Horse Sense

The proposal presented by our governor and some in the legislature leveling a statewide sales tax on all Alaskans defies logic. Nor does it even make horse sense.

The governor appears to support a $2700 PF dividend. Some in the Senate propose a $1300 dividend. If the $2700 dividend were to be approved by the legislature it would create a $600 M deficit. That is about what the governor would need to come from his sales tax proposal to fund his higher dividend. So, the sales tax proposal funds the difference, and it comes from the pocket of every Alaskan on virtually every purchase he or she might make.

Some suggest that this increased sales tax funds a bigger dividend. Yet it’s collected over the course of a year from each and every Alaskan. And the PFD is taxed as income. So, is it really free money? Clearly most Alaskans understand and oppose the tax because we would get a much bigger bang for the buck by investing in Alaska’s future through increased funding for education.

Further the application of sales tax traditionally belongs exclusively to municipal governments. The tax rate usually ranges from 2-8%.

It’s been pointed out that if the federal government can carry a deficit, why can’t the state? First, unlike the federal Constitution the State Constitution requires a balanced budget. Second, the federal government can print money. And that causes inflation that we now know too well.

The Permanent Fund was designed to be the principal State savings account and source of income to run State government operations. Non-recurring Revenue from oil taxes should be used to meet the State’s obligation to grow the Permanent Fund for the future needs of Alaskans.

Money for the dividend was meant to be sized after State government services obligations had been met. That remains the case – only a portion of the Fund’s earnings should be allocated to the dividend after State services are funded.

Further to withhold school funding and to add a state sales tax to fund the shortfall caused by an overly generous dividend is certainly contrary to the intent of those who drafted the Permanent Fund’s enabling legislation. It is fair to say that our late Governor Jay Hammond would say simply ‘it just doesn’t make horse sense.’

Governor Frank Murkowski

Wrangell, AK

Better Health Care, Fewer Headaches with Direct Primary Care

“So doctor, why did you decide to go into health care?”

“Oh, I don’t care for the health part. I just love all the paperwork.”

That’s a conversation that has likely never happened in the history of medicine—because for doctors, providers, patients, and caregivers alike, the “non-health” parts are the very worst parts of health care.

From unexpected costs, to confusion, to access challenges, to long wait times, the barriers to seeing a doctor are more than just annoying—they’re actually standing in the way of the health care we need.

In Alaska, two bills in the legislature are poised to make a major, fundamental change in the broken health care system. It’s a simple change known as direct health care, introduced this session as Senate Bill 45 and House Bill 47.

The idea is straightforward. With these bills, health care providers would be able to enter into service arrangements directly with patients, instead of only through a gatekeeping third party such as a health insurance company or government health care program.

This would allow patients to enroll in a “membership” with their health care provider of choice, including family doctors and primary and specialty care providers. In exchange for a fixed monthly fee (typically ranging from $50 to $100), patients get ‘round-the-clock access to their doctors, guaranteed appointments, and significantly shorter waiting times.

Best of all, because of the direct relationship between the provider and the patient, doctors are able to spend more time with their patients, answering questions and focusing on health, instead of filling out paperwork and fighting with insurance companies. One of the top frustrations felt by patients is not feeling heard by their doctor, which can happen when the doctor has to shuffle people in and out in order spend more time dealing with paperwork and insurance disputes instead of health care.

The current model squeezes out time for preventative checkups that can catch problems early and improve health overall, and confusion over networks and long wait times for initial visits can cause many people to avoid it all together.

Instead, the direct health care model has countless benefits for both the patient and the provider, including same-day appointments (instead of long waits), transparent pricing, and easier and more reliable preventative care.

Because this administrative change cuts out the middleman of the insurance or government, there’s more transparency for the real cost of the service, rather than complex billing agreements, in-network vs. out-of-network puzzles, and confusion over who to call to actually talk to someone.

This model of direct health care is already at work in 49 states, with 26 states passing legislation to codify that it’s not insurance, and shall not be regulated as insurance.

Alaska is a prime candidate to update its laws and follow in their footsteps. Alaska residents currently pay some of the highest health care costs in the country—one study found that Alaskans pay the most of any state for their health care, at more than $11,000 per person. We’ve all seen horror stories about unexpected medical bills destroying life savings—two-thirds of bankruptcies in America are tied to medical issues.

Up-front, transparent pricing also means fewer surprises when the bill comes, and fewer hidden costs that result from disagreements over what insurance decides to cover.

Unfortunately, this kind of direct model for health care is currently blocked by state law, which treats these provider-patient arrangements the same as health insurance policies. This requirement comes with prohibitive costs, regulations, and (you guessed it) piles of paperwork.

Alaska lawmakers can change that and offer a better way forward by passing the two bills under consideration right now, Senate Bill 45 and House Bill 47.

In 2021, Montana—another large rural state with similar health care challenges—signed direct patient care into law. In just a year, 16 providers decided to offer membership options, at an average membership cost of $77 per month, significantly below the cost of traditional employer-sponsored or individual insurance coverage.

It’s time for Alaska to follow the lead of other states by offering an option for lower costs, faster service, more time with your doctor, and fewer headaches from dealing with insurance.

That way, we can all spend less time on the paperwork, and more time on our health.

Adam Habig, President and Co-Founder

Freedom Healthworks

Example: 9075434113