Legislature(2023 - 2024)DAVIS 106
04/20/2023 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| SJR10 | |
| HB80 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | SJR 10 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 80 | TELECONFERENCED | |
SJR 10-MEDICARE REIMBURSEMENT 3:04:06 PM CHAIR PRAX announced that the first order of business would be SENATE JOINT RESOLUTION NO. 10, Encouraging Alaska's Congressional delegation and the federal government to raise Medicare reimbursement rates to meet the actual cost of care for the state's senior citizens. 3:04:43 PM SENATOR CATHY GIESSEL, Alaska State Legislature as the prime sponsor, introduced SJR 10. She explained that SJR 10 encourages Alaska's Congressional delegation and the federal government to raise Medicare's inadequate reimbursement rates to meet the actual cost of care. The inspiration for SJR 10, she said, was the closure of a senior Medicare clinic in Anchorage, which left hundreds of seniors rushing to find a new health care provider. SENATOR GIESSEL pointed out that Alaska's senior population is the fastest growing in the nation, and at the same time Alaska has the highest health care costs in the nation, and the U.S. has the highest healthcare costs in the world. This "senior tsunami," she said, coupled with inadequate Medicare rates, is resulting in the shutdown of many senior care clinics, or these clinics have stopped accepting new Medicare patients. This leaves Medicare seniors going to emergency rooms and urgent care centers, she stated. SENATOR GIESSEL related that the federal Medicare Payment Advisory Commission's annual meeting occurred after SJR 10 was written. The commission's [2023] annual report to the U.S. Congress, she continued, stated that Medicare spending in 2022 grew by 7.5 percent, mainly driven by the increasing number of beneficiaries across the country. This report, she further related, recognized that cost increases will be difficult for clinicians to absorb, with primary care physicians versus specialists being the hardest hit by inadequate reimbursement. The repricing for clinical services, she advised, needs to be targeted particularly at primary care. She stated that SJR 10 is meant to send a strong message to Alaska's congressional team and the federal government that this is a huge problem in Alaska and is detrimental to Alaska's clinicians and seniors. 3:08:35 PM REPRESENTATIVE RUFFRIDGE commented that the steadily increasing rate of Medicare costs is also tied to an increase in the actual cost of care. He inquired about these increases. He further inquired about whether people might be getting wealthy off the Medicare "dime" given that many insurance companies are creeping into the top 10 Fortune 500 companies. SENATOR GIESSEL replied that the [Medicare] Payment Advisory Commission identified the growth of the cost at 7.5 percent and projected a cost of care growth of 6 percent to 7 percent next year. She expressed uncertainty about where this falls in terms of insurance companies. 3:10:37 PM ERIC GURLEY, Executive Director, Access Alaska Inc., provided invited testimony in support of SJR 10. He expressed uncertainty concerning Representative Ruffridge's question, as he only has information for the people served by Access Alaska through the [Medicare] waiver, Veterans Directed Care, and private pay. He explained that his service supports in-home medical care needs versus an assisted living model. He noted he is a constituent of Senator Giessel's and works with Senator Tobin and Representative Fields because Access Alaska is located in their districts. MR. GURLEY pointed out that Access Alaska and Centers for Independent Living are in different parts of the state and are not the same. He related that while doing research to support SJR 10, he found that the number of Alaskans who are 65 and older are expected to increase by 30 percent per the June 2022 report, "Alaska Population Projections 2021-2050," [published by the Alaska Department of Labor and Workforce Development]. Current Medicare reimbursement rates, he further related, do not support seniors' need for access to health care providers. He added that the workforce shortages, clinic closures, and primary care delays all create more significant needs. He advised that a senior waiting for service and for primary care often must go to the emergency room to receive adequate support. MR. GURLEY urged that SJR 10 be moved forward because it is an absolute need. He further noted that the penalties for seniors who are late in enrolling for Medicare result in a lifelong penalty which has few, if any, remedies for getting fixed. 