An engaged Alaskan democracy

Alaskans face the nation’s highest health care costs. Why?

Author: Cliff Groh | Opinion Updated: December 10, 2017 Anchorage Daily News

An Alaskan spends on average more than $3,000 on health care per year over what the average American spends, according to the latest federal data. That overall comparison, however, masks much bigger disparities for certain procedures and treatments. One Alaskan researching last year, for example, found that the “all-in” cost of her hip replacement surgery in Seattle was well under half what the total cost would have been in Anchorage. (By far the biggest cost difference was in the facility fee quoted by the hospital in Anchorage vs. that charged in Seattle, not the relatively small difference in the orthopedic surgeon’s charge.)

Experts have identified some causes of Alaska’s high health care costs as:

• Hospital margins in urban Alaska that are higher than national averages (the most recently released study shows that Anchorage hospitals have margins almost three times the national average);

• The relative shortage in Alaska of beds at facilities with skilled nursing and other behavioral health centers that would allow some patients to avoid expensive hospital stays;

• Limited competition and/or leveraging of market power by some medical providers — particularly specialty physicians such as orthopedic surgeons, neurosurgeons, and cardiologists — that keeps prices/fees higher than they would be otherwise (although some Alaska medical practitioners appear to make only 1/50th — or even 1/100th as a few specialist practitioners do per year and some family practitioners are clearly struggling financially, the top is quite high in our state; one neurosurgeon more than tripled his annual income by moving north, going from $1.5 million in Washington State in 2007 to $5.5 million in Alaska in 2009).

• A regulation adopted in 2004 establishing “the 80th percentile rule” for medical provider compensation that critics say has boosted some medical specialists’ fees;

• A statute adopted in 1998 that appears to make it difficult to rely on managed care to hold down costs;

• A slowness to adopt value-based compensation for medical providers instead of the traditional fee-for-service model of reimbursement;

• Expensive medical infrastructure built at least in part for convenience that Alaska may not be able to afford;

• Wasteful overutilization of certain procedures and treatments that are particularly profitable for physicians on the Last Frontier given Alaska’s unusually high reimbursement rates.

Alaska Common Ground will take a deep dive into the difference between the health care costs of Alaska and those of the rest of the country at an event Wednesday evening, Dec. 13.  This event — the third of at least four events on our state’s high health care costs — is at the 49th State Brewing Company, 717 W. Third Ave., from 7 p.m. to 9 p.m. The Anchorage Public Library is cosponsoring this series, which is financially supported by the Alaska Humanities Forum. This event is open to the public and free, with a requested donation of $10.

Important players in the health care field will hash out on Wednesday the relative importance of the factors set out above — and others — in the high costs of Alaska’s health care.   Participating that evening will be physicians, a hospital CEO, a state of Alaska regulator and other knowledgeable observers. There will be an opportunity for the audience to ask questions.

Folks, this is your chance to learn more about this critical topic in a congenial environment. You should come, as your health and wealth may depend on it.

Cliff Groh is chair of Alaska Common Ground, a nonprofit and nonpartisan organization devoted to helping Alaskans understand and reach consensus on the major issues facing our state. If you are interested in watching the video from the previous two events in the health care series, you can see video of each at

Tips to Control Your Doctor and Hospital Bills

You have a good chance to hold down your medical bills through preparation, research, negotiation, and keeping a good attitude. Let’s walk through some recommendations by category. As you go through this advice, remember that you need to help yourself first by taking care of yourself. As one Alaska physician observed, the most cost-effective way to interact with the health care system is not to need it.

Choosing Where You Get Your Medical Care

  • Seek in-network providers: Before you choose your primary care provider (physician, nurse practitioner, or physician’s assistant), imaging facility, or specialists, you should make sure that you choose within your insurance-preferred provider network if possible. If you are being referred for testing or consultation, you can make sure that you ask your referring provider to choose among your in-network providers, one that the primary care provider thinks would provide high-quality care.
  • Lab work: If you need blood work, your clinic can manage the most common blood tests. Specialty blood work can be done at local medical laboratory testing facilities. Shop around, as there are wide variations in price.
  • Avoid the ER if you can: Get the “right level of care.” If you have a life-threatening emergency, you should go to the emergency room. If you do not, go to a walk-in clinic or urgent care facility if you can’t get to your regular primary care provider. Several groups of primary care providers in Anchorage have clinics operating after regular business hours, and many are in network with insurance providers. In most instances, the most expensive place that you can receive care is in the ER. 

At the Clinic, Office of the Primary Care Provider, or the Emergency Room/Emergency Department

  • Come prepared to describe your complaint in detail to the doctor, nurse, nurse practitioner, or physician’s assistant. If your problem has been evaluated before, know what tests have been done—and it is even better to keep records. This allows the provider to have the best information and avoids the problem of providers ordering up a bunch of tests to determine what you could have told them.
  • Ask questions. Listen carefully to the answers. Take notes. (You could also audio record the discussion on a smartphone.) If you don’t know what is happening, you can’t make an informed decision.
  • Bring a relative or friend: If you think that you need help, get a trusted, tough-minded relative or friend to assist you as your patient advocate. This person can be your second set of eyes and ears, although if you can you should be speaking more than the patient advocate. Unless there is a language barrier, health care providers prefer that you describe your symptom in your own words.
  • Ask questions: Sample questions include: Why is this procedure being ordered? Why do you think I need this test that you recommend? What about this medication that you want to prescribe? What are the alternatives? Steel yourself with these truths: Medical providers expect questions, and you have the right to say “No.” And never assume that all the medical personnel have all the relevant information. If you have an insurer, get pre-approval from that insurer for procedures.
  • It is OK to ask a provider “How will the results of this test change the way that my condition is managed?” Sometimes providers reflexively order tests. Making sure that tests are truly necessary based on evidence-based guidelines will reduce your overall costs. Make sure as well that the tests are performed at facilities that are in your network.


