Legislature(1999 - 2000)

02/08/2000 03:38 PM House HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
HB 260 - MEDICAL ASSISTANCE PROGRAM COVERAGE                                                                                    
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 0165                                                                                                                     
REPRESENTATIVE COGHILL, sponsor, stated that his intention on HB
260 is purely to bring up the debate about how far the state wants                                                              
to go on government health care.  The people who run the Denali                                                                 
KidCare (DKC) program have done a wonderful job of implementing it.                                                             
His argument is not with the Denali KidCare program.  He has                                                                    
received a fair amount of phone calls, fax and e-mails.  In                                                                     
amending AS 47.07.020, HB 260 takes care of some housekeeping items                                                             
in the language.  The main portion of the bill is on page 4, lines                                                              
5, 9 and 13 where he suggests the poverty level be reduced from 200                                                             
percent to 100 percent.                                                                                                         
Number 0375                                                                                                                     
REPRESENTATIVE COGHILL made a motion to adopt Amendment 1 which                                                                 
would change the poverty level to 133 percent on page 4, lines 5,                                                               
9 and 13.                                                                                                                       
Number 0409                                                                                                                     
REPRESENTATIVE BRICE objected for purposes of debate.                                                                           
REPRESENTATIVE BRICE stated that he was pleased to see                                                                          
Representative Coghill willing to bring the number up to 133                                                                    
percent given the fact that is the federal minimum.  The state                                                                  
really has no ability to go below the federal minimum without once                                                              
again flying in the face of the Medicaid program.  He clarified                                                                 
that the 100 percent level would not be acceptable to the federal                                                               
government and simply returning it back to the 133 percent level,                                                               
which is where it was before, brings it back into compliance with                                                               
the basic Medicaid rate.  He asked for a response on that from the                                                              
Department of Health and Social Services.                                                                                       
Number 0498                                                                                                                     
KAREN PERDUE, Commissioner, Department of Health & Social Services,                                                             
came forward to respond.  She said Representative Brice was correct                                                             
in the point he raised.  She indicated that the bill was confusing                                                              
the way it was drafted because to participate in the $400 million                                                               
federal Medicaid program, they would have to provide care to                                                                    
pregnant women and certain children up to 133 percent so the                                                                    
amendment simply clarifies that it is in compliance with the                                                                    
federal Medicaid program, therefore making sure the state doesn't                                                               
lose $400 million.  However, the department already thought the                                                                 
bill said that.  The affect of the amendment is simply                                                                          
REPRESENTATIVE BRICE withdrew his objection.                                                                                    
Number 0565                                                                                                                     
CHAIRMAN DYSON asked if there was any further objection.  There                                                                 
being none, Amendment 1 was adopted.                                                                                            
REPRESENTATIVE COGHILL reiterated that his reason for introducing                                                               
this is to raise the debate on how far the state wants to go in                                                                 
health care.  He understands there was going to be a major cost to                                                              
go under 133 percent.  That is a good place to stop and say "Do we                                                              
want to go any further."  There is a demonstrated savings, but that                                                             
is really not his argument as trying to find more money.  He is not                                                             
trying to fly in the face of many people in Alaska who have now                                                                 
signed up for this health care.  It is true that it is an                                                                       
expansion, and he was not involved in the debate two years ago.  He                                                             
felt strongly when it came up, and he doesn't believe the state                                                                 
wants to go in this direction.  He knows there are a lot of people                                                              
who will testify that they have legitimate needs and the DKC                                                                    
program has supplied some of that need.  He will not argue the fact                                                             
that it has supplied the need.  He will argue the philosophy on                                                                 
whether the state should even supply the need.  One alternative was                                                             
presented earlier today [The Alaska State Health Care Access                                                                    
Committee Resolution Proposal], and it is worthy of some                                                                        
consideration.  "Instead of going into a dependency on government                                                               
we need to start paying our way.  There just has to be a better                                                                 
Number 0739                                                                                                                     
REPRESENTATIVE BRICE appreciates the fact that Representative                                                                   
Coghill supports the concept of the socialized medicine access to                                                               
health care that was presented earlier.  If that were the case in                                                               
this state and every person had access to health care, then this                                                                
bill would be okay.  In terms of the philosophy, he asked if it is                                                              
too far to provide people who are difficult to insure access to a                                                               
health care pool or too far by providing state employees with                                                                   
health care.  The state is self-insured, and it is a socialized                                                                 
program.  He asked if they are going too far providing the                                                                      
legislature access to health care.                                                                                              
Number 0843                                                                                                                     
PAMELA GUY came forward to testify.  She is deaf and a single                                                                   
parent.  She expressed concern because she is enrolled in the                                                                   
program and if it is eliminated, she will be sunk.  She worries                                                                 
about possibly losing her home if she had to pay for insurance.                                                                 
She works 50 to 60 hours a week, and she has health insurance from                                                              
her employer, but her two boys do not.  She would like to keep                                                                  
Denali KidCare for her two boys because she doesn't know how she                                                                
could afford other insurance for them.                                                                                          
RENA SIMS came forward to orally interpret for Ms. Guy and added                                                                
that she is a foster mom for six children.  She has children from                                                               
ages 19 to 22 who have four babies with severe problems like half                                                               
a brain, blind, deaf or paralyzed, and they need the Denali KidCare                                                             
program.  The young parents work, go to school and are covered by                                                               
