Legislature(1999 - 2000)
02/15/2000 03:56 PM House HES
| Audio | Topic |
|---|
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
HB 260 - MEDICAL ASSISTANCE PROGRAM COVERAGE Number 0280 CHAIRMAN DYSON announced the next order of business as House Bill No. 260, "An Act relating to coverage of children and pregnant women under the medical assistance program; and providing for an effective date." Number 0262 KAREN PERDUE, Commissioner, Department of Health & Social Services, came forward to testify in opposition to HB 260. She informed the committee the Denali KidCare program will reach its first birthday March 1. The legislature enacted the program about two years ago, and it has only operated for one full year; that is a pretty short time to talk about changing it. Denali KidCare offers more children in working families health care coverage, it covers pregnant women, and it is a streamlined way of government doing business in signing up children. If the coverage went away today, approximately 7,000 children and about 800 pregnant women would lose their coverage. The program has turned out to be cheaper than the department thought. It roughly costs the state around $472 in general funds a year, about $40 per month. COMMISSIONER PERDUE informed the committee the federal government is paying 72 cents on the dollar for this service, and this program is authorized for ten years. The state is only in the second year of the program, and the state part of Denali KidCare is financed through savings in changing the Medicaid match. Money was freed up for use toward more health care coverage. If HB 260 were to pass, Alaska would be the only state in the nation without a child health insurance program. She discovered in talking to private insurers and business people, there is a hole in the market. TAPE 00-15, SIDE A Number 0011 COMMISSIONER PERDUE explained the national Child Health Insurance Program was launched to provide health insurance access for the person working in small business or part-time who didn't have coverage. Alaska has a more extensive problem because many more people are either self-employed or are in very small businesses. She has not heard of a private sector solution that would meet this need for insurance. She concluded by expressing her opposition to HB 260. CHAIRMAN DYSON asked how reducing the qualifying level from 200 percent down to 133 percent makes Alaska a state without a child health insurance program. Number 0154 NANCY WELLER, Medical Assistance Administrator, Division of Medical Assistance, Department of Health & Social Services, came forward to explain. Under federal law, children up to the age of six are required to be covered at 133 percent of the federal poverty level. Children over the age of six up to the age of 18 are being phased in one year at a time to 100 percent of the federal poverty level which is the mandatory level for those children 6-18. The 16 year old children are now being phased in this year and in two years mandatory coverage at 100 percent of the federal poverty level for children up to age 18 will be complete. Therefore the child health insurance program would only include children ages 6-18 at the 133 percent level under the proposed committee substitute. The new fiscal note shows only 2,738 children would retain coverage on the Child Health Insurance Program of the 7,000 expansion children that are currently covered under Denali KidCare. Number 0257 CHAIRMAN DYSON asked if it was accurate to say if this bill were to pass in its present amended form, there would be an insurance program in Alaska that continued at the level that the federal government had before, so there is still a program going on, there just isn't the supplementary coverage provided by the state in Denali KidCare. COMMISSIONER PERDUE replied that she didn't know if that would be accurate. She said Alaska's state health insurance program would be the puniest in the nation, and all the pregnant women would lose their coverage. REPRESENTATIVE GREEN asked Commissioner Perdue if that would put many unborn babies at risk if they were no longer covered. Number 0374 COMMISSIONER PERDUE replied absolutely. At any one time about 1000 pregnancies were covered, and many of the pregnant women now covered were foregoing prenatal care until later in their pregnancies. She believes prenatal care is the most cost- effective health care investment anyone can make. REPRESENTATIVE GREEN asked Commissioner Perdue if she thought some of those pregnant women might resort to abortions if they were not covered. COMMISSIONER PERDUE remarked that she can't say what people's personal decisions would be, but lack of coverage gives them less options. She reminded the committee that the year the legislature enacted this law for pregnancy coverage, the public funding for abortion was eliminated. That was part of the discussion at the time. This bill would certainly foreclose every option. REPRESENTATIVE KEMPLEN mention that the Center for Families made a presentation in the Children's Caucus today, and they emphasized it is important to implement prevention services for children because those services are the most cost-effective techniques available. He wanted to confirm that is what Denali KidCare does. Number 0550 COMMISSIONER PERDUE answered it does that, and it also helps with catastrophic events. If people don't have insurance or are only covered for catastrophic coverage, it is often a choice for the family between going for the checkup and getting the last week out of the paycheck. More children show up at the emergency room, which is the most expensive care, because the emergency room takes a credit card; usually people have to write a check at the doctor's office. She emphasized that it is not that parents are irresponsible; it is that they don't necessarily always have the money when the illness arises. COMMISSIONER PERDUE noted the other issue is if people were to try to