Legislature(2005 - 2006)CAPITOL 106
03/23/2006 03:00 PM House HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB356 | |
| HJR33 | |
| HB430 | |
| SB255 | |
| HB436 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HJR 33 | TELECONFERENCED | |
| += | HB 430 | TELECONFERENCED | |
| += | SB 255 | TELECONFERENCED | |
| *+ | HB 436 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 356 | TELECONFERENCED | |
HJR 33-SUPPORTING IN-STATE MED. CARE FOR VETS CHAIR WILSON announced that the next order of business would be HOUSE JOINT RESOLUTION NO. 33, Urging the Alaska Department of Health and Social Services to seek authority and funding from the United States Department of Veterans Affairs to establish a system allowing Alaska veterans treatment in both public and private Alaska facilities. 3:30:16 PM MICHAEL O'HARE, Staff to Representative Pete Kott, introduced HJR 33, on behalf of Representative Kott paraphrasing from the sponsor statement as follows [original punctuation provided]: With approximately 72,000 veterans that call our great state home, I believe that Alaska's veterans deserve top quality health care in their own communities. Currently forced to seek medical treatment with U.S. Veteran's facilities, many of these heroes have to leave their communities and even go outside of Alaska. Many millions of dollars have been spent in airfare alone in order to get Alaskan's treatment when the treatment and facilities are available in state. This policy is costly and inefficient, and it disrupts Alaskans' lives. House Joint Resolution 33 urges the United States Department of Veterans' Affairs to authorize funding and management to establish a system whereby Veterans can seek treatment from medical facilities other than that of the U.S. Military and Veteran's Affairs doctors and hospitals, many of which are available in the State of Alaska. This would give veterans a greater choice and flexibility for healthcare and increase the interaction between the Department and Military and Veterans Affairs doctors and the public and private medical facilities in the state thus, significantly reducing medical costs and increasing efficiency for veterans' medical care. This system would support the use of a veteran's medical identification card as an insurance card for medical billing to the U.S. Department of Military and Veteran's Affairs. The passage of HJR 33 will give veterans a choice, and will allow them local access to quality healthcare. 3:32:29 PM CHAIR WILSON related that veterans who come to a clinic have to call ahead and receive permission to receive treatment at the clinic. The aforementioned permission takes some time to obtain. How would this legislation change the aforementioned, she asked. MR. O'HARE related his understanding that the veteran would present his/her veteran's medical identification card. There would be an agreement between the U.S. Department of Veterans' Affairs and the medical community to accept the aforementioned identification card as an insurance card in order that veterans can receive treatment in a competitive manner within the community. In response to Representative Gatto, Mr. O'Hare specified that the nearest Veterans' Administration (VA) hospitals are located in Seattle and Oregon. 3:33:46 PM REPRESENTATIVE GATTO indicated that perhaps even taking the airfare into consideration, in-state treatment options may be more costly. He questioned whether there is any way to match information with regard to the cost of Alaska's veterans receiving medical services in state versus out of state. 3:35:16 PM REPRESENTATIVE CISSNA, drawing upon her experience with her late husband who was a veteran and discussions with other veterans, related that the travel required to reach approved VA hospitals poses a risk on the ill veteran. She recalled that often her husband couldn't receive his treatment because, after traveling to the hospital, he wasn't well enough. Furthermore, the airfare can be expensive. She, too, inquired as to the current regulations for veterans living in the Bush. MR. O'HARE related his understanding that veterans are required to go to a veterans' hospital for certain treatments. This resolution attempts to help minimize the cost, time, and trauma of travel in order to allow the veterans to seek treatment in an in-state facility if possible. Mr. O'Hare acknowledged that the costs [for medical treatment] may be more expensive in Alaska than in the Lower 48, even with the flight costs. Therefore, he suggested that there should be an option for the veteran with regard to where to receive treatment. 3:38:49 PM CHAIR WILSON noted that some insurance companies will offer the option of flying a patient to [the Lower 48], if it's cost effective. 3:39:05 PM DAVID STOCKWELL, Associate Director, Alaska Veterans Healthcare System and Regional Office, U.S. Department of Veterans Affairs, explained that the $2 million was the entire travel budget for the year stated. However, only around $600,000 was spent to send patients to the Seattle and Portland VA facilities. He noted that a fair amount of money is spent for patients to access medical care in the state as well. Mr. Stockwell related that for fiscal year (FY) 04 a little over $17 million was saved by using federal facilities. 