Legislature(1999 - 2000)
02/08/2000 03:38 PM House HES
| Audio | Topic |
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
HOUSE HEALTH, EDUCATION AND SOCIAL
SERVICES STANDING COMMITTEE
February 8, 2000
3:38
MEMBERS PRESENT
Representative Fred Dyson, Chairman
Representative Jim Whitaker
Representative Joe Green
Representative Carl Morgan
Representative Tom Brice
Representative Allen Kemplen
Representative John Coghill
MEMBERS ABSENT
All members present
OTHER HOUSE MEMBERS PRESENT
Representative Con Bunde
Representative Gary Davis
COMMITTEE CALENDAR
HOUSE BILL NO. 224
"An Act requiring a public employee labor organization representing
employees of a school district, regional educational attendance
area, or a state boarding school to give notice before striking."
- HEARD AND HELD
HOUSE BILL NO. 260
"An Act relating to coverage of children and pregnant women under
the medical assistance program; and providing for an effective
date."
- HEARD AND HELD
PREVIOUS ACTION
BILL: HB 224
SHORT TITLE: PERA: NOTICE BEFORE STRIKE
Jrn-Date Jrn-Page Action
5/05/99 1180 (H) READ THE FIRST TIME - REFERRAL(S)
5/05/99 1180 (H) HES, L&C
5/06/99 1214 (H) COSPONSOR(S): OGAN
5/07/99 1247 (H) COSPONSOR(S): DYSON
1/25/00 (H) HES AT 3:00 PM CAPITOL 106
1/25/00 (H) -- Meeting Canceled --
2/03/00 (H) HES AT 4:00 PM CAPITOL 106
2/03/00 (H) -- Meeting Canceled --
2/08/00 (H) HES AT 3:00 PM CAPITOL 106
BILL: HB 260
SHORT TITLE: MEDICAL ASSISTANCE PROGRAM COVERAGE
Jrn-Date Jrn-Page Action
1/10/00 1887 (H) PREFILE RELEASED 12/30/99
1/10/00 1887 (H) READ THE FIRST TIME - REFERRALS
1/10/00 1887 (H) HES, FIN
1/10/00 1887 (H) REFERRED TO HES
1/27/00 (H) HES AT 3:00 PM CAPITOL 106
1/27/00 (H) <Bill Postponed>
2/08/00 (H) HES AT 3:00 PM CAPITOL 106
WITNESS REGISTER
RANDY LORENZ, Researcher
for Representative Vic Kohring
Alaska State Legislature
Capitol Building, Room 421
Juneau, Alaska 99801
POSITION STATEMENT: Presented sponsor statement for HB 224.
KAREN PERDUE, Commissioner
Department of Health & Social Services
P.O. Box 110601
Juneau, Alaska 99811
POSITION STATEMENT: Answered questions and asked the committee to
give the Denali KidCare a chance.
PAMELA GUY
P.O. Box 20337
Juneau, Alaska 99802
POSITION STATEMENT: Testified against HB 260 and in support of the
Denali KidCare Program.
RENA SIMS
8311 Aspen Avenue
Juneau, Alaska 99801
POSITION STATEMENT: Testified in support of the Denali KidCare
Program.
DOROTHY ARENSMAN, Superintendent
Southeast Island School District
P.O. Box 19569
Thorne Bay, Alaska 99919
POSITION STATEMENT: Testified against HB 260.
NICKI SHELTON
P.O. Box 101
Hoonah, Alaska 99829
POSITION STATEMENT: Testified against HB 260.
JAMES CULLEY, Chief Executive Officer and Administrator
Valdez Community Hospital
P.O. Box 550
Valdez, Alaska 99686
POSITION STATEMENT: Testified against HB 260.
KELLIE TALBOT
P.O. Box 828
Bethel, Alaska 99559
POSITION STATEMENT: Testified on HB 260.
MARY ANARUK, Vice President
Community Services
Yukon-Kuskokwim Health Corporation
P.O. Box 1541
Bethel, Alaska 99559
POSITION STATEMENT: Testified on HB 260.
LAURA BAEZ
P.O. Box 3587
Bethel, Alaska 99559
POSITION STATEMENT: Testified on HB 260.
MARY MESSNER, Public Health Nurse
Children with Special Needs Program
North Slope Borough
P.O. Box 1069
Barrow, Alaska 99723
POSITION STATEMENT: Testified against HB 260.
KIMBERLY MACK
North Slope Borough Counseling Services
P.O. Box 247
Barrow, Alaska 99723
POSITION STATEMENT: Testified on HB 260.
ROBIN LUNETTA, Education Coordinator
Cordova Family Resource Center
P.O. Box 863
Cordova, Alaska 99574
POSITION STATEMENT: Testified on HB 260.
PATRICIA BOILY
4135 Clover Lane
Homer, Alaska 99603
POSITION STATEMENT: Testified against HB 260.
SCOTT WHEAT
P.O. Box 22353
Homer, Alaska 99603
POSITION STATEMENT: Testified against HB 260.
GEORGE MARTIN
P.O. Box 2920
Soldotna, Alaska 99669
POSITION STATEMENT: Testified in support of HB 260.
TOMMY THOMPSON
111 Paula Street
Kenai, Alaska 99611
POSITION STATEMENT: Testified in support of HB 260.
SUSAN GIBSON
P.O. Box 2325
Kenai, Alaska 99611
POSITION STATEMENT: Testified in support of HB 260.
MARGARET WRIGHT
P.O. Box 170
Kotzebue, Alaska 99752
POSITION STATEMENT: Testified against HB 260.
MARCI SCHMIDT
2040 Wasilla Fishhook Road
Wasilla, Alaska 99654
POSITION STATEMENT: Testified against HB 260.
KELLI MAHONEY
925 Lone Cub Drive
Wasilla, Alaska 99654
POSITION STATEMENT: Testified on HB 260.
JERI LANIER
620 Fifth Avenue
Fairbanks, Alaska 99701
POSITION STATEMENT: Testified on HB 260.
ELAINE LANDON, Health Operations Administrator
Tanana Chiefs Conference, Inc.
122 First Avenue
Fairbanks, Alaska 99701
POSITION STATEMENT: Testified against HB 260.
CHERYL KILGORE
311 Hawk
Fairbanks, Alaska 99709
POSITION STATEMENT: Testified on HB 260.
ERIN CASTLE
123 West Twelfth Avenue, Number A
Anchorage, Alaska 99501
POSITION STATEMENT: Testified against HB 260.
VIANA STAM
4938 East 34 Avenue, Apartment B5
Anchorage, Alaska 99508
POSITION STATEMENT: Testified against HB 260.
JENNIFER DEFORD
3641 Chiniak Bay Drive
Anchorage, Alaska 99503
POSITION STATEMENT: Testified against HB 260.
NORMA PERKINS, Director of Business Services
SEARHC
222 Tongass drive
Sitka, Alaska 00835
POSITION STATEMENT: Testified on HB 260.
PATRICIA MACPIKE, Children's Coordinator
Sitka Mental Health Clinic
409 Monastery Street #3
Sitka, Alaska 99835
POSITION STATEMENT: Testified in support of Denali KidCare
program.
JEAN FRANK
623 DeGroff Street
Sitka, Alaska 99835
POSITION STATEMENT: Testified on HB 260.
