“I don’t understand who can afford this? I mean who really can afford this?” he says.  “I can pay it, but I can’t afford it.”

The premium for his family of five came to more than $40,000 a year. That’s for a bare bones plan with a $10,000 deductible that he buys through the marketplace set up by the Affordable Care Act.

Customers can begin buying plans on HealthCare.gov starting on Nov. 1 and do so through Jan. 31, 2016.  Rates for individual health plans nationally. Within that not-too-alarming average are outliers. Some states saw their average rate go down; others saw a big percentage leap from a reasonable starting price. For instance, Boise, Idaho, saw a 30 percent spike in premiums from about a month.

But Alaska is a special case.  It has the highest premiums in the country, and it has seen some of the highest percentage increases over the past two years. That makes paying for insurance especially difficult for families like the Ebbessons.

Ebbesson doesn’t qualify for a subsidy to help pay for insurance because his family income is more than $142,000 a year. But, he says, his insurance costs more than his mortgage.

“I’m not able to put money in retirement, savings for my kid for college, my ten year old. Believe me I could find lots of stuff to do for my future with $40,000,”  he says.

Ebbesson supports the Affordable Care Act. He calls the Alaska rates a wrinkle in the law that needs to be fixed.

The for a 40-year-old in Anchorage is $719 a month – more than double the national average, according to an analysis by the Kaiser Family Foundation. (KHN is an editorially independent program of the foundation.)

Most Alaskans, and , qualify for a subsidy that rises with premium increases – insulating consumers from big jumps. But about 5,000 Alaskans pay full sticker price.

“We want people to have access to affordable coverage and that’s not happening right now in the marketplace in Alaska,” says Eric Earling, a spokesman with insurer Premera Alaska.

Premera is one of only two companies selling on Alaska’s exchange. Earling says even with the high prices, the company is losing millions of dollars on Alaska’s tiny individual market.  In the first six months of this year, 37 Premera customers filed over $11 million in claims, Earling says.

“The important thing is they deserve access to coverage, and we’re glad they have it,” he says. “The trick is creating a sustainable environment where those costs can be absorbed in a way that doesn’t adversely impact all consumers.”

Premera is backing legislation to use Alaska’s high risk pool, which will allow the biggest claims to be paid by a special fund.

The state’s Division of Insurance hasn’t taken a position on the idea.

Victoria Cronquist is a dental hygienist in Anchorage. She doesn’t care what the solution is, as long as it helps her find more affordable insurance.

“It’s just getting too expensive,” she says. “I’m up against the wall. I can’t do it all.”

This year, she pays $1,600 a month for herself, her husband and two kids, ages 16 and 20. She gets a stipend from her work to help pay that premium, but her rate is going up to $2,600 a month next year. And her stipend isn’t going up. Cronquist says she may cancel her insurance.

“To be quite frank, to have a $2,600 monthly premium payment and all this is stressful to me. Extremely. And that increases my odds of getting ill! That’s the other way I look at it,” she says.

Cronquist doesn’t take the decision lightly. Her family has dropped health coverage in the past. And they paid the price when her daughter ended up in the ICU a few months later.

Ebbesson also has a difficult decision ahead.  He’s thinking about dropping his policy and saving money instead. Ebbesson says his family could fly to Thailand for any big medical procedures that were necessary. If something catastrophic happened though, it would put his family in a tough position.

“It’s a scary proposition. There’s always bankruptcy but, my goodness, why should I be having to even think about things like that related to my health insurance?” he says.

The high rates will push more Alaskans into a category that allows them to avoid paying the penalty for going uninsured. The law includes an “unaffordability” exemption if the lowest cost insurance amounts to more than eight percent of income.

This story is part of a reporting partnership with , and Kaiser Health News.

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But for Walker, it’s a no-brainer. Around 40,000 low-income Alaskans — mostly childless adults — would receive health benefits under Medicaid expansion. The federal government would pay 100 percent of the costs until the end of 2016. After that, the state’s share would slowly increase to 10 percent by 2020. Plus, he says, Alaskans already pay taxes that fund the expansion.

“I always will default back to what is best for Alaskans, and it’s best for Alaskans to have the health care coverage we’ve already paid for,” says Walker, who took office Dec. 1.

The Alaska Chamber of Commerce, the Alaska State Hospital and Nursing Home Association and the Alaska Native Tribal Health Consortium all support expansion. So far  have expanded Medicaid, and Laura Snyder with the Kaiser Family Foundation says most of those governors have had legislative support. (KHN is an editorially independent program of the foundation.)

