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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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Alaska

The 2025 Alaska Music Summit comes to Anchorage

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The 2025 Alaska Music Summit comes to Anchorage


ANCHORAGE, Alaska (KTUU) – More than 100 music professionals and music makers from Anchorage and across the state signed up to visit ‘The Nave’ in Spenard on Saturday for the annual Alaska Music Summit.

Organized by MusicAlaska and the Alaska Independent Musicians Initiative, the event began at 10 a.m. and invited anyone with interest or involvement in the music industry.

“The musicians did the work, right,” Marian Call, MusicAlaska program director said. “The DJ’s who are getting people out, the music teachers working at home who have tons of students a week for $80 an hour, that is real activity, real economic activity and real cultural activity that makes Alaska what it is.”

Many of the attendees on Saturday were not just musicians but venue owners, audio engineers, promoters and more, hence why organizers prefer to use the term “music makers.”

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The theme for the summit was “Level Up Together” a focus on upgrading professionalism within the musicmaking space. Topics included things like studio production, promotion, stagecraft, music education policy.

“We’re kind of invisible if we don’t stand up for ourselves and say, ‘Hey, we’re doing amazing stuff,‘” Call said.

On Sunday, participants in the summit will be holding “office hours” at the Organic Oasis in Spenard. It is a time for music professionals to network, ask questions and share ideas on music and music making.

“You could add us to the list of Alaskan cultural pride,” Call said. “You could add us to your conception of being Alaskan. That being Alaskan means you wear Carhartts, and you have the great earrings by the local artisan, and you know how to do the hand geography and also you listen to Alaskan music proudly.”

The event runs through Sunday and will also be hosted in February in Juneau and Fairbanks.

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Legislative task force offers possible actions to rescue troubled Alaska seafood industry • Alaska Beacon

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Legislative task force offers possible actions to rescue troubled Alaska seafood industry • Alaska Beacon


Alaska lawmakers from fishing-dependent communities say they have ideas for ways to rescue the state’s beleaguered seafood industry, with a series of bills likely to follow.

Members of a legislative task force created last spring now have draft recommendations that range from the international level, where they say marketing of Alaska fish can be much more robust, to the hyper-local level, where projects like shared community cold-storage facilities can cut costs.

The draft was reviewed at a two-day hearing in Anchorage Thursday and Friday of the Joint Legislative Task Force Evaluating Alaska’s Seafood Industry. It will be refined in the coming days, members said.

The bill that created the task force, Senate Concurrent Resolution 10, sets a deadline for a report to the full Legislature of Jan. 21, which is the scheduled first day of the session. However, a final task force report may take a little longer and be submitted as late as Feb. 1, said Senate President Gary Stevens, R-Kodiak, the group’s chair.

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The draft is a good start to what is expected to be a session-long process, said Rep. Louise Stutes, R-Kodiak, a task force member.

“We can hit the ground running because we’re got some good solid ideas,” Stutes said in closing comments on Friday. The session can last until May 20 without the Legislature voting to extend it.

Another task force member, Sen. Jesse Bjorkman, R-Nikiski, urged his colleagues to focus on the big picture and the main goals.

“We need to take a look at how we can increase market share for Alaska seafood and how we can increase value. Those two things aren’t easy, but those are the only two things that are going to matter long term. Everything else is just throwing deck chairs off the Titanic,” he said Friday.

Many of the recommended actions on subjects like insurance and allocations, if carried out, are important but incremental, Bjorkman said. “If the ship’s going down, that stuff isn’t going to matter,” he said.

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Alaska’s seafood industry is beset by crises in nearly all fishing regions of the state and affecting nearly all species.

Economic forces, heavily influenced by international turmoil and a glut of competing Russian fish dumped on world markets, have depressed prices. Meanwhile, operating costs have risen sharply. Climate change and other environmental factors have triggered crashes in stocks that usually support economically important fisheries; Bering Sea king and snow crab fisheries, for example, were closed for consecutive years because stocks were wiped out after a sustained and severe marine heatwave.

Senate President Gary Stevens, R-Kodiak, and Rep. Louise Stutes, R-Kodiak, listen to testimony on Thursday from Nicole Kimball of the Pacific Seafood Processors Association. Kimball was among the industry representatives who presented information at the two-day hearing, held on Thursday and Friday, of the Joint Legislative Task Force Evaluating Alaska’s Seafood Industry. (Photo by Yereth Rosen/Alaska Beacon)

In all, the Alaska seafood industry lost $1.8 billion from 2022 to 2023, according to the National Oceanic and Atmospheric Administration.

