RENEE MONTAGNE, HOST:
Valerie Davidson is the Health Commissioner of Alaska. It's a challenging job. She's leading her state through a Medicaid expansion which could bring health insurance to up to 40,000 Alaskans in need. And she's handling all that pressure by staying equally focused on her native Alaskan roots. Alaska Public Media's Annie Feidt reports.
ANNIE FEIDT, BYLINE: In less than 24 hours, Valerie Davidson has 50 people coming to her house for dinner. She planned to catch and cook enough salmon for the main course. But early in the morning, the state opened the river to commercial fishing, shutting out subsistence fishermen.
VALERIE DAVIDSON: Did we miss them? Did they already come?
FEIDT: So Davidson and I have spent the last hour in her bright orange '83 Chevy pickup stalking the free fish container where state biologists deposit their test catches.
DAVIDSON: I wonder if they're coming? What the heck?
FEIDT: But Davidson is exceedingly patient and persistent. It's a strategy she used as she worked to expand Medicaid in Alaska as Health Commissioner. During this year's legislative session, lawmakers blocked Medicaid expansion from coming to a full vote. It was a real low point for her.
DAVIDSON: I always have a hard time when, as a state, we make a decision to turn our backs on Alaskans who really need help. That's a tough one for me.
FEIDT: So in July, Davidson was thrilled to stand with Alaska Governor Bill Walker as he announced he would expand Medicaid without lawmakers' approval. At the press conference, she made a uniquely Alaskan case for bringing federal healthcare to low income residents.
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DAVIDSON: We have so many hard-working Alaskans who simply don't have access to health care. They are missing work. It is affecting businesses. They can't take care of their children. They can't hunt. They can't fish when they're not healthy enough to do so.
FEIDT: What does fishing have to do with health care? For Davidson, a lot. She was born in Bethel near the Bering Sea. In 1998 she earned a law degree and was soon recruited to work as a lawyer in Alaska's tribal health system. She lives in Anchorage but spends her summers at this house in Bethel working on health policy by day and fishing for salmon on the Kuskokwim River at nights and on weekends that her family will eat all winter long.
DAVIDSON: I always kind of feel like I'm playing Tetris.
FEIDT: Dozens of long strips of silver salmon are hanging from racks in her smokehouse.
DAVIDSON: We need to put a fresh piece on.
FEIDT: She stuffs one more cottonwood log into the wood stove, trying to get the right flavor for the fish. Davidson learned this from her mom, a stern woman she lovingly describes as conveying the loudest silence you've ever heard. She talks about her mom's response when Davidson told her about the health commissioner job. Her mom uses Davidson's Yup'ik name.
DAVIDSON: And I said, well, what do you think, mom? She says, well, you know Nurrii, we Yup'iks - we're very hard to impress. (Laughter) Such a classic Yup'ik response.
FEIDT: Davidson tells me this in her kitchen where her counter has already disappeared under piles of zucchini, asparagus and peppers.
DAVIDSON: OK, so here's the master list.
FEIDT: The guests are coming with the W.K. Kellogg Foundation, an organization that a decade ago helped Davidson fund a new type of health provider in Alaska - dental therapists. Now the state has more than two dozen working in isolated villages in Alaska. Davidson wants to develop more unique solutions to the state's toughest public health challenges.
DAVIDSON: We've seen it play out time and time again that when you can provide services at the local community level you have better outcomes.
FEIDT: But right now, she needs salmon. Back at the free fish bin, Davidson is rubbing her eyes and wishing for coffee. Then finally a truck pulls in and Davidson springs out of her seat.
DAVIDSON: Are these silvers?
UNIDENTIFIED MAN: Yup.
DAVIDSON: Yay, love it. Thank you.
FEIDT: The biologist drops 10 massive silver salmon into her plastic tote. She finds cooking a nice contrast to the more extreme patience she needs for her job where it can take a decade or more to see results.
DAVIDSON: With cooking there's a start, there's a finish. You feed people, you have something to show for it.
FEIDT: In both instances she has a lot of work ahead of her. For NPR News, I'm Annie Feidt in Bethel.
MONTAGNE: That story is part of a reporting partnership with NPR Alaska Public Media and Kaiser Health News.
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