03/07/2011 01:30 PM Senate HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| SB14 | |
| SB5 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 14 | TELECONFERENCED | |
| *+ | SB 5 | TELECONFERENCED | |
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
Davis.
SB 14-PROTECT HEALTH CARE PROVIDER CONSCIENCE
1:33:15 PM
CHAIR DAVIS announced the first order of business would be SB
14.
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
follows:
· 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;
and
· 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
frontier.
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
program.
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 |