Legislature(2001 - 2002)
02/12/2002 03:05 PM House HES
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
HB 367-MEDICAL ASSISTANCE PROGRAM COVERAGE CHAIR DYSON announced the next order of business, HOUSE BILL NO. 367, "An Act relating to coverage of children and pregnant women under the medical assistance program; and providing for an effective date." Number 1880 REPRESENTATIVE COGHILL, sponsor, explained that HB 367 addresses the [income eligibility level] of the Denali KidCare program. Right now, the program's level is 200 percent of the poverty level; HB 367 seeks to bring this down to 150 percent. The bill also contains "housekeeping" measures addressing such issues as removing the hyphen from "child-care". He explained that the drafter had taken this opportunity to clean up some language. REPRESENTATIVE COGHILL pointed out that the real [intent of HB 367] is on page 4, lines 5 and 9, wherein the [household income threshold] is changed from 200 percent to 150 percent of the federal poverty guideline. He posed questions: What does this translate into for a family of three to five? How does this relate to child health care? He explained that he'd broached this issue two years ago, proposing a change to 100 percent of the [federal poverty guideline]. "I barely got out of here alive," he said. Representative Coghill continued: It was just asking the question, was that expansion really what we wanted to do? And the resounding answer was yes, that is something that they wanted to do. And it was under the Smart Start program that passed some years ago. But once again, I'm here asking us the question: Is this really the direction we want to go? There [are] two sides to it - there's the dollar side and there's a policy side. To me, the policy side of an expanding subsidy level for health care is something that ... I'm not willing to go for. There's a dollar side that right now, under the fiscal condition we're in, can we really afford to go down this road further? But what I'm not saying, and I want everybody to hear this real clear ..., is there is not a need out there. The need for child health care is there, just as sure as we're sitting here. So, I understand that there are going to be some people who are going to say, "We can't afford to do that anymore." But I think that has to be part of the legitimate discussion of "what are we going to do to fill the $800 million hole in Alaska." Number 1763 REPRESENTATIVE COGHILL said this does affect policy, although he doesn't expect [savings in HB 367] to fill the $800 million [fiscal gap]. He remarked, "The argument that the investment into children's health care is going to be cheaper at this end than at the other end, I agree with." He offered that this argument is an important part of the discussion. On the other hand, he added his belief that there are families between the 150 percent and 200 percent levels that can afford [health care]. He said, "Before I'm willing to take money out of somebody else's pocket to pay for this, I'm willing to say, 'You've got to be a part of that discussion too.'" He told members that his aide would explain the family income levels associated with the aforementioned percentages. He drew members' attention to a chart in the committee packet showing income levels and the different, adjusted federal poverty levels. Number 1694 RYNNIEVA MOSS, Staff to Representative John Coghill, Alaska State Legislature, explained that Alaska's [poverty level] is set at 125 percent of the federal poverty level. CHAIR DYSON asked for clarification. MS. MOSS replied that the federal poverty level for a family of four is a monthly income of $1,472. Alaska's poverty level is set 25 percent higher by the federal government; therefore, Alaska's poverty level is set at a monthly income of $1,840. Exemptions such as the permanent fund dividend, Native corporation dividends up to $200 per recipient, income of nonbiological or nonadoptive parents, and income of a step- parent are not considered as income for eligibility purposes for Denali KidCare. MS. MOSS explained that a family of four, under the 200 percent of the federal poverty level - which is based on the 125 percent initial adjustment - can have an annual income of $44,160. Adding [last year's amount] of the permanent fund dividend [times four] to this income, the result is $51,561. This is a monthly income for a family of four of $3,680, without the dividend. By contrast, the 150 percent level to which HB 367 proposes to lower the 200-percent figure would change the [pre- dividend] monthly income to $2,760; this translates to an annual income of $33,120. A family of four would add approximately $5,400 [of permanent fund dividends] to that figure to arrive at nearly $40,000, Ms. Moss explained. Number 1568 REPRESENTATIVE WILSON commented that [the foregoing income levels] would include teachers who are single parents; she noted that many teachers earn less than that, although they have insurance. MS. MOSS clarified that the Denali KidCare program is not for people who already have insurance through their employer. Number 1543 REPRESENTATIVE WILSON recounted that an upset mother recently had informed Representative Wilson that the mother's health care provider had told her to drop her health insurance and sign up for Denali KidCare; this switch would result in less paperwork and more ease for the provider, the mother had been told. Representative Wilson explained that this