Legislature(2005 - 2006)CAPITOL 106
07/14/2006 08:00 AM House HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| "using Health Care Dollars Wisely" | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
ALASKA STATE LEGISLATURE
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE
July 14, 2006
8:05 a.m.
MEMBERS PRESENT
Representative Peggy Wilson, Chair
Representative Sharon Cissna
Representative Berta Gardner
MEMBERS ABSENT
Representative Paul Seaton, Vice Chair
Representative Tom Anderson
Representative Carl Gatto
Representative Vic Kohring
OTHER LEGISLATORS PRESENT
Senator Bettye Davis
COMMITTEE CALENDAR
WORKING GROUP: "USING HEALTH CARE DOLLARS WISELY"
- HELD
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
STEPHANIE BIRCH
Women and Children, Family Health
Division of Public Health
Department of Health & Social Services (HESS)
Anchorage, Alaska
POSITION STATEMENT: Participated in the discussion during the
work group on using health care dollars wisely.
PATRICIA A. CARR, Health Program Manager IV
Health Planning & Systems Development
Office of the Commissioner
Department of Health & Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Participated in the discussion during the
work group on using health care dollars wisely.
KARLEEN K. JACKSON, Ph.D., Commissioner
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Participated in the discussion during the
work group on using health care dollars wisely.
JERRY FULLER, Project Director
Office of Program Review
Office of the Commissioner
Department of Health & Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Participated in the discussion during the
work group on using health care dollars wisely.
DENNIS DeWITT, Special Staff Assistant
Office of the Governor
Juneau, Alaska
POSITION STATEMENT: Participated in the discussion during the
work group on using health care dollars wisely.
PAULYN SWANSON, Staff
to Representative Mike Hawker
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Took part in the work group discussion on
using health care dollars wisely, on behalf of the House Finance
Subcommittee on Health and Social Services, which is chaired by
Representative Hawker.
ACTION NARRATIVE
CHAIR PEGGY WILSON called the House Health, Education and Social
Services Standing Committee meeting to order at 8:05:30 AM.
Representatives Gardner and Wilson were present at the call to
order. Representative Cissna arrived as the meeting was in
progress.
^WORKING GROUP:
^"USING HEALTH CARE DOLLARS WISELY"
8:05:57 AM
CHAIR WILSON announced that the only order of business was the
work group session to address using health care dollars wisely.
CHAIR WILSON asked the participants to introduce themselves.
8:08:06 AM
STEPHANIE BIRCH, Women and Children, Family Health, Division of
Public Health, Department of Health & Social Services, told the
group that her area of focus was birth outcomes. She mentioned
the Alaska Maternal and Child Health (MCH) data book, which is
written on the topic of birth defects. She said she would
compile the major points for the group.
REPRESENTATIVE WILSON stated her intent that the work group
choose topics for its future meetings.
8:10:21 AM
PATRICIA A. CARR, Health Program Manager IV, Health Planning &
Systems Development, Office of the Commissioner, Department of
Health & Social Services (DHSS), directed attention to a handout
she provided entitled, "Alaska State Health Plans and Special
Reports."
REPRESENTATIVE WILSON said the group can pick focus subjects
from the handout.
8:11:21 AM
KARLEEN K. JACKSON, Ph.D., Commissioner, Department of Health
and Social Services (DHSS), directed attention to page 7 of the
aforementioned handout and noted there is a web site link listed
under the heading of "Public Health - Center for Health Data and
Statistics." The web site covers various topics.
8:12:34 AM
REPRESENTATIVE CISSNA said her presentation regarding a "road
show" would be forthcoming.
8:13:23 AM
JERRY FULLER, Project Director, Office of Program Review, Office
of the Commissioner, Department of Health & Social Services
(DHSS), said he had been asked to pull together studies related
to long-term [health] care. He held up a stack of papers dating
from 1996 to present, all of which he said point to the same
problem. He explained, "We've got a problem coming with the
increasing number of aged and disabled, and we need to do
something about it." He said it is a lot of information and he
did not make copies for everyone.
8:14:32 AM
REPRESENTATIVE CISSNA asked to see the copies to figure out what
information she needs.
8:15:25 AM
CHAIR WILSON stated the need to prioritize goals, and she held a
discussion regarding the order of the topics on a handout
entitled, "June 2006 Health Priorities Meeting."
8:18:11 AM
MS. CARR described the priorities handout as a list compiled
through brainstorming; she said it holds ideas put forward that
now need to be considered by the entire group.
