Legislature(2009 - 2010)CAPITOL 106
03/18/2010 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| SB199 | |
| HB260 | |
| SB13 | |
| HB392 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | SB 13 | TELECONFERENCED | |
| + | SB 199 | TELECONFERENCED | |
| *+ | HB 392 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 260 | TELECONFERENCED | |
SB 13-MEDICAL ASSISTANCE ELIGIBILITY
3:31:47 PM
CO-CHAIR KELLER announced that the next order of business would
be SENATE BILL NO. 13, "An Act relating to eligibility
requirements for medical assistance for certain children and
pregnant women; and providing for an effective date."
SENATOR BETTYE DAVIS, Alaska State Legislature, expressed
appreciation to the committee and requested to have the bill
moved out of the committee without any amendments.
3:33:42 PM
GEORGE BROWN, Doctor, read from a prepared statement: [original
punctuation provided]
I am George Brown and reside at 1640 Second St. in
Douglas, Alaska. Thank you for the opportunity to
speak in strong support of passage of SB 13. I would
like to focus on three themes today, and then close
with words from an Alaskan Superior Court Judge.
First, I applaud your ongoing concern with governing
from a responsible budget for all Alaskans. I enjoyed
sitting at the hearing in this room on March 9th and I
learned some important information. We, who pay close
attention to the current domestic situation in our
country, know that governing is much more difficult
than campaigning - which is never a cake walk. Your
questions on that Tuesday kept returning to fears
about affordability and how can you know such
increased inclusion will eventually bring about
savings in Alaska health care costs. A variety of
university studies in the 1990's show how every $1
invested in prevention work for improving children's
health saves at least $4. Dr. Gross spoke about the
savings when children visit a physician or nurse
practitioner office compared with Emergency Room and
hospital admissions. One of the underlying mechanisms
for this saving is the gradual, but effective learning
about how to wisely use medical care. This begins
with pre-natal health care and continues all the way
through to adulthood. On every preventive visit,
parents and children are learning they are more
responsible for their health than anyone else. Such
regular attention to prevention and wellness prevents
life threatening and expensive infections, serious and
fatal physical injuries, school failure and dropout,
obesity, family disruption from chronic developmental
and health conditions, substance abuse, and now early
child behavior problems. Helping young parents, whose
parents never had a chance for such learning, to
wisely use medical care, is a tedious and challenging
endeavor, but I have been blessed to see such changes
in many Alaskan families ever since I began to see
children covered by Medicaid in the 1970's. That is
part of the joy of being a pediatrician.
Please pass SB 13 to increase such cost savings.
Second, I speak to an issue that may irritate some
medical colleagues. I have been outspoken about the
access to health care in these United State for many
years. I learned long ago, in 1969 when working with
a pediatric resident who had trained in Canada, how
fee for service is a major driver of excess costs in
our health care system. If a physician gets to decide
how much will be billed for each visit, the temptation
to select a lower figure is "sorta like Eve's apple."
Fee for service must be eliminated to bring down these
wasteful costs. There must be added a way to pay for
the outcomes of service. Medicaid and other insurance
companies have begun to examine such excess charging.
I urge my colleagues to think carefully about such
costs every time we complete the coding for the fee
for service to be paid for each visit. For those who
honestly question this view point, I would ask, "Have
you ever known a really poor physician?"
Please support national health care reform to reduce
our wasteful costs.