PAT AAMODT
Arctic Slope Native Association
Member, Barrow Tribal Council
P.O. Box 68
Barrow, Alaska 9973
POSITION STATEMENT: Testified in support of Denali KidCare program
as it now stands.
DOROTHY BUNTI REED
Families and Parents Anonymous
3725 Portage Boulevard
Juneau, Alaska 99801
POSITION STATEMENT: Testified against HB 260.
LARAINE DERR, Executive Director
Alaska Hospital and Nursing Home Association
426 Main Street
Juneau, Alaska 99801
POSITION STATEMENT: Testified against HB 260.
JEROME SELBY
Providence Health System in Alaska
P.O. Box 1962
Kodiak, Alaska 99615
POSITION STATEMENT: Testified against HB 260.
LINCOLN BEAN
Alaska Native Health Board
P.O. Box 318
Kake, Alaska 99830
POSITION STATEMENT: Testified against HB 260.
MORISSA WILLIAMS
329 Fifth Street, Apartment 2
Juneau, Alaska 99801
POSITION STATEMENT: Testified against HB 260.
WILSON JUSTIN, Health Director
Mount Sanford Tribal Consortium
Member, Alaska Native Health Board
SR 1355
Slana, Alaska 99586
POSITION STATEMENT: Testified against HB 260.
SHERRY OLSON, Clinical Social Worker
P.O. Box 21008
Juneau, Alaska 99802
POSITION STATEMENT: Testified against HB 260.
MS. LARE'
1805 Bunker
Anchorage, Alaska 99503
POSITION STATEMENT: Offered thanks for the Denali KidCare program.
WALTER MAJOROS, Executive Director
Alaska Mental Health Board
431 North Franklin Street, Suite 201
Juneau, Alaska 99801
POSITION STATEMENT: Testified against HB 260.
ACTION NARRATIVE
TAPE 00-9, SIDE A
Number 0001
[The minutes for the Alaska State Health Care Access Committee
Resolution Proposal can be found in the 3:04 p.m. minutes of the
same date.]
CHAIRMAN FRED DYSON reconvened the House Health, Education and
Social Services Standing Committee at 3:38 p.m. Members present
were Representatives Dyson, Whitaker, Green, Morgan, Brice, Kemplen
and Coghill.
HB 224 - PERA: NOTICE BEFORE STRIKE
CHAIRMAN DYSON announced the first order of business as House Bill
No. 224, "An Act requiring a public employee labor organization
representing employees of a school district, regional educational
attendance area, or a state boarding school to give notice before
striking."
Number 0022
RANDY LORENZ, Researcher for Representative Vic Kohring, Alaska
State Legislature, came forward to present the sponsor statement
for HB 224. He stated that this bill was requested by the
Anchorage School District. The bill amends the Public Employees
Relation Act (PERA) to require the school district to receive a
minimum of three work days advance notice before a strike can be
called by the union representing the district. Prior notice was
provided in two of the three strikes that have been called in the
past few years. In January 1999 the Totem Association representing
the support personnel called a strike after 10 p.m. on Thursday.
The strike began the following morning, and the district had no
time to provide sufficient notification to the parents. This bill
does not prevent the union the ability from striking; it protects
the children. It is a public safety issue, and he requested
consideration of the bill.
Number 0118
CHAIRMAN DYSON announced the committee would suspend the hearing on
HB 224 to take testimony on HB 260.
Number 0154
HB 260 - MEDICAL ASSISTANCE PROGRAM COVERAGE
CHAIRMAN DYSON announced the next order of business as House Bill
No. 260, "An Act relating to coverage of children and pregnant
women under the medical assistance program; and providing for an
effective date."
Number 0165
REPRESENTATIVE COGHILL, sponsor, stated that his intention on HB
260 is purely to bring up the debate about how far the state wants
to go on government health care. The people who run the Denali
KidCare (DKC) program have done a wonderful job of implementing it.
His argument is not with the Denali KidCare program. He has
received a fair amount of phone calls, fax and e-mails. In
amending AS 47.07.020, HB 260 takes care of some housekeeping items
in the language. The main portion of the bill is on page 4, lines
5, 9 and 13 where he suggests the poverty level be reduced from 200
percent to 100 percent.
Number 0375
REPRESENTATIVE COGHILL made a motion to adopt Amendment 1 which
would change the poverty level to 133 percent on page 4, lines 5,
9 and 13.
Number 0409
REPRESENTATIVE BRICE objected for purposes of debate.
REPRESENTATIVE BRICE stated that he was pleased to see
Representative Coghill willing to bring the number up to 133
percent given the fact that is the federal minimum. The state
really has no ability to go below the federal minimum without once
again flying in the face of the Medicaid program. He clarified
that the 100 percent level would not be acceptable to the federal
government and simply returning it back to the 133 percent level,
which is where it was before, brings it back into compliance with
the basic Medicaid rate. He asked for a response on that from the
Department of Health and Social Services.
Number 0498
KAREN PERDUE, Commissioner, Department of Health & Social Services,
came forward to respond. She said Representative Brice was correct
in the point he raised. She indicated that the bill was confusing
the way it was drafted because to participate in the $400 million
federal Medicaid program, they would have to provide care to
pregnant women and certain children up to 133 percent so the
amendment simply clarifies that it is in compliance with the
federal Medicaid program, therefore making sure the state doesn't
lose $400 million. However, the department already thought the
bill said that. The affect of the amendment is simply
clarification.
REPRESENTATIVE BRICE withdrew his objection.
Number 0565
CHAIRMAN DYSON asked if there was any further objection. There
being none, Amendment 1 was adopted.
REPRESENTATIVE COGHILL reiterated that his reason for introducing
this is to raise the debate on how far the state wants to go in
health care. He understands there was going to be a major cost to
go under 133 percent. That is a good place to stop and say "Do we
want to go any further." There is a demonstrated savings, but that
is really not his argument as trying to find more money. He is not
trying to fly in the face of many people in Alaska who have now
signed up for this health care. It is true that it is an
expansion, and he was not involved in the debate two years ago. He
felt strongly when it came up, and he doesn't believe the state
wants to go in this direction. He knows there are a lot of people
who will testify that they have legitimate needs and the DKC
program has supplied some of that need. He will not argue the fact
that it has supplied the need. He will argue the philosophy on
whether the state should even supply the need. One alternative was
presented earlier today [The Alaska State Health Care Access
Committee Resolution Proposal], and it is worthy of some
consideration. "Instead of going into a dependency on government
we need to start paying our way. There just has to be a better
way."
Number 0739
REPRESENTATIVE BRICE appreciates the fact that Representative
Coghill supports the concept of the socialized medicine access to
health care that was presented earlier. If that were the case in
this state and every person had access to health care, then this
bill would be okay. In terms of the philosophy, he asked if it is
too far to provide people who are difficult to insure access to a
health care pool or too far by providing state employees with
health care. The state is self-insured, and it is a socialized
program. He asked if they are going too far providing the
legislature access to health care.
Number 0843
PAMELA GUY came forward to testify. She is deaf and a single
parent. She expressed concern because she is enrolled in the
program and if it is eliminated, she will be sunk. She worries
about possibly losing her home if she had to pay for insurance.