provider was one that receives state funds. Representative Wilson reported that more than one parent had told her this. She noted that she did not know how prevalent this problem actually was, but said this parent was aggravated by the incident. Number 1475 REPRESENTATIVE COGHILL explained that a discrepancy was discovered in some of the numbers; he noted that he'd asked the [Department of Health and Social Services] to present some of the monthly costs [for clarification purposes]. He added, however, that he was "content to let the people [testify] because it really is a policy call, no matter what the numbers shake out at." Number 1448 CHAIR DYSON expressed interest in hearing a brief statement from the department. REPRESENTATIVE JOULE asked whether Chair Dyson intended to move HB 367 out of committee at this hearing. CHAIR DYSON replied that he did not believe the committee would hear all the testimony at this hearing. He confirmed for Representative Joule that the bill would not be moved at this hearing. Number 1425 JAY LIVEY, Commissioner, Department of Health and Social Services, spoke in opposition to HB 367. He noted that should this bill be enacted, approximately 3,800 children and 722 pregnant women would lose coverage. He concurred that this bill reduces [income] eligibility levels from 200 to 150 percent of [the federal] poverty level. COMMISSIONER LIVEY pointed out that the fiscal note indicates the proposed reduction would save about $5 million in general funds; however, it means the state would lose approximately $12 million in federal funds. Denali KidCare funding is such that for every dollar spent, about 71 cents comes from the federal government, he explained. In addition to providing health care for children and pregnant women, Denali KidCare allows the state to leverage federal funds into the state's health care system. COMMISSIONER LIVEY turned attention to savings associated with [the diminution of coverage]. He pointed out that these savings will be shifted to other payers because these children who lose coverage will go somewhere to receive care - most likely, the emergency room. Unpaid emergency room bills will generally be paid by the state; other payers in the system will pay some of that bill. When that happens, that bill will probably not be paid at the 70/30 federal-share rate; he suggested that the state will pay a larger share [than 30 percent]. Number 1334 COMMISSIONER LIVEY turned to Representative Wilson's concern about people being told to sign up for Denali KidCare. He explained that there is a 12-month waiting period [for coverage]. When a person applies for Denali KidCare coverage, he/she is asked about other insurance coverage. A person who has insurance is not eligible to sign up for the program. Consequently, the aforementioned parent who was told to drop her coverage and sign up for Denali KidCare would be unable to get coverage in that manner. He noted that there would be a waiting period; the children would have to go without coverage for a period of time. Number 1303 REPRESENTATIVE WILSON asked how this issue of an applicant's insurance coverage is policed. COMMISSIONER LIVEY replied that quality checks are done on applications. Number 1276 BOB LABBE, Director, Division of Medical Assistance, Department of Health and Social Services, explained that through the Division of Public Assistance, quality control reviewers have found this is not occurring to the extent one might think because of anecdotes. He reported that some applicants have dropped insurance and applied for coverage; he indicated there was good cause to do so in some cases. "For the most part, it's not occurring to that extent," he added. MR. LABBE said [the division] has advised grantees not to advise people in that manner; some were not aware of the disqualification and the fact that some people would be left [without coverage]. He added, "I can't say there aren't some instances where things happen or get by, but ... we've done a quality review on that, and it was not ... going on to any extent." He offered to obtain the related report for members. Number 1216 MR. LABBE, in response to a question from Chair Dyson, explained that a "spot check" is done on people who have applied and been approved, to view the circumstances [present at the time of application]; he noted that this is an intensive review. CHAIR DYSON asked whether an individual's personal records can be "invaded" to find out whether he/she has insurance elsewhere. Number 1175 MR. LABBE replied, "I'm not sure that we can, the way you're saying it. We do have, though, if a person has applied, ... access to information that comes through ... them and from the providers that submit claims, as well as from other 'data-match' sources." He indicated most of the information is gathered when asking the applicant questions such as: Where do you work? Does that employer offer health insurance coverage? He said the application process is fairly simple, but the quality-control review process is much more detailed. CHAIR DYSON said, "My question is, do you have access to peoples' records, whether or not they have entered into a private relationship with an insurance carrier?" Number 1131 MR. LABBE answered, "Not generally." He stated that [the division] has access to the applicant's employer to determine whether the employer provides coverage. He explained that this is generally where this is addressed. REPRESENTATIVE COGHILL