Independent Bill Walker, who won election last month in a governor’s race so tight the results weren’t known a week after the voting was over, campaigned on the promise that he’d expand Medicaid as one of his first orders of business. To make good on that, he’ll have to face Alaska’s Republican-controlled legislature that hasn’t been willing to even consider the idea.

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 28 states 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. Anna MacKinnon 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 Valerie Davidson 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 aren’t functioning properly right now and Davidson wants to address those issues before any expansion.

This story is part of a partnership that includes Alaska Public Media, NPR and Kaiser Health News.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

As some companies add egg freezing to their list of fertility benefits, they’re touting the coverage as a family-friendly perk. Women’s health advocates say they welcome any expansion of fertility coverage. But they say that the much-publicized changes at a few high-profile companies like Facebook and Apple are still relatively rare, even for women with serious illnesses like cancer who want to preserve their fertility.

News stories about company-paid egg freezing for female employees have focused on whether the benefit truly gives women and men more options for balancing work and family life or instead sends a message that they’re expected to put off having a family if they want to get ahead on the job.

But that is not the main concern for some women who, because of illness or age, are worried that time is running out for them to have children. After their mid 30s, women can still carry a pregnancy but their eggs are less viable. Egg freezing allows women to extend their fertile years.

“I’ve never met anyone who fits the mold of the stereotypical egg freezer who’s career mad and waiting for Mr. Right,” says Brigitte Adams, 42, who became the face of oocyte cryopreservation, as egg freezing is called, when Bloomberg BusinessWeek put her on its cover for a story on the subject last spring. “A lot of women will tell you, ‘I didn’t expect to be here. I just want the possibility of having a child.’”

Adams is one of those women. Divorced in her mid 30s, she froze her eggs three years ago, paying for the $12,000 egg retrieval procedure with personal savings and help from her parents. Adams pays $300 annually to store her eggs, and she’s pondering becoming a single mother. Her marketing job at a tech start-up in Los Angeles doesn’t provide any coverage for egg freezing and storage or the in vitro fertilization that will be required if she decides to go ahead.

Adams is keenly aware that there is no guarantee that the 11 eggs she’s storing will result in a pregnancy. “It’s not a silver bullet,” Adams says, “but it gave me the sense I’d done everything I could and that has helped me tremendously to just move on.”

Two years ago, the American Society for Reproductive Medicine declared that it no longer considered egg freezing to be experimental. Research shows that fertilization and pregnancy rates using frozen eggs are similar to those using fresh eggs, and children born using frozen eggs don’t have higher levels of chromosomal abnormalities or birth defects, the ASRM said in its revised practice guideline.

Yet insurance coverage for egg freezing and other infertility treatments remains spotty, says Richard Reindollar, executive director at the ASRM. “Of all the disease processes, insurance coverage is available for essentially all of them, but not for infertility,” he says. “It’s not seen as such.”

America’s Health Insurance Plans hasn’t surveyed insurers specifically about egg freezing coverage, says Susan Pisano, a spokesperson for the trade group. However, she said her understanding is that many plans cover egg freezing when there’s a diagnosed fertility problem or when an individual is at risk for infertility because of treatments like radiation therapy or chemotherapy. Coverage for non-medical reasons is much less common, Pisano says.

Roughly a third of companies with 500 or more workers provide no coverage for infertility services, according to benefits consultant Mercer’s annual survey of employer health benefits. High-tech companies are more likely to cover fertility services than other firms, according to Mercer. Forty-five percent of high-tech companies cover in vitro fertilization and 27 percent cover other advanced reproductive procedures such as egg freezing, for example. The comparable figures for non-high-tech companies were 26 percent and 14 percent, respectively.

In January of this year, Facebook began offering up to $20,000 in egg freezing coverage for medical or non-medical reasons for its U.S. employees, a spokesperson confirmed.

“Silicon Valley is probably leading the way [in coverage for egg freezing] since competition is fierce and companies are always looking for ways to attract recruits,” says Dan Bernstein, a senior consultant at Mercer’s San Francisco office, who has seen an increase in companies offering the benefit. Bernstein says a few of his clients currently offer egg freezing benefits.

Some fertility clinics and companies like EggBanxx are stepping in to offer package deals and financing options. At EggBanxx, which opened for business in May, women whose credit score is 650 or higher can get a 15 percent discount on egg retrieval and one year of storage at participating fertility clinics and a loan to finance the cost, says Jennifer Palumbo, vice president of patient care.

“Insurance would typically cover the consultation, diagnostic testing and some medications,” she says, “but not the retrieval and not the freezing.”

Infertility advocates would like to see more companies adopt egg freezing policies, especially for women who have cancer, for example, and are likely to become infertile as a result of chemotherapy.