Third, I want us to think about the pervasive
atmosphere of fear in our time. The list just keeps
on being broadcast hourly: Global warming, Climate
change, Worsening natural disasters, AIDS, Economic
recession, Neighborhood violence, Homelessness,
Terrorism, Illegal immigrants, Youth drug addiction,
US government debt, and not too long ago, the dreaded
"Spanish or H1N1 worldwide pandemic." Medical and
public health colleagues all over Alaska provided care
for thousands of H1N1 cases and just as soon as CDC,
working with reliable vaccine manufacturers, made an
effective vaccine available, gave thousand of doses of
H1N1 influenza vaccine. There were a few deaths and
more hospitalizations, but this pandemic gradually
passed with nowhere near the levels of deaths and
hospitalizations that are now hallmarks of the three
previous H1N1 influenza pandemics. We in these United
States, along with the World Health Organization and
numerous other national governments, did something
correctly. I could not have predicted this with
certainty last August and September. In short, I am
grateful for this most successful work of clinical and
public health medicine and I think the over-marketing
of fear is a much larger enemy than any of dozen
listed above.
Please pass SB 13 to continue overcoming fear.
In closing, I read the wisdom about children by the
Alaskan judge to whom I remain forever grateful for a
truth that keeps me living in reality.
3:42:30 PM
DR. BROWN read the following poem: [original punctuation
provided]
Each of us
must come to care
about everyone's children.
We must recognize that
the welfare of our children and grandchildren
is intimately linked to the welfare
of all other people's children.
After all, when one of our children
need lifesaving surgery,
someone else's child will perform it.
When our children dial 911,
someone else's child will answer it.
When our children need a helping hand,
someone else's child will be there to lend it.
If one of our children is threatened
or harmed by violence,
someone else's child will be responsible
for the violent act.
The good life
for our own children
can be secured
only if a good life
is secured
for all other people's children.
3:43:25 PM
CO-CHAIR KELLER expressed gratitude for Dr. Brown's sincerity.
3:44:12 PM
PATRICE GRIFFIN, Head Start Director, Rural Alaska Community
Action Program, stressed that Denali Kid Care coverage was very
important for the children and prenatal women in its program.
She stated that Denali Kid Care allowed children to receive
important medical services and screenings. She reported that
Head Start and Early Head Start served 868 children in Alaska,
of whom 397 were enrolled in Denali Kid Care, but she pointed
out that 76 children had no medical coverage. She shared that
Head Start helped children and families access medical services,
and it used program dollars to help children receive medical
service. She expressed support for SB 13.
3:46:59 PM
CO-CHAIR KELLER asked how many of the 76 non medically covered
children would have been covered by proposed SB 13.
MS. GRIFFIN replied that she would find that information.
3:47:56 PM
ELIZABETH RIPLEY, Executive Director, Mat-Su Health Foundation,
explained that the Mat-Su Health Foundation was a non-profit and
part owner of the Mat-Su Regional Medical Center, which had been
built to provide better access to acute care for the borough.
She reported that the Foundation was an overseer for the
hospital policies. She declared that this included ensuring
that indigents had equal access to top quality care. She
directed attention to the growing uninsured community
population, and the rise in uncompensated care and bad debts.
She pointed out that the number of uninsured children had
declined nationally, but had increased in Alaska. She said that
there was an increase of 3000 uninsured children, despite a zero
percent population growth. She said that it was the middle
income households that were suffering, as these households were
becoming uninsured at a faster rate than any other income
levels. The average cost of a family's insurance policy rose 81
percent between 2000 and 2008, while the median household income
fell 2.5 percent. She stated support for SB 13.
3:52:24 PM
REPRESENTATIVE T. WILSON asked how many more kids would have
been covered if coverage were for 200 percent FPL.
MS. RIPLEY estimated 1530 children in Mat-Su.
CO-CHAIR KELLER allowed that his statistics reflected that 1277
children would be eligible statewide.
3:53:00 PM
MS. RIPLEY clarified that this would include all eligible but
uninsured people in Mat-Su, and noted that some were already
qualified but not enrolled.
3:53:59 PM
MS. RIPLEY, in response to Co-Chair Keller, said that she did
not have the regional information.
3:54:57 PM
DONNA GRAHAM, Nurse, said that there was a lack of access to
health care. She listed the FPL rates for many states, and
noted that only Alaska and North Dakota were 175 percent or
below. She stated support for SB 13 and urged the committee to
take immediate action.