She works 50 to 60 hours a week, and she has health insurance from
her employer, but her two boys do not. She would like to keep
Denali KidCare for her two boys because she doesn't know how she
could afford other insurance for them.
RENA SIMS came forward to orally interpret for Ms. Guy and added
that she is a foster mom for six children. She has children from
ages 19 to 22 who have four babies with severe problems like half
a brain, blind, deaf or paralyzed, and they need the Denali KidCare
program. The young parents work, go to school and are covered by
Medicaid, but the babies are not covered in some instances. It
would be a hardship for these young adults. There has to be a way
to bridge over so they can make it.
Number 1073
DOROTHY ARENSMAN, Superintendent, Southeast Island School District,
testified from Thorne Bay via teleconference. She asked why anyone
would deny children who needed health care. As a school
superintendent with more than 30 years of dedicated service, she
was excited for the children who are needy when Denali KidCare
became available last spring. Southeast Island School District
volunteered to distribute information and assist parents in
completing the necessary paperwork. Since that time more than 175
children from Prince of Wales and surrounding islands have applied
for Denali KidCare. With the State of Alaska paying only 28 cents
for each dollar that is going to fund the health insurance for
children and the other 72 cents that is spent is federal funds, she
asked why they are reducing health care for children. The
elimination of Denali KidCare would result in a great loss of
federal funds for health care for Alaskan children.
MS. ARENSMAN noted healthy Alaskan children result in savings. As
a long-term special educator, she has helped parents seek funding
for their disabled children. Too often the expense of educating
special needs children could have been reduced if health care
coverage had allowed them the services of well-baby, well-child
care, adequate immunizations and early identification of care and
problems through early detection. Many disabilities can be reduced
through prenatal care of pregnant women. To reduce Denali KidCare
is to increase special education dollars necessary to educate the
special needs children and to increase the dollars for supporting
them throughout their lives. It is her hope that Denali KidCare
continues with its current success.
Number 1168
NICKI SHELTON, Parents and Teachers of Hoonah, testified via
teleconference from Hoonah. The Parent and Teachers of Hoonah are
the Denali KidCare grantee that provides services in enrolling and
assisting eligible families in Hoonah. She strongly urged the
committee not to pass HB 260. Alaskan children's health depends
upon their health insurance coverage. Denali KidCare has often
been the primary factor that determines if children receive health
care in Hoonah. There are many families in Hoonah either
under-employed with seasonal or part-time jobs and neither carry
health benefits. There are also some families being helped trying
to move off Medicaid, but their children's health care is still a
prime concern, and it is a consideration in making the change.
Before Denali KidCare in March 1999, those families without
insurance could simply not get health care even though they were
working. It is not affordable from Hoonah.
MS. SHELTON said her group has helped pregnant women apply for
Denali KidCare and three of those mothers had no previous prenatal
care before they enrolled in Denali KidCare. The $472 per year of
state funds that Denali KidCare paid to cover each of those babies
is money well spent to ensure that those babies will be healthy at
birth. She speculated that without Denali KidCare, the cost and
inconvenience of going to Juneau for prenatal care, it is very
likely those babies would have been born without any health care at
all. Losing Denali KidCare and the federal dollars that will go
with it is not cost effective when compared to the increased costs
for children who are ill or developmentally delayed due to the
absence of health care.
MS. SHELTON summarized that they need to have Denali KidCare so
that working parents who do not have health benefits and are on
modest incomes can support and afford health care for their kids.
Alaska does not want to become the only state without a state child
insurance program or it'll be funding remediation in the future
years. She thanked the committee for supporting healthy Alaskan
children.
Number 1297
JAMES CULLEY, Chief Executive Officer and Administrator, Valdez
Community Hospital, testified via teleconference from Valdez. He
expressed opposition to the amended version of HB 260. The
hospital very aggressively marketed Denali KidCare in Valdez. They
made people aware at the hospital, the school system, at public
health, Valdez Counseling Center and the medical clinic so eligible
individuals were able to utilize this program. They were so
successful that much of his knowledge on the success of Denali
KidCare program is anecdotal rather than first hand.
MR. CULLEY indicated there aren't as many sick children being seen
in the emergency room as in the past. For many individuals who
can't afford health care, the emergency room serves as their
medical clinic. But now these children are being seen at the
dentist office, the medical clinic and the optometrist. This
translates into increased school attendance and better course work
for children who were previously at risk. Valdez Community
Hospital sponsors a visiting optometrist to Valdez, and he has
noticed an increase of the number of young children that are being
seen and getting glasses. The optometrist has indicated to Mr.
Culley that many of these children are in the Denali KidCare
program and among this group, he has found several that were
probably unable to read the blackboard and a number who undoubtedly
had difficulty. Unfortunately it is difficult, if not impossible,
to determine the ultimate cost benefits of these students over the
course of their academic career and beyond.
MR. CULLEY also mentioned two pregnant women who were considered
high risk for obtaining prenatal care and eventually had uneventful
births and healthy babies that otherwise would have been extremely
expensive. These expenses are not avoided, but they would have
been borne by the hospital. The good thing about Denali KidCare is
there is not another option for these monies other than health
care. They are not seeing Denali KidCare being used for
catastrophic events, rather it is being used for wellness. He
cautioned it is much easier to show direct monies cut from a budget
than it is to show the costs that were avoided by the expenditure
of these same monies. Denali KidCare is an investment in the
future and the future of children in Alaska.
Number 1520
KELLIE TALBOT testified via teleconference from Bethel. She
stated: "We all know or have children who are near and dear to our
hearts. I would make the assumption that most of them are safely
insured, and we can go to bed every evening and not have to worry
about that. What is the difference between your children and our
children here in the Delta. If you cut Denali KidCare you deny
health services to our children. Health care is a right not a
privilege. If Denali KidCare is cut, programs that are attempting
to provide for better services will no longer exist. Thank you."
Number 1573
MARY ANARUK, Vice President, Community Services, Yukon-Kuskokwim
Health Corporation (YKHC), testified via teleconference from
Bethel. She is in charge of the village based programs such as
health aides, substance abuse counselors, home-care workers and so
forth. A few years ago YKHC began to focus on a well-child program
because access to health care is a major problem for most of the
village residents. The health aides, which are the primary
providers in the village, receive special training which enable
them to do all the examinations and immunizations needed for
children. One of the problems has always been enrollment and
getting pregnant women to enroll on Medicaid in order to receive
appropriate care. She admitted many of the village residents
qualify for Medicaid, but there are also many residents who have
low paying jobs with their respective village corporations, school
districts or councils who do not qualify for Medicaid, and the
Denali KidCare program has facilitated increased enrollment.
MS. ANARUK mentioned another positive aspect has been the outreach
benefit derived from this program. There has been an increased
enrollment of 4 to 5 percent under Denali KidCare this past year
and those are not the final figures. One of the more serious
concerns in the region is a lack of adequate prenatal care. She
agreed that prenatal care is the single, most cost-effective health
care expenditure, ensures the best birth outcomes of the baby and
is the best method of assuring a healthy start for the newborn.
The people in the Yukon-Kuskokwim region have long wanted to bring
health care as close to where the people live, and Denali KidCare
has helped to reach more children and provide the preventative care
that is needed. Considering the high statistics of domestic
violence, suicide, child abuse and substance abuse in the region,
decreasing any program reaching out to the entire state and to the
children seems totally inappropriate.