8:20:20 AM
REPRESENTATIVE CISSNA, regarding improving birth outcomes, said
she does get the same feedback when in Juneau that she receives
when she is home talking to people on the street, and that
concerns her.
8:21:34 AM
COMMISSIONER JACKSON noted that she serves on the executive
committee for Commonwealth North Round Table on Healthcare. She
said the round table discussion was related to what is being
done and can be done in health care. She mentioned repetition
in talking about matters, reports that just sit on the shelf,
and trying to connect who's doing what.
8:23:17 AM
REPRESENTATIVE CISSNA clarified that she is talking about "holes
that are occurring ... in out-of-the way places where people
aren't looking at that specific population." She said going
door to door is the best method she's found to find out the
issues.
8:25:04 AM
CHAIR WILSON directed attention back to the priorities list and
asked the group to consider what can be addressed now.
The committee took an at-ease from 8:28:15 AM to 8:31:18 AM to
review the list.
8:31:19 AM
CHAIR WILSON said she noticed several issues on the list related
to communities, as well as issues regarding the need for the
health commission to change as the legislature and
administration each change.
8:31:49 AM
MS. CARR highlighted the issue of vertical and horizontal
communication, and she noted related priority items. Regarding
working with the information available, she mentioned the
process of synthesis and communication, and the creation of the
process itself.
8:33:51 AM
MR. FULLER talked about low- and no-cost options, when to move a
process forward, and fostering the processes for sustainability
by educating everyone.
8:38:18 AM
REPRESENTATIVE GARDNER, in response to a comment by Chair
Wilson, said she thinks legislators need to focus on specialties
and brief themselves on issues that aren't their specialty by
talking to people who are knowledgeable in those other subjects.
8:39:15 AM
COMMISSIONER JACKSON said she knows the department can't force
people to come listen to the issues, but it is difficult to
encapsulate in a short legislative presentation what has been
discussed over a long period of time during many meetings. She
asked for suggestions to address that issue.
8:40:38 AM
DENNIS DeWITT, Special Staff Assistant, Office of the Governor,
suggested an overview to find out what interests people and to
give them a better idea of what the issues are. He said there
is a need to outline a point of focus. He added, "If you have
no idea where you're going, any road will get you there."
8:44:05 AM
CHAIR WILSON suggested starting on the last page of the handout,
which lists action steps.
8:44:28 AM
MR. FULLER said the bottom line shows that the financial aspects
of Medicaid will not decrease; they will only compound. He
offered further details. He said he would like the legislature
to give the department the permission to find ways to become
more efficient.
8:46:55 AM
CHAIR WILSON suggested another way to keep costs down is by
using tried and true methods of prevention.
8:47:49 AM
REPRESENTATIVE CISSNA asked to hear individually what each
person took away from the [previously mentioned June 2006 Health
Priorities Meeting] in Denver.
8:48:52 AM
MS. CARR indicated that the visual aides [from that meeting] are
available and may be helpful to view, and she offered to get a
copy for the committee.
8:49:19 AM
MR. FULLER, regarding the expansion of health care benefits,
suggested figuring out if it makes sense to put together a
"prevention package," rather than a "sick package."
8:50:22 AM
SENATOR BETTYE DAVIS, Alaska State Legislature, said she would
like the department to present to the legislature - or at least
to a committee within the legislature dealing with the issue of
health - what it would like to promote, including how much money
is needed, why it is necessary, and how the decisions were made,
and she expressed her wish to see that done prior to the
legislature meeting again in Juneau.
8:52:41 AM
MS. BIRCH listed four major themes related to using health care
dollars wisely: communication with communities, the
legislature, and the department; prevention, including the areas
of birth and contraception, chronic disease, and mental health;
personal responsibility; and access. She agreed with Senator
Davis that the list is too large to tackle, and she suggested
that the group could choose to work on one of the themes, while
assigning other interested parties to investigate the other
themes.
8:55:01 AM
REPRESENTATIVE GARDNER said what these issues come down to is
money and getting ideas out to legislators. She said having
missions and measures is helpful. She talked about "speaking
the language of people who don't volunteer to come to health-
related things." She mentioned lobbying efforts and repeated
messages from the health care industry, saying that written
communications will be ignored by all but the most committed.