  • Ask for generics: Make sure that you ask about “generics” and medications that are offered at relatively low prices on your insurance “formulary” (an official list giving details of medicines that may be prescribed). This information is readily available on many physicians’ electronic medical record systems. You can also check your insurer’s formulary to find what drugs in the same class are preferred. Check the $4.00 medication lists offered by most chain pharmacies and big box stores before filling prescriptions.
  • There are two free applications ( and which can be downloaded for a comparison of medication charges at local pharmacies. 

If You Get Admitted to the Hospital

  • Pre-approve your admission: If you are going to be admitted to the hospital, get your health insurer to pre-approve that admission.
  • Clarify your status: As Dr. Elisabeth Rosenthal notes in her book An American Sickness, you should be clear on the status of your stay. Ask whether you are on “observation status” or are instead being admitted into the hospital, because the answer might well have a big impact on your finances. Although they are still in hospital beds, patients on observation status will be considered outpatients and be on the hook for outpatient co-payments (the dollar amount associated with a type of care) and deductibles (the amount that you pay out of pocket before your insurance starts to pay), which are generally far higher than those for an inpatient stay. (And unless you get a terrific justification of why you need a private room, turn down that honor unless you want to risk a much higher bill.)
  • Ask about the length of stay: Ask for an estimate of how many days you will spend in the hospital (but be prepared to get the answer “You will be in the hospital for only as long as it takes for me to discharge you safely”).
  • Ask for a financial counselor: If you are worried about your ability to pay, ask to speak to one of the hospital’s financial counselors.
  • Make sure your providers are in your network: At least one of the documents you will be asked to sign upon admission to the hospital will cover your willingness to accept financial responsibility for charges not covered by your insurer. Dr. Rosenthal recommends that before you sign such a document, you write in “as long as the providers are in my insurance network” (that is, under contact with your insurance provider). Dr. Rosenthal also passes on the advice that you insert on every chart you see the words “Consent is limited to in-network care only and excludes out-of-network care.” Dr. Rosenthal suggests that such an annotation will at the very least give you a basis for contesting charges later.
  • Document your care: Identify and document every person who appears at your bedside, and identify and document every test, procedure, and medication you are given. (Make your requests for this information with a smile, as this will reduce the defensiveness that might otherwise arise.) Get a patient advocate to do this if you are unable. Try to take your own home medications at the hospital if you can. Refuse unnecessary equipment. Talk to the doctors, nurses, and aides who come into your room; key times include the morning (when doctors usually make their rounds) and during nursing shift changes. 

After You Are Discharged from the Hospital

  • Review the billing statements from all sources. Get itemized bills so that you check the costs of each medication, lab test, and procedure. Keep track of any claims and payouts by insurers. Be prepared to dispute charges, and do so on a timely basis. Keep careful notes documenting the date, time, person contacted, and content of communication. Work to decipher the codes on the bills. Don’t be afraid to call to figure out what a bill and a code mean. “It is your right as a patient and health consumer to know what you are paying for,” as health care specialist attorney David J. Holt told Mikey Box of Ask for discounts and write-offs, and you might find that an in-person visit to the office of the provider might yield the best results.
  • Work hard to avoid taking out a loan to pay your medical bills, whether that loan comes from the financial institution or from your provider. If necessary, go higher up the chain of command for an answer or a justification of the charge. Finally, be prepared to complain to state or federal regulatory agencies if you can’t get relief otherwise.

If You Have Been Told that You Need a Big-Ticket Procedure

  • Non-emergency surgeries performed in Alaska are both costly and some of the biggest reasons our state’s health care costs are higher than those of any other state. This is particularly true for procedures done by specialist practitioners such as orthopedic surgeons, cardiac surgeons, and neurosurgeons.
  • Be skeptical if you are told that you need something new, fancy, and expensive. The most cutting-edge procedure or technology is not necessarily the best course for you, and a doctor’s high fees are no guarantee of quality. For example, if your knee or shoulder is hurting, that pain might go away if you started swimming and/or had some physical therapy, and you might not need that MRI test or surgery that a surgeon advised.
  • Don’t pressure doctors to give you the most high-dollar or invasive treatment you have ever heard of, and don’t let them pressure you either. A second opinion is critical, particularly if the first specialist you see recommends an expensive procedure or treatment. As one hospital executive says, don’t be a victim.
  • It is often helpful to ask your primary care provider “If your mom was going to have this surgery done, where would you send her?”
  • If you do decide that you need big-ticket surgery, research your options. Websites such as can give estimates of what various procedures should cost in locations around the country, and they can give you the CPT code as well for the procedure. In general, it is better to go on the Internet after you have a diagnosis as opposed to trying to diagnose your problem on the Internet yourself.
  • The next step is to negotiate. Be assertive. Get price comparisons, either in the office or by telephoning. Announce that you are investigating several providers for options and that you seek the most favorable prices. More than one Alaska doctor has expressed amazement that patients appear afraid to question doctors about recommended work and request discounts the way that those patients would if the recommendations came from an automobile dealership or an auto body shop. As one Alaska doctor said, “Providers know that health care costs in this state are high and most/many are willing to help you determine the most cost-effective and safe options if you just ask.”
  • A representative from Angie’s List told that a prospective patient should get the quote in writing with a signature, name, and title along with the price quoted.
  • Additionally, that observer—Cheryl Reed—recommended that “When getting prices, be sure you cover all fees associated with your procedure, rather than just the surgical costs—e.g. anesthesiologist, radiologist, laboratory costs, etc.”
  • Another tip: Be wary of a surgeon whose office puts you on the surgical schedule as soon as you call the office for an appointment.
  • If you decide that your best option is for a surgery outside of Alaska, be aware that you might have difficulty securing follow-up care from an Alaska surgeon upon your return to the state. One Alaska physician recommends that anyone considering going outside the state for surgery to remain at that location long enough to be reasonably certain that complications have not arisen.