inquired what it takes to waive the 12- month [waiting period]. Number 1112 MR. LABBE replied that the division has [created] a formula to look at household circumstances. He stated that he did not know the numbers exactly, but offered that the division has approved about half-a-dozen requests for waivers. He indicated the waivers have been granted based on income and family circumstances; this [waiver-request review] is handled in his office in Juneau. He stated that approximately 95 percent of the waiver requests have been denied. He added that the number of waivers was not large. COMMISSIONER LIVEY, in response to a question from Chair Dyson, clarified that the qualifying threshold is 200 percent of the Alaska income level, which is the federal poverty level adjusted [upward] 25 percent to account for Alaska's cost of living. CHAIR DYSON surmised that it is close to the 250 percent level, as compared to the Lower 48 [poverty] level. COMMISSIONER LIVEY replied, "I don't think that's the math, but I'd have to think about it for a minute." CHAIR DYSON queried about the process the department had used to decide that a multiplier of two was the correct threshold to set for Alaskans. Number 1005 COMMISSIONER LIVEY explained that this decision was made when the federal CHIP [Children's Health Insurance Plan] proposal was first made. He noted that Alaska had several choices to make, such as whether to have a Medicaid program or a stand-alone program. He offered that the state chose a Medicaid program for several reasons. For one, a stand-alone program, by federal law, must cover individuals who are also eligible for the Indian Health Service (IHS). In a stand-alone program, Alaska's costs for covering IHS-eligible Alaska Natives would not be reimbursed at 100 percent. On the other hand, if the state covers the cost of IHS-eligible individuals through Medicaid, the state receives 100 percent of the cost of that care, reimbursed from the federal government. He explained that Alaska has the highest percentage of IHS beneficiaries anywhere in the country. For that reason alone, it made sense to [choose a Medicaid system]. COMMISSIONER LIVEY recalled that when the [department] looked at the income threshold, it had a policy discussion similar to what Representative Coghill is suggesting: At what point should the state stop subsidizing health care and a private citizen be [responsible] for his/her own coverage? He said the 200 percent level was chosen because it appeared to be a level of income at which individuals and families had trouble purchasing their own insurance. The insurance market was not sufficiently developed for a parent to purchase a policy for a child, he offered. COMMISSIONER LIVEY indicated these types of policies were difficult to obtain and expensive. This issue was discussed with executives from some of the state's largest insurance companies; these executives told [the department] that low- income insurance is not necessarily one of the companies' prime focus markets. Commissioner Livey explained that this low- income-insurance market has high administrative costs because people enter and leave this coverage frequently. He concluded, "It seemed to us that 200 percent ... was a reasonable cutoff in terms of what a family could afford or what was available to them out in the market." Number 0878 CHAIR DYSON asked if Representative Coghill was "in the ballpark" when saying that a family of four has an income eligibility of about $44,000 plus whatever is added by the dividend. COMMISSIONER LIVEY replied, "Correct." CHAIR DYSON added, "And it would be reduced down to [$]33,000- and-change, plus the dividend?" COMMISSIONER LIVEY answered that he had not done the math himself, but presumed that number was correct. Number 0843 REPRESENTATIVE WILSON stated that when a woman visits the doctor and finds out she is pregnant, right away [she is advised] to sign up for WIC [Special Supplemental Nutrition Program for Women, Infants, and Children] because it is retroactive to before she became pregnant. Representative Wilson asked how much overlap [of benefits] there is between WIC and [Denali KidCare]. COMMISSIONER LIVEY pointed out that these programs provide two different services. Whereas WIC provides services related to nutrition, Medicaid is more medically oriented. The services would not necessarily overlap. REPRESENTATIVE WILSON asked what other [coverage] pregnant women apply for. She also asked [which entity] pays for doctor bills. MR. LABBE offered his assumption that it would have to be the Medicaid program. Noting his belief that WIC does not pay for any kind of medical services, he offered to check on this for a certainty. He said there are "linkages," however; when people apply for WIC, they can pick up applications for Denali KidCare at those offices. REPRESENTATIVE WILSON indicated this is the focus of her question - what program "kicks in" - because she has been to clinics that [offer multiple applications for programs]. She said, "That makes sure that the clinic or the doctor gets paid for maternity care throughout that pregnancy." She expressed interest in knowing whether the 722 pregnant women alluded to earlier who wouldn't receive Denali KidCare coverage might qualify under some other program. Number 0726 COMMISSIONER LIVEY offered his belief that there is no overlap of coverage for prenatal care; he said he'd make certain that is the case. CHAIR DYSON indicated