3:40:16 PM REPRESENTATIVE GATTO pointed out that the analysis of the fiscal note by the Department of Health and Social Services (DHSS) indicates that three new positions would be necessary. However, none of the three new positions are shown in the fiscal note for succeeding years. He then inquired as to the meaning of the references to "$14,700 mil", "$10,000 mil", and "$25,000 mil". MR. STOCKWELL said that he didn't have the fiscal note to which Representative Gatto referred. However, he related that the U.S. Department of Veterans Affairs budget for Alaska is about $103 million a year. 3:42:24 PM DAVE WILLIAMS, Program Coordinator, Division of Alaska Pioneer Homes, Department of Health and Social Services (DHSS), explained that the $85.3 [million] is to fund one position to work out how this funding process would be addressed. Mr. Williams related support for the concept proposed in HJR 33, but he emphasized that it will take some work to achieve the goal of treating the state's veterans in state. With regard to the analysis provided in the fiscal note, Mr. Williams said that the figures presented were received from the U.S. Department of Veterans Affairs. He specified that the "$14,700 mil" refers to $14.7 million. The U.S. Department of Veterans Affairs estimated that it would have spent $10 million if veterans had been sent to in-state hospitals. 3:45:40 PM REPRESENTATIVE SEATON turned attention to the portion of the fiscal note analysis that relates that 40 percent of Alaska's health care budget for veterans paid providers in Alaska community settings to provide care to veterans to supplement what is provided directly through the in-state VA outpatient clinics. Therefore, he questioned whether the goal of HJR 33 is being accomplished already with that 40 percent of the budget. MR. STOCKWELL agreed that the aforementioned 40 percent of the budget is spent to obtain health care from community providers and hospitals within the state on behalf of veterans. Therefore, when a patient isn't medically stable to transport, the care is purchased in the community. He then highlighted that about 600 patients a year are admitted to the Joint Venture Hospital on Elmendorf Air Force Base and cared for by VA providers. He acknowledged that everyone can't manage to get to Anchorage for care at the medically appropriate time, and thus a fair amount of care is already purchased from the community. 3:47:10 PM CHAIR WILSON surmised that [to accomplish the goal of HJR 33], the state would have to get permission at the federal level, which could be difficult if it's an increase. 3:47:37 PM MR. STOCKWELL, in response to Chair Wilson, clarified that Alaska only has the largest number of veterans when viewed on a per capita basis. In fact, Alaska has practically the least total number of veterans in the state. 3:47:59 PM REPRESENTATIVE GARDNER recalled that during a recent visit with the staff of the Alaska Veterans Healthcare System it was related that the Veterans Administration in Anchorage is working on arrangements with hospitals in Anchorage to encourage and increase the use of those facilities by veterans. MR. STOCKWELL noted that there is a new construction project to build a larger outpatient facility next to the existing federal hospital on Elmendorf Air Force Base in order to expand the scope of services offered for outpatients. There is also a contract with [Providence Medical Center] such that almost one- third of all admissions go to the aforementioned facility. Mr. Stockwell said that there is no strategic effort to expand the use of community hospitals. REPRESENTATIVE GARDNER asked if there is a reason that only 30 percent of veterans are going to Providence Medical Center. She further asked if more could be sent there if the contract was different. MR. STOCKWELL specified that the first choice is for veterans to go to the Elmendorf Air Force Base facility, but if the services aren't available the veteran is sent to Providence Medical Center. The other third of the admissions in state are due to it not being medically safe to transport the patient. About that same number of patients are sent to Seattle for major tertiary care. He noted that some of the care for which veterans are sent out of state to obtain can't be obtained in state. 3:50:47 PM VIRGINIA SMILEY, Director, Division of Alaska State Pioneer Homes, Department of Health and Social Services (DHSS), in response to Chair Wilson, explained that the Palmer Pioneers' Home that is to be used as a veterans' home hasn't been certified as such. At the moment the facility is in the renovation process. In further response to Chair Wilson, Ms. Smiley confirmed that about 101 veterans are in the pioneers' homes. She related that the division and the VA in Anchorage have been discussing developing a liaison who would work with the veterans in the Palmer facility to maximize benefits for those in veterans homes. 3:52:19 PM REPRESENTATIVE GATTO returned to his earlier point that the three positions listed in the first year of the fiscal note do not appear in subsequent years. MR. WILLIAMS said that the main interest was the first year because the work has to be done and depending upon that the division wasn't sure when the three positions would appear. He clarified that those three positions represent the minimum of an office that could negotiate with hospitals to receive veterans rates, process claims, make payments, and create reports. MS. SMILEY offered that the following years didn't show the positions because if this actually was developed, it would take a long time to achieve and have a full staff. 