8:57:46 AM
COMMISSIONER JACKSON said the concept she brought back from the
meeting in Denver was that it would be useful to be able to
convey to people that "just because it's not in the budget as a
healthcare access cost, doesn't mean it's not important to
health." She revealed that Senator Lisa Murkowski, who has
recently been appointed to a federal committee considering
prevention efforts related to health care, told her that she
would keep her up to date on any new ideas that are formed. She
mentioned a book by Richard Lamm, [former governor of Colorado],
in which there is a chart that shows why the U.S. federal health
care system is broken. She said she wants to share this
information in talking with legislators, to help them see the
bigger picture. She remarked that people don't tend to respond,
unless they can see that an issue is in crisis.
8:59:56 AM
PAULYN SWANSON, Staff to Representative Mike Hawker, Alaska
State Legislature, on behalf of the House Finance Subcommittee
on Health and Social Services, which is chaired by
Representative Hawker, told the group what she learned at the
meeting in Denver, including issues related to the extra cost in
health care for low birth-weight babies, as compared to healthy
babies.
9:00:41 AM
CHAIR WILSON listed the following topics: communications, cost
savings, prevention, personal responsibility, and access.
9:01:16 AM
MS. CARR highlighted the following issues: increasing access to
care, looking at issues affecting people's choices, and birth
outcomes. She stated that she thinks those issues are
"grounding."
9:02:28 AM
CHAIR WILSON listed sustainability as the overall biggest issue.
She suggested that birth outcomes can be addressed under the
heading of prevention.
9:04:37 AM
MR. FULLER said long-term care could be addressed under the
heading of sustainability.
9:05:10 AM
SENATOR DAVIS, regarding Medicaid, told Mr. Fuller that the
legislature needs recommendations from the division to be
apprised well ahead of session whether cuts will need to be made
or funds will be requested.
9:06:16 AM
MR. FULLER agreed that the division needs to give the
legislature what information it can. He explained that although
the division has a good idea of what the Deficit Reduction Act
provisions are, it doesn't know what the federal actions based
on President George W. Bush's FY 07 budget will be. He offered
further details. He said Senator Lisa Murkowski is aware of the
situation and supports the division's position that it would
like the administration to pay attention to Congress. He
offered further details.
9:08:46 AM
CHAIR WILSON said six years ago the whole state budget was the
amount that just the Medicaid budget is now.
9:09:14 AM
REPRESENTATIVE CISSNA said, "It was a conscious effort to move
things to that ... funding source." She said she would like to
see an analysis to determine whether that was the wisest move
for the long-term perspective.
9:09:37 AM
SENATOR DAVIS mentioned a 2001 Medicaid waiver task force. She
asked if the outcome of that task force has yet reached the
department. She mentioned the Key Campaign.
9:11:08 AM
REPRESENTATIVE CISSNA said there has been a change to the senior
and disability waiver.
9:11:37 AM
MS. SWANSON confirmed that there is a report addressing a waiver
and wait list, which she said she would make available.
9:11:56 AM
CHAIR WILSON asked what subjects should be put under the heading
of cost containment and savings. She suggested Medicaid and
Medicare.
9:12:24 AM
MS. CARR suggested prevention results in cost saving.
CHAIR WILSON recommended dealing with prevention on its own,
because there is so much related to it.
9:12:53 AM
MR. DeWITT suggested two reasons to focus on prevention are for
quality of life or for cost containment, and each issue is
approached differently. He said he doesn't think the group has
decided what its focus is yet.
CHAIR WILSON and REPRESENTATIVE GARDNER simultaneously said the
focus is on both; quality of life and cost containment are not
separable.
9:14:16 AM
MR. DeWITT stated his disagreement. He explained that the
priorities will change based upon whether the goal is lifestyle
or cost containment.
9:14:28 AM
COMMISSIONER JACKSON said she thinks Mr. DeWitt has made a good
point. She talked about health versus health care, and she said
preventative efforts are key to health care access and health
care cost containment.
9:15:01 AM
CHAIR WILSON said cutting programs in order to save money will
result in spending more money in the long run. She emphasized
the importance of prevention. She said the state cannot cover
everything, so it must decide where to place its efforts.
9:16:03 AM
REPRESENTATIVE CISSNA said she has worked on and off within the
mental health community since 1963, and she stated that it is
almost impossible to remove behavioral health - the choices
people make - from physical health. She said the legislature
hears the most from lobbyists who represent "the expensive part
of health care," not the "cheap part." Health has become
commercialized, she explained, and prevention doesn't make
money, so no one is going to come to the legislature and lobby
for it.