Number 1675
LAURA BAEZ, Mental Health Clinician, Yukon-Kuskokwim Health
Corporation, testified via teleconference from Bethel. She stated
that many of the children in the villages would be without health
care if it wasn't for Denali KidCare. This service is needed and
people are afraid it will increase the problems of high suicide
rates and other mental health problems in the village if it is no
longer available.
Number 1768
MARY MESSNER, Public Health Nurse, Children with Special Needs
Program, North Slope Borough, testified via teleconference from
Barrow. She agrees with previous testimony on prenatal care and
prevention. There are many children with neuro-disorders and have
great needs. If the needs of these children are met early, they
can grow up to be productive people. Some of these children need
highly specialized services which cost a lot. It would be
devastating to Barrow to cut the support for Denali KidCare in
half. This is a terrible idea.
Number 1837
KIMBERLY MACK, North Slope Borough Counseling Services, testified
via teleconference from Barrow. She has been without health
insurance during times in her life but she was lucky that nothing
happened during that interim. She hoped that luck wasn't the only
thing to rely on.
Number 1882
ROBIN LUNETTA, Education Coordinator, Cordova Family Resource
Center, testified via teleconference from Cordova. She testified
to the importance of Denali KidCare in Cordova. Cordova is
comprised mostly of fishing families with little or no insurance
coverage, and this leaves many children and pregnant women without
means to pay for essential health, dental and prenatal care. She
has assisted several families in applying for Denali KidCare that
were in desperate situations with nowhere else to turn. These
families either had past medical expenses with no means to pay them
or had upcoming unavoidable expenses due to pregnancy or ongoing
treatment. Denali KidCare has also provided the families of
Cordova with a consistent financial means to maintain good health
by staying current on vaccinations and checkups. She is frustrated
that such an important and needed program has fallen victim to the
political arena. This is not a republican or democratic issue; it
is a program greatly needed by Alaskans and its existence should
not be determined by what political party is in office. If the
Legislature is truly seeking to help Alaskans, it will vote to keep
this program, not eliminate it. Please make the right decision for
Alaskans not for political affiliation.
Number 1953
PATRICIA BOILY testified via teleconference from Homer. She
objected to Representative Coghill's proposed changes to Denali
KidCare. In spite of what he claims, she finds him extremely mean
spirited. In a state with 4.7 percent unemployment, she finds it
significant that over 27 percent of those who are employed are
city, borough, state or federal government workers, virtually all
of whom have the best benefit packages imaginable. She believes
the Legislators are included in the state benefits. There is at
least another 19 percent of workers who are nonresidents. Most of
those don't have their families in Alaska so that leaves about 49
percent of people employed in the private sector, many of whom have
either no insurance at all or inadequate insurance because it is
really hard for small businesses to find affordable health plans.
MS. BOILY pointed out that Denali KidCare program meets the needs
of middle income families that are struggling to make it. There is
nothing like unforeseen medical bills to blow apart a budget and
send someone entirely into debt. Without adequate health insurance
coverage, working families put off going to family doctors for
preventive health care and/or less serious illnesses. This puts
them at risk of ending up in the emergency room or hospital with
huge medical bills that can take months or years to pay. This
affects the doctors and the hospitals to render services they
either don't get paid for at all, or they extend credit for so long
that it costs more to send out the bills than just to write off the
balances. This is cost shifting of the most expensive kind.
MS. BOILY noted that intervention can prevent more serious medical
conditions from developing. The proposal to reduce the income
qualifications to even 133 percent of the poverty level will
eliminate a significant number of children and pregnant women from
the Denali KidCare program. Representative Coghill claims it will
save the state Medicaid office up to $19 million eventually, but
she wondered how much of that savings will be shifted to the family
practitioners and the hospitals in Alaska who will absorb the
unpaid outpatient and inpatient costs. She found Representative
Coghill's insert of the Wall Street Journal referring to a Heritage
Foundation study to be offensive. She hates to see him maintain
his conservative credentials on the back of those in the health
care industry by victimizing the least powerful residents of the
state. She believes it is the government's prime directive to
supply the solution for people's health care needs, health,
education and the well being of its citizens. With the federal
government contributing 72 percent of the cost, it is a bargain for
the State of Alaska to protect the health and welfare of its
youngest citizens. They deserve to be treated like the assets they
are.
SCOTT WHEAT testified via teleconference from Homer. He referred
to comments made by Representative Coghill and wondered if people
think that the poor are held in poverty by their own fault or by
their own choice and to what purpose. It seems like most folks
want a hand up and not a hand out. The article from the Wall
Street Journal talks about defining poverty and ownership of
appliances seem to be some measurement of economic viability, and
he feels that is a specious argument. He owns quite a few
appliances that have come from garage sales, second, third and
fourth hand, and some were free; that is not a good measurement.
The ownership of a car in most of Alaska is not an option but a
requirement to get to any sort of appointments.
MR. WHEAT agreed that preventative health care proves to be cost
effective. Prenatal and non-emergency room services and keeping
people out of jail and API [Alaska Psychiatric Institute] proves to
be cost effective. He wondered what the private sector provides to
prime the pump of economic viability of our children and families.
At this point he doesn't believe that the private sector does very
much. He acknowledges some donated dental and some pro bono work
by the doctors and lawyers, but he believes it is the government's
function to coordinate that sort of improvement in people's lives.
Denali KidCare is cost effective, and it would be a big mistake to
cut the program.
Number 2156
GEORGE MARTIN testified via teleconference from Kenai and
expressed his support for HB 260. He stated it is time to make the
decision in Alaska whether to continue down the road to socialism
or to encourage independence while allowing for those with real
needs. He pointed out the misconception in much of the testimony
that HB 260 is about doing away with the Denali KidCare program,
and that is not the case. It is talking about how rich someone
needs to be before not qualifying for the program. He admitted he
qualifies for this program but chooses to stand on his own feet and
provide for his family's need. He could lower his pride and say it
is owed to him. He doesn't choose to do that. In September 1999
the people of Alaska spoke loudly and clearly that they wanted to
see a smaller, leaner government. They don't want to lose their
permanent fund dividends (PFD), but they'd like to see government
cut the cost.
MR. MARTIN suggested this is a good example of one of the places
cutting can be done. He believes those people in remote areas who
testified strongly against HB 260 voted a loud no to protect that
permanent fund dividend. He commented that people could take that
PFD and spend it on health care. That $1700 would have gone a long
way towards providing money for health insurance. The Denali
KidCare at 200 percent covers a lot of people that really are doing
quite well in their businesses and so forth. He urged the passage
of HB 260.
Number 2248
TOMMY THOMPSON testified via teleconference from Kenai. He spoke
in support of HB 260. He commented many of the people who
testified have a vested interest in being part of the program. He
reminded people that no one is wanting to cut off medical care to
the poor, but presently this covers families well into the middle
class. A family of four is eligible if they have an income of
$43,000 which not a bad income. This creates a dependency in
people's minds on governmental handouts; not for folks who are
really poverty stricken but for folks who spend their money
someplace else. According to an article in The Anchorage Daily
News yesterday, one third of this money is going to psychiatric
care. If that figure is correct, it is a worrisome figure of what
is going on out there where this much of this money is going to
psychiatric care when there are physical cares that need to be met.
