Legislature(2001 - 2002)
03/19/2001 09:09 AM Senate FIN
| Audio | Topic |
|---|
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
SENATE CONCURRENT RESOLUTION NO. 7
Establishing a Health Care Cost Review Task Force.
This was the first hearing for this resolution in the Senate
Finance Committee.
Senator Green announced that while the Department of Health and
Social Services Budget Subcommittee was addressing that
department's budget, the members were "surprised" at the growth of
the Medicaid program. She emphasized the increasing costs and
subsequent impacts to both the federal and state governments. She
spoke of continued proposals for new matching fund programs, but
stated that the question is how to continue to pay for existing
Medicaid programs.
Senator Green informed that the Medicaid program in Alaska expends
approximately $10 million a week of combined state and federal
funds. She calculated this equals about one-half billion dollars
annually. She pointed out that Medicaid is the second largest state
program behind education. She ascertained several state agency
budgets could be combined and still cost less than the cost of a
month of Medicaid expenses.
Senator Green expressed the difficulties in examining the Medicaid
expenses because there are "various layers" of service providers,
vendors, agencies, departments, individuals and nonprofit groups
that rely on Medicaid funds as a part of their on-going operations.
Senator Green stated the intent of this resolution is to establish
a group to investigate the reasons for the high costs and possibly
identify cost containing alternatives. This, she said would include
determining whether the state is participating in programs not
mandated by the federal government, finding out if any programs
could be restructured or privatized to have less impact on the
state general fund and perhaps build a better program.
Senator Green stressed there is no intent to "negatively impact the
Medicaid budget."
Co-Chair Kelly commented that any attempt to reduce the budget is
beneficial.
JIM BRADY, Kenai Peninsula Independent Living Center, testified via
teleconference from Homer to request the Committee keep in mind the
costs required to care for disabled people. He stressed that for
many, Medicaid is the only method of health insurance. He noted
that providing care at the early stages of a condition could save
considerable money in the long run. He referenced the "buy-in"
option that allows disabled individuals to pay for continued
Medicaid coverage once they are employed.
Co-Chair Kelly noted that the discussion at this time is to
determine whether or not to form the task force. He stated there
would be another opportunity to debate the issues before the task
force.
DAVID JACOBSON, Member, State Independent Living Council, testified
via teleconference from Fairbanks in appreciation that the
Committee was not yet setting the agenda for the task force.
However, he emphasized that Medicaid is an essential program. He
also spoke of the necessity of treating illnesses in their early
stages rather then waiting for the condition to become more
serious. He spoke of the savings to the state in allowing the
elderly to remain in their community rather than an institution. He
supported a proposed language change prepared by the Department of
Health and Social Services. He explained this language addresses
specific needs of the disabled and elderly and also gives
recommendations on the membership of the task force to include
consumers. He commented on the Long-Term Care Task Force,
commending the representation by all factions of the community.
TIM ANDERSON, Senior Service Provider and Director, Wasilla Area
Seniors, testified via teleconference from Mat-Su about the various
services provided to the elderly by Medicaid. He estimated that 30
percent of Medicaid costs in his community go to pay for senior
services.
RICHARD TUBBS, Executive Director, Palmer Senior Center, testified
via teleconference from Mat-Su that he understood the reasons the
state wishes to reduce costs, but emphasized the necessity of home
community based senior services. He referenced a state conducted
study that found that community based services cost much less than
nursing home care. He urged that the task force include
representation from the senior care community.
JANE DEMMERT, Executive Director, Alaska Commission on Aging,
testified in Juneau about the Long-Term Care Task Force. She stated
that there were recommendations of this task force that remains
unimplemented. She suggested the new task force consider the work
and structure of the earlier task force. She stressed the lack of
flexibility of insurance for elderly care.
ROSEMARY HAGAVIG, Executive Director, Catholic Community Services,
testified in Juneau to echo the remarks of the previous testifiers.
She also noted that Alaska is one of only a few states that does
not provide Medicaid for Alzheimer disease, which she stressed is a
growing portion of elderly needs. She spoke of the benefits of
providing care in the early stages of this disease. She hoped the
task force would consider this.