buy the preventive coverage, the people whose children are very sick would be attracted to the pool because those people really need the coverage. The premiums go up because those people are attracted to the product. That has been the difficulty of having small pools of people in the private insurance settings. Therefore only the catastrophic coverage gets offered. CHAIRMAN DYSON said it was reported to him that a family of four would qualify at the present 200 percent level if their income was under $41,000. With permanent fund dividends (PFD,) the income would be up to $48,000-$49,000. He asked if it was correct that the PFDs were not counted in the income to qualify. Number 0674 MS. WELLER answered that it would depend on when people applied. Coverage is based on the monthly income unless people are seasonally employed in which case the income is annualized. CHAIRMAN DYSON asked if it is the Administration's position that a family with a $48,000 annualized income is the working poor that can't afford health insurance for their children. COMMISSIONER PERDUE answered generally, yes. Those individuals are not thought to be destitute, but the goal is to try to provide access for parents to get health insurance for their children and/or pregnancy and to act responsibly. Sometimes the choice is quitting a job and going back on welfare. In some ways that is the most responsible thing to do if the children need health coverage. The problem is responsible parents cannot access the coverage, and the goal is to try to get as many children as possible covered. CHAIRMAN DYSON asked Commissioner Perdue if it is her position that 200 percent is exactly the right number. COMMISSIONER PERDUE answered it is unfair to count the PFD as extra income because it is not counted for a lot of other things. The decision has been made in this state that the PFD does not disqualify people for things. She believes that 200 percent is a good level. It is a medium level compared to other states. Many states are way above 200 percent in this program. It is not out of line for what is going on in the nation. Number 0873 REPRESENTATIVE COGHILL disagreed that the 200 percent level is where people really become needy. Number 0949 COMMISSIONER PERDUE summarized by saying she does understand the philosophical issue; it was debated two years ago when the legislature passed this bill. She deeply resents the concept that these parents are somehow not responsible. She believes the parents are doing responsible things. She does not believe someone could take a PFD and turn it into health insurance for a child; it would only buy a couple of month's worth of coverage. The message should not be sent out that these parents are somehow not doing right by their children by getting this health coverage or that pregnant women are not somehow doing right by getting this coverage. CHAIRMAN DYSON said if he implied that, it certainly was not his intention. REPRESENTATIVE COGHILL stated that was not his intention. Number 1006 COMMISSIONER PERDUE emphasized that this is not welfare. This is health coverage for children whose families are working, and they cannot access it easily in the private market. REPRESENTATIVE GREEN asked if the threshold is one where someone either is or is not covered, or is it a sliding scale. COMMISSIONER PERDUE answered that it is not a sliding scale. Number 1061 JANICE TOWER, Alaska Chapter of the American Academy of Pediatrics, testified via teleconference from Anchorage. She dittoed Commissioner Perdue's remarks about why this bill should not pass. She testified on behalf of the Alaska Chapter of the American Academy of Pediatrics which is an organization of 63 pediatricians and pediatric sub-specialists from across the state. In 1998, the legislature passed HB 369 by 26-8 and 14-5; that authorized the Denali KidCare program. Representatives Green, Kemplen and Brice each voted in favor of this bill. The legislature is to be congratulated for having passed one of the best bills ever devised for children and expectant moms. MS. TOWER stated that HB 260 is a step backwards to the twentieth century. Since Denali KidCare was launched last March, there has been a 27.6 percent increase in the number of children in the Fairbanks North Star Borough who now have health insurance through this program. Similarly, the Kenai Peninsula Borough can be proud that there's been an increase of 55.3 percent in health insurance enrollments through this program. She pointed this out because she understands that at the last hearing there was testimony from Kenai opposing this program. It is unfathomable that something so successful can be looked upon as undesirable. She sincerely hopes this will be the last that is heard about rescinding this valuable program and that more monumental decisions that benefit children and families will be made this session. Number 1182 LEILA WISE testified via teleconference from Anchorage. She said it sounds like Representative Coghill and other members of the committee believe that Denali KidCare represents some kind of socialized medical program; she doesn't see it that way. One of the ways she looks at it is as a subsidy to business to allow businesses, whether big or small, to pay their employees small amounts of money and fail to provide health insurance. She urged the committee to look at the bill in other ways. It is not just the 28 cents on the dollar that the state provides for health insurance for low income children and pregnant women. MS. WISE stated that anytime pregnant women are covered with health care or deafness in children can be avoided because their ear infections were treated is important. She is interested in preventing incidences of fetal alcohol syndrome or cocaine babies, and she is also interested in mental health care. The dollar investment in preventing and treating mental health issues will prevent greater costs later. The small amount of money paid for this