his desire to ensure that witnesses be able to testify who would be unable to testify on February 14. REPRESENTATIVE STEVENS expressed concern about the salary levels; he indicated this can be misleading. Many teachers do not earn $44,000; when benefits are added, however, the result far exceeds $44,000. He asked whether many professional or fully employed people use [Denali KidCare]. Number 0676 COMMISSIONER LIVEY observed that many families with incomes between the 150 percent and 200 percent poverty levels are working families. Generally, these are families who do not have an option to purchase health care through their employer. REPRESENTATIVE STEVENS noted that he was specifically interested in discovering whether families with insurance were seeking coverage. "Are there a lot of teachers in your program?" he queried. MR. LABBE stated that he wouldn't necessarily know. He offered his impression that most of the people [using Denali KidCare] are self-employed, such as people in the building trades. Some may qualify on the income level, but they typically have coverage through the district, the state, or some other entity. Number 0520 KATHLEEN FITZGERALD, Key Coalition of Alaska, testified via teleconference in opposition to HB 367. She stated that Denali KidCare is an important piece of health care for Alaskan families. She stated that the coalition believes Denali KidCare promotes the best outcomes for children; when they are healthy, they can learn. Pregnant women who receive prenatal care are less likely to deliver children with health care problems or disabilities. She added that the coalition believes that families with children with disabilities [between the 150 percent and] 200 percent range have a difficult time due to increased costs associated with raising a child with disabilities. The coalition supports the 200 percent level for this reason, she indicated. Number 0412 MS. FITZGERALD added, "We also think that it's just good business to provide that coverage; even though it costs us 5 million in Medicaid dollars, what it saves us in the federal dollars and provides for the medical community and for healthy families is really important to us." She concluded, saying that the Key Coalition is strongly opposed to reducing the income level for Denali KidCare. Number 0348 MS. FITZGERALD read a letter from someone unable to attend the hearing, as follows: I am a single parent with four children, three still at home. I work full-time and attend the University of Alaska half-time in order to secure a future for my children and myself. Even with full-time employment, I still struggle financially and need some temporary support until I have completed my education. Denali KidCare ... has been a wonderful benefit for our family. I no longer have to decide if they can make it until Monday because I can't afford to take them to the doctor, gambling on their health over money. It has made access to medical treatment by reducing the financial burden that is ... often expected at the time of treatment. My children no longer have to ask, "Can we afford glasses or medicine?" Denali KidCare has decreased the stress level in our home by affording access to needed medical care for my children. CHAIR DYSON announced that witnesses may send written testimony, which would be distributed to members. Number 0250 THOMAS CONLEY, Pediatrician; Member, Sitka Borough School District School Board, testified via teleconference and thanked members for the opportunity to testify. He offered that he has been in practice in Alaska for 27 years. He characterized patients as falling into three [medical-coverage] classes: patients who are poor and covered by Medicaid; patients who have considerable resources or insurance and can afford self-care; and patients such as fishermen, small business owners, and entrepreneurs who do not have access to insurance and must obtain care on a "self-pay" basis. Dr. Conley stated that this latter group of people is the group "left behind" in terms of medical care. These patients would frequently wait until a [health concern] was severe before seeking treatment; they skimped on prenatal care and child [health] care. He suggested that the price to this population to secure care was frequently quite high; this was often eventually paid by the state. Number 0148 DR. CONLEY offered that should these people be dropped from coverage, the state would wind up paying considerably more down the road. He added that he serves on the school board in Sitka; as a member, he observes that problems not addressed early in life frequently become problems for the school system. He concluded by expressing his opinion that the program should continue as it is; it is covering something that needs to be covered. CHAIR DYSON reminded participants that there has been no talk of discontinuing the program. TAPE 02-9, SIDE A Number 0043 MEG MITCHELL testified via teleconference in support of retaining Denali KidCare [eligibility] at the current level. She clarified that she is not a parent; therefore, this is not a program from which she can benefit. She stated that she has worked with families administering a child-care-assistance program in Homer; in this role, she was able to tell parents about this "incredible program" that the state offered. She indicated the best impact of the program is that it helps working families. She mentioned that the Denali KidCare motto is insuring Alaska's children and our