9:18:38 AM
CHAIR WILSON responded that there actually were lobbyists for
prevention for the first time this year: the Boys and Girls
Club, and the Alaska School Board Association.
9:19:15 AM
SENATOR DAVIS said she wants to know if the department is doing
anything to get the message of prevention out to the public.
She said children take notice of information and pass it along
to their parents. She opined that if the state educates people,
those people will be more concerned about their personal health,
and the state will save money as a result.
9:20:34 AM
COMMISSIONER JACKSON proffered that one example of what Senator
Davis is talking about has been the tobacco cessation efforts.
She said many parents stopped smoking because children were
educated through the school system and passed the message on to
their parents that "smoking kills you."
9:20:49 AM
MR. FULLER, in response to a question from Chair Wilson, said a
major portion of the budget - probably 40 percent - is spent on:
elder care, long-term care, and nursing homes.
MR. FULLER said the next biggest areas of expense are probably
hospital and pharmacy. He said the inflation on drugs grows
exponentially, and nothing has been in place to restrain that
growth. He said when drug rebates were offered years ago giving
states a certain percentage back, "it took the drug
manufacturers maybe nine months to inflate their prices enough
to make up the difference."
9:22:36 AM
CHAIR WILSON listed the following subcategories under cost
containment: long-term care, drugs, and hospitalization. She
indicated that increasing [funds for] prevention may decrease
the expenses under cost containment.
9:23:46 AM
MR. FULLER said Alaska has quite a good long-term care system in
regard to the nursing home proportion compared to "the total."
However, he posited that the system has grown "topsy-turvy." He
stated, "We don't have a true system; we've got pieces that ...
don't mesh together very well." He indicated that there is a
definition of assisted living that covers one person in a
private home to the Alaska Pioneer Home. He said he thinks the
state could get a price suppression by reconfiguring its current
system. He concluded, "... It's not going to give you [a] $10-
million savings, but it will slow the growth so that when we get
out there to 2025, maybe that cost will not be $2 billion, but
$1.5 billion, or whatever."
CHAIR WILSON asked if the changes that are needed are statutory
or regulatory.
MR. FULLER surmised the changes would be mostly regulatory, with
political support to make the changes.
CHAIR WILSON asked Mr. Fuller to prepare his thoughts into a
presentation for the House Health, Education and Social Services
Standing Committee, so that the committee can make some helpful
suggestions "somewhere along the line."
9:25:45 AM
REPRESENTATIVE CISSNA offered her understanding that a long-term
care study that addresses these issues was supposed to be
available long ago.
MR. FULLER said he thinks the latest date of release is slated
for 20 July 2006.
REPRESENTATIVE CISSNA said the committee should incorporate the
recommendations that will be in that study.
MR. FULLER said he will certainly incorporate the study in the
presentation that Chair Wilson requested, while he indicated
that other sources for recommendations will also be used. He
stated that an important aspect of long-term care that is seldom
talked about is that the biggest provider of long-term health
care is family members, and he recommended finding ways to
support that.
MS. CISSNA said she doesn't want to jeopardize that source of
long-term care, and she talked about the burnout of caregivers.
CHAIR WILSON said, "So, providing them respite ... is in the
long run a cost savings."
MR. FULLER responded, "It can be, as long as the state is able
to manage that, so it doesn't become babysitting for grandma so
that [they] can all take off." He indicated that there needs to
be a balance between the family doing as much as it can and
having the state, community, or faith-based group help them
along.
9:28:18 AM
CHAIR WILSON suggested that the committee should invite someone
from the faith-based community to address these issues and let
the committee know what kind of help is available.
COMMISSIONER JACKSON noted that the Office of Faith-based &
Community Initiatives is now in the Department of Health and
Social Services, and Stephanie Wheeler is the executive
director.
CHAIR WILSON recommended having a faith-based group available in
every community in the state.
9:29:50 AM
REPRESENTATIVE CISSNA suggested that the committee not limit the
discussion to faith-based groups, but instead think about total
community involvement. She said bringing in a broader group
will ensure more people will shoulder the load, [thus preventing
burnout].
9:30:33 AM
COMMISSIONER JACKSON said the long-term care study coming out on
July 20, as well as Mr. Fuller's upcoming presentation, will be
good examples of all the things that can be done, but she asked
the committee to remember that all those things will have a
cost. She stated, "And like the personal care attendant debacle
that we went through, we need to be very conscious that whatever
we develop is sustainable."