3:15:50 PM REPRESENTATIVE MINA inquired about the percentage of Access Alaska's population who are eligible for both Medicaid and Medicare. MR. GURLEY replied that in this population, Access Alaska serves about 248 [individuals] across Alaska. He added that this is a little less than half of the total served by Access Alaska with long-term type supports. REPRESENTATIVE MINA inquired about the number of individuals served by Access Alaska who are dual-eligible for Medicaid and Medicare or whether they all are dual-eligible. MR. GURLEY responded that [they all are] not necessarily [dual- eligible]. For example, he explained, somebody experiencing an intellectual developmental disability might have been on Medicaid for life and then upon reaching eligibility switches over to Medicare. He said this is a much smaller percentage of the population supported by Access Alaska. 3:17:38 PM ELIZABETH RIPLEY, President, CEO, Mat-Su Health Foundation (MSHF) testified in support of SJR 10. She noted that she is a co-owner of the Mat-Su Regional Medical Center [in Palmer], and MSHF invests its share of the hospital's profits back into the community through grants, scholarships, and systems-change work. She said that MSHF supports SJR 10 because the Matanuska-Susitna (Mat-Su) Valley has one of the fastest growing senior populations in Alaska. From 2015-2020 the valley's population of residents 65-plus increased 47.3 percent, she reported, and it will continue to accelerate over the next 10 years. MS. RIPLEY pointed out that this population is spread across a vast geography that is medically underserved according to the [federal] Health Resources and Services Administration (HRSA). She continued that data from the U.S. Census shows that in 2015 the Mat-Su had 8,271 people enrolled in Medicare, and by 2021 the number grew to 14,527. She reported that the average 65 to 74-year-old only has one chronic disease, while the average 75 to 84-year-old has three. She advised that this increase mandates the need for more medical care by primary care physicians; however, because of Medicare's low reimbursement rates, most providers cap the percentage of Medicare patients they receive. She related that providers report that the current Medicare reimbursement rates are less than the provider's cost; therefore, providers must make the difficult decision to either limit the number of Medicare patients allowed in their practice or to not accept Medicare patients at all. MS. RIPLEY noted that a patient with multiple payer sources has less trouble finding a physician than a patient who only has Medicare, which is the case for over 3,400 Mat-Su residents. These patients, she continued, often go without a primary care provider, and end up in the emergency room, often for problems which could have been solved through routine care. She related that according to the Behavior Risk Factor Surveillance System Data, in 2021 more than 9 percent of Mat-Su seniors aged 65 and over did not have a primary care provider. She further noted that only 26.3 percent of women and 39.8 percent of men over 65 in Mat-Su are up to date on receiving core preventative services. She said the Mat-Su Health Foundation has made significant investments in supporting senior services and enhancing workforce development through its focus areas called Healthy Aging and Healthy Futures. But, Ms. Ripley advised, the foundation's efforts alone will not solve the shortage of providers who accept Medicare patients. This is where SJR 10 can help, she said, and MSHF urges that the resolution be moved out of committee. 3:21:30 PM REPRESENTATIVE MINA offered her understanding that the Anchorage Neighborhood Health Center and Providence Alaska Medical Center can take in new patients on Medicare. She asked about the number of facilities in the Mat-Su that can take new patients on Medicare. MS. RIPLEY answered that it is a dynamic situation because, within a physician's practice, people are aging into this category, and Mat-Su is the only place where the in-migration of older adults is greater than the out-migration. She expressed the understanding that the private primary care physicians she knows either do not take Medicare, or limit [the number they will take]. She stated that the three federally qualified health centers (FQHC) in the Mat-Su all take Medicare and Medicaid, and to her knowledge, none of them have a limit. She noted that Mat-Su Regional Medical Center used to own and operate a physician practice specializing in geriatric medicine, but it lost this provider about seven years ago. REPRESENTATIVE MINA inquired about how the influx of Medicare patients going into these FQHCs has impacted the wait times for other patients trying to get appointments. MS. RIPLEY expressed uncertainty but offered to report back to the committee. 