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 |