Legislature(2011 - 2012)BUTROVICH 205

03/07/2011 01:30 PM HEALTH & SOCIAL SERVICES

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                    ALASKA STATE LEGISLATURE                                                                                  
      SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                    
                         March 7, 2011                                                                                          
                           1:30 p.m.                                                                                            
MEMBERS PRESENT                                                                                                               
Senator Bettye Davis, Chair                                                                                                     
Senator Dennis Egan                                                                                                             
Senator Johnny Ellis                                                                                                            
Senator Kevin Meyer                                                                                                             
Senator Fred Dyson                                                                                                              
MEMBERS ABSENT                                                                                                                
All members present                                                                                                             
COMMITTEE CALENDAR                                                                                                            
SENATE BILL NO. 14                                                                                                              
"An   Act   providing   for   the   protection   and   reasonable                                                               
accommodation  of   a  health   care  provider's   expression  of                                                               
conscience  pertaining to  a health  care service;  and providing                                                               
for  immunity, an  exception, and  prohibition of  discrimination                                                               
for an expression of conscience by a health care provider."                                                                     
     - HEARD AND HELD                                                                                                           
SENATE BILL NO. 5                                                                                                               
"An Act relating to eligibility requirements for medical                                                                        
assistance for certain children and pregnant women; and                                                                         
providing for an effective date."                                                                                               
     - HEARD AND HELD                                                                                                           
PREVIOUS COMMITTEE ACTION                                                                                                     
BILL: SB  14                                                                                                                  
SHORT TITLE: PROTECT HEALTH CARE PROVIDER CONSCIENCE                                                                            
SPONSOR(s): SENATOR(s) DYSON, COGHILL                                                                                           
01/19/11       (S)       PREFILE RELEASED 1/7/11                                                                                
01/19/11       (S)       READ THE FIRST TIME - REFERRALS                                                                        
01/19/11       (S)       HSS, JUD                                                                                               
03/07/11       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
BILL: SB   5                                                                                                                  
SHORT TITLE: MEDICAL ASSISTANCE ELIGIBILITY                                                                                     
SPONSOR(s): SENATOR(s) DAVIS, EGAN, ELLIS, FRENCH, WIELECHOWSKI                                                                 
01/19/11       (S)       PREFILE RELEASED 1/7/11                                                                                
01/19/11       (S)       READ THE FIRST TIME - REFERRALS                                                                        
01/19/11       (S)       HSS, FIN                                                                                               
03/07/11       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
WITNESS REGISTER                                                                                                              
CHARLES COBB, Staff to Senator Dyson                                                                                            
Alaska State Legislature                                                                                                        
Juneau, AK                                                                                                                      
POSITION STATEMENT: Presented SB 14 for sponsor.                                                                              
TOM OBERMEYER, Staff to Senator Davis                                                                                           
Alaska State Legislature                                                                                                        
Juneau, AK                                                                                                                      
POSITION STATEMENT: Presented SB 5 for sponsor.                                                                               
MARIE DARLIN                                                                                                                    
American Association of Retired Persons (AARP)                                                                                  
Juneau, AK                                                                                                                      
POSITION STATEMENT: Testified in support of SB 5.                                                                             
ELIZABETH RIPLEY                                                                                                                
Mat-Su Health Foundation                                                                                                        
Wasilla, AK                                                                                                                     
POSITION STATEMENT: Testified in support of SB 5.                                                                             
WILLIAM J. STREUER, COMMISSIONER                                                                                                
Department of Health and Social Services                                                                                        
Juneau, AK                                                                                                                      
POSITION STATEMENT: Answered questions regarding SB 5.                                                                        
JOHN SHERWOOD, Medical Assistance Administrator                                                                                 
Department of Health and Social Services                                                                                        
Juneau, AK                                                                                                                      
POSITION STATEMENT: Answered questions regarding SB 5.                                                                        
ACTION NARRATIVE                                                                                                              
1:33:04 PM                                                                                                                    
CHAIR BETTYE DAVIS  called the Senate Health  and Social Services                                                             
