Federal legislation's effect on Alaska.

• Author: Ajango, Deb

Several federal plans attempting to confront the healthcare issue are on the drawing table. As is the case with Alaska's lawmakers, federal sponsors have chosen very different approaches to the problem.

For example, President Clinton's healthcare bill will retain the employer/insurance relationship, perhaps cementing it even further with a proposed employer mandate. In turn, each American would be guaranteed a basic health plan.

The Consumers Choice plan (also known as the Nickles-Stearns bill) is another popular federal bill. It would require all Americans to purchase insurance, but citizens could choose from a variety of packages, including only catastrophic-type coverage. It includes no employer mandate, but it does require businesses to become bookkeepers for their employees' insurance plans. The bill calls for a free-market approach that relies on competition to help keep prices down.

People are arguing over which plan is best. But what the advocates fail to mention is that each tries to fit all Americans into a mold, hoping that the majority of people will be happy.

Alaskans know all too well how the "one size fits all" plan often doesn't work for them. Critics say proposed legislation doesn't address individual states' particular problems.

Alaska, in fact, has unique circumstances that will require unique reform. "Several aspects make Alaska different," says Karen Perdue, co-owner of Northern Research & Planning and former deputy commissioner for the Alaska Department of Health and Social Services.

These factors include high transportation costs (of getting to and from care), extremely high healthcare costs in general (compared to the nation), and low numbers in a rural state. The scattered population contributes to the lack of Bush doctors, and in some instances, lack of any care.

Clinton's plan does acknowledge the high cost of rural care, Perdue admits, but "Washington, D.C., has defined rural as having to drive 30 miles to a hospital. Our rural is obviously different." Low numbers also contribute to a lack of competition, which contributes to dramatic price variations.

Another important point, she notes, is that "we are a resource-based state with a high number of seasonal and part-time workers. These are not traditional jobs tied to the office. There are also many small mom-and-pop businesses with few employees."

Ultimately, Perdue concludes, any federal proposals will be tough on the state. "The federal plans just don't make...