Number 2325
SUSAN GIBSON testified via teleconference from Kenai. She
expressed support for HB 260 because the number of expanded
taxpayer funded entitlement programs is literally breaking the back
of taxpayers. Whether an entitlement program is funded either by
federal or state dollars, the result is the same. The burgeoning
financial burden is borne on the backs of taxpayers. She has never
heard any word of concern for the taxpayer who continually is
turned to for a few more dollars out of every paycheck to support
the entitlement programs that only serve to promote a mind set on
the part of the entitlement recipients that it is someone else's
duty to carry their load. She is someone else, and she has carried
the financial responsibility of raising two children as a single
parent on far less than $20,000 a year. She was well below the
poverty level rate during the whole time she raised her children,
but they did have excellent care. She didn't avail herself of any
government entitlement, and therefore she raised two children who
are adults now and have an instilled sense of self responsibility.
That is a concept that certainly is not being fostered in people
anymore. If this were a bill to eliminate Denali KidCare, she
would not be in favor of that. She has heard from a lot of people
who have a vested interest in job security by virtue of this
entitlement program. She pointed out the other side because the
taxpayers are just about at their breaking point.
Number 2247
MARGARET WRIGHT, Public Health Nurse, testified via teleconference
from Kotzebue. She reiterated that Denali KidCare is a program
that takes advantage of incentives from the federal government to
leverage state funds to help a large number of working poor
families in the state. Denali KidCare offers poor working families
health care for their children when they are not insured through
their workplace. The children of the state are the most important
resources and a worthy investment. Healthy children today are more
likely to be healthy, productive adults who will contribute to the
state in meaningful ways over the decades of their lives.
MS. WRIGHT sees children daily who receive well-child care and
immunizations, as well as children with special needs who receive
treatment through Denali KidCare program. Since the implementation
of Denali KidCare program, the list of eligible children has grown
significantly. That means children who previously weren't getting
well-child care were putting off sick care and were not going to
the clinic for care just like other children who are insured.
MS. WRIGHT noted many people believe that all Bush children are
covered by IHS [Indian Health Services] so there is not a real need
for an insurance program for these people out in the Bush. She
agreed some children are IHS eligible but certainly not all of
them. In many parts of the state no child is IHS eligible. Rural
children need this program as much or maybe more than their urban
cousins. This is the only insurance available for Bush families.
When a child has a recurring ear infection or health care condition
like a cleft lip and palate, and the child is uninsured, often the
needed care is delayed or not received. The care is not just a car
trip away for rural children. The needed health care services are
a plane flight and hotel stay away at the very least. Certainly
well-child checkups and immunization rates decline when children
are not insured. If those same services can prevent much larger
problems in the future, then Denali KidCare is a long-term
investment. Certainly the children and working families deserve
more investment than a few months at a low cost insurance program.
Number 2123
MARCI SCHMIDT testified via teleconference from the
Matanuska-Susitna (Mat-Su) Legislative Information Office (LIO).
She thanked Representative Coghill for his work on child protection
issues but disagreed with him on HB 260. She will be losing her
health insurance soon because she can't afford $3500 per year for
her children, and the Denali KidCare program has been an avenue of
recourse in order to make sure her children are provided with
adequate medical care. She urged the committee to look elsewhere
for budget cuts.
Number 2079
KELLI MAHONEY testified via teleconference from the Mat-Su LIO.
She is a student at an adolescent drug treatment program, runs a
program for pregnant teens and is a parent of five children who are
not insured. It would have cost her $4,800 a year to insure her
children with both parents were working. At the Turnaround
Treatment Center, she sees many clients in treatment now because
Denali KidCare provides for them. Some of the therapy they receive
which ensures their successful completion of treatment is part of
what is paid for, about two-thirds of those kids receive that
money. They need to be in treatment at least three months or more
in her opinion for significant treatment outcomes to occur. She
has up to 70 pregnant teens per year in her program. Roughly
four-fifths of those parents have to rely on Denali KidCare.
MS. MAHONEY said she was never able to afford health care for her
children. They turn to the state for solutions which is just why
Representative Coghill thinks the citizens of Alaska are looking to
the government for health care reform. The difference between
their points of view is in outcome. If the desired outcome is to
keep government out of health care provision and save money, then
it is cut; if the desired outcome is to keep kids and pregnant
women healthy and prevent further problems, then it is funded. If
there is concern about Alaskans becoming dependent on Denali
KidCare changes should be made in the insurance industry and that
will be a tough battle for government to undertake. She urged the
committee not to limit the poverty level unless it goes to 150 or
185 percent and requires a small co-pay. She asked how much hidden
cost is there in ignoring health care for a young child over time
and who will supply this need. She doesn't want to live in a state
that doesn't want to provide health care for its working poor.
Number 1994
JERI LANIER, Family Centered Services of Alaska, testified via
teleconference from Fairbanks. One of the things that got her
attention was a quote in the newspaper that Representative Dyson
was concerned with the number of dollars being spent on mental
health care through Denali KidCare. She pointed out in private
health insurance there is usually little or no mental health
coverage unless the Legislature wants to take up HB 149. The needs
are being identified at younger ages which would account for a lot
of it. Early detection of SED [seriously emotionally disturbed]
kids or mentally ill children allows for intervention with a much
higher treatment success rate. There is a difference between
enabling a system and providing necessary services to children.
Nobody is looking for a way to enable the state to save more and
more on taxpayers' backs or rake in the big bucks. Health care
doesn't get paid to the parents, it gets paid to the providers.
Number 1919
ELAINE LANDON, Health Operations Administrator, Tanana Chiefs
Conference Inc., testified via teleconference from Fairbanks. The
Tanana Chiefs Conference is the primary health care provider for
Alaska Natives in the Interior, and they take strong opposition to
HB 260. Eliminating Denali KidCare jeopardizes gains made in
public health by reducing access to preventative services for the
working poor. A few years ago there was a measles outbreak in
Anchorage which was attributed to low immunization rates. When
budget cuts are to be made whether at the state or family level,
prevention efforts are often sacrificed for more immediate needs.
If you have to chose between fixing the car and immunizations for
the kids, most people fix the car so they can continue to work.
Unfunded federal mandates are often burdensome on states. However,
Denali KidCare provides two ways for Alaskans to benefit. The
tremendous return on the state's matching share of CHIP [Children's
Health Insurance Plan] funds is a good investment in itself.
Additionally a cost savings is realized when Indian Health Service
beneficiaries are seen at tribal facilities. In these cases, the
state pays nothing because the cost of care is reimbursed 100
percent by the federal government. Moreover, Denali KidCare
revenue is often used to enhance programs funded primarily by the
Indian Health Service and with token state funds. Mental health
services are a good example. In parts of the Interior, Indian
Health Service pays for approximately 75 percent of mental health
services while the state only pays about 25 percent. Services are
minimal yet the state is not meeting its obligation to provide
services equitably statewide. These programs serve all Alaskans
and just not tribal members.