Standing Committee meeting  to order at 1:30 p.m.  Present at the                                                               
call to order  were Senators Dyson, Egan, Ellis,  Meyer and Chair                                                               
         SB  14-PROTECT HEALTH CARE PROVIDER CONSCIENCE                                                                     
1:33:15 PM                                                                                                                    
CHAIR DAVIS announced the first order of business would be SB                                                                   
SENATOR  FRED  DYSON,  sponsor  of  SB 14,  said  this  bill  was                                                               
prompted by  a conversation  with a pharmacist  who was  tired of                                                               
dispensing large amounts  of Oxycontin to people  on Medicaid. It                                                               
is sold on the streets, and  people have figured out how to smoke                                                               
it  and  shoot it.  Senator  Dyson  then  read from  the  sponsor                                                               
statement, as follows:                                                                                                          
     A health care professional's  view of health, sickness,                                                                    
     patient care  and purpose of medicine  comprise a well-                                                                    
     formed  professional  conscience.  This  conscience  is                                                                    
     changed with  new information  and technology.  A broad                                                                    
     application  of a  right of  conscience applies  to the                                                                    
     issues of  end of life care,  consumer genetic testing,                                                                    
     the  practice  of  pain management,  psychotropic  drug                                                                    
     use, sterilizations,  race-specific medications, infant                                                                    
     circumcision,   physician  and   nurse  complicity   in                                                                    
     capital   punishment,   physician   assisted   suicide,                                                                    
     abortion, etc.                                                                                                             
     This  bill   recognizes  the  societal   benefits  that                                                                    
     divergent   organizational    identities   bring;   the                                                                    
     relational   dimension   of   professional   conscience                                                                    
     between   health  care   institutions  and   providers,                                                                    
     between providers  and patients, and  between providers                                                                    
     and  communities;  and   helps  ensure  the  conditions                                                                    
     necessary  for  the   conversations  of  conscience  to                                                                    
     continue concerning the health care profession.                                                                            
     Most states have laws  protecting the conscience rights                                                                    
     of  health care  providers. Alaska  law currently  does                                                                    
     not  provide   for  a  general  health   care  provider                                                                    
     protection of conscience.                                                                                                  
     SB 14 provides  a guarantee for the  exercise of health                                                                    
     care   provider    conscience   in    an   increasingly                                                                    
     pluralistic  environment.  All  health  care  providers                                                                    
     must be treated equally, and  must have recourse to the                                                                    
     exception made for conscience.                                                                                             
1:37:08 PM                                                                                                                    
CHARLES COBB,  Staff to  Senator Dyson,  summarized the  bill, as                                                               
   · Provides within Alaska Statutes, Title 18, a protection and                                                                
     reasonable  accommodation  for   a  health  care  provider's                                                               
     expression  of  conscience  pertaining  to  provision  of  a                                                               
     health care service;                                                                                                       
   · Establishes written notice as the method of communicating                                                                  
     an  expression of  conscience, and  that  the employer  will                                                               
     reasonably  accommodate  and  not discriminate  against  the                                                               
     employee providing notice; and                                                                                             
   · Provides that the notice does not have to include the                                                                      
     reason  for  the  objection,  but must  be  related  to  the                                                               
     provider's conscience and  not to a protected  status of the                                                               
     patient; and                                                                                                               
   · Provides that an employer is not required to accommodate                                                                   
     the employee if the  employer demonstrates the accommodation                                                               
     poses undue hardship  or the objecting employee  is the only                                                               
     health  care   provider  available  in   a  life-threatening                                                               
     circumstance,  and that  the health  care  provider may  not                                                               
     refuse to  provide treatment or  care in  a life-threatening                                                               
     circumstance  until an  alternate  health  care provider  is                                                               
     available; and                                                                                                             
   · Provides civil and criminal immunity to health care                                                                        
     providers  who express  conscience in  compliance with  this                                                               
     section; and                                                                                                               
   · Provides that this section will be construed in a manner                                                                   
     consistent with Title  VII of the Civil Rights  Act of 1964;                                                               
   · Defines terms.                                                                                                             
1:39:22 PM                                                                                                                    
SENATOR  MEYER said  he  was concerned  about  rural areas  where                                                               