Those problems inspired the creation of the task force last spring. The group has been meeting regularly since the summer.

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The draft recommendations that have emerged from the task force’s work address marketing, product development, workforce shortages, financing, operating costs, insurance and other aspects of seafood harvesting, processing and sales.

One set of recommendations focuses on fisheries research. These call for more state and federal funding and an easy system for fisheries and environmental scientists from the state, federal government and other entities to share data quickly.

The draft recommends several steps to encourage development of new products and markets for them, including non-traditional products like protein powder, nutritional supplements and fish oil. Mariculture should be expanded, with permitting and financing made easier, according to the draft.

The draft recommendations also propose some changes in the structure of seafood taxes levied on harvesters and processors, along with new tax incentives for companies to invest in modernization, product diversification and sustainability.

Other recommendations are for direct aid to fishery workers and fishing-dependent communities in the form of housing subsidies or even development of housing projects. Shortages of affordable housing have proved to be a major challenge for communities and companies, the draft notes. More investment in worker training — using public-private partnerships — and the creation of tax credits or grants to encourage Alaska-resident hire, are also called for in the draft recommendations.

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Expanded duties for ASMI?

The Alaska Seafood Marketing Institute, the state agency that promotes Alaska seafood domestically and internationally, figures large in the draft recommendations.

The draft calls for more emphasis on the quality and sustainability of Alaska fish and, in general, more responsibilities for ASMI. An example is the recommended expansion of ASMI’s duties to include promotion of Alaska mariculture. That would require legislation, such as an early version of bill that was sponsored by outgoing Rep. Dan Ortiz, I-Ketchikan. It would also require mariculture operators’ willingness to pay into the program.

But ASMI, as it is currently configured, is not equipped to tackle such expanded operations, lawmakers said. Even obtaining modest increases in funding for ASMI has proved to be a challenge. A $10 million increase approved by the Legislature last year was vetoed by Gov. Mike Dunleavy, who cited a failure by ASMI to develop a required plan for the money. 

The governor’s proposed budget released in December includes an increase in state money for ASMI, but his suggestion that $10 million in new funding be spread over three years falls far short of what the organization needs, Stevens said at the time.

Incoming House Speaker and task force member Bryce Edgmon, I-Dillingham, said there will probably be a need to reorganize or restructure ASMI to make it more autonomous. That might mean partnering with a third party and the creation of more managerial and financial independence from whoever happens to be in political office at the time, as he explained it.

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Dillingham, and Sen. Jesse Bjorkman, R-Nikiski, listen to information presented on Jan. 9, 2025, at a hearing held by the Joint Legislative Take Force Evaluating Alaska's Seafood Industry. Edgmon and Bjorkman are two of the eight task force members. (Photo by Yereth Rosen/Alaska Beacon)
House Speaker Bryce Edgmon, I-Dillingham, and Sen. Jesse Bjorkman, R-Nikiski, listen to information presented on Thursday at a hearing held by the Joint Legislative Task Force Evaluating Alaska’s Seafood Industry. Edgmon and Bjorkman are two of the eight task force members. (Photo by Yereth Rosen/Alaska Beacon)

“The umbilical cord needs to be perhaps cut to some degree,” Edgmon said on Friday, during the hearing’s public comment period. The solution could be to make ASMI more of a private entity, he said.

“Because the world is changing. It’s a global marketplace. We need to have ASMI to have as large a presence as possible,” he said. 

But for now, ASMI and plans for its operations have been constricted by political concerns. “People are afraid of how it’s going to go back to the governor’s office,” Edgmon said.

Federal assistance

U.S. Sen. Lisa Murkowski, R-Alaska, spoke to the task force on Thursday about ways the federal government could help the Alaska seafood industry.

One recent success, she said, is passage of the bipartisan Fishery Improvement to Streamline Untimely Regulatory Hurdles post Emergency Situation Act, known as the FISHES Act, which was signed into law a few days earlier.

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The act establishes a system to speed fisheries disaster aid. It can take two to three years after a fisheries disaster is declared for relief funds to reach affected individuals, businesses and communities, and that is “unacceptable,” Murkowski said.  The bill addresses that situation, though not perfectly. “It’s still not the best that it could be,” she said.

Another helpful piece of federal legislation that is pending, she said, is the Working Waterfronts Bill she introduced in February. The bill contains provisions to improve coastal infrastructure, coastal energy systems and workforce development.