program now is well worth it. Number 1341 GEORGE HIERONYMOUS, Executive Director, Beans' Cafe and Kids' Kitchen, testified via teleconference from Anchorage. The Kids' Kitchen program feeds underprivileged children in Mountain View, Fairview and the Muldoon area. A number of those children are now covered with this program that would not have had coverage before because their parents made over the 100 or 133 percent. By the time a single mother with three children pays for clothes, school costs and everything else, she can't afford to pay for insurance for her children. Bean's Cafe offers insurance for the employees, but if one of the employees want to insure their children, it costs $400 a month, not the $40 a month that the state pays. Not many people making $25,000-$35,000 can afford another $400 a month. MR. HIERONYMOUS noted that preventive care is very important. He sees what happens without the preventive care every day at Bean's Cafe. He can't serve corn on the cob because a number of the people did not have dental care when they were young, nor have dental care now. The children need to have their dental, health and mental problems taken care of early. He opposed HB 260. Number 1423 MICHELLE SCHUMACHER testified via teleconference from Homer. She told the committee that her son was born with a tumor in his head. Had he not been covered by Denali KidCare, she and her husband might have waited to have his head examined. After many tests, it was discovered that the tumor was rapidly growing further into his brain. She is happy to report that her son had surgery and now has a clean bill of health. She and her husband are so thankful for the Denali KidCare program and can't stress that enough. If it weren't for Denali KidCare, her family would presently be seriously in debt. Now she and her husband have health insurance through their jobs. She once again thanked Denali KidCare for the health of her son. She urged the committee to help the children by not passing this bill. Number 1486 LAUREN CARLTON testified via teleconference from Homer. She is pregnant, is on Denali KidCare now and is grateful for the program. She feels strongly that Representative Coghill is missing the whole point of this program. It's not just for the lower income people. This program was to fill a gap that the private sector has not filled even though there has been great economic growth in the country. Yet the private sector hasn't found a way to make insurance available to everyone that needs it other than catastrophic insurance. MS. CARLTON read in the newspaper on February 7, where Representative Coghill states that he doesn't think the government should be the supplier. She would like to know why people pay federal income tax, sales tax or property tax if people don't get something out of it that would really make a difference. The Denali KidCare program is making a huge difference to a lot of people. It is not a handout; it is a way for people to get insurance. An income of $40,000 (prior to taxes taken out and social security) for a single parent who has two or three children is not a lot of money these days in Alaska. She also noted that the federal government has guaranteed this program for ten years. She feels frustrated that all this time and energy is being spent on removing something that is a good thing. Number 1639 RUTHE KNIGHT testified via teleconference from Valdez. She has listened to all the previous testimony, and one thought going through her head is the possibility that many of the children that will need more time on task in school [as a result of failing the benchmarks or high school graduation qualifying exam], wouldn't need more time on task if they had adequate prenatal care. MS. KNIGHT has seen the Denali KidCare program help many families throughout the state of Alaska. It is one of the few pieces of legislation that has really helped the people in Alaska. There are many resource industry families that have never been able to have health insurance for their children, and this last year those families got that. More children are getting preventive care so they don't have to have the treatments they would have had if the prevention hadn't been there. It is way too soon to do anything with the original legislation that was passed in 1998. It needs to run for at least ten years. She believes cost savings will be seen in many difference places that probably haven't even been looked at. She urged the committee not to touch the original legislation, and she opposed HB 260. Number 1752 PATRICIA MACPIKE testified via teleconference from Sitka. She works with emotionally disturbed children and her child is covered by Denali KidCare. It dismays her to be considered part of the working poor because she works very hard with emotionally disturbed children. Some of the people in that field cannot be paid enough. She challenged the committee to work with emotionally disturbed children one day. MS. MACPIKE pointed out that parents who work seasonally have difficulty finding health insurance for their children. Her husband works seasonally for the Alaska Department of Fish & Game; his position has been downsized due to funding cuts. It costs $586 a month for continued coverage of the state insurance during the off season for her husband and daughter. If the deductibles are included, it is quite costly and almost not effective. They just hope no one in the family gets ill. She wondered if the legislators are covered by state health insurance when they are not in session. She noted that the cost of living and the cost of health care are continually increasing. Along side that comes the cost of education. She and her husband both have degrees, and it did not come cheap. They only have one child by choice because between the costs of education and health care, they can only afford one child. She opposes HB 260. [HB 260 was heard and held.]
| Document Name | Date/Time | Subjects |
|---|