there is only one health care provider.                                                                                         
SENATOR DYSON  responded if it  was a life  threatening situation                                                               
they must provide the care.                                                                                                     
MR. COBB  said the bill  recognizes relationships.  For instance,                                                               
if one provider provides 99.9  percent of all requested services,                                                               
we don't  want that  provider to  be shut  down. It  is important                                                               
that  those things  are discussed  with  patients. Conscience  is                                                               
different in each community.                                                                                                    
SENATOR  DYSON stated  that most  doctors think  the bill  is not                                                               
necessary.  One  doctor   did  not  want  to   use  a  particular                                                               
medication  because patients  were  dying when  he  used it.  His                                                               
professional judgment was to use what was best for his patients.                                                                
1:43:39 PM                                                                                                                    
SENATOR DYSON noted  the bill was endorsed by  the state pharmacy                                                               
board, as well as several doctors.                                                                                              
CHAIR DAVIS said she has  gathered research information about the                                                               
bill,  which  she  will  distribute  to  committee  members.  She                                                               
announced that SB 14 would be held in committee.                                                                                
             SB   5-MEDICAL ASSISTANCE ELIGIBILITY                                                                          
1:45:40 PM                                                                                                                    
CHAIR DAVIS announced  the next order of business would  be SB 5,                                                               
the Denali Kid Care bill.                                                                                                       
TOM OBERMEYER,  staff to  Senator Davis,  said SB  5 is  the same                                                               
bill that  was introduced as  SB 13  last year. That  bill passed                                                               
both houses  but was  vetoed by  Governor Parnell.  He summarized                                                               
the bill, as follows:                                                                                                           
     This  bill increases  and restores  to original  levels                                                                    
     established   14  years   ago  the   qualifying  income                                                                    
     eligibility  standard to  200  percent Federal  Poverty                                                                    
     Level (FPL)  for the State Children's  Health Insurance                                                                    
     Program  (SCHIP)  called   Denali  KidCare  in  Alaska.                                                                    
     Alaska  as one  of  the nation's  wealthiest states  is                                                                    
     only one of  four states which funds  its SCHIP program                                                                    
     below  200   percent  FPL.   This  bill   makes  health                                                                    
     insurance  accessible   to  an  estimated   1,277  more                                                                    
     uninsured children  and 225  pregnant women  in Alaska.                                                                    
     Denali KidCare  is an "enhanced"  reimbursement program                                                                    
     receiving up to 70 percent federal matching funds.                                                                         
     Denali  KidCare   serves  an  estimated   7,900  Alaska                                                                    
     children and  remains one of  the least  costly medical                                                                    
     assistance programs  in the state  at about  $1,700 per                                                                    
     child with  full coverage,  including dental,  which is                                                                    
     about 20 percent of the  cost of adult senior coverage.                                                                    
     Early  intervention and  preventive  care will  greatly                                                                    
     increase   Alaska    children's   health    and   yield                                                                    
     substantial  savings  to  the   state  and  public  and                                                                    
     private  sector  hospital  emergency rooms  which  must                                                                    
         admit indigent and uninsured patients for non-                                                                         
     emergency treatment.  It is  estimated that  the 18,000                                                                    
     or  9  percent  uninsured  children in  Alaska  with  a                                                                    
     medical need  are five  times as likely  not to  have a                                                                    
     regular doctor as insured children  and four times more                                                                    
     likely to use emergency rooms at a much higher cost.                                                                       
MR.   OBERMEYER  further   stated   that  a   similar  bill   was                                                               
overwhelmingly passed with bipartisan  support by the Legislature                                                               
in  2010.  Governor Parnell  subsequently  vetoed  the bill  over                                                               
concerns  that  increased  eligibility to  Denali  KidCare  would                                                               
require  an  increase  in state-funded  abortion  services  which                                                               
amounted  to  about 0.18%  of  the  $217 million  Denali  KidCare                                                               
budget. Denali  KidCare is  required under  a 2001  Supreme Court                                                               
ruling  to fund  "medically necessary"  abortion services  if the                                                               
program is to  remain part of the state's  Medicaid program. This                                                               
bill,  however, is  not about  abortions. It  is about  providing                                                               
quality health care for our  most vulnerable low income youth and                                                               
pregnant  women.  It is  pro-family,  pro-life,  and imbued  with                                                               
Alaska values by  caring for the least able among  us on the last                                                               
1:47:46 PM                                                                                                                    
Medicaid  funds 51  percent  of  births in  Alaska.  In order  to                                                               
