Legislature(2007 - 2008)CAPITOL 106
03/15/2007 03:00 PM House HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB159 | |
| HB2 | |
| HB140 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 159 | TELECONFERENCED | |
| *+ | HB 2 | TELECONFERENCED | |
| *+ | HB 140 | TELECONFERENCED | |
HB 140-MEDICAL ASSISTANCE ELIGIBILITY CHAIR WILSON announced that the final order of business would be HOUSE BILL NO. 140, "An Act expanding medical assistance coverage for eligible children and pregnant women; relating to cost sharing for certain recipients of medical assistance; and providing for an effective date." 4:13:18 PM REPRESENTATIVE LES GARA, Alaska State Legislature, speaking as the sponsor, informed the committee that the goal of the bill is to ensure that every child in the state has health insurance. He said HB 140 will provide health care to children whose parents work, but who do not have health insurance. Representative Gara opined that this issue finds common ground with his fellow legislators. This legislation follows what six other states have done, and that is to expand coverage to families that earn up to 200 percent of the federal poverty guideline. He noted that only two other states provide health coverage to residents at a lower level than Alaska. In addition, HB 140 leverages federal funding and will only cost approximately $6 million to extend available health care coverage to every child in the state. Representative Gara warned that, without improvements, Denali Kid Care will lose federal eligibility under the federal Children's Health Insurance Program (CHIP). The CHIP program requires that states extend insurance coverage to those living at 150 percent of the poverty level and, due to Alaska's fixed income level established in 2003, inflation continues to reduce the percentage. In Alaska, the poverty level is currently at 156 percent, and is expected to lower to 150 percent in the next one to two years. 4:16:04 PM REPRESENTATIVE GARA explained the coverage of Denali Kid Care, and noted that 500 children have been deemed ineligible based on the poverty level changes due to inflation. Representative Gara relayed that the cost of uninsured patients in Anchorage hospitals is $90 million per year. This loss is only recovered by transferring higher costs to other consumers. In Alaska, 18,000 children are uninsured and about one-half of them are in families that earn 200 percent of the poverty level. In addition, one-third of uninsured children do not receive routine medical care. Over the last decade, Alaska has seen a 31 percent decline in the number of children covered by private health insurance. HB 140, along with 70 percent federal funding though Denali Kid Care, will provide free health insurance to children whose families are living at 200 percent of the poverty level. Above the 200 percent poverty level, families can buy insurance through Denali Kid Care for a sliding fee. He noted that the committee may want to review the terms of the 20 percent copayment written in the bill. Pregnant woman are covered by free coverage at the 200 percent of the poverty level. 4:21:18 PM REPRESENTATIVE GARA emphasized that this is the most efficient method that can be devised to include every child in the state. The program is funded by a plan that must be qualified by the federal government. If approved, the federal program will pay 70 percent of the cost through CHIP. If federal approval is not secured, Medicaid will pay 57 percent under the federal authorization that covers Denali Kid Care. The rates are adjustable and also need to be approved by the federal government. Representative Gara concluded by saying that HB 140 provides a universal health plan for a reasonable price and provides prevention against higher cost long-term medical costs. 4:24:15 PM REPRESENTATIVE ROSES referred to page 3, line 28, CSHB 140, Version K, and asked for clarification of the percentages of federal poverty levels. REPRESENTATIVE GARA responded that the bill refers to the Alaska poverty level which, given the Cost of Living Allowance (COLA), is higher. REPRESENTATIVE ROSES remarked: ... so, adding, the federal poverty guidelines for Alaska, as opposed to the official poverty line, then goes to that 135 percent, and then on top of that, 250 percent. So, we're no longer talking about 250 percent of the federal level, we're talking about 250 percent of the Alaska level, which equals 337.5 percent of the federal level. So, that's substantially different than 250 percent. REPRESENTATIVE GARA affirmed that he was speaking of the Alaska poverty level, set by the department, which is higher than levels set outside of the state. 4:26:26 PM REPRESENTATIVE NEUMAN asked whether there is a $500 deductible for copayments. REPRESENTATIVE GARA replied that there is no deductible level in this bill. He added that a family required by its income level to make copayments, will already be paying more than the state's contribution. Therefore, there is no need to require a deductible. REPRESENTATIVE NEUMAN further asked how qualifying household income is verified. REPRESENTATIVE GARA explained that the federal government provides income guidelines. For example, for a family of two, the poverty limit in Alaska is an income of approximately $17,000. 