Number 1842
CHERYL KILGORE, Interior Neighborhood Health Clinic, testified via
teleconference from Fairbanks. She said the clinic is virtually
the sole agency in the Fairbanks North Star Borough that delivers
primary health care services to eligible patients on a schedule of
discount. Schedule of discount is based on household incomes and
size. The number of patients they saw in 1998-1999 was 3,242, and
47 percent were living at or below 200 percent of federal poverty
guidelines. Thirteen percent didn't have health insurance and the
overwhelming majority of those individuals were working. Seventeen
percent of those individuals have Medicaid. With Denali KidCare,
they have seen an increase to about 21 percent. In terms of total
numbers, it doesn't represent a huge increase for the budget, but
it does represent a very important investment in the health care
for children and pregnant women. Health care costs money, but the
investment and the money provided with Denali KidCare also saves
money. It saves money by providing prevention services and
screening services to children and pregnant women. As a society,
however it is defined, government, local state or national ends up
picking up the cost of health care and the lack of health care
access. If people do not have access to health care, they are
going to wait until they have a complication and then receive
emergency care which will be more expensive and will be borne by
the individual with insurance. Denali KidCare is a cost effective
prevention.
ERIN CASTLE testified via teleconference from Anchorage. Six years
ago her daughter was ill and almost died. She was encouraged not
to admit her daughter to the hospital because the family didn't
have health insurance. She was working full time at the time, and
her company did not provide insurance. With the help and kindness
of others, her family had people come into their home and take care
of the daughter, and the doctor provided his services free of
charge. Over the years she has become in debt by paying for her
health care. Denali KidCare program has given her the ability to
give her daughter good health care and allowed her to pay on some
of her debts which will take a long time to pay off. She does not
agree with this bill. People who are receiving services under AFDC
[Aid to Families with Dependent Children] that do get off the
program, get off because Denali KidCare is provided. If this bill
goes through, she believes people will go back on AFDC. More money
will be spent providing for them on a full-time basis than letting
them get out into the real world and work and have the health care
that they are given.
Number 1652
VIANA STAM testified via teleconference from Anchorage. She is a
college graduate and works full-time in Alaska as does her husband,
but they have no insurance. They have two children, one has a
disability, and she is pregnant with their third. They have always
had medical insurance, but her husband recently left military
service, and they have none nor can they afford it. Health
insurance would cost them $1000 per month, so using the permanent
fund dividend wouldn't go far. The Denali KidCare helps the
working class children and pregnant women with affordable health
care. Before she was on the prenatal program, she had to seek
medical care, and the expenses were outrageous. She was
misdiagnosed, and private physicians were skeptical or refused to
see her because she had no medical insurance. If these children
are phased out, this is what they are going to be going through.
Pregnant women will not be receiving prenatal care, and the infant
and mother mortality rate in Alaska will rise. Many families use
the Denali KidCare program on a temporary basis until they can find
employment with health insurance or some other means of accessing
health insurance. Please do not take away this preventive care
program away from the children of working class families.
JENNIFER DEFORD testified via teleconference from Anchorage. She
urged the committee to vote down HB 260. Do not place the burden
of balancing the state's budget on the shoulders of the children.
Denali KidCare is a highly efficient and effective program. The
federal government pays for over 70 percent of the program. The
remainder of the program should be funded by the federal
government's increased Medicaid reimbursement to the state by a
lower welfare roll and by the tobacco settlement. Of the $25
million per year that the state is receiving from the tobacco
settlement, only $1.4 million is designated for tobacco awareness
and cessation programs. The entire amount should be used for
health programs. This was the reason the state received the money
in the first place.
MS. DEFORD said while she and her husband have always worked but
never been on public assistance, they have lived without health
insurance. One of the times they were without health insurance was
when they started their own company. They couldn't afford medical
insurance for themselves much less their ten employees. It was a
very scary situation. Each time when one of the children got sick,
they wondered how much the doctor's bill would cut into their tight
budget. They gave up their business in part because of the lack of
medical insurance. Therefore, she believes that eliminating Denali
KidCare will hurt economic development. The elimination of Denali
KidCare will also hurt welfare reform. A person who now sits home
and receives a variety of state-supported benefits will have no
incentive to go to work. A single parent in this situation may
have to spend $800 per month on child care and another $800 a month
for family health insurance.
MS. DEFORD asked where the benefit of working is. Many of the jobs
people hold are low paying and lack fringe benefits. Alaska is the
only state economy where growth in state product has dropped in the
past five years. Per capita personal income dropped from the
highest in the country to below average. Alaska's economy is not
great. Denali KidCare families are taxpayers. She believes that
200 percent is a good level because health care is extremely
expensive, and health care may be the only thing one of these
families cannot afford. If they have a pre-existing condition, no
health insurance company is going to pick them up. She believes
health insurance is an important issue.
Number 1388
NORMA PERKINS, Director of Business Services, SEARHC [Southeast
Alaska Regional Health Consortium] Sitka, came forward to testify.
She noted that SEARHC is made up of 20 tribal communities
throughout southeast Alaska. She said SEARHC does compact with the
federal government to provide Indian Health Services in southeast
Alaska. In 1999 SEARHC saw Denali KidCare as an opportunity to
increase enrollment for children and pregnant women who had
financial barriers in accessing health care delivery systems
especially in the rural and hard to reach areas. A quick
comparative analysis from March to September of 1998 shows there
were 393 visits in the pediatric/ambulatory unit. In that same
time frame in 1999, there was an increase of 2,223 visits. This is
a tremendous impact. She reiterated that tribal beneficiaries who
are enrolled under Denali KidCare and are seen at the tribal
facility, the federal Medicaid program reimburses the facilities at
100 percent. It literally costs the State of Alaska nothing when
the tribal members are seen. She expressed shock and surprise to
hear that the legislature wants to eliminate a very vital program
for children and pregnant women.
Number 1231
PATRICIA MACPIKE, Children's Coordinator, Sitka Mental Health
Clinic, testified via teleconference from Sitka. She expressed
dismay that the committee is discussing discontinuing vitally
needed medical insurance and assistance for the children of Alaska.
In funding Denali KidCare, the state is investing in prevention.
She works with 14 severely emotionally disturbed children who would
not be able to receive therapeutic services and interventions
without the Denali KidCare program. Without these services, many
of these children would be required to be institutionalized at some
point in their young lives. These are children who at nine years
old have violent outbursts in their schools, home and community.
She asked if the committee wants to see how these children will act
at the age of 15 without any intervention. Research from many
fields shows the earlier the intervention, the higher the success
rate for children. Children who carry weapons to school and shoot
their peers are emotionally disturbed. She urged the committee to
support the Denali KidCare program. By supporting the program,
they are not only investing in the children, but all Alaskans.
Please maintain a fair level of funding.
Number 1152
JEAN FRANK testified via teleconference from Sitka. She stated no
dentist in Sitka serves Denali KidCare kids. She wondered how the
passage of this bill will serve the needs of those kids.
Number 1120
COMMISSIONER PERDUE spoke both as Commissioner of Health & Social
Services and as a person who has devoted her career to trying to
figure out health care financing in Alaska and how to improve it.
Whether a child has health insurance in this state almost entirely
revolves around the profession the parent has chosen. That is the
inequity the committee is hearing. If people are self-employed, or
if they work in the resource economy as fishers, loggers,
seasonally, part-time, they have difficulty accessing the private
health care insurance market. If the parents work for a large
company or large public entity, such as the state of Alaska, they
can access health insurance. Just because someone is working in a
profession where it is not efficient or easy for them to access the
health care market, she does not believe that means their children
are not entitled to some kind of access to health insurance.