continue  to  receive  federal funding  for  the  state  Medicaid                                                               
program and  in order to  comply with  state law, the  state must                                                               
provide medical services for  pregnant women, including medically                                                               
necessary  terminations, as  well  as  pre-natal and  post-partum                                                               
care. The Alaska Department of  Health and Social Services (DHSS)                                                               
estimated  that no  more  than 22  more  of induced  terminations                                                               
would  result from  increasing the  Denali Kid  Care Eligibility.                                                               
Induced  terminations under  the entire  Denali Kid  Care program                                                               
cost about  $384,000 annually,  or less than  .18 percent  of the                                                               
Denali Kid  Care budget. Denali Kid  Care is a small  fraction of                                                               
the   state  Medicaid   budget.   This   law  is   uncomplicated,                                                               
manageable, and could take effect immediately.                                                                                  
1:49:51 PM                                                                                                                    
CHAIR DAVIS opened public testimony.                                                                                            
SENATOR  DYSON  asked  if there  were  any  material  differences                                                               
between SB 5 and the bill vetoed by the governor last year.                                                                     
CHAIR DAVIS answered no; it is identical.                                                                                       
MARIE DARLIN,  representing AARP, said her  organization supports                                                               
SB  5.  AARP is  one  of  the  world's largest  organizations  of                                                               
grandparents. Many grandparents  are raising their grandchildren.                                                               
As  of  October  2007,  Alaska   had  8,188  children  living  in                                                               
grandparent  headed  households, which  was  4.3  percent of  all                                                               
children in the state. Of  those, 5,110 were living there without                                                               
either parent present. A total  of 5,419 grandparents report they                                                               
are responsible  for their grandchildren;  67.4 percent  of those                                                               
are under the  age of 60, and  many are still in  the work force.                                                               
Eleven percent  of these  live below  the federal  poverty level.                                                               
This bill  only raises the  eligibility back to  previous levels.                                                               
Thousands of  children could be  receiving health care  from this                                                               
1:54:43 PM                                                                                                                    
ELIZABETH RIPLEY, Mat-Su Health  Foundation, said that the Mat-Su                                                               
Health Foundation is  a 501(c)(3) organization that  owns part of                                                               
the Mat-Su Regional Medical Center.  They use revenues from their                                                               
local hospital  to make  grants to improve  the health  of Mat-Su                                                               
residents. Their  mission is to  improve the health  and wellness                                                               
of Alaskans  living in the Mat-Su  area, and their goal  is to be                                                               
the healthiest  borough in the  state of Alaska. One  strategy is                                                               
to  reduce  barriers  to  health  care  access.  Lack  of  health                                                               
insurance is a large barrier.                                                                                                   
In  2007, of  the 22,991  children in  Mat-Su, approximately  6.5                                                               
percent  were  uninsured.  However,  a  startling  650  of  these                                                               
children fell  below 200  percent of  the federal  poverty level.                                                               
The rate  of uninsured children  is higher  the closer we  get to                                                               
the federal  poverty level.  Since Alaska  decreased eligibility,                                                               
the rate of uninsured children has  grown each year by one or two                                                               
percentage points. Alaska  has also seen a 31  percent decline in                                                               
the  number  of children  covered  by  private health  insurance.                                                               
Uninsured children are  nine times less likely to  have a regular                                                               
doctor, four times more likely to  be taken to an emergency room,                                                               
and 20  times more  likely to miss  school. Medicaid  cost growth                                                               
can  be   slowed  by  prevention   and  maintenance   of  health.                                                               
Increasing income  eligibility levels  will increase  health care                                                               
access  for  children and  families  and  improve overall  public                                                               
health outcomes for Alaskan children.  Under current federal law,                                                               
states may  implement coverage up  to 300 percent of  the federal                                                               
poverty level.  Alaska is one of  a tiny majority of  states with                                                               
eligibility  levels as  low  as 175  percent.  The Mat-Su  Health                                                               
Foundation Board of Directors has  passed a resolution in support                                                               
of  Denali Kid  Care  eligibility levels  being  increased to  at                                                               
least  200 percent  of the  federal  poverty level.SENATOR  MEYER                                                               
said everyone on  the committee wants to provide  health care for                                                               
women  and children  in need,  but it  seems likely  the governor                                                               
will veto the bill again.                                                                                                       
WILLIAM  J.  STREUER,  Commissioner,  Department  of  Health  and                                                               
Social Services, said it is the same bill.                                                                                      
SENATOR MEYER asked if the governor would veto it again.                                                                        
COMMISSIONER STREUER said the department  is vigorously trying to                                                               
find a middle ground to allow the bill to go forward.                                                                           
