03/28/2011 09:00 AM Senate FINANCE

SENATE BILL NO. 87                                                                                                            
                                                                                                                                
     "An  Act establishing  a program  in the  Department of                                                                    
     Commerce,  Community,  and   Economic  Development  for                                                                    
     payment of grants to health  care providers for care of                                                                    
     patients who are 65 years of age or older."                                                                                
                                                                                                                                
10:14:03 AM                                                                                                                   
                                                                                                                                
Senator French,  Sponsor, explained the bill.  He maintained                                                                    
that Alaska's Medicare system is not working well.                                                                              
                                                                                                                                
     Too  many seniors  cannot find  a primary  care doctor.                                                                    
     Physicians who  do accept Medicare patients  are losing                                                                    
     money with  each visit, as  the cost of  providing care                                                                    
     exceeds the federal reimbursement rate.                                                                                    
                                                                                                                                
     We  can't  wait  for  the  federal  government  to  fix                                                                    
     Medicare;  instead,   we  need   to  act   today.  This                                                                    
     legislation  will immediately  improve seniors'  access                                                                    
     to primary care services in Alaska.                                                                                        
                                                                                                                                
     The  bill  establishes a  grant  fund  for health  care                                                                    
     providers serving Alaskans who  are sixty-five years of                                                                    
     age  or  over.  The  grants will  be  paid  to  medical                                                                    
     providers   that  increase   primary  care   access  to                                                                    
     Alaska's   seniors.  All   health   care  providers   -                                                                    
     including   physicians,    nurse   practitioners,   and                                                                    
     physician assistants - would be eligible for grants.                                                                       
                                                                                                                                
     Access  to  primary care,  as  you  know Mr.  Chariman,                                                                    
     improves  health outcomes  and  reduces medical  costs.                                                                    
     Instead of waiting for small  ailments to become major,                                                                    
     primary  care  prevents expensive  medical  treatments.                                                                    
     Instead of  requiring an emergency room  visit, primary                                                                    
     care keeps our seniors healthy.                                                                                            
                                                                                                                                
Senator French  observed that a  new Medicare  clinic opened                                                                    
in Alaska.  The clinic hopes  to serve five to  six thousand                                                                    
citizens,  which  is only  half  of  the 13,000  seniors  on                                                                    
Medicare  in  Anchorage that  do  not  have a  primary  care                                                                    
provider. While the Medicare clinic  is a good step forward,                                                                    
Senator  French did  not  feel that  one  solution could  be                                                                    
relied on to solve the  entire problem. He observed that the                                                                    
Institute of  Social and Economic Research  (ISER) estimates                                                                    
that Alaska  will have  86,000 non-native  Alaskans eligible                                                                    
for Medicare by 2020.                                                                                                           
                                                                                                                                
Senator French  estimated that the supplemental  cost of one                                                                    
primary care visit for those  that don't have a primary care                                                                    
doctor would cost  the state $1.2 million.  He stressed that                                                                    
costs  would  be  reduced  by the  coverage  of  nurses  and                                                                    
physician assistants.                                                                                                           
                                                                                                                                
10:17:51 AM                                                                                                                   
                                                                                                                                
In response to  a question by Senator  Olson, Senator French                                                                    
clarified  that  the Medicare  clinic  was  put together  by                                                                    
Providence Hospital.                                                                                                            
                                                                                                                                
Senator  Olson wondered  if there  were provisions  to cover                                                                    
dental   costs.  Mr.   Moderow   agreed   to  provide   that                                                                    
information.                                                                                                                    
                                                                                                                                
10:18:24 AM                                                                                                                   
                                                                                                                                
Senator  Olson  stressed  concern with  high  pharmaceutical                                                                    
costs. Senator French observed that  Medicare Part D and the                                                                    
Affordable Care  Act shrunk the "donut  whole" that affected                                                                    
so   many   seniors  that   had   to   pick  up   costs   of                                                                    
pharmaceuticals.   The   legislation   primarily   addresses                                                                    
primary care; pharmacy costs are not addressed.                                                                                 
                                                                                                                                
10:19:23 AM                                                                                                                   
                                                                                                                                
Co-Chair Stedman  wondered if there  were some areas  of the                                                                    
state that  are underserved. Senator French  stated that the                                                                    
south central region held the biggest issue.                                                                                    
                                                                                                                                