Before You Need the Medical Care

  • The easiest advice is both the most boring and the most important. A high percentage of your lifetime medical costs is likely to be determined by your nutrition and your lifestyle, so start by taking care of yourself before you are told to strip down and get in a gown.
  • Eat healthy food, exercise regularly, quit smoking, limit your alcohol intake, and establish visits with a primary care provider.
  • Know important facts like your blood pressure.
  • Make a list of the medications you take and keep it in your wallet or purse or on your smartphone.
  • Know who your primary care provider is and what specialists you see.
  • And to help your family, you should go to the next level and prepare an advance health care directive/living will to lay down your wishes for your care when you can’t do the speaking yourself. Share that directive with your family and your medical care providers—and you could also suggest to relatives that they also prepare such a document for themselves.


Cliff Groh prepared this document following conversations with more than a dozen Alaska medical providers and others knowledgeable about the provision of health care in Alaska. Particular thanks go to Theresa Philbrick, RN; the book An American Sickness: How Healthcare Became Big Business and How You Can Take it Back by Elisabeth Rosenthal, and the article by Mikey Box entitled “7 Smart Ways to Negotiate Your Medical Bills.” The above is not intended as legal advice, even though Groh is a lawyer as well as a writer and the Chair of Alaska Common Ground. Alaska Common Ground is holding a series of events on Alaska’s high health care costs that runs from November of 2017 through January of 2018, and details can be found at or on Facebook.

High Health Care Costs in Alaska: Facts, Causes, Consequences, and Remedies

Alaskans are used to superlatives, but when it comes to health care costs we have really outdone ourselves.

The United States has the world’s highest health care costs, and it sure looks like Alaska has the highest health care costs in the U.S. as well as the fastest-rising costs.

The Last Frontier’s sky-high costs show up in various ways.   The Kaiser Family Foundation’s data from 2014 (the most recent year released) has Alaska as highest among the states in per capita health expenditures, with only the District of Columbia higher.   Relying on data collected from 264 areas around the U.S., the Anchorage Economic Development Corporation reported that in 2016 the three cities with the highest health care costs in the nation were Juneau, Fairbanks, and Anchorage.   And the story is the same regarding health insurance, as the premiums for Alaskans on the exchanges for 2017 are at the top among the states.

No other state has experienced higher annual percentage growth in health care costs since 1991, according to the federal government’s Centers for Medicare & Medicaid Services.   In the old lingo of the popular music charts, Alaska is No. 1 with a bullet.

What are the causes of Alaska’s extremely high health care costs?   What are the consequences of this “Alaska premium” in the prices of health care?   Do remedies exist for the Great Land’s great costs for health care?


Observers have offered more than half a dozen explanations for Alaska’s extra-high health care costs.   The list includes:

  • Our state’s relatively small population and isolation from larger markets
  • Distribution of a substantial percentage of Alaskans in a variety of remote areas, including off the road system
  • Limited numbers of providers of medical services
  • Limited competition among providers, especially specialty physicians
  • Particularly high compensation for providers, especially specialty physicians who perform procedures (such as orthopedic surgeons, cardiologists, and neurosurgeons)
  • Hospital profit margins in urban Alaska that are higher than national averages
  • Particularly risky and/or antisocial behavior by patients
  • Regulation by the State of Alaska, particularly the “80th percentile rule”
  • Absence in Anchorage—the state’s largest community—of government-operated and/or teaching hospitals that are open to all patients

There is insufficient space allowed for this column to explore all these potential factors, but a few points are highlighted below.

Dr. Alan Gross, an Alaska orthopedic surgeon, has written that Alaska doctors often charge and collect 500 percent—or more—than the costs for obtaining the same service outside the state.   These higher fees appear to be mostly charged by specialty physicians.   Lori Wing-Heier, the Director of the Alaska Division of Insurance, told Alaska Dispatch News columnist Charles Wohlforth in 2016 that some specialist procedures cost 10 times as much in Anchorage as they do in Seattle.

Other observers have cited particularly risky and/or antisocial behavior by patients on the Lost Frontier that could increase health care costs.   Along with Alaska’s well-known problems with domestic violence and alcohol abuse, doctors point to what they see as a tendency of Alaskans to present their medical problems later than other Americans.   Alaskans, however, do not on average have higher rates of utilization of medical services than other Americans.


Alaska’s extremely high costs for health care and health insurance have generated some individual sad stories, including lost opportunities to start businesses and forced departures from the state.

It’s becoming increasingly clear that these high costs are having big impacts on Alaska’s economy and fiscal circumstances as well.

Two reports issued this year by the Anchorage Economic Development Corporation provide a window on the contortions health care introduces into economic discussions.   The most recent outlook by AEDC celebrates job growth in the health care sector while noting declines in employment in oil and gas, construction, professional and business services, and state government.

Another AEDC report gives quite a different picture, however.   A survey of more than 300 Anchorage businesses and organizations identified health insurance as one of the two top barriers to their organization’s growth, behind only the condition of the state economy.

