The “right fight” starts next week in Congress when the Senate will take up health care again in hopes of reworking the system to bring down its enormous costs, Sen. Lisa Murkowski told an Anchorage Rotary group Aug. 29.

Murkowski spent much of the August break back in Alaska tour-guiding cabinet members and senators. The most recent visitor was Secretary of Health and Human Services Tom Price, who followed a visit by Secretary of Transportation Elaine Chao.

“Instead of Alaska importing the experts, they are coming and learning from us — how we do things — and I’m proud of what’s going on,” she said.

After Price’s visit, he touted Alaska’s system for Alaska Native health care. Chao took her first tour of the Trans-Alaska Pipeline System and announced an agreement with the State of Alaska to take the lead role on permitting transportation projects.

The first week after Congress resumes from its summer recess, Murkowski anticipates taking up the gauntlet of replacing or amending the Affordable Care Act. On Sept. 6, the first rounds of talks begin before the Senate Committee on Health, Education, Labor and Pensions, known as HELP, of which she is a member.

“We’re going to take a targeted approach through working a process,” Murkowski said. “This is the way I have wanted to do it all along: follow the legislative process.”

State insurance directors will testify first, including Alaska’s Lori Wing-Heier. Then a panel of governors will answer questions for HELP.

Murkowski said everywhere she goes in Alaska, the insurance conversation brings an outpouring of emotion she hasn’t witnessed before during her years serving in the U.S. Senate.

“I’ve never seen an issue like this in my 15 years serving in the Senate where every single member was engaged. Because, health care is meaningful, it’s emotional, and it’s personal; maybe not personal to you but to your mother or your child or the family,” she said.

At home in Alaska, conversations continue as people tell her “in tears” that they can’t afford the insurance they do have or that they are grateful because they didn’t have health insurance until the ACA came along.

Murkowski intends to proceed in two specific ways, in addition to committee work. She has joined with Sen. Ted Cruz, R-Texas, “who I normally have little in common with” to address changes to the health savings accounts, or HSAs. Cruz, who voted to repeal the ACA, is nonetheless interested in protecting HSAs, which allows pre-tax contributions to a savings account that later can be used for medical expenses.

“We need to reduce the cost of health care, so that insurance costs will be more manageable,” Murkowski said.

That’s also one point of commonality she shares with Cruz: “If you don’t know your knee procedure’s cost, how do you know if you’re spending your HSA wisely in the first place?”

A second area is to set a one- or two-year plan for payments on cost supports for insurance. Cost sharing reduction, or CSR, payments have been authorized on a month-to-month basis by President Donald Trump, which “doesn’t do very much to stabilize the markets,” she said.

Murkowski wants the process of CSR payments to return to a congressional appropriation.

After a legal challenge during the Obama administration in U.S. House of Representatives v. Burwell, a federal judge agreed that only Congress has the power to appropriate funds and declared the CSR payments illegal, but stayed the ruling pending the appeal, which allowed the payments to continue under both Presidents Barack Obama and Trump.

Trump has held back on the appeal and continued to make the CSR payments in the hopes that Congress would repeal or repair the ACA. Murkowski would like to see that put back in the hands of Congress to help stabilize the ability of the insurance markets to set rates that then keep insurance costs for individuals down.

But she emphasized that in the long term, moves have to be made to bring down the cost of care.

“I would like to see a provision in the short-term piece that begins to address the cost of care,” she said. “Not of insurance, but the cost of care.”

High cost pharmaceuticals may prove one place to start, Murkowski said, but she “isn’t sure what the realm of possibilities is there.”

On tax reform, Murkowski said hearings are scheduled for the first week in September as well. The American tax code hasn’t seen an overhaul since 1982, she said. “Alaskans want a process that is simple, particularly the small business community wants to reduce the corporate rate,” she said.

After being thrust into the national spotlight during the health care vote when she was among three Republican senators that voted against repealing the ACA, Murkowski said she isn’t comfortable in the glare.

She said “Trump is a man with an agenda who wants some wins under his belt, so I think he’s impatient,” and advocated more work through an open process.

Addressing a half-dozen news reporters in the Dena’ina Civic and Convention Center after the Rotary luncheon, she said, “You’re about as much press as I want.”

The past few months have been “more than a little bit crazy in Washington,” because of the near constant stream of press inquiries and interviews.

“I’m not a camera seeker and I don’t set out to do things that generate headlines. I get up to do my job and do not do self-promotion. In that way, I’m probably a bad politician,” she said. “I do think that where we are right now in health care, and the pause we’ve taken these past few weeks, is that we have an opportunity to engage in back-to-regular order. That’s a good place for us as a governing body. I welcome that because that’s where I have my strength is in that legislative space.”

She acknowledges Alaska can benefit from the scrutiny, but wished it were from energy policy and not from health care.

“It does give you some leverage if people start to say, ‘look, you better go talk to Lisa about this’ — that’s not a bad thing,” she said. “It’s not about power seeking… my colleagues saw that even in a difficult position where you chose not to follow your party, but to follow a process that allows people to have some voice here, that proves to be positive.”

Murkowski said she’s not a bomb thrower.

“But I’m not afraid of the fight,” she said.

Naomi Klouda can be reached at naomi.klouda@alaskajournal.com.