for consideration, email commentary(at)adn.com. Send submissions shorter than 200 words to letters@adn.com or click here to submit via any web browser. Read our full guidelines for letters and commentaries here.





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Alaska Senate approves ‘baby box’ law for surrendering infants

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Alaska Senate approves ‘baby box’ law for surrendering infants


Sen. Robert Myers, R-North Pole, speaks during a floor session at the Alaska State Capitol in Juneau on January 21, 2026. (Marc Lester / ADN)

JUNEAU — The Alaska Senate passed a bill that would allow parents to surrender infants in safety devices, or “baby boxes.”

The measure passed 18-2 on March 31, with supporters saying the bill could save lives while critics say it would leave adoptees without knowledge of their background, among other concerns.

As of 2008, under Alaska law, a parent is able to turn over an infant under 21 days old to a doctor, nurse, firefighter or peace officer without being prosecuted.

The bill — introduced by Republican Sen. Robert Myers of North Pole — would also allow for a parent to surrender an infant into a baby box, installed at facilities like fire departments and hospitals, without being prosecuted.

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Since 2013, three Alaska infants have been abandoned, according to Myers. One in Fairbanks was found alive in 2021, despite subzero temperatures. One in Eagle River died in 2013, and another in Anchorage died in 2024, about a block from a fire station.

The idea behind the boxes is that they allow for anonymity, as shame and fear can be barriers to surrendering a baby directly to a person, Myers said.

Manufacturers design the devices to be installed into the exterior wall of a facility. The boxes are temperature-controlled and have a livestream camera on the inside. When a baby is closed inside, the outside door automatically locks. Opening the boxes also triggers an alarm — with a slight delay to allow for the parent to leave anonymously — after which a responder can retrieve the baby from an inside door.

The Bowling Green Fire Department’s Safe Haven Baby Box at BGFD’s Fire Station 7 is seen Friday, Feb. 10, 2023, in Bowling Green, Ky. (Grace Ramey/Daily News via AP)

Adoptee advocacy groups from the Lower 48 opposed the devices in written testimony about the bill, saying they are a “gimmick” solution to the broader societal issues that lead to a person surrendering an infant. Stop Safe Haven Baby Boxes Now and Bastard Nation: the Adoptee Rights Organization wrote that the devices represent relinquishment practices that are “rooted in shame and secrecy,” and “create a population of adopted people who have no birth records, identity, or history.”

Sen. Löki Tobin, an Anchorage Democrat, cast one of two no votes on the bill in the Senate. The other no vote was from Sitka Republican Sen. Bert Stedman, who declined to comment on why he voted no.

Tobin said that although she agrees with the underlying premise, she cited a series of concerns about the boxes, including that a lack of person-to-person interaction takes away informed consent and could lead to increased coercion in the surrender of infants, and that could leave the non-surrendering parent without a say.

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When an infant is surrendered to a nurse, for example, that nurse must advise the parent that they may, but are not required to, provide the infant’s or parents’ names and medical history.

After an infant is surrendered, the child goes to the custody of the state Office of Children’s Services.

Infants are then placed in OCS custody, which conducts a “diligent search” for relatives, including contacting tribal and community partners, according to the Alaska Department of Family and Community Services.

That process would still apply to a baby surrendered in a baby box, said Carla Erickson, chief assistant attorney general for child protection in the state Department of Law, at a committee meeting in February 2025.

Erickson said that in her experience, OCS had never begun a case where the child’s surrender was completely anonymous.

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During the Senate floor debate ahead of the vote on March 31, Tobin said the boxes could leave OCS guessing whether the infant is a tribal member. That, Tobin said, could open up the possibility of violations of the Indian Child Welfare Act, which requires the state to try to place Native children up for adoption within their tribe.

“It is our responsibility to pass law rooted in sound public policy supported by evidence. Baby boxes are not that,” Tobin said.

Myers responded saying that the same documents used to request health and family information at in-person surrenders would be available in the baby boxes.

He also said questions of identity are secondary to ensuring the child is safe.

“It’s tough to find out what your heritage is when you’re not alive,” Myers said.

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Safe Haven Baby Box Inc., the primary infant surrender device manufacturer in the U.S., has contracted installation for over 400 baby boxes across the Lower 48, according to its website. Time magazine reported last year that about 62 babies had been left in boxes since the nonprofit’s founding in 2016, according to its founder, Monica Kelsey.

The bill does not require the state to install or pay for baby boxes, so installation would come at the expense of facilities themselves.

The state Department of Public Safety estimates that each box would cost $16,000, excluding installation. A Fairbanks City Council member said at a February 2025 committee hearing that he estimates a baby box would cost about $22,000 for his community.

Doug Schrage, fire chief at the Anchorage Fire Department, said at the same hearing that members of AFD have consulted with Safe Haven Baby Boxes Inc. and led fundraising efforts to raise enough for a baby box in Anchorage.

Christian and anti-abortion organizations have also said they plan to fundraise to install the boxes, as well.

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Pamela Samash of Nenana, and a member of Interior Right to Life, said at a committee meeting for the bill last session that the organization is “just waiting” to do a fundraiser for this cause.

The bill now heads to the House for committee hearings.





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