3:24:54 PM JEROME GEORGE, representing self, testified in support of SJR 10. He stated he is 81 years old and a retired State of Alaska employee. He expressed the understanding that the state has the lowest ratio of doctors to population in the country, and Alaska's underperforming school system discourages doctors from coming to the state. He advised that the University of Alaska [School of Nursing] and Alaska Pacific University [Nursing Program] have problems with clinics and hospitals not accepting their students for internships. He argued that without these internships, students cannot get licensed, yet Alaska is importing nurses and paying them per diem. Problems like this need to be addressed, he stated. MR. GEORGE argued that besides Medicare, a plethora of other problems plague the system, and these problems are under the control of the legislature. For example, he said, doctors who were in the clinic that went out of business were prevented from practicing within seven miles of the clinic for one year because of noncompetitive clauses. He expressed the understanding that the clinic said it did not enforce this, while the doctors said it did. When noncompetitive clauses are enforced in this manner, he argued, it discourages doctors from coming to Alaska. MR. GEORGE maintained that one hospital in Anchorage is sending close to 50 percent of its serious cases to Seattle because the hospital does not have the capacity to treat these patients. He urged that this needs to be investigated. In addition to SJR 10, he urged that the legislature investigate other issues, such as the "blackmail clause" in Medicare. Under this clause, he expressed the understanding that if a clinic accepts a person on Medicare who has supplemental insurance, the clinic must also take Medicare patients who do not have supplemental insurance. He pointed out that he has supplemental insurance; however, he cannot find a primary care physician clinic because of this clause. He added that the clinic said it would take him if he paid 100 percent of his bill. He said these things, plus the lower [Medicare] reimbursement rate, cannot be ignored because it discourages Alaska's providers and clinics from serving seniors. 3:30:51 PM CHAIR PRAX stated that he imagines the committee will have some more meetings about other things associated with Medicare and Medicaid. 3:31:08 PM REPRESENTATIVE FIELDS offered his support for SJR 10. He said his constituents tell him that they cannot find Medicare primary care. He argued that seniors are an economic benefit to the state, not a burden, and senior care is an important part of growing the state's population. He shared a letter from a constituent in which it was reported that "retired seniors present a positive economic ratio of 10 to 1 for money in to cost out." Therefore, he continued, when considering this resolution and others, committee members should not only be cognizant of seniors, but of [the state's] economic self- interest as well. 3:32:11 PM REPRESENTATIVE MINA thanked Senator Giessel for bringing forward SJR 10. She noted that Medicare Part A is [hospital and skilled nursing facilities inpatient care], Part B is [doctor and other health care providers' services outpatient care], and Part D is prescriptions. She asked whether there is a specific need for just centering on Medicare Part B or whether there is a need to increase rates for all aspects of Medicare. SENATOR GIESSEL expressed uncertainty concerning the specific levels, but she does know the cost of medications and pharmaceuticals is going up. 3:33:33 PM CHAIR PRAX announced that SJR 10 was held over.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SJR 10 Support Redacted.pdf |
HHSS 4/20/2023 3:00:00 PM |
SJR 10 |
| SJR10 Fiscal Note LEG-SESS.pdf |
HHSS 4/20/2023 3:00:00 PM |
SJR 10 |
| SJR10 Sponsor Statement 03.22.23.pdf |
HHSS 4/20/2023 3:00:00 PM |
SJR 10 |
| SJR10 Support Document ADN 01.23.23.pdf |
HHSS 4/20/2023 3:00:00 PM |
SJR 10 |
| SJR10 Version 33-LS0490A.PDF |
HHSS 4/20/2023 3:00:00 PM |
SJR 10 |
| SJR10 Support AMA Letter to Congress 03.15.23.pdf |
HHSS 4/20/2023 3:00:00 PM |
SJR 10 |