02/19/2007 01:30 PM Senate HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| Presentation: Alaska's Community Health Care Centers | |
| SB4 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| + | TELECONFERENCED | ||
| *+ | SJR 1 | TELECONFERENCED | |
| *+ | SB 4 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
SENATE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE
February 19, 2007
1:34 p.m.
MEMBERS PRESENT
Senator Bettye Davis, Chair
Senator Joe Thomas, Vice Chair
Senator Kim Elton
Senator Fred Dyson
MEMBERS ABSENT
Senator John Cowdery
COMMITTEE CALENDAR
Overview: Alaska's Community Health Care Centers
SENATE JOINT RESOLUTION NO. 1
Relating to reauthorization of federal funding for children's
health insurance; and encouraging the Governor to support
additional funding for and access to children's health
insurance.
BILL POSTPONED TO 2/26/07
SENATE BILL NO. 4
"An Act extending the cash assistance benefit program for
seniors under the senior care program and increasing the benefit
amount; and providing for an effective date."
HEARD AND HELD
PREVIOUS COMMITTEE ACTION
BILL: SB 4
SHORT TITLE: SENIOR CARE PROGRAM
SPONSOR(s): SENATOR(s) OLSON
01/16/07 (S) PREFILE RELEASED 1/5/07
01/16/07 (S) READ THE FIRST TIME - REFERRALS
01/16/07 (S) HES, FIN
WITNESS REGISTER
Shelley Hughes, Director of Government Affairs
Alaska Primary Care Association (APCA)
Anchorage, AK
POSITION STATEMENT: Participated in presentation
Andre Hine
Crossroad Community Health Center
Glennallen, AK
POSITION STATEMENT: Participated in presentation
Marilyn Kasmar, Executive Director
Alaska Primary Care Association
Anchorage, AK
POSITION STATEMENT: Participated in presentation
Sonia Hanforth-Comb, Executive Director
Iliuliuk Family and Health Services Clinic
Unalaska, AK
POSITION STATEMENT: Participated in presentation
Tom Hunt, Medical Director
Anchorage Neighborhood Health Center
Anchorage, AK
POSITION STATEMENT: Participated in presentation
Stan Steadman, Executive Director
Central Peninsula Health Center
Kenai, AK
POSITION STATEMENT: Participated in presentation
SENATOR OLSON
Alaska State Legislature
Juneau, AK
POSITION STATEMENT: Sponsor of SB 4
Janet Clark, Assistant Commissioner
Department of Health & Social Services
POSITION STATEMENT: Testified on SB 4
Ellie Fitzjarrald, Acting Director
Division of Public Assistance
Department of Health & Social Services
Juneau, AK
POSITION STATEMENT: Testified on SB 4
ACTION NARRATIVE
CHAIR BETTYE DAVIS called the Senate Health, Education and
Social Services Standing Committee meeting to order at 1:34:29
PM. Present at the call to order were Senators Elton, Dyson,
Thomas, and Chair Davis.
^PRESENTATION: ALASKA'S COMMUNITY HEALTH CARE CENTERS
1:34:43 PM
CHAIR DAVIS announced that the committee would be hearing a
presentation on Alaska Community Health Centers.
SHELLY HUGHES, Government Affairs Director with Alaska Primary
Care Association (APCA), said that the Alaskan Community Health
Centers (CHC) are not-for-profit and utilize volunteer community
boards, 51 percent of which are clinic users. They provide
primary care in medically underserved communities but are open
to all Alaskans, and payment is accepted on a sliding scale.
Nationally, such centers have existed for 40 years and serve
over 15 million Americans. The first clinic in Alaska was
opened in 1974, and now there are 115 delivery sites statewide.
She said that 80 percent of the centers' patients are low-
income, and 40 percent are uninsured.
1:41:16 PM
SENATOR DYSON asked how native health service fits into the
system.
MS. HUGHES replied that some centers are dually funded,
receiving federal and tribal money. Tribal beneficiaries are
billed to such tribal funds.
ANDRE HINE, Crossroad Community Health Center, said that tribal
money does fund health aides in some communities but certain
services must be provided by the CHC clinics.
SONIA HANFORTH-COMB, Executive Director of the Iliuliuk Family
and Health Services Clinic, said that some clinics have
contracts with Native associations and that tribal patients'
fees are billed to the associations.
SENATOR DYSON asked if such patients pay on a sliding scale.
MS. HANFORTH-COMB said that they do.
MS. HUGHES introduced Marilyn Kasmar, Tom Hunt, Ms. Hine, Ms.
Hanforth-Comb, and Stan Steadman. She said that insured and
uninsured population numbers in Alaska have both grown in recent
years, and showed a pie chart explaining the clinic's patient
insurance categories.
1:47:45 PM
SENATOR DYSON said that some people prefer to pay fees out-of-
pocket rather than have health insurance.
MS. HUGHES said that everyone pays on a sliding scale, and
sometimes even the full amount regardless of insurance. CHC
patient numbers have increased by 65 percent in recent years.
1:49:34 PM
STAN STEADMAN, Executive Director of the Central Peninsula
Health Center, said that dental health treatment in the Kenai
CHC was established in 2003, and in 2006 the CHC had 8,000
patient encounters, 80 percent of which were with youth.
1:51:32 PM
MS. HUGHES showed photos from CHCs around Alaska, and said that
patient focus is the theme in the clinics. Uncompensated care is
one of the major costs to clinics, and federal dollars are so
far insufficient.
She said that Alaska is one of only 14 states that does not
invest in CHCs. Hawaii, for example, saw the same number of
patients in 2005 and received $19 million in state aid, while
Alaska received none. The ACPA is requesting $2.3 million for
CHC funding, and wants the legislature to begin supporting it. A
lack of CHC funding leads to an improper balance in the
provision of health care. CHCs' operating costs are lower than
comparable private providers through group purchasing, use of
mid-level staff, technical assistance from other organizations,
and health disparity collaboratives.