3:57:47 PM
MELINDA MYERS, Senior Manager, Best Beginnings, explained that
Best Beginnings was "a public - private partnership that
mobilizes people and resources to ensure all Alaska children
begin school ready to succeed." She stated that SB 13 was
critical to ensure that children and pregnant mothers had access
to quality health care. She stated support for SB 13. She
offered a personal anecdote about medical costs and its impact
on a low income family with small children.
3:59:27 PM
FRANK BOX relayed a personal story of the devastating cost of
medical bills even with good health insurance. He stated his
support for SB 13. He reported that $89.5 million was paid by
the state and the federal government for unpaid Anchorage
emergency room visits in 2005.
4:01:52 PM
ELENA MARCIL, Rural Alaska Community Action Program, stated that
SB 13 would help the program to better serve families.
4:03:02 PM
AMBER SAWYER said that she had been insured by Denali Kid Care
as a child. She explained that her father was in the military,
and while stationed in Alaska, the Tri Care insurance did not
offer all the necessary services so that her family needed
Denali Kid Care. She offered a personal story of her need for
therapy as a child, and that Tri Care could not accommodate her
need. She related that Denali Kid Care met her therapy needs
and that she did not think that she "would be sitting here
before you today if it weren't for Denali Kid Care." She stated
that the therapy and the support which she received from Denali
Kid Care had turned her life around. She relayed that Denali
Kid Care had influenced her decision to become an attorney, and
that she was currently working as a legal assistant. She
testified that more than half the cases in her law office were
medically related. She relayed that the inclusion of Denali Kid
Care within a case would often result in a settlement outside of
court.
4:07:37 PM
REPRESENTATIVE T. WILSON asked how many of the cases would
include people in the 175 to 200 percent FPL for approval to
Denali Kid Care.
MS. SAWYER replied that she worked most often with motorized
vehicle accidents and she estimated that Denali Kid Care was the
insurance in at least 12 of the 100 accident cases.
4:08:51 PM
REPRESENTATIVE T. WILSON asked if this was because there was not
any auto insurance.
MS. SAWYER replied that auto insurance would not always pay for
it.
4:10:38 PM
REPRESENTATIVE T. WILSON asked if co pay for Denali Kid Care
could be included without a burdensome administrative cost.
JON SHERWOOD, Medicaid Special Projects, Office of the
Commissioner, Department of Health and Social Services (DHSS),
replied that SB 13 only included children and pregnant women.
He said that there would be an administrative cost to both the
DHSS and the providers. He pointed out that there were federal
limits to co-pay.
4:12:14 PM
REPRESENTATIVE T. WILSON asked who set the standards for
qualification to Denali Kid Care.
MR. SHERWOOD replied that it was a federal policy for enhanced
funding of children through Medicare which set the coverage
limits when other insurance was also included. He pointed out
that any increase above these limits would result in a loss of
the federal State Children's Health Insurance Program (SCHIP)
enhanced funding for kids without insurance.
4:13:41 PM
REPRESENTATIVE T. WILSON asked about the combinations of various
coverages.
MR. SHERWOOD, in response to Representative Wilson, said that
coverage through Indian Health Services (IHS) was not considered
insurance for the purposes of eligibility. He pointed out that
an IHS provider could also bill Medicaid for any uncovered
amounts and was reimbursed at 100 percent of federal funds.
4:15:16 PM
REPRESENTATIVE T. WILSON asked about the earlier reference to
coverage through military insurance and Denali Kid Care.
MR. SHERWOOD replied that he would need to check if Tri Care was
considered insurance.
4:16:10 PM
CO-CHAIR KELLER noted that 1277 additional children would be
covered by SB 13, and an additional 200 pregnant women. He
asked if any of these were included in the Indian Child Welfare
Act (ICWA) projections.
MR. SHERWOOD replied that some of the children would be IHS
eligible, and he pointed to the fiscal note which showed an
assumption for 100 percent funding for some of the services.