3:54:49 PM REPRESENTATIVE GATTO opined that it's best to include the funding for the three positions so that the legislature can make a fair evaluation. 3:55:34 PM REPRESENTATIVE SEATON said that he is in favor of the spirit of the resolution. However, he expressed the need to differentiate between doctors and hospitals because the resolution almost seems to relate that veterans aren't able to see doctors locally or in Alaska. He requested that the aforementioned be incorporated in the legislation, but he left it to the sponsor to address. 3:58:40 PM REPRESENTATIVE SEATON moved Amendment 1, as follows: Page 2, line 9, following "hospitals": Delete "and" Insert "with" Page 2, line 17: Delete "possible" Insert "United States Department of Veterans Affairs doctors and hospitals are not easily accessible" There being no objection, Amendment 1 was adopted. 3:59:36 PM KEVIN MCGEE, Vietnam Veterans of America & American Federation of Government Employees read testimony for Rick Davidge, President, Vietnam Veterans of America, Alaska Chapter 904, paraphrasing from the following written statement: My name is Ric Davidge and I serve as President of the Vietnam Veterans of America, Chapter 904 - the Anchorage Chapter and the largest in Alaska. I also serve as President of the Alaska Veterans Foundation, Inc. a statewide veteran service organization that serves Alaskan War Veterans. And I serve as Vice Chairman of the Anchorage Military & Veterans Affairs Commission. In 1965 I was a medic with the First Air Cavalry in Vietnam and served honorably for 6 years. Why do we have this resolution before you and just what does it really do? I assume you have, in your packet, a copy of the most recent "Talking Paper" that we update regularly about the problems Alaskan veterans face in securing appropriate healthcare. This paper is an open ended discussion of problems that continue to come to light as our working group, made up of a wide range of veterans, VA employees, politicos of both political parties, and medical service professionals, wrestles with the challenges of meeting the moral and legal obligations of our community in the provision of healthcare for our veterans. We would be delighted to add any of you to the email tree we have set up on this issue so that you and your staff are kept informed of any developments. There is much to learn. As our talking paper points out, the health care of Alaska's veteran's faces serious and difficult structural problems in securing the funding authorized by federal law but not appropriated because veteran healthcare has become a partisan football. Veteran healthcare like so many other federal programs is politically "negotiated," regardless of need, every year unlike healthcare provided to our poor, our homeless, our elderly, and even our illegal aliens. Are not our war veterans at least as deserving as these groups when it comes to healthcare? Are not the men and women who voluntarily stand guard for America worth at least as much to our community? The other day a member of our legislature said to me, "You know veterans are really just another welfare group." This Alaskan of prominence never served in the military, and clearly does not understand that healthcare for veterans is not "welfare" but the moral, ethical, and legal obligation of our people and our leaders for the service and sacrifices we faced to ensure your liberties. We are only asking for what was promised and appropriate. As a community of veterans we are tired of all the talk. We are tired of all the political promises. We are tired of receiving healthcare based on "administrative convenience" rather than appropriate care at home. We are tired of being shipped outside of our communities and our state to receive healthcare available right here at home. We are tired and we are angry. So, why are we here before the State Legislature asking you to direct the Commissioner of Health and Social Services to "talk" to the Veterans Administration about what the state might be able to do to help Alaskan veterans? Yes, that's all we are asking is that our legislature recognize this problem, one that will likely not be solved in Washington DC as it should, but that will continue to harm, even destroy the lives of Alaskan veterans and their families. 