10:20:43 AM                                                                                                                   
                                                                                                                                
JOHN  SHERWOOD, DEPARTMENT  OF HEALTH  AND SOCIAL  SERVICES,                                                                    
stated  that the  responsibility of  the program  would fall                                                                    
under  the Department  of Commerce,  Community and  Economic                                                                    
Development.  Federal  legislation   allowing  state  grants                                                                    
without  Medicare  payment   issues  precludes  the  state's                                                                    
Medicare  agency  from  operating  the  grant  program.  The                                                                    
Department  of  Health  and Social  Services  is  the  state                                                                    
agency.                                                                                                                         
                                                                                                                                
Co-Chair    Stedman   queried    the    position   of    the                                                                    
administration.    Mr.    Sherwood    replied    that    the                                                                    
administration had not taken a position.                                                                                        
                                                                                                                                
10:22:04 AM                                                                                                                   
                                                                                                                                
Co-Chair Stedman  highlighted the  fiscal note:  $234,100 GF                                                                    
from  the Department  of  Commerce,  Community and  Economic                                                                    
Development for  two new positions and  supplies. The fiscal                                                                    
note does  not make  assumptions on  the possible  number of                                                                    
grants or provide grant funding.                                                                                                
                                                                                                                                
10:22:38 AM                                                                                                                   
                                                                                                                                
PAT LUBY,  AARP (via  teleconference), testified  in support                                                                    
of SB  87. The legislation  would enable a grant  program to                                                                    
help  providers that  see a  significant number  of Medicare                                                                    
patients.  He  pointed  to access  problems  faced  by  many                                                                    
Medicare  patients, primarily  in urban  areas. He  stressed                                                                    
that  older Alaskans  will leave  the state  if they  cannot                                                                    
find a health provider.                                                                                                         
                                                                                                                                
10:23:37 AM                                                                                                                   
                                                                                                                                
DENISE  DANIELLO, EXECUTIVE  DIRECTOR, ALASKA  COMMISSION ON                                                                    
AGING, spoke in  support of SB 87. Alaska  continues to lead                                                                    
all  states  with  the  growth  of  its  senior  population.                                                                    
Currently, there are 53,200 Alaskans  age 65 or older. Older                                                                    
Alaskans,  growing   in  number   and  living   longer,  are                                                                    
experiencing chronic medical  health conditions and physical                                                                    
disabilities. Alaska  is, at the  same time,  experiencing a                                                                    
shortage  of  primary  care   providers.  In  recent  years,                                                                    
seniors have  been unable to  access primary health  care as                                                                    
doctors  refuse  them  due  to  low  Medicare  reimbursement                                                                    
rates. A  statewide survey by  the Commission found  that 16                                                                    
percent of  respondents had difficulty finding  a doctor. In                                                                    
2005,  a similar  survey found  that 24  percent of  seniors                                                                    
experienced  a  health care  problem.  Today  31 percent  of                                                                    
seniors experience a health care problem.                                                                                       
                                                                                                                                
10:26:23 AM                                                                                                                   
                                                                                                                                
BOB  DOLL, PRESIDENT,  RETIRED PUBLIC  EMPLOYEES OF  ALASKA,                                                                    
testified  in support  of  SB 87.  Medicare  appears as  the                                                                    
state  sanctioned method  for providing  post-retirement age                                                                    
medical coverage  that was part of  employment for retirees.                                                                    
He  observed that  the retirees  look to  the plan  creators                                                                    
(legislature)  for remedy  to problems.  He maintained  that                                                                    
that SB  87 provides a  remedy and acknowledged the  work of                                                                    
the    Alaskan    congressional   delegation    in    making                                                                    
supplementary  payments  to  Medicare  providers  legal.  He                                                                    
maintained that  thousands of  Alaskan seniors  pass through                                                                    
the  Medicare window  every  year and  some  will find  that                                                                    
their health care is jeopardized.                                                                                               
                                                                                                                                
10:27:55 AM                                                                                                                   
                                                                                                                                
Co-Chair Hoffman  wondered why there  was a proposal  to set                                                                    
up  the  program   without  recommendations  for  individual                                                                    
grants.   Senator   French   replied  that   there   was   a                                                                    
recommendation  of $1.2  million,  which  would satisfy  the                                                                    
problem for a year.                                                                                                             
                                                                                                                                
10:28:46 AM                                                                                                                   
                                                                                                                                
SB  87  was   HEARD  and  HELD  in   committee  for  further                                                                    
consideration.