COMMISSIONER PERDUE has served on four health care task forces in
her professional career in Alaska trying to solve this problem. No
one has solved it. No private sector solution has come forward.
No other kind of governmental solution has been acceptable to the
issue of disparity. It would be a mistake to think that solution
is easy. The state is not willing to mandate that private
employers offer this kind of coverage, nor willing to turn over the
health care dollars to a foundation or a single payer. Most
employers are not willing to do that. A lot of smart people in
Alaska and across the nation have looked at this issue over a long
period of time. Congress finally decided to fill some of these
holes two years ago when they enacted the CHIP program. It was a
bipartisan reform; it was an incremental reform. It did not solve
all the health care financing problems of this nation, but it did
say that children and pregnant women should have some kind of
targeted access to health care coverage no matter where their
parents worked. That is where they are trying to straighten out
the inequity in the market.
COMMISSIONER PERDUE noted that Medicaid was called socialistic when
it began in the 1960s. Denali KidCare will have its first birthday
March 1. People don't like the fact that government changes its
mind. This program needs to be given a chance to settle out. Some
6,000 private doctors and hospitals as well as the people using the
program need to see some assurance there. The Legislature enacted
this law two years ago, and she believes it needs time to make it
work.
REPRESENTATIVE BRICE said Denali KidCare was a reinvestment of
dollars saved by changes in the federal Medicaid matching program.
The change was predicated on the fact that those dollars would be
invested into children's health care services. This is the year
the congressional delegation will have that debate again. If the
Administration and Congress find that Alaska is backing off on its
commitment to reinvesting those dollars, he asked what is the
likelihood of getting that matching rate taken away and what would
the cost be to the state for that.
COMMISSIONER PERDUE replied a lot has been said about the
instability of the program from the federal government funding it.
In actual fact, the federal government authorized their portion of
the money for ten years. Alaska paid for its match through the
savings from the Medicaid match rate change which is $30 million.
The state invested a small portion of that in this program.
Senator Murkowski addressed the Legislature recently and indicated
that he wanted a full accounting of what the state was doing with
the match rate savings because he is having to back to the Senate
Finance Committee and get that reauthorized this year. The State
of Alaska would lose $30 million if the match rate were not
reauthorized, a small portion of which has been put into Denali
KidCare.
Number 0713
PAT AAMODT, Arctic Slope Native Association, Member, Barrow Tribal
Council, came forward to testify. She urged the committee to
continue the Denali KidCare as it is. This is one investment that
the state has made where for $2 million per year from the general
fund, the state gets about $7 million, and that is quite a bit of
money. She urged the committee to consider that and the employment
opportunities it provides for people who are professionals, but
mostly consider it on behalf of the children in her region as well
as the whole state of Alaska. The people in the Barrow region, in
addition to the statewide organizations such as ANTHC [Alaska
Native Tribal Health Consortium] and ANHB [Alaska Native Health
Board], fully support this because it benefits all children who are
in need. The cost of living is high, and the 200 percent above the
poverty level fits well for the state. She encouraged the
committee to reconsider and know that this affects a lot of
families in her region where unemployment is high, and there are
pockets of unemployment statewide.
Number 0575
DOROTHY BUNTI REED came forward to testify. She spoke against HB
260 for many of the same reasons already heard. She read this
portion of the sponsor statement: "First, it brings the definition
of poverty back to the basic assumption that a family is poor if
they do not have the resources to provide for essential needs such
as food, clothing and shelter." She said that the $19,000 that a
family of four is defined at 133 percent of the poverty level would
not provide those things in this state. She read another portion
of the sponsor statement: "Second, it tell the federal government
that we disapprove of its move to instill socialized medicine as
status quo..." She suggested that this tells the federal
government that Alaska doesn't care about its children. She
believes that the logic of the argument in the last paragraph on
that page is also flawed.
MS. REED said she comes from a family of two working parents, both
of whom had health insurance. They were visited by a very
catastrophic medical condition that "maxed out" their insurance.
It is easy to "max" it out when a life flight to Seattle costs
$30,000; her family has had three such life flights. It is easy to
"max" it out when one parent has to stay home to care for a
disabled child as a result of an accident. Her family was
fortunate, or not, that her son's disability was such that he was
able to access disabled Medicaid funds. Her other children didn't
have that luxury. When she found herself owing over a half-million
dollars in medical fees, she doesn't believe she could have found
someone to give her a loan to make payments for the rest of her
life. Her family sold their home to try to make those payments.
In her family the parents worked opposing schedules to try to make
those payments. Her family declared bankruptcy; had Denali KidCare
been there at that time, it might have been an option to prevent
that. She and her husband still work; neither of them quit. She
and her husband still have health insurance albeit with new
employers who had them wait for coverage for their son for a
certain waiting period. Her other son did get Denali KidCare for
a time but when she was made eligible for insurance and could
purchase it at a reasonable rate, she purchased the insurance, thus
making her ineligible unless her level of income goes below poverty
level. Please consider that a loan program is not realistic given
real people and real medical needs and consider that when making
your decision.
Number 0328
LARAINE DERR, Executive Director, Alaska State Hospital and Nursing
Home Association (ASHNHA), came forward to testify. She noted that
Mr. Culley from the hospital in Valdez virtually testified from the
hospital standpoint. She indicated that ASHNHA opposes HB 260.
Number 0275
JEROME SELBY, Providence Health System in Alaska, came forward to
testify. He urged the committee to keep the income level
eligibility guidelines for Denali KidCare at the 200 percent of
poverty level. It is his understanding that dropping from 200 to
100 percent would cause about 7,000 children and about 800 pregnant
women currently enrolled to lose their benefits. It would also
mean Alaska is the only state not offering health insurance to more
children, and that is not a good idea. Research has clearly shown
that children with health insurance see the doctor for regular
well-baby checkups, they receive immunizations, and they are more
likely to have health problems discovered early, thus saving
millions of dollars in total health care. Denali KidCare does
exactly that by providing health insurance to more lower income
working families who for whatever reason are uninsured. According
to recent data reported by the Anchorage Access to Health Care
Coalition, about 38,000 people in Anchorage have no health
insurance and more than two-thirds of those work. In Alaska the
estimated number of children without insurance was about 12,000.
That was a three-year enrollment goal for the Denali KidCare
program. However, the need is apparently greater since more than
12,000 children were enrolled in less than one year.
MR. SELBY stated that since Denali KidCare started, parents don't
use the emergency room as frequently for primary care, and fewer
children are seen for more costly treatment resulting from delays
in seeing a doctor. This is cost-effective health care delivery
under this program. One way to ensure a healthy birth is to
provide pregnant women with prenatal care. This too is the very
best cost-effective health care expenditure made. He submits the
fact that everyone is going to help pay for this publicly whether
admitted or not. The difference is, through the Denali KidCare
program, it is known how much is spent, who the recipient is and a
program is defined. When the uninsured people move over into
uncompensated care, the cost won't go away. These people still
aren't going to be able to pay, but everyone else is going to pay
indirectly. When paying indirectly, there is no idea what it costs
and there is no way of trying to control or be involved in
determining that expense. It will cost more because these people
won't come in for care until much later in the development of a
disease. Society will pay more if this program is dropped. He
urged the committee to consider that. It is far wiser to go with
this defined program, get early intervention and take better care
of people. If the program is kept at the 200 percent of poverty
level, there will be healthier children and therefore healthier
Alaskans.