Mark Foster, a long-time financial analyst and former Chief Financial Officer of the Anchorage School District, has even argued that the high costs of medical services in Alaska serve as a significant deterrent to the long-held dream of bringing natural gas on Alaska’s North Slope to market.   His contention is that other expensive petroleum projects competing for investment dollars around the globe benefit from locations with much lower health care costs, a significant factor to consider for those deciding where to put in big money.

Whatever effect high health care costs might have on the prospects for monetizing Alaska North Slope natural gas, those costs are a giant driver in Alaska’s fiscal challenge.   Thirty-five percent of the total state budget is now devoted to health care, according to an estimate by Dr. Gross, the Alaska orthopedic surgeon mentioned above (who also holds a master’s degree in public health). This figure appears to cover all the ways the State of Alaska spends in this area, including on employees of departments, teachers, University of Alaska employees, retirees, Medicaid, and prisoners.   Health care expenditures for the State of Alaska have also increased as the overall budget has fallen for the fifth straight year.


Alaska health care costs appear to be unsustainable, as even those who some observers would perceive as the system’s winners are recognizing.   Dr. Stanley Watkins, an Anchorage interventional cardiologist, told Alaska Public Media’s Annie Feidt in 2016 that “The prices are probably going to have to go down up here.”

A useful data point is that Alaska did not always stand alone on top of the health care costs mountain.   An article by Natasha von Imhof (now a Republican State Senator from Anchorage) in Alaska Business Monthly in 2014 pointed out that the health care costs in Alaska and Wyoming were the same in 1990.   Two decades later, Alaska’s costs had doubled, while Wyoming’s grew a quarter of that.

Dr. Robert Hall, an Anchorage orthopedic surgeon, was nodding to the same facts when he wrote in 2017 that medical fees in Alaska were “much more aligned with the rest of the country” 20 years or so ago.   Dr. Hall observed that every other state has been undergoing “a gradual process of reduction,” and added that “Alaska will have to do this reduction more quickly but it cannot be done all at once if the system is to withstand the process.”

Whatever the pace of this reduction, there are a lot of ideas out there about how Alaska’s costs could be cut (or at least made to go up more slowly).   With suggestions drawn from articles by Natasha von Imhof, Charles Wohlforth, and Columbia University economist Jeffrey Sachs, here’s a list roughly set out in order from smaller-scale proposals to more thoroughgoing changes in the system. (Note that an idea’s appearance on this list does not imply an endorsement of it.)

  • Telemedicine, which allows doctors, nurses, local health aides, and patients to communicate about diagnosis and treatment through electronic means, avoiding the cost of travel
  • Expanded home visits for community-based health care, which could combat obesity, opioids, and mental illness as well as follow up on patients’ compliance with instructions following hospital discharge
  • Increased communication among employers regarding costs of health insurance and ways to encourage employee wellness
  • Medical travel/“medical tourism,” which provides patients opportunities to seek lower-cost and high-quality care outside of Alaska
  • Required transparency of fees and outcomes, which would allow patients to have important information before making decisions on their health care
  • Government-operated clinics for employees, employees’ dependents, and maybe others
  • Facilitation of “task shifting” from doctors to lower-cost health workers or health care teams for routine procedures
  • Greater use of foreign-born and/or foreign-trained doctors
  • Customer-driven whole person care, in which health care providers engage their patients to take control of their wellness and providers’ efforts are coordinated with each other
  • Capping of compensation for hospital CEOs and other top managers
  • Movement away from traditional fee-for-service medicine to various forms of value-based reimbursement.   As laid out by Michael E. Porter and Robert S. Kaplan in the Harvard Business Review, alternative methods could include capitation (where a health care organization receives a fixed payment per year per covered life and must meet all the needs of a broad patient population) and a bundled payment system (where providers are paid for the care of a patient’s medical condition across the entire care cycle).
  • Creation of a single health care plan in Alaska for all government employees, with companies and individuals allowed to buy in at cost, that could negotiate with providers to produce more reasonable fees and prices as well as models of medical care that increased value
  • Adoption of a single-payer health care system in which the government, financed by taxes, covers basic health care costs for all residents, thereby eliminating for-profit health insurance

Alaska Common Ground is holding a series of events in Anchorage on Alaska’s health care costs over the next 6-12 months.   This series will cover in more detail the costs and trends, the causes, the consequences, and potential remedies.   Speakers will include a variety of experts, including doctors, on this critical topic.


Cliff Groh is a lawyer and writer in Anchorage.   He is also the volunteer Chair of Alaska Common Ground, a non-profit organization that focuses on helping Alaskans understand and reach consensus on the major issues facing our state.

Let’s Look at the Value of Alaska’s PFD

Janet McCabe, published in the Alaska Dispatch News, October, 3, 2017

On Thursday, Oct. 5, the state will start a new round of Permanent Fund dividend distributions. As each qualifying applicant receives $1,100, approximately $672 million will start rippling throughout the state, infusing all Alaska communities with new economic life, from our smallest villages to our largest cities. The per-person distribution reaches people in all parts of the state at all economic levels.

Dividend distribution is an annual phenomenon, unique to Alaska. Over the 35 years since the first dividend checks were distributed, Alaskans have come to rely on this regular infusion of cash. Some may take it for granted. But other nations have seen Alaska’s dividend as a model, useful to reduce or replace welfare programs by having confidence that individuals know what is best for themselves.

Gov. Bill Walker has called a special session of the Legislature beginning Oct. 23. Decisions made or postponed during this session could determine the sustainability of the dividend in the future. So, now is a good time to look at the benefits of the dividend. They add up to far more than its cash cost.

• The most obvious benefit is the stronger economy that results from the annual infusion of new money. The dividend is an economic stabilizer, “lifting all boats.” Without it, the current recession caused by the loss of oil-related and state jobs could be far worse.