SENATOR MEYER said he appreciates the intent.                                                                                   
COMMISSIONER STREUER said it has not happened yet.                                                                              
SENATOR MEYER asked if talks were ongoing.                                                                                      
COMMISSIONER STREUER said yes.                                                                                                  
SENATOR MEYER asked if the  new federal health care program would                                                               
affect Denali Kid Care.                                                                                                         
COMMISSIONER  STREUER  said  the  Affordable Care  Act  does  not                                                               
affect  this  population.  It  would   expand  Medicaid  but  the                                                               
population covered in SB 5 is not affected.                                                                                     
JOHN  SHERWOOD, Medical  Assistance Administrator,  Department of                                                               
Health and Social  Services, said there is  maintenance of effort                                                               
requirement through 2019, but no guarantee of long-term funding.                                                                
SENATOR DYSON  asked where  the money comes  from to  fund Denali                                                               
Kid Care.                                                                                                                       
COMMISSIONER  STREUER answered  that it  comes through  the State                                                               
Children's Health Insurance  Program (SCHIP) authorization, which                                                               
is 75 percent federal and 25 percent state.                                                                                     
MR. SHERWOOD  said it  is actually blended  funding. SCHIP  is 65                                                               
percent, then  pregnant women under Medicaid.  Tribal health care                                                               
is  100 percent  funded, so  they  take that  funding first.  The                                                               
fiscal notes show a blending of different claiming rates.                                                                       
SENATOR DYSON said  so either federal taxpayers  or state revenue                                                               
subsidize the  program. There  is no  guarantee that  the federal                                                               
program will continue indefinitely.                                                                                             
MR. SHERWOOD said  the SCHIP program is  authorized through 2015,                                                               
with  maintenance of  effort provisions  through 2019.  There are                                                               
limits  to the  current authorizations.  It is  not uncommon  for                                                               
federal programs to require reauthorization.                                                                                    
SENATOR DYSON stated,  "So there is no  requirement that Congress                                                               
fund this."                                                                                                                     
MR. SHERWOOD  said the program  is funded through  allocations to                                                               
the  states,  and  Congress  has discretion  whether  or  not  to                                                               
continue funding it.                                                                                                            
2:09:31 PM                                                                                                                    
CHAIR DAVIS said if  it goes to 2019 we should  be in good shape,                                                               
and she doubts  if the federal government will  drop it. Congress                                                               
supports the program.                                                                                                           
SENATOR  DYSON  noted some  funding  may  be jeopardized  at  the                                                               
federal level and  we might look for another way  to take care of                                                               
this issue.                                                                                                                     
CHAIR DAVIS  said that tribal  health is 100  percent reimbursed,                                                               
and the state should make better use of this.                                                                                   
SENATOR  EGAN said  the committee  is discussing  a bill  that he                                                               
personally believes  means a  lot to many  people in  this state,                                                               
and asked if the administration is negotiating in good faith.                                                                   
CHAIR DAVIS said  she understands that this bill  might be vetoed                                                               
again, and she has been  working with the present administration,                                                               
trying to  convince the  governor not  to veto  it. She  said she                                                               
told him, "If you can't sign the bill, just let it go into law."                                                                
SENATOR DYSON noted the governor  did support funding health care                                                               
for children in need and would have  been glad to let the bill go                                                               
through until he was informed of  the abortion issue. He has been                                                               
trying to find a way to go  forward, but it is a very significant                                                               
human rights issue.                                                                                                             
CHAIR  DAVIS said  she would  not close  testimony but  set SB  5                                                               
aside for further consideration.                                                                                                
2:14:30 PM                                                                                                                    
There being  no further  business to  come before  the committee,                                                               
Chair Davis adjourned the meeting at 2:14 p.m.                                                                                  

Document Name Date/Time Subjects
SB14 Bill.pdf SHSS 3/7/2011 1:30:00 PM
SB 14
SB14 Sponsor Statement.docx SHSS 3/7/2011 1:30:00 PM
SB 14
SB14 Sectional.pdf SHSS 3/7/2011 1:30:00 PM
SB 14
SB14 Support Ltrs.pdf SHSS 3/7/2011 1:30:00 PM
SB 14
SB014 Fiscal Note.pdf SHSS 3/7/2011 1:30:00 PM
SB 14
SB 5 Bill.pdf SHSS 3/7/2011 1:30:00 PM
SB 5
SB 5 Sponsor Statement Rev 1-23-2011.pdf SFIN 4/8/2011 9:00:00 AM
SHSS 3/7/2011 1:30:00 PM
SB 5
SB 5 Leg Legl Memo Med Nec 11-18-2010.pdf SHSS 3/7/2011 1:30:00 PM
SB 5
SB005 Fiscal Note Public Assistance.pdf SHSS 3/7/2011 1:30:00 PM
SB 5
SB005 Fiscal Note Medicaid Services.pdf SHSS 3/7/2011 1:30:00 PM
SB 5
SB 5 ADN Parnell cites abortion in veto 6-4-2010.pdf SFIN 4/8/2011 9:00:00 AM
SHSS 3/7/2011 1:30:00 PM
SB 5
SB 5 Background of SCHIP.pdf SFIN 4/8/2011 9:00:00 AM
SHSS 3/7/2011 1:30:00 PM
SB 5
SB 5 CMS CHIRPA Letter 5-11-2009.pdf SFIN 4/8/2011 9:00:00 AM
SHSS 3/7/2011 1:30:00 PM
SB 5
SB 5 Docs - Repercussions of Unmet Health Care.pdf SFIN 4/8/2011 9:00:00 AM
SHSS 3/7/2011 1:30:00 PM
SB 5
SB005 Fiscal Note Medicaid Services II.pdf SHSS 3/7/2011 1:30:00 PM
SB 5