“I think it’s amazing for people at these companies, but can we also get this covered for women with cancer?” says Barbara Collura, president and CEO of Resolve, an infertility advocacy group.

Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

HHS awards more than $665 million to design and test state-led efforts to improve health care quality, accessibility and affordability

Ever been lost on a new trail on a hike? Or confused between north and south in a new city? Or after a certain age, unsure if you really took that anti-cholesterol pill last night, or was it the blood pressure pill?  They kind-of look the same.

GPS apps in your handheld may lead you back to the right path, but keeping track of your pills is another matter.  Only about 50 percent of patients take their medications as prescribed. And , according to the Centers for Disease Control and Prevention, in 2010 almost 40 percent of adults older than 65 were taking five or more prescriptions a day.

Managing real and potential medication conflicts and confusions is more pressing as 10,000 baby boomers turn sixty-five every day, and 90 percent suffer at least one chronic illness. Many boomers are now swallowing a cocktail of medications prescribed by various specialists: pain medicines for aching backs, antidepressants, proton pump inhibitors to control gastric distress, vitamins and other over-the-counter supplements.

With families sometimes far away and many older people unable to afford personal caregivers, companies have searched for a technological solution to monitoring medicine.

Forget armband monitors like Fitbit, the newest body monitors are as tiny as BBs. These so-called nanomeds, miniscule sensors embedded in a placebo pill that you swallow, set up shop in your gut. As they slowly work their way through your system, these “ingestibles” – which are actually not digested – are switched on by contact with saliva and/or gastric juices. The signal is picked up by another sensor which looks like a Band-Aid and is worn on your chest.

This system records medicine intake as well as other measures, such as heart rate. The information shows up on your smartphone or tablet, via Bluetooth and can automatically go to your doctors, family members or caregivers, with your permission.

“We are entering the commercial era of the Internet of Things (IoT) – your car, your clothes and increasingly your personal care products are going to be connected,” says Andrew Thompson, CEO of Proteus Digital Health, which makes these “ingestibles.”

He adds that the goal is to connect major health systems to consumers “to allow them to switch on their own health care, creating critical information that can be used to ensure they and their doctors make positive decisions about use of medicines and personal health choices.”

The Food and Drug Administration approved these devices in 2012, but they’re not on the open market yet. They’re still being tested in pilot projects, including with England’s National Health Service.

Proper use of powerful, sophisticated meds aimed at keeping the elderly active and out of institutional care, Bill Satariano of the UC Berkeley’s School of Public Health believes, will depend increasingly on these “indigestible chips.”

He says it’s part of the field of “techno-wayfinding” or relying on newer and newer information technologies to help us keep track of where we go, what we eat or drink and increasingly whether we’re following doctor’s orders in our pill consumption.

Satariano’s Berkeley colleague, David Lindeman, noted in a report published this year  that these and other forms of info-tech will play critical roles in what is broadly described as “connected health.” That relies on Internet-based technologies to help provide care in people’s homes or other non-clinical settings. “[T]echnologies is that can be used to monitor individuals with chronic conditions to detect, and thus prevent, complications and crises that can lead to acute episodes. To maintain their health and well-being, it is just as important to provide individuals with automated health coaching, based on monitoring vital signs, activity, and behavior,” the report says.

For example, if an aging baby boomer has elevated blood sugar levels, her medical team can find out about it (information that comes into the boomer’s own cellphone and is then distributed to whomever she’s designated) and correct the problem before the levels get dangerous, even if she doesn’t even notice.

Separate monitoring devices are, however, just the beginning of indigestible medicine.  Coming soon, according to one senior executive at Proteus Digital, will be the implantation of these nearly invisible chips in the actual prescription pills themselves, relieving the patient of even having to remember to take the monitoring pill, because the pills could send back the message that they’re now in the system.

All these new “wayfinding” health technologies could improve both medication usage and effectiveness for elders aging at home, and helping them have a better quality of life. And, these could reduce or eliminate expensive critical care in hospitals.

All good, but some raise a possible dark side: is this the ultimate Orwellian Big Brother technology, like an electronic bracelet attached to your gut?

Satariano’s answer? “Without question. We always have to ask what is the cost to each technological advance.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

For two decades Atlanta restaurant owner Jim Dunn offered a group health plan to his managers and helped pay for it. That ended Dec. 1, after the Affordable Care Act made him an offer he couldn’t refuse.

Health-law subsidies for workers to buy their own coverage combined with years of rising costs in the company plan made dropping the plan an obvious – though not easy – choice.

“I had a lot of regrets going into it,” Dunn, who owns three Italian Oven restaurants in suburban Atlanta, said of his decision. “I don’t think I have as many now — only because I’ve seen the affordability factor for my managers improve.”