future; she urged members to pay attention to the need for providing children with health care insurance. Number 0127 MS. MITCHELL offered her belief, based on the state's current economy, that there is no reasonable option for obtaining health care coverage for one's children. Alaska does not have many jobs that offer such coverage, she said. There is nothing else for parents to do if they are not fortunate enough to have a job that does so. "This is the program that is benefiting our working families, and I would really like to see the state continue to support ... the working families," she said. She noted that the economy is "not looking good," and that it isn't easy for families to meet all its needs in Alaska. She indicated Alaska's [poverty rate] is set higher than the rest of the nation due to the high cost of living. She urged members to not change the current Denali KidCare program. Number 0200 DANA LEE HALL, R.Ph., Village Operations Administrator, Yukon- Kuskokwim Health Corporation (YKHC), testified via teleconference, noting that the village operations program includes the health aide program, home care worker program, and an advanced-training program. She explained that [YKHC] began its well-child program in the Yukon-Kuskokwim (Y-K) Delta; health aides were trained to provide services such as EPSDT [Early and Periodic Screening, Diagnosis, and Treatment] well- child exams in villages. The mission at YKHC is to ensure that health care is delivered as close as possible to people's homes, she said; Denali KidCare has allowed them to do so. She noted that another priority of YKHC is to enroll all pregnant women in Medicaid in order for them to receive appropriate care. Number 0328 MS. HALL offered that many village residents qualify for Medicaid, but many other residents have low-paying jobs without insurance. These low-paid residents are not teachers. They may work for the village corporations or the tribal councils, or they may work as ancillary staff in the school. She pointed out that [YKHC] is witnessing increased Medicaid enrollment under the Denali KidCare program; this includes a 4-to-5 percent increase over the past year. MS. HALL said the lack of adequate prenatal care is [YKHC's] most serious concern, however. She offered that prenatal care is the single most cost-effective health care expenditure and ensures the best outcomes for babies. Denali KidCare was created to meet the needs of uninsured children and pregnant women with incomes too great for traditional Medicaid eligibility and too low to obtain insurance or pay directly for health care, she reported. The cost of delivering care in the Bush is "astronomical", she noted. A trip from Kotlik to Bethel to obtain care is $400 a person. Although she offered her understanding of the state's financial situation, she said providing preventative services for children and pregnant women is money well spent. She urged that Denali KidCare income requirements remain unchanged. Number 0453 REPRESENTATIVE STEVENS asked for clarification about the 100 percent federal health care coverage for Native children. He also asked whether this proposed reduction would affect only non-Native children. Number 0486 COMMISSIONER LIVEY replied that IHS beneficiaries who are Medicaid-eligible can sign up for Medicaid. The state pays the Medicaid bill and is fully reimbursed by the federal government. REPRESENTATIVE STEVENS expressed his understanding that all [Native] children would continue to be fully covered by the federal government; only non-Native children would fall under the provision [in HB 367], should it pass. COMMISSIONER LIVEY replied that this is true in 98 percent of the cases. Number 0550 JIM KOHLER, Tanana Chiefs Conference (TCC), testified via teleconference in opposition to the proposed change to the Denali KidCare program. He said, "We believe that the 200 percent of poverty is an accurate level of poverty of patients who can afford insurance." He noted that should this go into effect, 20 to 30 percent of TCC beneficiaries would be cut off of Denali KidCare. In addition, he said, "We would also lose the federal funding for this program, [because] it's our understanding that if [an] Alaska Native is served under Denali KidCare, 100 percent of the money comes from the federal government and not the state. We believe this to be a good investment of the federal funds for Alaska Natives." CHAIR DYSON queried, "Would you say that you're serving a lot of folks who don't qualify as Natives?" MR. KOHLER replied, "No. Tanana Chiefs just sees Alaska Natives." CHAIR DYSON expressed his understanding that all Alaska Natives would be fully qualified [under IHS]. Number 0624 DIANE CLARK, Group Home Daycare, testified via teleconference, noting that she is representing herself, a single parent with two children, as well as Group Home Daycare. She stated that she does not support HB 367, and that she is thankful she has Denali KidCare for her children for preventative care. She offered that the program has been beneficial to her children. As a daycare provider, she is witness to the needs of parents for health care [for their children]. The cost of health care is rising, she explained; it has doubled in her area. She indicated that if HB 367 passes, health care expenses that parents are unable to pay will be borne by the state; if the state is unable to pay, the federal government pays. She characterized this as a vicious cycle. MS. CLARK