• By mitigating poverty throughout Alaska, the dividend has helped people help themselves in an ongoing way. Many rural Alaskans rely on their dividends for heat and electricity. Dividends also help them buy the gas and gear that is essential to the work of subsistence hunting, fishing and gathering that feeds their families and communities, and sustains Native cultural traditions.

• As other nations have recognized, the dividend program is a way of reducing welfare and social service costs. In both urban and rural Alaska, loss of the dividend would make those who are already poor even poorer. More Alaskans would become homeless, adding to the difficulties of finding and keeping a job, and being self-supporting.

• Caught in homelessness, people are more prone to substance abuse and addiction and to crimes associated with addiction. Businesses, homeowners and communities are victimized. So, in addition to all its direct benefits to recipients, the dividend program helps the state avoid a significant amount of public expense for social services, public protection and incarceration.

• Perhaps the greatest benefit of the dividend is in its emphatic but unspoken annual message that the Permanent Fund should be preserved and sustained. This was a primary reason why Republican Gov. Jay Hammond and legislators of his time created the dividend program. They had seen how swiftly the $900 million from the 1969 Prudhoe Bay oil lease sale was spent on politically popular projects. They wanted future legislators to have public support for a more measured approach to spending Alaska’s newfound oil wealth. They wanted the Permanent Fund to be permanent.

The Permanent Fund now amounts to about $61 billion, of which $47 billion is protected by the Constitution; $14 billion is in the Earnings Reserve, which is unprotected. Unless the Legislature adopts a system that regulates appropriation from the Earnings Reserve, overspending could jeopardize the dividend, and ultimately the Permanent Fund itself.

Last session, legislators came close to establishing the needed structure. They adopted the well-tested percent-of-market-value (POMV) system used by most large foundations and institutions. Senate Bill 26 incorporates this system for distributions from the Earnings Reserve. Passed by both the House and Senate, SB 26 (often referred to as POMV) is awaiting conference committee and passage into law.

ction on POMV is needed now, not later. Otherwise, the Earnings Reserve could be spent without allowing time for it to replenish. Then the Legislature would cut the dividend program, despite its social and economic benefits, to balance the budget. The recession would be accelerated, need for public services would increase, and Alaska, once with so much potential, would be an impoverished state.

It’s useful to remember the favorite bumper sticker from the hard times of the late 1980s that read, “Oh Lord, please give me another $900 million. I promise not to p— it away.”

To explore this and other fiscal issues, Alaska Common Ground is inviting the public to a panel discussion of important goals and values in navigating the fiscal crisis. This first panel will be followed by a second panel of policymakers, including legislators and members of Gov. Walker’s office. They will discuss ways to move forward to achieve fiscal goals.

This free event is from 7 to 9 p.m. Thursday, Oct. 5, at 49th State Brewing Co., 717 W. Third Ave. in Anchorage. Do come and ask your questions to panelists at “Choosing Our Future: Alaska’s Fiscal Options.”

Janet McCabe and her family have lived in Alaska since 1964. Her education and experience are in community planning. She is actively involved in several nonprofit organizations, including Alaska Common Ground.

Follow up Fiscal Letter to the Legislators

We sent a third letter to the Alaska State Legislators urging them to action on the fiscal crisis on May 18, 2017. Alaska Common Ground fiscal letter 5-18-17

Dear Senator:

We recognize and appreciate the hard work of the Legislature in reviewing a wide range of proposals to address the State’s fiscal gap. However, to date the Legislature has not reached agreement on a broad-based and balanced solution.

This session remains a turning point for Alaska. If the Legislature again balances the budget by relying on savings in the Constitutional Budget Reserve Fund, there will be no ability to balance the budget in 2018 without spending a substantial amount of the Permanent Fund Earnings Reserve Account.

As former Alaska House Speaker Mike Bradner has pointed out, if the Legislature fails to take big steps in 2017, we will be out of money and out of time in 2018. Ignoring the revenue side of the equation in 2017 is a recipe for drastic cuts to services, a heavy reduction in Permanent Fund Dividends, and a significant loss of jobs in both the public and private sectors. Proposed cuts to education are particularly damaging to young Alaskans and the future of our State. The “wait and see” approach constitutes a direct threat to our economy and our way of life. Adjusted for inflation and population, the budget this fiscal year is the lowest it has been in 10 years. All State of Alaska employees could be laid off, and the State of Alaska would still have a deficit. Already the signs of a recession are all around us.

Global and state realities demand that in 2017 the Legislature adopt a comprehensive fiscal plan. Alaska’s needs require us to include a broad-based tax—as does every other state—in the State’s response to its continuing fiscal challenge. A progressive income tax, set at levels that would have little or no effect on those with low to moderate incomes, avoids competition with municipalities, and is preferable to a statewide sales tax. Without a broad-based tax, draws on the Permanent Fund Earnings Reserve Account will be increased, then Dividends can no longer be paid, and eventually the Permanent Fund itself will be threatened.

Timing is critical. The opportunity for an effective solution will be gone next year. We look forward to a plan that benefits all Alaskans, now and in the future.

Cliff Groh
Chair, Alaska Common Ground
On behalf of the Alaska Common Ground Board of Directors

Resolve the “Disconnect”, take Alaska Forward

Board member Janet McCabe’s Commentary in the Alaska Dispatch News on April 13th, 2017

Alaska is poised on the brink of a severe economic recession, and the state Legislature is about to make decisions that will influence whether the economy topples over this brink into an economic decline that builds on itself and gains momentum, or whether we pick ourselves up and move forward to thrive.

