Legislature(2011 - 2012)SENATE FINANCE 532
04/08/2011 09:00 AM Senate FINANCE
| Audio | Topic |
|---|---|
| Start | |
| SB15 | |
| SB5 | |
| SB27 | |
| SB101 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | SB 15 | TELECONFERENCED | |
| + | SB 5 | TELECONFERENCED | |
| + | SB 27 | TELECONFERENCED | |
| + | SB 96 | TELECONFERENCED | |
| + | SB 101 | TELECONFERENCED | |
| + | TELECONFERENCED |
SENATE BILL NO. 5
"An Act relating to eligibility requirements for
medical assistance for certain children and pregnant
women; and providing for an effective date."
9:15:30 AM
THOMAS OBERMEYER, STAFF, SENATOR BETTYE DAVIS, read the
bill title and referred to SB 5 as the "Denali KidCare
bill." He quoted the sponsor statement:
Senate Bill 5 increases and restores to original
levels established 14 years ago the qualifying income
eligibility standard to 200 percent of the Federal
Poverty Level (FPL) for the State Children's Health
Insurance Program (SCHIP) called Denali KidCare (DKC)
in Alaska. Alaska as one of the nation's wealthiest
states is only one of four states which fund their
SCHIP program below the 200 percent FPL. This bill
makes health insurance accessible to an estimated 1277
more uninsured children and 224 pregnant women Alaska.
Denali KidCare is an enhanced Medicaid reimbursement
program receiving up to 70 percent federal matching
funds.
Mr. Obermeyer noted that Denali KidCare currently received
approximately 65 percent in federal matching funds. He
continued to read from the sponsor statement:
Denali KidCare serves and estimated 7900 Alaska
children and remains one of the least costly medical
assistance programs in the state at about $1,700 per
child with full coverage, including dental care, which
is about 20 percent of the cost of adult senior
coverage. Early intervention and preventative care
will greatly increase Alaska children's health and
yield substantial savings to the state and public and
private sector hospital emergency rooms which must
admit indigent and uninsured patients for non-
emergency treatment. It is estimated per the Kaiser
Foundation the 24,000 uninsured children in Alaska
with a medical need are five times as likely not to
have a regular doctor as insured children and four
times more likely to use emergency rooms at a much
higher cost.
A similar bill was overwhelmingly passed with
bipartisan support by the legislature in 2010.
Governor Parnell subsequently vetoed the bill over
concern that increased eligibility to Denali KidCare
would require an increase in state-funded induced
termination of pregnancies. Medicaid funds 51 percent
of all births in Alaska. In order to continue to
receive federal funding for the state Medicaid program
of which Denali KidCare is part, and in order to
comply with state law, constitutional provisions, and
Alaska Supreme Court rulings, the state must provide
medical services for pregnant women including
medically necessary terminations, as well as prenatal
and postpartum care.
The Alaska Department of Health and Social Services
(DHSS) estimated that no more than 10 percent or 22
more induced terminations would result with minimal
expense from the increase in eligibility for Denali
KidCare to 200 percent FPL. Induced terminations under
Denali KidCare cost about $384,000 annually or less
than 0.18 percent of one-fifth of the 1 percent of the
$217 million of the DKC budget.
While the Governor understandably is concerned about
the mushrooming cost of the state Medicaid program,
Denali KidCare which is about 18 percent of the $1.2
billion total state Medicaid budget should not be
among his first cuts and expense of Alaska's most
vulnerable children and pregnant women. Increasing
eligibility for DKC to 200 percent FPL under Senate
Bill 5 is uncomplicated, manageable, and could take
effect immediately with prompt implementation by DHSS.
9:19:29 AM
Co-Chair Stedman pointed to the three fiscal notes from the
Department of Health and Social Services. The first note in
the amount of $221,800 ($77,600 in general funds and
$144,200 in federal receipts) from the Division of Public
Assistance funded two full-time positions to manage the
increased eligibility workload. The second note from the
Division of Health Care Services, totaled $567,000
($183,400 in general funds and $183,600 in federal
receipts) and would cover the additional Medicaid costs.
The third note in the amount of $2,718,200 ($820,400 in
general funds and $1,897,800 in federal receipts) from the
Division of Health Care Services funded increased Medicaid
costs.
9:21:01 AM
PAT LUBY, ADVOCACY DIRECTOR, AMERICAN ASSOCIATION FOR
RETIRED PERSONS (AARP) (via teleconference), spoke in
support of SB 5. The agency believed that every child in
Alaska should have access to insurance coverage. The
agency's members over the age of 65 enjoyed the security of
Medicare that covered prevention and acute care; the agency
felt that the state's children should enjoy the same
coverage. He stressed the importance of Medicare coverage
for newborns and their mothers. He urged the committee to
pass the legislation.
9:22:25 AM
ELIZABETH RIPLEY, EXECUTIVE DIRECTOR, MAT-SU HEALTH
FOUNDATION (via teleconference), voiced support for SB 5.
The foundation owned part of the Mat-Su Regional Medical
Center and used revenues from the local hospital to make
grants to improve the health of Mat-Su residents. The
foundation worked to reduce health care barriers that
included lack of insurance. Access to primary, dental, and
preventative health services was important for overall
health. In 2007 approximately 1,499 of the 22,991 children
in Mat-Su were uninsured and 650 of the children fell below
200 percent of the Federal Poverty Level (FPL). The overall
rate of uninsured children was 6.5 percent; however, the
rate for children at or below 200 percent of the FPL was
20.4 percent and had begun to increase between 1 percent
and 2 percent annually due to the decrease in eligibility
for Alaska KidCare. Alaska had seen a 31 percent decline in
the number of children covered by private health insurance
in the past decade. She explained that the cost of care was
passed on and raised premiums and out of pocket expenses
for other Alaskans and businesses. She stated that
uninsured children were not as healthy as insured children
and were nine times less likely to have a regular doctor,
four times more likely to be taken to the emergency room,
and 25 percent more likely to miss school. In order to get
a handle on the increased Medicaid costs in the state, it
was important to address chronic disease and other drivers
at the primary care level; uninsured children did not have
access to the necessary preventative care, which increased
system costs. She provided an example about a mother who
had taken her asthmatic child to the emergency room 12
times one year, but only 3 times the following year, as a
result of access to primary care and preventative
treatment. She emphasized that increasing Denali KidCare
eligibility levels to a minimum of 200 percent of the FPL
would increase health care access for children and families
in need and would improve public health throughout Alaska.
