Legislature(2007 - 2008)BUTROVICH 205
03/12/2007 01:30 PM Senate HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| SB62 | |
| SB76 | |
| SB27|| SB87 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 27 | TELECONFERENCED | |
| *+ | SB 87 | TELECONFERENCED | |
| = | SB 62 | ||
| = | SB 76 | ||
SB 27-MEDICAL ASSISTANCE ELIGIBILITY
SB 87-MEDICAL ASSISTANCE ELIGIBILITY
CHAIR DAVIS announced SB 27 and SB 87 to be under consideration.
1:50:23 PM
TOM OBERMEYER, staff to Senator Davis, sponsor of SB 27, said
that the bill updates eligibility requirements for medical
assistance for certain children, pregnant women, and persons in
medical care facilities. One third of American children get
their health services through Medicaid or the State Children's
Health Insurance Program (SCHIP), represented by Denali Kid Care
(DKC) in Alaska. The cost of DKC in 2006 was $25.9 million, $18
million of which was paid by the federal government. Eligibility
rates have been frozen at the 2003 federal poverty guideline,
and SB 27 will increase the rate to 200 percent of the poverty
guideline. It also requires that those who are able contribute
to their health care costs. If SB 27 is not implemented, by
April 2007 the eligibility rate will decline to 154 percent of
the poverty level and 1,000 children will be dropped from DKC.
He added that there are 18,000 uninsured children in Alaska;
these children are far more likely to have health problems.
7,600 children were covered under DKC last year at a cost of
$1,700 per child annually, whereas private health insurance
costs $8,000 to $17,000 for a family annually. SB 27 also will
reverse legislation from 2003 that froze the Medicaid income
eligibility and waiver standards; the bill will be implemented
immediately if passed.
1:56:31 PM
SENATOR WIELECHOWSKI, sponsor of SB 87, said that the bill will
make insurance available to all children in Alaska, while asking
families who can afford it to contribute to their costs.
Ensuring that all children have access to health services will
reduce costs to the state in the long run; the bill is cheaper,
smarter, and more moral than the status quo. The number of kids
covered by private insurance has declined by 31 percent in the
last decade; these children are at a higher risk for many
illnesses and use emergency rooms more frequently. Providence
and Alaska Regional hospitals provided $89 million in
uncompensated care on 2006; these costs result in higher charges
for medical services and higher insurance premiums. These costs
can be reduced by ensuring that all children have access to
health insurance.
He explained that SB 87 raises the DKC eligibility limit to 200
percent of the federal poverty level; this change would put
Alaska in line with other states, and 70 percent of the cost of
the program would be covered by the federal government. The bill
would provide for a sliding scale and co-pay; those with the
greatest means would reimburse the state roughly 90 percent of
the cost. With this act, Alaska will join other states such as
Idaho and Illinois that are working to ensure that all children
are insured.
He said that in 2006 the department paid under $1,400 per child
for DKC coverage; it could cost up to $5.7 million to cover all
kids who are eligible at up to 350 percent of the federal
poverty level.
2:01:07 PM
SENATOR THOMAS said that he was trying to see the differences
between SBs 27 and 87, and asked if there will be a change in
the supplemental security income benefit.
SENATOR WIELECHOWSKI replied that there will not be.
2:02:09 PM
SENATOR DYSON said that the legislature will likely be in a
deficit position for the next decade, and asked what services
will have to be cut to provide future funding for this program.
SENATOR WIELECHOWSKI replied that other states seem to make do
with their funding for similar programs, and no matter the
fiscal situation Alaska needs to make this issue a priority.
2:04:12 PM
KARLEEN JACKSON, Commissioner for the Department of Health and
Social Services (DHSS), said that the DKC eligibility threshold
should not be frozen in statute.
SENATOR ELTON remarked that the savings of the bills will be
unclear, and it appeared that not approving the program would be
tantamount to a tax increase. He then asked about potential
savings resulting from preventative care.
2:06:34 PM
MS. JACKSON replied that a dollar amount would be difficult to
name but she agreed prevention will make a big difference in
later costs.
2:07:11 PM
JERRY FULLER, Medicaid Director for the DHSS, said that an ounce
of prevention is worth a pound of cure, and that while studies
from other states on savings could perhaps be referenced, it
would be better not to speculate.
SENATOR ELTON asked if future savings will exceed the costs
incurred by the bills.