Mike Navarre, former state legislator and current three-term mayor of the Kenai Peninsula Borough, provided insight about this choice in the  April 6 Alaska Dispatch News and in recent testimony to the House Finance Committee. He described the Alaska Disconnect, so named by Alaska’s Institute of Social and Economic Research (ISER) over a decade ago. In short, the Alaska Disconnect means that the lack of a broad-based source of tax revenue cripples Alaska’s ability to provide the state services required by the population increases that accompany new development. As a result, the budget gap becomes worse. Another study stated in 2003 that, unless the Alaska Disconnect is solved, “new non-oil-producing employment is a net drag on state finances.”

Multiplier effects must also be considered when the Legislature makes choices about ways to fill the budget gap. When Alaska’s economy is healthy, new money comes into the economy from primary sources such as the oil industry, mining, tourism, other industries and, especially, state spending. These expenditures contribute to the success of secondary businesses that employ people who, in turn, spend in a way that makes other businesses thrive. Under this scenario, the multiplier effect is positive.

State spending and distributions are significant primary sources of new money that stimulate a positive multiplier effect. We are reminded of that annually when Permanent Fund dividend checks arrive. On the other side of the coin, ISER has found that a state budget cut of $100 million results in the loss of 1,000 to 1,250 jobs. Cuts generate negative multiplier effects.

Alaska’s major recession of the late 1980s provides a vivid picture of the way a negative multiplier effect works. In 1986, crude oil prices fell from an inflation-adjusted all-time high of $107 per barrel to $31 per barrel, a 71 percent decline. Alaska was a young state with few other options, so the Legislature and governor cut state spending to balance the 1967 budget.

The effect on the economy was not immediate. Uncompleted “Project 80s” construction projects had a brief sustaining effect, but soon the economy started to wither.

The sudden loss of jobs, from state spending cuts and oil industry cuts, forced many Alaskans to leave the state or reduce their own spending. This loss of new money circulating in the economy impacted the service sector, and owners of restaurants, gas stations, saloons and beauty salons, automobile dealerships, retail stores, architectural firms, and construction and maintenance companies, to name a few, found they had less business. In turn, these businesses were forced to cut staff or close, and more people lost their livelihoods and left Alaska.

As the negative multiplier effect of the late 1980s spread and people left or downsized, the supply of housing exceeded demand. Anchorage streets soon had rows of “For Sale” signs and property values collapsed. Many people found that their mortgage obligations exceeded the value of their property. Frequently, they were unable to sell. If a work-out was possible, the forgiven debt became taxable income in the eyes of the IRS.

Under these circumstances, some homeowners simply drove away. One bank employee told me he hated to open the drop box on Monday because it would be full of house keys. Eight banks, or 40 percent of all banks in Alaska, failed during the late 1980s. The crash had huge human costs in terms of broken dreams and broken relationships. Families split up and friends left forever.

The hard times of the 1980s ended because of the Exxon Valdez oil spill and the resulting infusion of primary spending for cleanup — $2.1 billion, according to Exxon. Alaska was yanked out of the economic doldrums. Still, it took years before oil prices recovered.

[House, Senate need closers for budget deal]

The similarities and differences between then and now are instructive. In the 1980s, the Alaska Legislature saw no option except to cut the budget. They did so, and that approach, in combination with the reduction of spending by the oil industry, resulted in an extremely harmful self-perpetuating economic recession. Thankfully, the current Alaska Legislature has a much wider range of options for solving the fiscal crisis.

Circumstances affecting Alaska’s oil industry — the worldwide oversupply of oil, the consequent fall in prices and the declining productivity of Alaska’s oil fields — are also very different than they were in the 1980s. Regardless of recent announcements by oil companies, we have reached a time when a major infusion of new oil revenue is insufficiently probable to serve as a basis for the critical decisions that will shape our state’s economic future. Most likely, the oil industry will lobby intensely to oppose measures that would free Alaska from dependence on oil revenues. This must be recognized for what it is.

Fortunately, in this session the Legislature can fill the budget gap without further operating-budget cuts. So far, we have seen progress. Both the House and Senate proposals include an annual dividend. The agreement to use a percent-of-market-value draw from the Permanent Fund Earnings Reserve Account for public purposes is a major step forward. In combination with the oil credit and tax measures proposed by the House in HB 111, and a state income tax, legislators could stop the destructive cutting and give businesses and the public a measure of assurance that they are on the way to solving the problem.

Sure, we all hate to pay taxes, but paying the modest graduated or progressive income tax proposed by the House would be fair. Those with high incomes would pay taxes; those with low to moderate incomes would pay nothing or very little. We would be buying a better of quality of life for everyone. We could step off the oil-industry roller coaster, pay our share and, at long last, solve the Alaska Disconnect.

Janet McCabe and her family have lived in Alaska since 1964.  Her education and experience are in community planning. She is actively involved in several nonprofit organizations.

Second Fiscal Letter to State Legislators

Alaska Common Ground sent a second Fiscal Letter April 2017 to Alaska State Legislators on April 7, 2017.

Dear Legislator:

Alaska Common Ground focuses on public policy issues and seeks to build consensus through public forums including speakers with diverse perspectives. We have held over 30 such meetings about Alaska’s fiscal gap and have put on more of them recently because of the urgency of the situation. These forums have been well received by the public and the media, in part because of participation by various legislators. Thank you for joining us!

We are gratified that both the House and the Senate are considering bills that include use of a portion of the Permanent Fund Earnings Reserve Account (ERA) as part of a fiscal plan, with an annual percent-of-market-value (POMV) calculation governing the amount of the draw for the state budget. That is an important step towards finding common ground, but, as both houses recognize, the POMV is only part of the solution.