4:28:20 PM REPRESENTATIVE NEUMAN repeated his question regarding the verification of household income. REPRESENTATIVE GARA opined that the declaration of income could require an under-oath statement with penalties for fraud, similar to what is required on the Alaska Permanent Fund Dividend application form. 4:30:26 PM REPRESENTATIVE ROSES observed that the bill is inconsistent and uses the multiplier of income levels by the federal poverty guidelines in some sections, and by the Alaska poverty guidelines in other sections. In addition, he remarked Have you done a comparison, not for school districts or public employees where, quite often, the family is covered under the same plan, ... but go to some of the private companies where they cover the [employee] only and then they have to pay extra for the family members. Have you compared the cost of what a person is paying to cover their children there, as opposed to what would they pay if they had to cover two children here. We may be setting ourselves up for a scenario where people that currently have their kids covered ... they're going to cancel their insurance there and come to the one that the state has, just simply ... to save money. REPRESENTATIVE GARA clarified that the federal poverty guideline for Alaska is to be used throughout the bill. He added that his research did not check on the cost of adding a child to an employer plan; however, a private insurance plan to cover a child can cost between $3,000 and $5,000 per year. The benefit of having Medicaid coverage is that the larger pool of participants brings down the cost. Representative Gara assured the committee that the intent of the bill is not for residents to cancel a work health care plan and enroll in the state program to save money. In fact, a provision in the bill requires that the enrollee certify that they do not have insurance coverage available through their employer. He pointed out that at the higher income levels, there is no cost to the state, anyway. REPRESENTATIVE ROSES asked whether an applicant would not be eligible if employer insurance coverage is available or is in force. REPRESENTATIVE GARA replied that the wording of the bill will eliminate applicants who have an available work plan. 4:33:28 PM REPRESENTATIVE GARA verified that a family of two with an income of approximately $40,000 per year may have a health care plan costing $5,000 per year. 4:34:26 PM REPRESENTATIVE ROSES asked whether HB 140 can help a family that can not afford coverage through the employer if the family is exempted from this program. REPRESENTATIVE GARA stated that the exemption applies only when a family income is over 200 percent of the poverty level. He suggested that the exemption could be limited by including a maximum amount for the cost of insuring a child. 4:35:25 PM REPRESENTATIVE NEUMAN recalled the pending overhaul of the state health program and asked whether HB 140 will have an effect on the changes to the department. REPRESENTATIVE GARA said that this plan is contingent on receiving federal approval, and the federal government must also reauthorize the state CHIP program. 4:36:22 PM CHAIR WILSON opened public testimony. 4:37:18 PM BRENDA MOORE, member, Alaska Mental Health Board, and chair, Alaska's Covering Kid's Coalition, provided statistics from the Robert Wood Johnson report regarding the current population surveys and annual social and economic supplement. She informed the committee that the 200 percent of federal poverty level is the federal definition for low income, and allows families to provide basic needs. For a three year average, the report indicates that 11,000 children, aged 0 to 18 years, are living with families below 200 percent of federal poverty level and are uninsured. The number of children not in poverty, but without health insurance, is 2,500. Ms. Moore concluded by saying that the cost of uninsured children is borne by everyone. JODY BUTTO, M.D., President, Alaska Chapter of the American Academy of Pediatrics, stated her support for HB 140. Research done by her organization determined that many working parents do not have access to health insurance because it is not offered by their employers. Dr. Butto said that children who are not seen by a doctor on a routine basis need preventative care to prevent visits to the emergency room and learning disabilities due to untreated medical conditions. 4:42:18 PM MONICA GROSS, M.D., Fellow, American Academy of Pediatrics, stated her support for HB 140. Dr. Gross said that when children have health insurance, medical care is shifted from crisis oriented care to well child and preventative care. The result has positive ramifications for children's, family and community health. She read from a prepared statement [original punctuation provided]: When families don't have medical insurance, kids are brought to the doctor when they are very sick and parents are scared. Doctors respond in emergency mode - tests are ordered, drugs are prescribed and parents admonished for "waiting too long." When kids have medical insurance they are brought in for well child checkups and preventative care. The whole medical model shifts. Parents and doctors are a team working together to keep children healthy and prevent disease. Parents are empowered, and the important job they are doing is validated. Time is available to answer questions and counsel about age appropriate health promotion and illness prevention. This exchange sets the stage for families where children can develop and grow and become productive and healthy members of their community. Please support House Bill 140. 