JOHN SHERWOOD, with the Office of Program Review for the DHSS,
said that health care savings don't accrue to the state; the
cost of treatment is borne across the population, through
private insurance, state employee insurance, etc. It's well-
known that preventative measures save money, and in prenatal
care, for example, every one dollar spent saves four dollars in
later costs. As opposed to saving money now, the program will be
reducing future cost increases.
SENATOR ELTON commented that he feels more comfortable with the
program now.
CHAIR DAVIS asked if the DHSS had any comments regarding the
fiscal note, and said that she thought the issue would be best
addressed in the finance committee.
She added that she would be interested in seeing studies of
other states' health care plans and savings.
2:11:26 PM
DR. DAVID ALEXANDER, Chair, Medical Care Advisory Committee,
said that there's no question that the number of uninsured
children has vastly increased; at routine visits children are
screened for the most common issues and those without insurance
are being missed. The state as a whole has created a fourfold
increase in health care costs by cutting money from the DKC
program, which also results in federal funding losses.
He opined that sliding scale insurance would be more effective
than requiring families to purchase private insurance, like some
states have done. Government programs can provide approximately
50 percent more health coverage than private companies due to
low overhead costs. Supporting these bills will greatly decrease
expenses for the whole state.
2:14:46 PM
THEDA PITTMAN, representing herself, said that she is in favor
of increasing the eligibility threshold for DKC, a modest co-pay
for those in the upper levels of eligibility, and a buy-in
option for those not eligible. Medicare eligibility should also
be expanded.
She urged the committee to adopt the more generous features of
each bill.
2:15:50 PM
REGAN MATTINGLY, State Affairs Coordinator for the Alaska
Primary Care Association (APCA), said that in 2005 the APCA's
sites provided primary health care to 23,258 children, 6,566 of
whom were enrolled in DKC. The uninsured are more likely to be
hospitalized for a treatable condition because of the lack of
early intervention; the uninsured segment of the population is
greatly underserved due to high non-insured health care costs.
The expansion of the program will increase health care access
for nearly 18,000 uninsured Alaskan children who need and
deserve such care.
2:18:46 PM
TAMI ELLER, Grand Families Network Project, Volunteers of
American, related a personal story about a six-year old boy who
when his grandparents got him at three years old, he had four
rotted teeth in his mouth, had received no immunizations and had
significant behavioral difficulties. His grandparents were able
to access Denali Kid Care and were able to get his four front
teeth pulled out, to get his immunizations and to get him into
mental health care. Without Denali Kid Care they would never
have been able to do that and the boy would not be as happy and
health as he is today.
Grandparents raising young children kids are often using their
own Medicare insurance for their grandchildren rather than
themselves. The bills before committee would allow everyone's
health to be taken care of equally.
2:21:25 PM
DR. GEORGE BROWN, Private Pediatrician, said that Medicaid and
SCHIP, what people know as Denali Kid Care, have been
instrumental in providing health care for Alaskans, and
referenced a report that showed a direct connection between
infant mortality and poverty. He likened infant mortality rates
to a canary in a coal mine, and cited statistics showing how the
US health care system is inferior to other industrialized
countries'. While these rates have gradually declined, they
remain high among minorities and poor families who are less
likely to have steady health care.
He said that despite these issues, Medicaid and SCHIP have been
beneficial to a great number of children whose families would
otherwise be afraid to seek high-cost uninsured care. SCHIP
coverage needs to be increased to cover those at more than 200
percent of the federal poverty level.
He then referenced newspaper articles about the health care
crisis, and said that increasing youth health care is the least
expensive and longest lasting investment that can be made on
behalf of children. Including early education and health care
costs, every one dollar spent saves six dollars later on;
there's no question that it's cost effective.
2:30:19 PM
WALTER MAJORIS, Executive Director of Juneau Youth Services
(JYS), said that the relationship between DKC and youth mental
health services is important; DKC is the main way that kids with
mental, emotional, behavioral, and chemical dependency problems
access behavioral health services in Alaska. As the eligibility
threshold goes down, fewer kids receive these services, which
need to be improved so that kids can remain closer to home
during treatment.
He said that historically 75 percent of JYS's clients have used
DKC, but in the last year the number has declined to 69 percent
and will likely decline further. Additionally, the number of
children on the wait-list has increased greatly and some
children who do not qualify for basic services are being forced
into extreme levels of service provision. The Alaskan program
has the third-lowest threshold of eligibility in the country;
it's critical that Alaska support these bills for insurance so
that the state can invest early and prevent more serious later
issues.