More broadly, Murkowski said she and others continue to push for legislation or policies to put seafood and fisheries on the same footing as agriculture. That includes the possibility of fishery disaster insurance similar to the crop insurance that is available to farmers, she said.

But getting federal action on seafood, or even attention to it, can be difficult, she said.

“It is a reality that we have faced, certainly since my time in the senate, that seafood has been viewed as kind of an afterthought by many when it comes to a food resource, a source of protein,” she said.

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Inclusion of seafood in even simple programs can be difficult to achieve, she said. She cited the U.S. Department of Agriculture’s decision, announced in April, to include canned salmon as a food eligible for the Special Supplemental Nutrition Program for Women, Infants, and Children, also known as WIC. She and others had been working for several years to win that approval, she said.

Tariffs a looming threat

Seafood can also be an afterthought in federal trade policy, Murkowski said.

Jeremy Woodrow, at right, fields questions from lawmakers on Jan. 9, 2025, at an Anchorage hearing of the Joint Legislative Task Force Evaluating Alaska's Seafood Industry. Woodrow is executive director of the Alaska Seafood Marketing Institute. Next to him is Tim Lamkin, a legislative aide for Senate President Gary Stevens, R-Alaska, the task force chair. (Photo by Yereth Rosen/Alaska Beacon)
Jeremy Woodrow, at right, fields questions from lawmakers on Thursday at an Anchorage hearing of the Joint Legislative Task Force Evaluating Alaska’s Seafood Industry. Woodrow is executive director of the Alaska Seafood Marketing Institute. Next to him is Tim Lamkin, a legislative aide for Senate President Gary Stevens, R-Kodiak, the task force chair. (Photo by Yereth Rosen/Alaska Beacon)

Tariffs that President-elect Donald Trump has said he intends to impose on U.S. trade partners pose a serious concern to Alaska’s seafood industry, she said.

“The president-elect has made very, very, very, very clear that this is going to be a new administration and we’re going to use tariffs to our advantage. I don’t know what exactly to expect from that,” she said.

In the past, tariffs imposed by the U.S. government have been answered with retaliatory tariffs that cause problems for seafood and other export-dependent industries.

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Jeremy Woodrow, ASMI’s executive director, has similar warnings about tariffs, noting that about 70% of the Alaska seafood, as measured by value, is sold to markets outside of the U.S.

“We tend to be, as an industry, collateral damage in a lot of trade relationships. We’re not the main issue. And that usually is a bad outcome for seafood,” he told the committee on Thursday.

To avoid or mitigate problems, Alaska leaders and the Alaska industry will have to respond quickly and try to educate trade officials about tariff impacts on seafood exports, Woodrow said.

Task force members expressed concerns about impacts to the export-dependent Alaska industry.

“If we raise tariffs on another country, won’t they simply turn around and raise tariffs on us?” asked Stevens.

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Tariffs on Chinese products, which Trump has suggested repeatedly, could cause particular problems for Alaska seafood, Stutes said. She pointed to the companies that send fish, after initial processing, to China for further processing in preparation for sale to final markets, some of which are back in the U.S.

“If there is a huge tariff put on products going and coming from China, that would seem to me to have another huge gut shot to those processors that are sending their fish out for processing,” Stutes said.

Bjorkman, a former high school government teacher, said history shows the dangers of aggressive tariff policies.

The isolationist “America-first” approach, as carried out at turns over the past 150 years, “hasn’t worked out very well. It’s been real bad,” Bjorkman said.” As an alternative, he suggested broader seafood promotions, backed by federal or multistate support, to better compete in the international marketplace.

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Rural Alaska schools face funding shortfall after U.S. House fails to pass bipartisan bill • Alaska Beacon

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Rural Alaska schools face funding shortfall after U.S. House fails to pass bipartisan bill • Alaska Beacon


Rural schools, mostly in Southeast Alaska, are facing a major funding shortfall this year after the U.S. House of Representatives failed to reauthorize a bill aimed at funding communities alongside national forests and lands. 

The bipartisan Secure Rural Schools and Community Self-Determination Act was first passed in 2000, and enacted to assist communities impacted by the declining timber industry. It provided funds for schools, as well as for roads, emergency services and wildfire prevention. The award varies each year depending on federal land use and revenues. The legislation is intended to help communities located near federal forests and lands pay for essential services. In 2023, the law awarded over $250 million nationwide, and over $12.6 million to Alaska.