4:43:51 PM REPRESENTATIVE SEATON asked whether Dr. Gross has experienced a higher level of missed appointments by patients who are not required to make a copayment for their care. DR. GROSS agreed that some families may abuse the system. 4:44:54 PM REPRESENTATIVE SEATON then asked whether a copayment should be required for a missed appointment. DR. GROSS opined that a copayment could cause families to feel more responsible. 4:45:24 PM CHAIR WILSON asked whether preventative care is worth the state's expense. DR. GROSS replied that the opportunity to help support patients and give well child care is an investment in their future health. Also, if an emergency comes in, and there is no history with a child and his/her family, tests may be done that would not be necessary if they have been seen regularly. She stressed that there will be a decrease in costs over the long term. Routine well child care also empowers families who can visit the doctor under comfortable circumstances. Every parent is helped by that interaction. 4:49:17 PM KARLEEN JACKSON, Commissioner, Department of Health & Social Services, expressed her hope that the fixed poverty level, currently in statute, will be changed to a percentage level set out in HB 140. The legislature will then have the responsibility to determine what the percentage should be. She pointed out that her department has attached fiscal notes to address the issue of how the bill is constructed. REPRESENTATIVE ROSES relayed that his personal insurance does not cover well baby care, prevention, or check ups of any kind. He asked whether Denali Kid Care provides well baby check ups. COMMISSIONER JACKSON answered that this program provides periodic, regular, preventive check ups for children. 4:51:27 PM REPRESENTATIVE NEUMAN said: This bill asks for federal poverty level to rise between 200 and 350 percent, a percentage ... of the poverty level, but your main concern is making sure it stays above 150 percent, so you don't lose that federal contribution. COMMISSIONER JACKSON said yes. REPRESENTATIVE NEUMAN asked: ... right now the state's major concern is making sure we stay there. What steps have you taken ... to ensure that we stay above that 150 percent? COMMISSIONER JACKSON replied: We're here testifying to you and to others that have other bills, that we really need to have this freeze lifted. There's also the issue of the re- authorization of the [state] CHIP program and we've spoken to that in the past, in terms of working with the congressional delegation, and the National Governors Association, to make that happen. ... The bottom line answer is that we need a bill that will do that. 4:52:46 PM REPRESENTATIVE NEUMAN inquired whether Commissioner Jackson has asked, through the administration, for a bill to lift the freeze. COMMISSIONER JACKSON responded that her expectation is that the bills currently offered will be successful. 4:53:18 PM REPRESENTATIVE ROSES remarked: So, when you talk about the 150 percent of the poverty level ... you are talking about the federal and not the state, not 150 percent of the state's level, it's already adjusted by an additional 35 percent. Is that correct? 4:53:38 PM JANET CLARKE, Assistant Commissioner, Central Office, Finance and Management Services, Department of Health & Social Services, informed the committee that there is one federal poverty level for Alaska. The Alaska level has a 25 percent COLA added. In fact, Alaska and Hawaii have poverty levels of 25 percent above the national level. She opined that the language contained in the bill is the correct language. 4:54:21 PM REPRESENTATIVE ROSES concluded that the department's assumption, when reading the bill, would be the Alaska adjusted poverty level. 4:55:07 PM REPRESENTATIVE SEATON recalled that this bill allows copayments, and asked whether copayments are disallowed by federal law. 4:55:52 PM JERRY FULLER, Project Director, Office of Program Review, Office of the Commissioner, Department of Health & Social Services, advised the committee that in federal law and Medicaid copayments are restricted to $2 or $3 for residents under the 150 percent poverty level. For higher poverty levels, copayments and premiums combined can be no more than five percent of the annual income. 4:56:35 PM JON SHERWOOD, Medical Assistant, Office of Program Review, Office of the Commissioner, Department of Health & Social Services, agreed. 4:56:55 PM CHAIR WILSON asked whether the value of requiring copayments will outweigh the additional administration cost. MR. FULLER replied that premiums are easy to administer, but copayments are problematic in that they are paid directly to the provider, are restricted by law, and only apply to certain services. CHAIR WILSON further asked whether the charges will be cost effective. MR. FULLER asked for time to investigate the answer to her question. 4:58:55 PM REPRESENTATIVE GARDNER stated her support for requiring copayments if there is an effective method of collection. 4:59:29 PM CHAIR WILSON requested that Mr. Fuller provide information to the committee regarding the cost of the collection of copayments. 4:59:45 PM REPRESENTATIVE SEATON also requested an analysis of page 6, line 21, (d), to determine whether the copayment required in the bill is acceptable under federal law. 5:00:11 PM CHAIR WILSON announced that HB 140 would be held over with public testimony open.
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