A plan that is insufficient to fill the FY2018 budget gap – approximately two thousand eight hundred million dollars or $2.8 billion – will cause more harm than good. Postponing necessary decisions will perpetuate, even accelerate, Alaska’s current economic recession.

Important points to consider include:

1) Additional substantial budget cuts are likely to exacerbate the recession. A budget cut of $100 million costs Alaska 1,000 to 1,250 jobs, according to ISER. Many Alaskans have not yet felt the bite of a serious recession, but, without swift legislative action to stop sweeping cuts and adopt revenue measures, it is highly probable that job losses will continue, and negative impacts on the economy will multiply and become widespread and enduring.

2) Protecting the Permanent Fund Dividend protects the Permanent Fund, as Governor Jay Hammond argued. Eliminating the Permanent Fund Dividend, on the other hand, would have a huge and unfair impact on lower-income Alaskans, including people in rural communities.

3) A fiscal plan that is sufficient to fill the fiscal gap should include one or more broad-based sources of revenue in addition to the POMV. A progressive income tax, set at levels that would have little or no effect on those with low to moderate incomes avoids competition with municipalities, and is preferable to a statewide sales tax. Note that Dillingham and Bethel, for example, each have six percent local sales taxes.

Many businesses seeking a startup or expansion in a new location look at quality of life factors such as good schools, universities, infrastructure, and public safety, that will help these businesses attract and retain employees. Those in the service sector—such as air transportation—are extremely reluctant to invest in a declining economy. This is yet another reason additional big budget cuts and a failure to establish an adequate revenue stream for the annual state operating budget will accelerate the downward spiral of Alaska’s economy.

            For Alaska to flourish, the state must have a stable revenue stream. To stabilize the revenue stream several sources are required. Diversity is the key to security. Please act now to adopt the essential fiscal measures that will give our Alaska a positive future.


Cliff Groh, Chair
Alaska Common Ground Board of Directors


Come join talks about transportation in Anchorage/Mat-Su

From Here to the Future: Transforming Anchorage/Mat-Su Transportation

Transportation options affect every Anchorage and Mat-Su Borough resident nearly every day. Everyone has to get to somewhere: work, medical care, school, groceries, errands, family gatherings and social events. It impacts everyone’s daily life, either making it easier or harder to get from place to place. And as a “winter city” and region with a substantial moose population wandering on our roads, Anchorage and the Mat-Su have some particularly tough transportation challenges.

The region’s transportation system is good, but it can be improved. For example, Anchorage has a great recreational trail system, but many bicyclists and walkers need to get places via safe roads and sidewalks that may not exist. Many of us want to increase walkability in our town. Mat-Su commuters to Anchorage have options, but they are limited. Addressing snow and ice is costly and difficult.

And there are questions. The People Mover bus system is undergoing a transformation – what will this mean for the public? Will we get Uber type service? Are driverless cars on the horizon? The state and federal governments share jurisdiction over Anchorage roads – does this division of governmental responsibilities make sense? Is the public sufficiently engaged in transportation decision-making and are decision makers responsive?

What are other cities and regions doing that we can learn from? Can the Anchorage/Mat-Su region offer more transportation choices, and how can we fund those options?

If you are interested in these transportation topics and questions, and ways that our transportation system can be improved and made relevant for the future, please join Alaska Common Ground as it hosts a series of free evening events with cutting edge speakers, followed by discussions with local experts on key transportation topics.

The first speaker is Rollin Stanley, General Manager of Urban Strategy in Calgary, Alberta, who will kick off the series giving a free public lecture on “Technology, Demographics, and Transportation.” Stanley says, “Transportation investments are about the generations that come long after they are made. What impacts do technology and demographics play in guiding these decisions?” His talk will be on Wednesday, March 22 from 7:00 to 8:30 pm in the Anchorage Museum Auditorium. Stanley has worked in the suburbs of Washington DC, as well as in St. Louis, Toronto, and Calgary.

On April 5th, Paul Soglin, Mayor of Madison, Wisconsin will give a free public lecture on “A Multi-Modal Transportation System (Winter or Not).” Mayor Soglin has served several terms as Mayor of Madison and is now in his 20th year as mayor. His tenure is noted for major commitments to public transportation, equity, sustainability, walkability and livability. His talk will be on Wednesday, April 5 from 7:00 to 8:30 pm in the Anchorage Museum Auditorium.

These public lectures will be followed three topical panel discussions, all at the 49th State Brewing Company from 7:00 – 8:30 pm. April 11 will be an engaging panel and audience discussion on “How does transportation planning work, and how do I engage?” April 25 will be a panel and audience discussion on “Anything but Cars” looking at how we might better connect our varied modes of transportation. The series will finish on May 9 with a policy maker’s panel from Anchorage and the Mat-Su Borough engaging with the audience on regional transportation visions for the future.

Please join us for these thoughtful conversations on how to envision and transform our region’s transportation system. Alaska Common Ground is a non-partisan, non-profit, which promotes community education and dialog on public policy issues.

For more information, go to or to Facebook and Twitter @akcommonground.

Mary Lu Harle is a board member of Alaska Common Ground and is a resident of Anchorage for 39 years.





Read the piece on

A Good Solution to Our Fiscal Crisis

Compass piece in Alaska Dispatch, 2-16-17 by Helen Nienhueser

Kudos to Representative Paul Seaton, Representative Neal Foster, the House Finance Committee and the House majority coalition for their proposed solution to Alaska’s fiscal crisis! Thank you! Finally we have a solution that looks at the whole problem!

On Friday the House majority introduced House Bill 115, the State Revenue Restructuring Act. This bill would use two major sources for state revenues that together would cover 80% of the state’s current 2.7 billion deficit. And it protects the Permanent Fund dividend!