9:31:27 AM
REPRESENTATIVE CISSNA responded, "That happened over a course of
about three years, and apparently it was not seen happening."
She asked how that situation can be avoided in the future. She
spoke of applying missions and measures to the budget.
9:32:02 AM
COMMISSIONER JACKSON said the department currently is working
with the Office of Management & Budget on missions and measures
related to the next budget.
9:32:14 AM
MR. DeWITT said he has to disagree with Representative Cissna's
assessment that "it happened and nobody was watching." He said
the issue was handed to the present administration without
having been dealt with and "there was not the political will to
address it." He mentioned a "fire storm" that occurred. He
offered further details, mentioning a change that was made to
rules related to personal care attendants (PCAs). In response
to a remark from Representative Cissna, he clarified that a
question to ask is, "Do we have the political will to make those
calls and stand up for them?" Hard choices have to be made and
followed, which he said is a tough thing to do in the area of
health care.
9:34:41 AM
CHAIR WILSON warned that the state must be careful in regard to
giving more services, "because it's a lot easier not to give
them then it is to take them back." Regarding the previously
mentioned issue of the PCAs, she said, "There were so many
people getting paid for doing things that they did before for
nothing, and then all at once they found out they could get paid
for it." She said she doesn't want the committee to start
blaming anyone; she just wants to hear the facts.
9:35:14 AM
REPRESENTATIVE CISSNA said she has spent a lot of her personal
money traveling around the state and finding out what
administrators are saying about their communities. She said
that in communities that have been losing sources of income due
to the loss of mining and fishing jobs, for example, people have
been getting off of welfare to become PCAs. She emphasized the
importance of being aware of "the progression" and basing
choices on that awareness.
9:36:28 AM
CHAIR WILSON reiterated that people are doing things now for
money that they did previously for free. She illustrated this
phenomenon through examples of what is happening in her
community. She said, "So, that's one area that we did look ...
at and we did pull back on, and I don't know where we're at with
it now." She asked Mr. Fuller, "Is it getting contained?"
9:37:31 AM
MR. FULLER answered that [containment] is beginning. He
compared the issue to an out of control gorilla. He indicated
that the department will try to anticipate the outcomes of any
new programs or changes, but resources will be necessary in
order to have people track what is happening. He said the
administration within the department is "really thin for very
huge programs," which he said is a choice.
9:39:09 AM
COMMISSIONER JACKSON said the balance has been that the
department cuts internally in order to allow the services to get
out to Alaskans.
CHAIR WILSON warned that the department must be careful about
that balance.
9:39:53 AM
CHAIR WILSON turned back to the making of the list. She named
the subcategories under prevention as: birth, chronic disease,
mental health, drugs, and alcohol. She mentioned faith-based
community incentives.
CHAIR WILSON suggested that the topic of personal responsibility
could be listed under communication. In response to a remark
from Representative Cissna that "personal responsibility is
something that comes with knowledge," she agreed that education
could be the subcategory under communication, and then personal
responsibility could be listed under education. The subject of
communication, she said, could be divided into the following:
individuals, communities, and legislators. She asked that those
present pick a topic and get back to the group with more
information.
9:42:59 AM
CHAIR WILSON asked for feedback regarding the topic of health
and health care.
9:43:15 AM
MS. CARR stated, "During our meeting in Denver, we did talk
about access to 'cares,' but through two channels: ... through
the insurance channel and through services and facilities. ...
So, that may be a concept that we keep, because I think there
are two very different sets of strategies that they work through
on that."
9:43:35 AM
COMMISSIONER JACKSON suggested that it would be good to focus on
access in cost and quality.
9:44:12 AM
CHAIR WILSON concluded that under the category of health and
health care, the group could consider following subcategories:
access, quality, and cost. Under access, she announced, would
be insurance and services. She reviewed the groupings of
categories thus far.
The committee took an at-ease from 9:45:07 AM to 9:46:10 AM.
9:57:13 AM
CHAIR WILSON, after much input from those present about
possibilities for grouping subjects, announced a tentative
schedule: 7/26, 8/30, 9/27, and 10/25.
ADJOURNMENT
There being no further business before the committee, the House
Health, Education and Social Services Standing Committee meeting
was adjourned at 10:02:50 AM.
| Document Name | Date/Time | Subjects |
|---|