SUZANNE PRICE Executive Director, Fairbanks Community Mental Health
Center and representative of Mental Health Providers Association of
Alaska, testified in Juneau sharing the message that cost-
containment has been included in the organization's practice for a
number of years. She offered the groups input in the task force's
efforts. She warned of the "domino effect" when a task force makes
cost-containment decisions. She stressed, "Cost containment is a
tricky issue." She said that the providers association has
knowledge in this area and she requested they be allowed to
participate in the task force.
Senator Green noted that there would be a decrease in federal
participation in Medicaid funding in the year 2002. She said it
needed to be decided how the state's general funds would be
prioritized. She ascertained that additional programs would be
introduced, making the need to prioritize greater.
RUTH L'HOMMIDIEU, Chair, State Independent Living Council,
testified via teleconference from Fairbanks, to advise the
Committee to proceed with caution in establishing the task force.
She stated that Medicaid is the number one form of medical
insurance for people with disabilities. She recommended expanding
the Medicaid buy-in option. She listed the annual cost of nursing
home treatment as $96,809 per person. She stressed the need to
ensure people can remain in their own community, and return to
work. She supported the Department of Health and Social Services'
proposed language.
RICHARD RAINERY, Acting Executive Director, Alaska Mental Health
Board testified in Juneau to reiterate other points raised. He
agreed that the proposed task force membership excludes several
factions. He opined that health care users, payers and providers
should be included in the primary membership instead of ad hoc
members. He predicted that the task force would learn that Medicaid
is a "very complex subject" and he was concerned that the timeframe
allowed would be inadequate. He warned that the impacts on access
to health care should be carefully considered, in the mental health
field. He spoke of the reliance on Medicaid by many community
mental health care providers and the limited ability to replace
that funding from other sources. He pointed out that Alaska does
not have a health insurance parody clause, so private insurance is
not required to include mental health coverage.
JAY LIVEY, Deputy Commissioner, Department of Health and Social
Services, testified in Juneau to voice concerns about the
resolution. He expressed that the task force is "narrowly charged"
in that it is only directed to review cost containment. He
emphasized the "interrelationships and complexity of health care"
He stated that the department supports cost containment and he
agreed that the cost of health care is rising. However, he said,
"cost containment itself does not exist entirely in a vacuum."
Mr. Lively shared there are three ways to reduce costs within a
health care program. He listed them as reducing the number of
participants, lowering the reimbursement rate and reducing the
amount of services. He pointed out that each of these would have
other ramifications on the health care system. He stressed that
many elderly and disabled patients do not have other health
insurance options, due to preexisting conditions, lack of income to
purchase private insurance, and other factors.
Mr. Lively spoke of the connection between publicly funded health
care programs and local health care economies. He explained that in
many smaller communities, there is a connection between Medicaid
funding for long-term care and the economic viability of small
rural hospitals. He stated that the Medicaid portion of long-term
care funding keeps the hospitals operational. He also noted that
Medicaid funding for disabled patients provides funding to maintain
many mental health care programs. While he acknowledged that these
programs do not serve Medicaid eligible patients exclusively,
without the Medicaid funding, there would not be adequate private
funding income to provide the services to any patients.
Senator Green asked if the witness was addressing the impact of
private insurance and subsidized Medicaid in providing lower rates
to those individuals that pay for services without insurance.
Mr. Livey agreed there is an interrelationship between Medicaid
payments and the health care economy. He explained that if an
individual does not have health care coverage, and must seek
medical care, "somebody has to pay for that." He said that the
"somebody" is "the rest of the public that pays the health care
bill."
Mr. Lively qualified that "the worst" would not necessarily happen,
but stressed that because of the complexity of the issue, if the
task force only addresses cost containment, "it is going to miss
some of these connections. He was concerned that unless the scope
of the task force is broadened to include access, the impact on
other health care economies and other providers, unintended
consequences could result.
Mr. Livey concluded suggesting that the task force membership
should include additional representation from recipients, families
of recipients or advocates for recipients as well as additional
membership for the Administration.
Co-Chair Kelly ordered the bill HELD in Committee.
| Document Name | Date/Time | Subjects |
|---|