CAROL LEE, representing herself, explained how her family has
benefited greatly from the DKC program.
NANCY DAVIS, Vice President of the Alaska Nurse's Association,
said that the effort to bring health care coverage to a wider
population is a return to the progress that the state was making
in past years; the bills are steps in the right direction for
Alaska. In 2003, when the enrollment reduced, there were 10,500
youth in kid care; now there are 7,500. Reducing coverage is
counterintuitive because the state is falling behind in its
commitment to its population. The state could potentially be a
model for health care coverage, with its large budget and low
population.
2:39:21 PM
DEBBIE STANDEFER, Operations Director for the Central Peninsula
Health Center, listed the numbers of youth being served by the
center and explained that even discounted health care is a
barrier to many people.
2:40:38 PM
GEORGE HIERONYMUS, Volunteer State President for the American
Association of Retired Persons, related a personal story
regarding DKC, and said that the 89,000 AARP members in Alaska
are in strong support of the bills.
2:42:29 PM
JANICE TOWER, with the American Academy of Pediatrics (AAP),
said that the 88 AAP-affiliated pediatricians across Alaska are
in strong support of the increase of the DKC eligibility
threshold. The emergency room is a terrible place to deliver
primary care and children shouldn't be seen as costs but rather
as people deserving of health care.
PATRICIA SENNER, with the Alaska Nurses Association, said that
paying for health care must be a partnership between
individuals, employers, and the government.
CLOVER SIMON, Chief Executive Officer for Planned Parenthood of
Alaska, said that she supports the bills because living in
poverty can have lasting affects on peoples' health; increasing
the eligibility threshold will have long-lasting positive
effects. She also applauded the inclusion of a sliding scale for
care fees.
2:46:18 PM
KAREN ROBINSON, with the Alaska Women's Lobby, said that the two
bills are the most important before the legislature this year;
the 2003 reduction of the threshold was a major disappointment.
She then related a personal story about the negative effects of
a lack of insurance.
2:49:43 PM
PATRICIA O'GORMAN, program coordinator for the Anchorage School
District, said that there's a significant need to expand the DKC
program. Many families live paycheck to paycheck and agonize
over decisions to seek health care because it's too expensive;
this results in more long-term costs to the health care system.
2:51:44 PM
CHIP WAGONER, Executive Director for the Alaska Conference of
Catholic Bishops, said that the organization supports both the
bills; it opposed the changes in 2003 relating to eligibility in
the DKC program; the purchasing power of the minimum wage has
decreased for the people that can least afford it.
He added that the bill onerously cites Office of Management and
Budget (OMB) poverty guidelines; the OMB doesn't establish
poverty guidelines, but rather only approves the definition of
poverty. The Federal Department of Health and Human Services is
the entity that develops the poverty guidelines.
2:56:38 PM
MARIKO SELLE, with the Alaska Public Health Association, said
that the organization supports expanding the DKC program, and
that its target is to see all Alaskan children insured by 2010.
AMY DEVEREAUX said that her monthly salary doesn't fit under the
current DKC threshold, and her work insurance is too expensive.
She supports both bills, as well as a buy-in option for those
who don't fit the requirements.
CHAIR DAVIS thanked the presenters and announced her intention
to pass the bills to finance. She remarked that either bill may
face issues in the next committee.
2:59:55 PM
SENATOR ELTON moved to adopt a conceptual amendment to SB 27
that changed the definition of "poverty level" as being
established by OMB (Office of Management and Budget) and asked
for unanimous consent. There being no objection, the motion
carried.
SENATOR ELTON moved to adopt the same conceptual amendment to SB
87. There were no objections and it was so ordered.
3:01:24 PM
SENATOR ELTON moved to report CSSB 27 (HES) from committee with
unanimous consent and attached fiscal note(s). Chair Davis asked
for a roll call vote. Senators Elton, Thomas and Davis voted
yea; and CSSB 27(HES) moved from committee.
SENATOR ELTON moved to report CSSB 87(HES) from committee with
attached fiscal notes. Chair Davis asked for a roll call vote.
Senators Thomas, Elton and Davis voted yea; and CSSB 87(HES)
moved from committee.
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