72,000 veterans have chosen to be Alaskans. The highest per-capita in the nation. When extended to their immediate families, we estimate that at least 150,000 Alaskans are directly affected by veteran policies. We should be proud that this many veterans choose to live in Alaska. And now our Alaskan guard and Reserves face the largest and longest active duty deployments in combat in our state's history. But as a state, what are we - what is Alaska doing to ensure they receive the healthcare they have earned when they come home? We don't have all the answers, but we are gathering lots of the questions. We have asked the VA to provide the facts and figures identified in the last page of our talking paper. This is something our legislature and our state government can help us with, and this resolution will facilitate that and more. We have talked about veteran healthcare, but let's now look at some of the other implications of current VA policies on our Alaskan based medical services industry. We are told for example that the VA spent over $2 million in air fare alone to send veterans out of state for healthcare. We know that at least most of these medical services are available not only in Alaska but often in the veteran's home community. We are told that over $17 million of healthcare services were proved [provided to] veterans outside of Alaska. With all other costs considered, that's over $20 million in healthcare services that are taken out of our economy. We know of prominent Alaskan doctors who have recently lost their significant veteran client base as their patients are now sent out of state. We know of Alaskan based hospitals, now loosing money because the services they built to serve a particular medical need in their community, including long-term veteran patients, are no longer economically viable due to the loss of these patients causing other Alaskan patients to assume these losses. So, there are serious economic implications to VA policies that now ship more and more Alaskan veterans outside for medical services. Certainly if these services are not available in Alaska one can understand this. But when they are here, and the veterans are currently being served here in their home communities, there are other "costs" associated with these policies. Taking a veteran away from his/her family at a critical and vulnerable time, is clearly not in the best interests of our veterans, their families, or of Alaskans as a community. So, we are asking our State Legislature to direct the Commissioner of Health and Social Services to "talk" with the VA and see if there is something we in Alaska can do to better serve our veterans. That's all. Now, what we would like the Commissioner to also do is gather information that should be reported back to you. We believe the Commissioner can prepare an assessment of these problems and their implications to veterans, our economy, and our community in a few months and provide it back to this and other committees of the legislature so that we can begin to get a real handle on what is happening, what it all means, and why. We believe the Commissioner has it within his department's budget to gather a taskforce of veterans, medical groups, and the VA and seriously, openly, look at the healthcare of our veterans in Alaska and what it will mean over time. We believe you can do this with committee language in the appropriations bill for the Office of the Commissioner of Health and Social Services. "Never will one generation of veterans abandon another." That is the motto of the Vietnam Veterans of America and the Alaska Veterans Foundation. Please remember that when we came home, not only did our nation, and our communities dishonor our service, most national veteran service organizations refused us membership. That is why the Vietnam Veterans of America was chartered by Congress. We have stood guard for America and human liberty in the jungles and deserts of our world when you, our elected officials, have asked us to do so. We now stand before you and ask for your help. Help to ensure we receive the healthcare we have earned, is morally and ethically appropriate, and consistent with what is in the best interests of our families, our state, and our nation. CHAIR WILSON closed public testimony and inquired as to the wishes of the committee. 4:09:51 PM REPRESENTATIVE GARDNER pointed out that the committee packet includes a list of questions for the VA to which only two had answers. She suggested that the remainder of the questions should be answered. 4:10:26 PM MARCIA HOFFMAN-DEVOE, Alaska Veterans Healthcare System and Regional Office, U.S. Department of Veterans Affairs, informed the committee that the department has received the questions and is preparing responses, which she assumed Mr. Davidge would pass along to the committee. 4:11:01 PM REPRESENTATIVE CISSNA moved to report HJR 33, [as amended], out of committee with individual recommendations and the accompanying fiscal notes. 4:11:34 PM REPRESENTATIVE GARDNER objected and opined that this is premature and more information is required. It seems that the resolution acknowledges a debt to veterans, but it seems to be a federal obligation. Therefore, she said she wasn't convinced that the state should take on the service that the VA may or may not be meeting adequately. 4:12:25 PM REPRESENTATIVE SEATON reminded the committee that it received testimony that the $2 million figure specified as being spent on airfare during 2004 to fly Alaska veterans out of state to receive medical services is about $600,000. Therefore, he suggested that the resolution be changed to reflect the correct amount. 4:13:23 PM MS. HOFFMAN-DEVOE offered to provide the correct figures with the responses to the list of questions. 4:13:52 PM REPRESENTATIVE CISSNA withdrew the motion to report HJR 33 [as amended] out of committee. 4:14:29 PM CHAIR WILSON announced that HJR 33 would be held until the committee receives further information.
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