To do this the bill calls for restructuring how the earnings of the Permanent Fund will be used. The annual draw from the Permanent Fund Earning Reserves would be 4.75 % of the market value of the entire fund. This is a safe, conservative figure that will allow the fund to continue to grow in the future.   Two-thirds of this draw or 1.52 billion would go to the state’s general fund to cover state operations such as education, public safety, and road maintenance/plowing.

The second major revenue source would be a progressive income tax of 15% of your federal tax. This is slightly LESS than we paid in the 1980s.! This would generate an estimated $655 million annually, part of which will be paid by non residents.. This is fairer than a sales tax because a sales tax hits those who are least able to pay hardest. In addition, most communities other than Anchorage already have a sales tax which would put a double burden on the residents of those communities.

This leaves a remaining deficit of about 500 million, a much more manageable amount to cover with smart budget cuts (e,g. travel for legislators and state employees?), reduction in oil tax credits, and other taxes such as alcohol, tobacco, and gas.

The remaining third of the draw on the Permanent Fund earnings would go to pay the dividend. The 2018 dividend would start at about $1100 and would grow sustainably over time. Those of us who pay income tax could choose to do so with our dividend, which would cover the tax for many of us.

The House Finance Committee is holding a hearing on HB 115 at 1:30 Friday. You can testify by going to the Legislative Information Office (2nd floor, Wells Fargo building, 1500 W Benson Blvd at the corner of Benson and Minnesota ) at 1:15. You can also testify by phone; call 586 9085. Or send written testimony to, with copies to your own legislators (subject line: written testimony HB115)..

Please support this bill! It will ensure an Alaska where our children and grandchildren can stay!

Alaska Common Ground Holds Several Successful Educational Events in Juneau Regarding Alaska’s Fiscal Challenge

By Chair, Cliff Groh

Alaska Common Ground put on seven fiscal events in Juneau open to the public during the first three weeks of the legislative session. The venues included the State Capitol, a conference room at the University of Alaska Southeast (UAS), an ice cream shop, and the back room of a sports bar. The largest event was the Policymakers’ Fiscal Forum at the historic Red Dog Saloon, which drew 80-100 people.  Five legislators—including the Speaker of the House, the President of the Senate, the Chair of the Senate Rules Committee, and the Co-Chair of the House Finance Committee—joined the Commissioner of Revenue and the Governor’s Director of the Office of Management and Budget to answer questions from each other and from the audience. That audience included at least four other legislators plus legislative staff members and officials from the administration and the Permanent Fund Corporation. Advance publicity appeared for the Policymakers’ Fiscal Forum in the Juneau Empire (including a teaser on the front page).  Two TV crews covered the forum, which ran 2.5 hours on a Tuesday evening. KTUU-TV ran a three-minute story on the evening newscast and Gavel Alaska rebroadcast the forum. I served as moderator at the Policymaker’s Fiscal Forum and prepared an updated version of undisputed facts regarding the fiscal challenge that I distributed to both the participants and the audience. (For those who have been to the Red Dog over the decades, there is no sawdust on the floor in the winter, but Wyatt Earp’s pistol is still on the wall.)

Three other events were televised. I made two “Lunch and Learn” presentations in the Capitol, one on questions of history and values associated with the fiscal challenge and the other a demonstration of the Alaska Fiscal Balance Game. ISER Professor Emeritus of Economics Gunnar Knapp, Department of Labor Economist Caroline Schultz, and I appeared on a panel discussion before a live audience in the studio of KTOO public television. The Lunch and Learn events were televised on a delayed basis within the Capitol, and the panel discussion was shown on Gavel Alaska public TV. Gunnar Knapp and I also made presentations and answered questions at a campus-wide event at UAS.  Then there were the events where Gunnar and I spoke that were less traditional and even more fun.  There was free ice cream at “Get the Scoop on the Budget” at Coppa, with special flavors for the occasion—Fiscal Crunch (maple caramel ice cream with cinnamon and nutmeg brittle) and Sustainable Budget (blueberry ice cream with chocolate fudge chunks). Later that same night, there was free beer at “Beer and Budget” in the back room at McGivney’s.  The events at Coppa and McGivney’s were the focus of a story that ran on “Alaska News Nightly,” the flagship evening program of statewide public radio. In addition to those seven events open to the public, I gave a guest lecture at one UAS course and demonstrated the Alaska Fiscal Balance Game at another.

The feedback to these events has been overwhelmingly positive. As an example, two legislators—the Speaker of the House (a Democrat) and the Chair of the Senate Rules Committee (a Republican)—asked me immediately after the Policymakers’ Fiscal Forum to arrange for Alaska Common Ground to hold another similar event soon. There was surprise in the Capitol at the turnout at the Red Dog, as some legislative staff members and at least one legislator had told me before the event that few of their colleagues would go to an educational event where they had to pay for their own food and alcohol.

Several people deserve thanks. UAS Professor Jim Powell organized the campus-wide event as well as the gatherings at Coppa and McGivney’s. Theresa Philbrick designed the flyers, helped publicize the events, and paid for (and named) the ice cream flavors. Alaskan Brewing Company donated the beer at the McGivney’s event. Three volunteers from the League of Women Voters staffed the table at the door of the Red Dog and circulated the question cards. Future gatherings could include additional events in Juneau featuring policymakers answering questions from each other and from the audience as well as a demonstration of the Alaska Fiscal Balance Game in a Juneau bar. I have also been asked to explore the possibility of holding Alaska Common Ground events in the next few weeks in Fairbanks and the Matanuska-Susitna Valley that would have policymakers talking about the fiscal challenge. I have also had discussions about making presentations to civic and professional organizations in Juneau.