1:57:00 PM
MARILYN KASMAR, Executive Director for the Alaska Primary Care
Association, said that preventative services offered through
CHCs results in lower costs for later health problems.
1:58:02 PM
MR. HUNT said that the primary causes of hospitalization are
pneumonia, diabetes, and heart disease complications. Early
treatment and preventative health care can dramatically cut
costs and hospitalizations. CHCs also do middle-ground
psychiatric care.
1:59:49 PM
MS. HINE said that her CHC lost its physician in 2005 and has
been unable to recruit another; it cannot compete with other
centers because of the lack of resources. She related a personal
story of the difficulties of rural care.
2:02:41 PM
MS. HUGHES said that she had prepared a proposal for CHC funding
and service improvement.
CHAIR DAVIS asked for Ms. Hine's previous doctor's salary.
MS. HINE replied that it was $125,000.
2:03:32 PM
MS. HUGHES explained the points of the request by the ACPE:
increased operation costs, additional replacement funds, a
Medicaid cost reduction campaign, and an emergency room
diversion plan which could help avoid some of the 32 million
annual unnecessary ER visits.
2:08:55 PM
MS. HANFORTH-COMB said the previous business model for her
Unalaska clinic was losing money every day until it became a CHC
in 2002. The clinic is able to treat 100 patients yearly who
would otherwise being going to a hospital at a much higher cost,
including an air ambulance which costs $28,000.
2:13:06 PM
MS. HUGHES explained that some communities have recently been
denied federal funding because the federal government wants to
see state involvement first. There is still a large medically
underserved population in Alaska, and the award-winning Alaskan
CHC system is a way to assuage rising health care costs;
however, it needs support from the state to continue its
success.
2:16:20 PM
SENATOR DYSON said he was surprised to see that Seward is
considered as needing a CHC, when they have a hospital.
MS. HUGHES said that it would have to do with the population of
the town, and that the hospital must not have the capacity or
proper outreach.
MS. KASMAR explained that a goal of CHCs is to keep people out
of hospitals.
2:19:37 PM
MR. HUNT said that an availability of providers doesn't mean
that everyone have access to them. Discrimination, hours of
operation, and language differences can all be barriers to
obtaining health care from a private provider.
MS. HINE said that CHCs provide services to those even unable to
pay and that hospitals only see 9 percent of uninsured patients,
and private providers only 5 percent of such
2:21:40 PM
MS. HANFORTH-COMB said that CHCs have overcome the barriers
facing larger medical institutions and so are reaching more of
the population than ever.
2:22:52 PM
CHAIR DAVIS asked if the CHCs receive any municipal funding.
MS. KASMAR said that besides occasional grants, most funding is
federal.
MR. STEADMAN said that CHCs have a positive rapport with
hospitals but other state budgets are strapped financially so
there is no direct state funding.
SENATOR THOMAS asked if certificates of need are an issue with
existing facilities.
MS. HUGHES said that certificates are not an issue.
SENATOR THOMAS asked how the sliding scale is established.
2:25:31 PM
MR. HUNT said that rates are communal, and if a patients' income
is 200 percent of the Federal Poverty Limit (FPL), they must pay
full charges. At 100 percent of the FPL, the patient pays only
$10 for the service. There are 25, 50, and 75 percent levels as
well. Income is established with pay-stubs, renters' forms, and
income tax forms. Occasionally files are referred to collections
agencies.
SENATOR ELTON asked if CHCs services are provided to prisoners.
MS. KASMAR said that in some parts of the country, CHCs will
provide such services.
MR. HUNT said that some Alaskan CHCs do so as well.
SB 4-SENIOR CARE PROGRAM
2:29:45 PM
CHAIR DAVIS announced SB 4 to be up for consideration.
SENATOR OLSON, Sponsor of SB 4, said that it would eliminate the
Senior Care Program's scheduled sunset date of June 2007, remove
the underutilized prescription drug benefit, and increase the
monthly financial assistance from $120 to $150. The program is
currently needs-based, with applicants' income not exceeding 135
percent of the 2005 federal poverty guidelines. There are 7,000
eligible seniors in the state.
He said that the Department of Health and Social Services (DHSS)
is in favor of the bill.
2:32:45 PM
JANET CLARK, Assistant Commissioner for the Department of Health
& Social Services, said that the governor supports SB 4, and is
developing new legislation regarding senior assistance.
ELLIE FITZJARRALD, Acting Director for the Division of Public
Assistance for the Department of Health & Social Services, said
that the fiscal note represents an overall net savings, because
of the elimination of the prescription drug benefit and the
assumption that many seniors will choose the Alaska Longevity
Bonus (ALB) rather than the senior care benefit. The overall
savings, even with the increase in the monthly payment proposed
by the bill, will be $3.9 million in the first year. 2208
seniors received the ALB when it was phased out, and would be
likely to choose it over the senior bonus when it is reinstated.
2:36:31 PM
SENATOR DYSON asked if the administration would prefer for the
bill to not be enacted until the governor's plan has been
introduced.
MS. FITZJARRALD said that was correct.
SENATOR ELTON asked when the governor's bill would appear before
the legislature.
MS. CLARK said that it was expected any day.
SENATOR ELTON asked if the governor's bill allowed the
qualifying standard to be self-adjusting.
MS. CLARK said that she couldn't say.
CHAIR DAVIS asked if the governor would be willing to work with
Senator Olson.
MS. CLARK said that she would.
SB 4 was held in committee.
CHAIR DAVIS, seeing no further business to come before the
committee, adjourned the meeting at 2:39:38 PM.
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