TAPE 00-10, SIDE A
Number 0029
LINCOLN BEAN, Alaska Native Health Board, came forward to testify
and greeted the committee in Tlingit and then he said, "Honorable
leaders, respectful friends, ladies and gentlemen, it is an honor
to be here to testify on behalf of the Denali KidCare." He raised
this issue with Representative Coghill to preserve this service
that is so vital and important to communities that may have 80
percent unemployment. "How could we be talking about taking a
service for a small child. This isn't for everyone. It's for
those who are in need, and that's how we look at it. I support the
Denali KidCare and I oppose HB 260. Thank you."
Number 0145
MORISSA WILLIAMS came forward to testify. She introduced her son
Noah who is a Denali KidCare kid. She said they are incredibly
grateful for the program. She mentioned that she had spoken to
Representative Coghill and believes he is sincere in his regard to
children, they just differ on what they each believe the children
need in the long term. The Denali KidCare program is vital and
urged the committee to keep it. She left her written testimony
with committee members.
Number 0248
WILSON JUSTIN, Health Director, Mount Sanford Tribal Consortium,
Member, Alaska Native Health Board, came forward to testify. He is
sympathetic to what he has heard about not ever using medical
facilities by people who are self-sufficient. His family was
raised isolated and in a small business environment, and they
fortunately never had to worry about medical bills. He regards
that as a blessing, and that does not give him the right to judge
the level of need of those who are less fortunate. He read the
following testimony:
Mr. Chairman, members of the Committee. My name is
Wilson Justin. I am the Health Director for the Mount
Sanford Tribal Consortium and a member of the Alaska
Native Health Board. The Alaska Native Health Board
appreciates the opportunity to provide testimony
regarding HB 260. We urge that you do not move this
measure.
The bill will result in 6,696 children and 780 pregnant
women losing access to Medicaid. If Medicaid is lost,
most of these children will receive health care only
after they are sick, and, all too often, only when the
child is brought to a hospital emergency room. such care
is most expensive in dollars and loss of quality of life.
Follow-up is lost; prevention does not occur. School
days are missed and parents miss work to care for their
sick children.
I know that some of you are wondering why the Alaska
Native Health Board cares about this issue since our
member health providers receive funding from IHS [Indian
Health Services.] First, as health providers we cannot
sit quietly by while any child loses access to health
care. It is not good for our communities or our state.
Secondly, the assumption that Native children and
families are unaffected is simply wrong. The IHS direct
appropriations, based on recent federal studies, provide
only about 25 percent of needed funds to provide care for
Alaska Natives and American Indians.
Congress relies on the Medicaid program to supplement the
IHS direct appropriations. It authorizes the state to
recover 100 percent of its Medicaid payments to IHS and
tribal health providers. However, payment is only made
for services to eligible children. If this bill is
enacted into law, no reimbursement will be available for
the services we provide to approximately 2,200 Alaska
Native children whose family income is between 100
percent and 200 percent of poverty. This means that our
very limited direct funding is stretched even more
thinly. Village visits by health professions will
diminish, more children will become ill unnecessarily,
and resources will be diverted from prevention to acute
care. This is the poorest use of limited resources.
We know that state resources are limited, however this is
not where cuts should occur. This cut will make Alaska
the only state in the United States that is not
implementing the federal Children's Health Insurance
Program. It will reduce federal spending in Alaska by
more than $7 million in the first year and $12 million in
the second year. It will lead to increased uncompensated
emergency room costs. Most important, it will lead to
increased preventable health problems and inevitably to
some preventable deaths.
We urge each of you to cast your vote in support of
Alaska's most valuable natural resource, our children;
vote "do not pass" on HB 260.
Number 0573
SHERRY OLSON, Clinical Social Worker, came forward to testify. She
testified against HB 260. Denali KidCare benefits Alaska children.
She understands the worry of this program fostering dependency, but
this is not an issue of dependency. Parents who qualify for Denali
KidCare are working now, and they will continue to work. The issue
is whether or not their children can get appropriate and needed
health care, including mental health care. She cited two examples
of children with complex mental health needs through this program.
One boy was an aggressive kindergartner last year who needed daily
intervention to ensure his safety and other students' safety. He
would stab children with pencils, strike out at teachers, throw
furniture, scream inconsolably and so on. With comprehensive
services, his behavior has turned around in one year. He has had
one aggressive incident in the last 90 days, as opposed to daily
aggressive incidents, and his services are being decreased. Both
of his parents work, but they cannot afford health care. He is
succeeding as a first grader and is doing well.
MS. OLSON told of another boy, who at the age of 11, was setting
fires, burglarizing and doing drugs and alcohol. He was on his way
to McLaughlin Youth Center where the cost of treatment is
expensive. Comprehensive services have again turned him around.
He is succeeding in high school and has had no legal involvement
for over a year. His mother is a professional single mom who is
raising five children. Denali KidCare has benefited these two
children mentioned and many others. Please do not damage this
resource to this state. Early intervention is cheaper each time it
is used.
Number 0715
MS. LARE' came forward to testify. She is a grandparent from
Anchorage and a long time advocate for young children and their
families. She told the committee about a family who had problems
during a pregnancy. The family sold their house to pay for the
care of the expectant mother. Every month it got worse, but the
child now is very healthy, as are the mom and dad. She thanked the
committee for Denali KidCare on behalf of one family.
WALTER MAJOROS, Executive Director, Alaska Mental Health Board
(AMHB), came forward to testify. He expressed strong opposition to
HB 260 on behalf of the AMHB. The AMHB remains strong advocates
for Denali KidCare. He pointed out that the program is critical to
children's mental health in preventing more serious mental health
conditions from developing later on and for serving children who
have more serious emotional disorders. The program helps children
and families live more successfully and independently in the
community. It helps parents from losing custody of their children.
The AMHB board has heard testimony from parents who had to give up
custody of their children in order to enroll them in the Medicaid
program. It helps prevent involvement with the juvenile justice
system; it helps prevent institutionalization and higher cost
services. A significant amount of the expenditures go to mental
health services, and this is necessary and appropriate.
MR. MAJOROS noted Denali KidCare is seen as an issue of a basic
support program. About 120 organizations across the state have
gotten together since last session when HB 161 was being considered
to oppose to that bill. Those organizations believe that basic
support programs such as Medicaid, the adult public assistance, and
the Alaska temporary assistance program provide needy Alaskans with
consistent means to meet their fundamental living expenses such as
food, shelter, medical care and transportation. Denali KidCare is
a critical part of the safety net for vulnerable Alaskans. He
urged the committee to vote no on HB 260.
CHAIRMAN DYSON announced the committee would continue hearing HB
260 next Tuesday, February 15. [HB 260 was heard and held.]
ADJOURNMENT
Number 0940
There being no further business before the committee, the House
Health, Education and Social Services Committee meeting was
adjourned at 5:28 p.m.
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