CO-CHAIR KELLER asked for a percentage.
MR. SHERWOOD replied that, overall, 35 percent were eligible for
IHS, but he could not state positively about the percentage of
eligibility for the income level stated in SB 13.
4:17:54 PM
REPRESENTATIVE T. WILSON asked if there was a wait list for
Denali Kid Care.
MR. SHERWOOD, in response, said there was not a wait list for
entry due to limitations of capacity, but that there had been
processing backlogs to verify citizenship and identity with
original documents. He explained that if eligibility was
granted, then coverage was offered for three months prior to the
date of application.
4:19:24 PM
REBECCA LEVENSON, Senior Policy Analyst, Family Violence
Prevention Fund, said that Alaska had the highest per capita
rates of sexual and domestic violence in the country. She
explained that the Family Violence Prevention Fund worked on the
impact of violence on health outcomes. She said it was
important to consider the issue of perinatal health when
increasing to 200 percent of FPL. She explained that pregnant
women experiencing violence were much less likely to carry to
term, which would cost the state a lot more money. She
suggested consideration of the cost benefit to the increase to
FPL percentages versus the cost of negative outcomes from
decreased perinatal care.
4:22:52 PM
CO-CHAIR KELLER closed public testimony.
4:23:04 PM
CO-CHAIR KELLER moved to adopt Amendment 1, labeled Version 26-
LS0076\A.12, Mischel, 3/17/10, which read:
Page 4, line 3:
Delete "200"
Insert "210"
Page 4, line 14:
Delete "may"
Insert "shall [MAY]"
Page 4, line 16:
Delete "150 and 200"
Insert "185 [150] and 210"
Page 4, lines 16 - 17:
Delete "if the department requires premiums or
cost-sharing contributions under this subsection, the"
Insert "The [IF THE DEPARTMENT REQUIRES PREMIUMS
OR COST-SHARING CONTRIBUTIONS UNDER THIS SUBSECTION,
THE]"
4:23:22 PM
REPRESENTATIVE T. WILSON objected for discussion.
4:24:18 PM
The committee took a brief at-ease.
4:24:51 PM
[Due to technical difficulties, the audio was not recorded from
4:24:51 until 4:25:21.]
4:25:53 PM
CO-CHAIR KELLER repeated that SB 13 was not about coverage for
children, but about who would pay for it. He declared the
intent for state programs was to help people become self
sufficient once again. He preferred the message to be that the
state would help out, not to pay for as much as possible for
everyone.
4:28:19 PM
REPRESENTATIVE SEATON asked to clarify that there were no steps,
percentages, or amounts for co pay in the amendment, but that
these would be whatever the DHSS determined.
4:30:01 PM
REPRESENTATIVE LYNN asked about the expense to implement the co
pay. Pointing to the intent of the amendment, he asked if it
was to save money, or to teach parents to be more self
sufficient.
4:31:30 PM
CO-CHAIR KELLER replied that his intent was for the will of the
committee to happen. He noted that his intent was for greater
self sufficiency for parents, but that the issue was for who
would pay.
REPRESENTATIVE LYNN asked if the children would suffer because
of this.
CO-CHAIR KELLER said that it was necessary to draw a line for
support.
4:34:38 PM
REPRESENTATIVE HOLMES, in response to Representative Seaton,
pointed to page 4, lines 18 and 19, and said that DHSS would be
required to adopt "a sliding scale for premiums or contributions
based on household income."
4:35:27 PM
MR. SHERWOOD said that the bill language usually provided a
great deal of flexibility for levels of cost sharing.
4:35:56 PM
REPRESENTATIVE HOLMES asked how the co pay would be shared with
the federal government, and also asked about the cost for
administrative overhead. She referred to the current statute
which allowed for a department option to premiums or co pays.
She asked Mr. Sherwood how much money was really going to be
saved.