She relayed that currently Alaska was one of four states
with the lowest eligibility levels.
9:25:28 AM
STEPHANIE BERGLUND, CHIEF EXECUTIVE OFFICER, THREAD (via
teleconference), testified in support of SB 5. She stated
that the bill would increase access to health care for more
women, children, and families. The organization worked with
over 7,500 families annually and was aware of the
importance of health care resources for healthy development
in children. According to research, the support of children
during their early years was the most critical and families
with access to care were more likely to obtain early
intervention to support their child.
9:26:32 AM
GUS MARX, GRANTS COORDINATOR, ALASKA ASSOCIATION OF HOMES
FOR CHILDREN, spoke in support of SB 5. The association was
made up of 19 behavioral and mental health providers
throughout the state that served children primarily through
Denali KidCare. He explained that the bill would increase
Denali KidCare service and would provide children with
service who had not previously had access.
9:27:44 AM
JOY LYON, EXECUTIVE DIRECTOR, ASSOCIATION FOR THE EDUCATION
OF YOUNG CHILDREN, vocalized support for SB 5. She thought
that the $600 annual cost to the state represented the best
financial deal to help children to become strong citizens
in the future. The bill was a priority for the coalition of
early childhood associations throughout the state,
including the Alaska Association for the Education of Young
Children, Best Beginnings, Alaska Head Start Association,
Alaska Infant Learning, and THREAD. She stressed the
importance of providing at risk families with a connection
to a medical home and doctor. At times a doctor was the
only individual who saw a family; therefore, their role was
necessary to ensure that a child was able to grow and
thrive. She relayed that other states including
Mississippi, Tennessee, and Alabama had higher support for
young children in spite of tougher state financial
conditions. She urged the committee to pass the
legislation.
Senator Olson wondered what help the program offered to
community health aides that saw children in rural villages.
Ms. Lyon replied that she was not very familiar with the
health systems in Alaska's rural communities.
9:30:50 AM
NANCY DAVIS, PRESIDENT, ALASKA NURSES ASSOCIATION,
testified in support of SB 5 that would expand health care
coverage to more children. She had participated in a Yukon-
Kuskokwim training for community health aides that taught
them how to perform early preventative screenings. She
believed that under Denali KidCare, health aides could
perform initial screenings and make referrals. She
communicated that it was important to invest in healthy
children and to make it possible for parents to take good
care of their children. Denali KidCare covered pregnant
women to support the health of babies and to prevent pre-
term deliveries. She had led the enrollment effort when
Denali KidCare had first been offered in Alaska; the state
had led the nation in enrollment numbers. She believed the
need for the program was great in Alaska.
9:32:55 AM
Senator Stedman CLOSED public testimony.
Senator McGuire spoke in support of SB 5. She stressed the
importance of providing all children with access to health
care. She wondered what communications had occurred with
the governor and his staff in order to ensure that the bill
would not be vetoed as it had been in the past.
SENATOR BETTYE DAVIS, SPONSOR, replied that the
administration had worked on a solution to ensure the
governor would not veto the bill. She believed that there
were many options available that did not include cutting
Denali KidCare. She expressed interest in introducing other
legislation that would possibly reduce the number of
abortions that would be added to the program. Additional
options included adoption services and other. She felt that
the bill should be passed as written in order to provide
coverage to women and children who were in need of the
services. She was open to other suggestions by the
administration that would appease the governor.
Senator Davis discussed that the bill would increase and
restore original Denali KidCare levels established 14 years
earlier to the qualifying income eligibility standard to
200 percent of the FPL. The bill had passed the House and
Senate the prior year, but had been vetoed by the governor.
She had met with the governor who had indicated there was
flexibility on some items but not on others; she had
agreed. She believed that the governor did not have to veto
the bill. She discussed the separation of powers between
the legislative and executive branches of government and
that the legislature needed to act not based on what the
governor may do. She recounted that Governor Parnell had
supported the bill the prior session, but he had received
information prior to signing it into law that had caused
him to change his mind. She believed the program was needed
and efficient. Alaska was one of three states with an
eligibility standard of 200 percent or less of the FPL. She
emphasized that there was no need for the state to be at
such a low number when it had the finances to fund the
program.
9:37:16 AM
Senator McGuire reiterated her support of the legislation.
She discussed that the Alaska Supreme Court had decided
that abortion services should be covered if Denali KidCare
offered services to pregnant women. She explained that the
governor was upset about the court's decision, which was
beyond the control of the legislature. She encouraged
Senator Davis to consider talking with the governor before
the end of the current session; she had heard that the
governor had been considering a definition of medical
necessity related to abortions or other. She understood the
philosophical concern, but believed it would be unfortunate
if the bill was vetoed again over the item.
Senator Davis stressed that there was a medical necessity
definition that could be utilized. She believed there were
other options. She discussed that the governor's office had
the information. She stressed that the governor's statement
that he would veto the bill if he received it, was not
helpful.
SB 5 was HEARD and HELD in committee for further
consideration.