added that lower self-esteem and a higher crime rate would result from the bill's passage. Denali KidCare coverage now provides a greater chance for families to receive well-child care and to detect health problems early on. She noted that a higher self-esteem is the result of greater stability [provided by Denali KidCare coverage]. She thanked members for their time and expressed her hope that this bill would not pass. Number 0760 TRUDY ANDERSON, Consumer Awareness Manager, Alaska Native Health Board, testified via teleconference. She explained that the Alaska Native Health Board is a statewide nonprofit corporation established more than 30 years ago to promote spiritual, physical, mental, social, and cultural well-being and pride of Alaska Native people. The board of directors represents regional and village health providers from across the state. In most cases, she noted, these organizations are the only health care providers for their region, serving both Native and non- Native patients who would otherwise have virtually no access to health care services. She emphasized that the CHIP funds are 100 percent reimbursed by the federal government for Alaska Natives and IHS beneficiaries who use Denali KidCare and Medicaid. She said, "We are opposing HB 367 and urge the legislature not to pass this bill." Number 0859 GAY WELLMAN, Copper River Native Association, testified via teleconference and explained that she wished to speak on behalf of the association as well as herself. She stated that the Copper River Native Association provides services to both Native and non-Native residents. One service it provides is for treatment for Fetal Alcohol Syndrome (FAS); Denali KidCare is an integral part of enabling the association to provide that FAS service. Denali KidCare assists in paying the out-of-state doctor for diagnosis and services. She stated that this service would be difficult to provide, were HB 367 to pass. MS. WELLMAN explained that several years ago, she and her husband were earning more than the $44,000 [eligibility] limit; her husband was working in the private [sector] and she for the federal government. She reported that they had difficulty finding coverage for their children; she was unable to afford coverage through her job for more than herself. Although they found a policy that was initially affordable, rates were raised within several months' time and continued to rise. Eventually, her family was unable to afford this policy, she said. Number 0945 MS. WELLMAN summarized by stating that the insurance that is available for families is really not affordable. Often these companies do not pay what they should when a claim is filed, she said. She indicated that her family was reimbursed $200 for a $3,000 medical bill for one of their children. She said, "I hope that you will keep it the way it is; it would certainly help us out here greatly." Number 0978 COMMISSIONER LIVEY asked department personnel to assist him in responding. NANCY WELLER; Unit Manager; State, Federal, and Tribal Relations; Division of Medical Assistance; Department of Health and Social Services, clarified that if the income level [for program eligibility] is lowered, it would affect all children of all races. She said, "Medicaid would not be getting the hundred percent pass-through funds for Native children because they would no longer be covered at that income level." CHAIR DYSON queried whether there wasn't other medical care available for Native Alaskan children. MS. WELLER replied that Native health coverage is funded directly through Indian Health Service funds at approximately 60 percent of the need. This funding level is documented in many studies, Ms. Weller said. She stated that the U.S. Congress had allowed [IHS] to bill Medicaid for services to assist [IHS] in covering the cost of health care for beneficiaries. CHAIR DYSON asked for further clarification [in the future]. He expressed his understanding that children who would not qualify under Denali KidCare would still qualify to have 60 percent of their medical bills paid by IHS. MS. WELLER responded that the IHS system is funded for 60 percent of the need of Alaska Native people. CHAIR DYSON queried, "Does 60 percent of the need ... not mean paying 60 percent of the bills?" COMMISSIONER LIVEY noted that it probably means that the health corporations do not have enough money to pay for all of the medical services for their beneficiaries. Therefore, the corporations have to choose what is covered and what is not covered. He explained that 60 percent of the need is covered by the federal government; 40 percent is not covered. Whether or not a corporation would choose to cover prenatal care or children is up to the corporation. Number 1102 CHAIR DYSON said, "So we're talking about 60 percent of the aggregate need, not of a particular individual." [He received confirmation from both Commissioner Livey and Ms. Weller that this is correct.] REPRESENTATIVE COGHILL referenced a study indicating $63 million comes directly to Alaska through IHS. He said, "So there is money going to health care in Alaska." He indicated [HB 367] would not destroy that; it still allows 60 percent to be [covered]. He expressed his opinion that this should be debated in the House Finance Standing Committee. CHAIR DYSON announced that HB 367 would again be heard by the committee on February 14. [HB 367 was held over.]
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