4:37:12 PM
MR. SHERWOOD replied that any income from co-pays would be
shared with the federal government at the same rate as the
expenses. He agreed that there were administrative costs for co
pays and premiums. He opined that there could be a savings from
deterrence, in that some people would just not apply, though
neither co pay or premium would contribute to a large savings.
He clarified that the administration supported a clean
expansion, without co-pays, to 200 percent FPL for pregnant
women and children. He expressed a desire for a simple program
for DHSS and the providers.
4:40:47 PM
REPRESENTATIVE CISSNA said there was a shortage for health care
providers which accepted Medicaid. She asked if co pay would
create a necessity for more personnel, and would the co pay
create a hardship for the health care provider network.
MR. SHERWOOD, in response, offered his belief that the DHSS
workload would increase, but he did not know if it would be
necessary to hire more staff. He shared that co pay was not
uncommon, but that he could not speak for the health care
providers.
4:44:20 PM
CO-CHAIR KELLER asked for clarification about the co pay.
MR. SHERWOOD replied that the co pay was paid to the provider,
which would reduce the payment to the provider from the state
and the federal government. He clarified that the co pay
benefit to the state would be to the same percentage as the cost
payment for the service.
4:44:55 PM
REPRESENTATIVE T. WILSON asked if the co pay process could be
similar to the current system used by clinics in her district.
MR. SHERWOOD replied that degrees of co pay could be set up, but
he explained the necessity to categorize all the recipients by
qualifications, and then to notify all the health care providers
of each recipient's category.
4:46:09 PM
REPRESENTATIVE T. WILSON asked about the current adult co pay
system.
MR. SHERWOOD reported that providers were aware of the co pay
services and the eligibility categories, so that the co pay was
requested at the time of payment.
4:47:26 PM
MR. SHERWOOD, in response to Representative T. Wilson, offered
an example of buying a prescription at a pharmacy.
REPRESENTATIVE T. WILSON asked if this was the same system for
children.
MR. SHERWOOD explained that it was necessary to identify the
individuals subjected to co pay, and to identify any differences
in co pay amounts.
4:49:21 PM
REPRESENTATIVE LYNN expressed his concern for any impact of co
pay on the children. He asked if this could be studied during
the interim. He asked about the cost for a premium.
MR. SHERWOOD, in response, said that premiums could not exceed 5
percent of the household income, based on a monthly or a
quarterly income.
4:52:36 PM
CO-CHAIR KELLER withdrew his amendment. He declared his
philosophical differences with the federal government.
4:53:41 PM
REPRESENTATIVE CISSNA agreed that it was necessary to maintain
awareness of the program costs. She stressed the importance of
"dealing with one part of a generation" and she voiced her
support for a better system.
4:54:53 PM
REPRESENTATIVE T. WILSON expressed her frustration with the
inequity to small businesses which offered a health care plan.
4:57:16 PM
REPRESENTATIVE CISSNA offered her belief that Alaska did not
encourage small businesses. She stated that a large number of
uninsured in Alaska were employed by small businesses. She said
that SB 13 would allow these employees to keep their children
healthy, while it supported the small businesses ability to
remain in business.
4:58:45 PM
CO-CHAIR HERRON moved to report SB 13 out of committee with
individual recommendations and the accompanying fiscal notes.
CO-CHAIR KELLER objected. He said that he cared about the
children. He offered his belief that the committee had the
wrong understanding and he directed attention to a pie graph,
titled "Children in Alaska." [Included in the committee
packets.] He opined that SB 13 would send a message to families
that the government was there to take care of them. He offered
his belief that SB 13 would only affect a small number of
children, and that these were not the children who needed the
most support.
5:02:07 PM
A roll call vote was taken. Representatives Lynn, Seaton,
Cissna, Holmes, and Herron voted in favor of SB 13.
Representatives T. Wilson and Keller voted against it.
Therefore, SB 13 was reported from the House Health and Social
Services Standing Committee by a vote of 5 -2.
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