But this year, the bill passed the Senate, but stalled in the House of Representatives amid partisan negotiations around the stopgap spending bill to keep the government open until March. House Republicans decided not to vote on the bill amid a dispute around health care funding, a spokesperson for the bill’s sponsor, Oregon Sen. Ron Wyden, told the Oregon Capital Chronicle, which first reported the story. 

Eleven boroughs, as well as unincorporated areas, in the Tongass and Chugach national forests have typically received this funding, awarded through local municipalities. According to 2023 U.S. Forest Service data, some of the districts who received the largest awards, and now face that shortfall, include Ketchikan, Wrangell, Petersburg, Sitka and Yakutat, as well as the unincorporated areas. 

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“We’re already at our bottom,” said Superintendent Carol Pate of the Yakutat School District, which received over $700,000 in funding, one of the largest budget sources for its 81 students. 

“We are already down to one administrator with six certified teachers,” Pate said in a phone interview Thursday. “We have a small CTE (career and technical education) program. We don’t have any art, we don’t have any music. We have limited travel. Anything that we lose means we lose instruction, and our goal is for the success of our students.”

Yakatat is facing a $126,000 deficit this year, a large sum for their $2.3 million budget, Pate said. “So that’s a pretty significant deficit for us. We do our best to be very conservative during the school year to make up that deficit. So wherever we can save money, we do.” 

The school has strong support from the borough, Pate said. However, last year they were forced to cut funding for one teacher and a significant blow for the school, she said. 

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“We’re trying very hard to break the cycle, but it’s a continuing cycle,” she said. “Every time we lose something, we lose kids because of it, and the more kids we lose, the more programs we lose.”

In the southern Tongass National Forest community of Wrangell, the school district received over $1 million in funds last year, and Superintendent Bill Burr said the federal funding loss is dramatic. 

“It’s pretty devastating from a community standpoint,” Burr said in a phone interview. “Because that is very connected to the amount of local contribution that we get from our local borough, it has a dramatic effect on the school district, so I’m disappointed.”

“As these cuts continue to happen, there’s less and less that we’re able to do,” he said. “School districts are cut pretty much as thin as they can. So when these things happen, with no real explanation, the impact for districts that do receive secure schools funding is even more dramatic.”

Whether and how the funding loss will impact the district has yet to be determined, as budgets for next year are still in development, Burr said, but it could mean cuts to matching state grants, facilities projects, or staff salaries. He said most non-state money for the district comes from the federal program.

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“Part of our funding does come from sales tax, but a majority of it comes from the secure rural schools (grant),” he said. “So without increases in other areas, the amount of money that can come to the schools is going to be injured.”

“We do have contracts, and a majority of our money is paid in personnel. So we would have those contracts to fill, regardless of the funding, until the end of the year. A major reduction really will affect our ability to provide school services and personnel, so it could have a massive impact on next year’s, the fiscal ‘26 year, budget,” he said. 

The district is facing an over $500,000 budget deficit this year, Burr said, and so the loss puts further pressure on the district.

“So we’re continuing to find areas that we can cut back but still provide the same service. But that’s getting harder and harder,” he said. 

The schools in unincorporated areas known as regional educational attendance areas, received over $6 million in funding through the program.  

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Alaska Sens. Lisa Murkowski and Dan Sullivan supported the bill through the Senate.

Murkowski was disappointed that the bill was not reauthorized, a spokesperson for the senator said. 

“As a longtime advocate for this program, she recognizes its critical role in funding schools and essential services in rural communities,” said Joe Plesha, in a text Friday. “She is actively working to ensure its renewal so that states like Alaska are not disadvantaged.”

Former Alaska Rep. Mary Peltola also supported the funding. 

Alaska’s school funding formula is complex, and takes into account the local tax base, municipalities’ ability to fund schools, and other factors. With the loss of funding for the local borough’s portion, whether the Legislature will increase funding on the state’s side is to be determined. 

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The Department of Education and Early Development did not respond to requests for comment on Friday. 

Superintendents Burr and Pate described hope for the upcoming legislative session, and an increase in per-pupil spending. “The loss of secure rural schools funding makes it even more difficult to continue with the static funding that education in the state has received,” Burr said. 

“I really have high hopes for this legislative season. I think that the people that we’ve elected recognize the need to put funding towards education,” Pate said. 

The funding could be restored, if the legislation is reintroduced and passed by Congress. Both Oregon Democratic Sen. Wyden and Idaho Republican Sen. Mike Crapo have said they support passing the funding this year.

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