“There have been a few states where the governor has acted on his own through executive authority,” she says, “but most states have generally incorporated it into state budgets which usually require legislative sign off.”

Walker will probably need the legislature to fund part of the expansion because the state has to pay administrative costs that would add up to as much as $10 million per year. Those millions could be a tough sell for the Republican legislature. Republican State Sen.  says Walker will have to make a strong case.

“It will be a lively debate, but I look forward to work with him to the best of my abilities within the financial constraints that this state is currently facing,” she says.

To help his case, Walker has appointed  as health commissioner. She’s been a leader in the Alaska Native health care system and a determined advocate for expansion since the health law passed. She says she’ll rely on a cooperative work ethic as she negotiates with lawmakers over expansion. Davidson is confident Alaska can get it done.

“It may not be something everyone’s 100 percent happy with, but we may be able to find middle ground that we can all live with,” she says. “I think that’s what makes Alaska so great. We don’t back down just because things get difficult. If it’s 40 below we go about our day and get things done. That’s just what we do. And we do that with policy issues as well.”

Beyond the legislature, Alaska faces big technical hurdles before Medicaid expansion can work. The state’s payment and enrollment systems  right now and Davidson wants to address those issues before any expansion.

This story is part of a partnership that includes , and Kaiser Health News.

This <a target="_blank" href="/medicaid/alaskas-new-governor-sets-sights-on-medicaid-expansion/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

“The only one that possibly applied to me was disaster,” Korshin says. “So I picked disaster and I described my disaster as old age and I submitted as my supporting document a copy of my passport.”

Korshin knew that argument probably wouldn’t work, but he still won’t make the switch. Starting next year, the federal government will penalize him – withholding 1 percent of his Medicare payments.

EHR,  ICD-10 and PQRS may sound like alphabet soup. But most doctors around the country know exactly what those acronyms stand for. They are programs championed by the federal government to improve quality and bring medicine into the electronic age. But in Alaska, where small medical practices and an aging physician workforce are common, the new requirements can be a heavy burden.

Korshin practices three days a week in the same small office in east Anchorage he’s had for three decades. Many of his patients have aged into their Medicare years right along with him.

Korshin has just one employee, a part-time nurse. And his lease runs out in four years, when he will be 75 and expects to retire.  He says for his tiny practice, an electronic medical records system would cost too much to set up and to maintain.

“No possible business model would endorse that kind of implementation in a practice situated like mine, it’s crazy,” he says.

Korshin will lose another 1.5 percent of his Medicare payments next year for failing to enroll in PQRS, a federal program that requires doctors to report quality data.  And then there is ICD-10, a new coding system for medical bills — also set to take effect in the fall of 2015.

“This flurry of things one has to comply with,” Korshin says, “means that unless you work for a large organization like a hospital that can devote staff and time to dealing with these issues, there’s no economy of scale, I can’t share these expenses with anybody.”

Alaska State Medical Association Executive Director Mike Haugen says half of the doctors in Alaska are over the age of 50 and very few are employed by large organizations.

“Most practices in Alaska are small practices,” Haugen says. “They’re one-, two- and three-doctor practices. The number of really large practices — and that’s relative in Alaska — you can probably count them on one hand.”

Haugen says he hears a lot of complaints from doctors who are feeling overwhelmed by the federal requirements. And he worries the burden is forcing many — especially older doctors — to consider retiring early.

“There won’t be some flashing neon sign we ever see that says ‘X number of doctors have left.’ It’s a very quiet process,” Haugen says. “That for me is the scary part, because you take a look at the medical association membership a year or two from now, and it may be smaller and access to care in this state is a real issue.”

But Rebecca Madison, executive director of Alaska eHealth Network, thinks a lot of doctors would decide to stay in practice if they had help with the transition to electronic health records.

Madison encounters a lot of resistance, but she tries to sell doctors on the benefits. She reminds them electronic records can make their offices more efficient and give them better data on patients. And it will make it easier when it comes time to sell their practices. Madison also sees the issue from the patient’s perspective.

“My whole goal and the reason I got into this process is to give the data to the patient,” she says. “They deserve to have it — it’s their data — they should be able to access it.”

This story is part of a partnership that includes , and Kaiser Health News.

This <a target="_blank" href="/health-industry/alaska-doctors-overwhelmed-by-new-federal-rules/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">