Dunn and five managers are now covered under individual plans bought on healthcare.gov. How many other owners make the same decision will help set the future of small-business health insurance. Although the evidence so far is mixed, brokers expect more firms to follow in the next few years.

Companies like Dunn’s — those with fewer than 50 workers — provide medical coverage to roughly 20 million people. Unlike larger employers, they have no obligation under the health law to offer a plan. Now they often have good reason not to.

If employees qualify for government subsidies, like the managers who switched from Italian Oven’s corporate insurance to individual Obamacare coverage, everybody can win.

Owners don’t have to pay premiums, meaning they can give workers raises, invest in equipment or add to profits instead. And employee take-home pay can rise if subsidies — available even to families with middle-class incomes — are worth more than what a company was contributing.

Whether to cancel a company plan and let workers buy insurance on healthcare.gov or another online exchange “is something that I would say comes up in every conversation with a small-group” employer, said Adam Berkowitz, a consultant with Caravus, a benefits firm based in St. Louis.

“I just had another [small] business call in today and say, ‘You know, we can’t do it. We’re packing it in,’” said Roger Howell, head of Howell Benefit Services in Wilkes-Barre, Pa.

Anthem, the largest seller of small-business health insurance, lost almost 300,000 members in such plans — many more than expected — in the first nine months of the year. That was 15 percent of the enrollment. Many of those consumers are presumably switching to individual plans sold through exchanges, including those offered by Anthem, officials said.

It’s far from clear, however, that most companies will take the same steps as Italian Oven.

Many small employers see health coverage as an essential piece of compensation. They note that premiums in company-sponsored plans are tax-deductible — for workers as well as employers — while the tax advantages of individual plans are limited.

“I feel like we have to have a medical plan in order to hire people and keep them employed,” said Dan Allen, head of a 15-worker engineering firm in Decatur, Ill. Allen Engineering renewed its Coventry Health Care plan for 2015 even though the premiums rose 21 percent, he said.

No other major insurer has reported cancellation of small-business plans at the same rate as Anthem.

“We didn’t see that,” said Rick Allegretti, vice president of marketing at Health Care Service Corp., operator of Blue Cross plans in five states including Illinois and Texas. “We actually saw our [small-group] business grow slightly — mind you it’s probably a tenth of a percent.”

Businesses shifting workers into the individual exchanges tend to be the very smallest, employing a handful of people, said Skip Woody, a partner at Hill, Chesson & Woody, a  North Carolina benefits firm. “Anything above 15, we haven’t had any dropping coverage,” he said.

Instead, many small companies are taking advantage of rules letting them maintain insurance bought before the health law took effect. President Barack Obama, who promised consumers they could keep coverage they liked, allowed carriers to extend noncompliant plans after facing fierce criticism over their imminent extinction.

Most, but not all, states approved the adjustment. Because older policies may lack features required by the health law and because their rates are often set according to employee health history, not community-wide costs, they can be less expensive than compliant plans, say brokers and consultants.

“I haven’t sold one of the new plans yet” to a small employer, said John Jaggi, an Illinois broker and consultant. Faced with price increases of as much as a third or more for new plans, all 40 or so of his small-business clients including Allen Engineering renewed older coverage for 2015, he said.

Heavy renewal of old plans plus workers shifting to individual coverage help explain why the health law’s online portal for new small-business plans has attracted only modest interest, analysts say.

For some companies there is logic to ending coverage altogether.

For Italian Oven’s Dunn, “it made sense to recommend that he drop coverage,” said Elena Merino, CEO of the Meridian Group, a benefits firm in Alpharetta, Ga. “It hurts me. But that was the responsible thing to tell him.”

Italian Oven employs the equivalent of about 30 people — less than the 50-worker threshold that would get it fined for not sponsoring insurance. The company does not offer coverage to servers and kitchen staff, but full-time managers have always had a plan.

All are eligible for tax credits to buy insurance on healthcare.gov, said Dunn. Next year, the subsidies are available for individuals with income of up to $46,680 and families of four with income of up to $95,400.

With subsidies factored in along with unrelated pay increases, the managers “are going to be saving money out of the deal” while getting coverage comparable to what they had before, Dunn said. “My managers actually got excited about it because they’re saving money on their health insurance.”

Brokers expect more small businesses to make the same move, especially after the ability to extend older, noncompliant plans expires between now and the end of 2017, depending on state policy. Allen, the engineering firm executive, is concerned premiums could rise even higher next year than they did for the 2015 renewal.

“If it’s up in the 25- to 30-percent increase [range] — I’ve heard as high as 40 — we’ll just have to drop it,” he said. “Turn everybody loose.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Statement by Health and Human Services Secretary Sylvia Burwell on Senate Confirmation of Dr. Vivek Murthy as U.S. Surgeon General