Medicaid, but the babies are not covered in some instances.  It                                                                 
would be a hardship for these young adults.  There has to be a way                                                              
to bridge over so they can make it.                                                                                             
Number 1073                                                                                                                     
DOROTHY ARENSMAN, Superintendent, Southeast Island School District,                                                             
testified from Thorne Bay via teleconference.  She asked why anyone                                                             
would deny children who needed health care.  As a school                                                                        
superintendent with more than 30 years of dedicated service, she                                                                
was excited for the children who are needy when Denali KidCare                                                                  
became available last spring.  Southeast Island School District                                                                 
volunteered to distribute information and assist parents in                                                                     
completing the necessary paperwork.  Since that time more than 175                                                              
children from Prince of Wales and surrounding islands have applied                                                              
for Denali KidCare.  With the State of Alaska paying only 28 cents                                                              
for each dollar that is going to fund the health insurance for                                                                  
children and the other 72 cents that is spent is federal funds, she                                                             
asked why they are reducing health care for children.  The                                                                      
elimination of Denali KidCare would result in a great loss of                                                                   
federal funds for health care for Alaskan children.                                                                             
MS. ARENSMAN noted healthy Alaskan children result in savings.  As                                                              
a long-term special educator, she has helped parents seek funding                                                               
for their disabled children.  Too often the expense of educating                                                                
special needs children could have been reduced if health care                                                                   
coverage had allowed them the services of well-baby, well-child                                                                 
care, adequate immunizations and early identification of care and                                                               
problems through early detection.  Many disabilities can be reduced                                                             
through prenatal care of pregnant women.  To reduce Denali KidCare                                                              
is to increase special education dollars necessary to educate the                                                               
special needs children and to increase the dollars for supporting                                                               
them throughout their lives.  It is her hope that Denali KidCare                                                                
continues with its current success.                                                                                             
Number 1168                                                                                                                     
NICKI SHELTON, Parents and Teachers of Hoonah, testified via                                                                    
teleconference from Hoonah.  The Parent and Teachers of Hoonah are                                                              
the Denali KidCare grantee that provides services in enrolling and                                                              
assisting eligible families in Hoonah.  She strongly urged the                                                                  
committee not to pass HB 260.  Alaskan children's health depends                                                                
upon their health insurance coverage.  Denali KidCare has often                                                                 
been the primary factor that determines if children receive health                                                              
care in Hoonah.  There are many families in Hoonah either                                                                       
under-employed with seasonal or part-time jobs and neither carry                                                                
health benefits.  There are also some families being helped trying                                                              
to move off Medicaid, but their children's health care is still a                                                               
prime concern, and it is a consideration in making the change.                                                                  
Before Denali KidCare in March 1999, those families without                                                                     
insurance could simply not get health care even though they were                                                                
working.  It is not affordable from Hoonah.                                                                                     
MS. SHELTON said her group has helped pregnant women apply for                                                                  
Denali KidCare and three of those mothers had no previous prenatal                                                              
care before they enrolled in Denali KidCare.  The $472 per year of                                                              
state funds that Denali KidCare paid to cover each of those babies                                                              
is money well spent to ensure that those babies will be healthy at                                                              
birth.  She speculated that without Denali KidCare, the cost and                                                                
inconvenience of going to Juneau for prenatal care, it is very                                                                  
likely those babies would have been born without any health care at                                                             
all.  Losing Denali KidCare and the federal dollars that will go                                                                
with it is not cost effective when compared to the increased costs                                                              
for children who are ill or developmentally delayed due to the                                                                  
absence of health care.                                                                                                         
MS. SHELTON summarized that they need to have Denali KidCare so                                                                 
that working parents who do not have health benefits and are on                                                                 
modest incomes can support and afford health care for their kids.                                                               
Alaska does not want to become the only state without a state child                                                             
insurance program or it'll be funding remediation in the future                                                                 
years.  She thanked the committee for supporting healthy Alaskan                                                                
Number 1297                                                                                                                     
JAMES CULLEY, Chief Executive Officer and Administrator, Valdez                                                                 
Community Hospital, testified via teleconference from Valdez.  He                                                               
expressed opposition to the amended version of HB 260.  The                                                                     
hospital very aggressively marketed Denali KidCare in Valdez.  They                                                             
made people aware at the hospital, the school system, at public                                                                 
health, Valdez Counseling Center and the medical clinic so eligible                                                             
individuals were able to utilize this program.  They were so                                                                    
successful that much of his knowledge on the success of Denali                                                                  
KidCare program is anecdotal rather than first hand.                                                                            
MR. CULLEY indicated there aren't as many sick children being seen                                                              
in the emergency room as in the past.  For many individuals who                                                                 
can't afford health care, the emergency room serves as their                                                                    
medical clinic.  But now these children are being seen at the                                                                   
dentist office, the medical clinic and the optometrist.  This                                                                   
translates into increased school attendance and better course work                                                              
for children who were previously at risk.  Valdez Community                                                                     
Hospital sponsors a visiting optometrist to Valdez, and he has                                                                  
noticed an increase of the number of young children that are being                                                              
seen and getting glasses.  The optometrist has indicated to Mr.                                                                 
Culley that many of these children are in the Denali KidCare                                                                    
program and among this group, he has found several that were                                                                    
probably unable to read the blackboard and a number who undoubtedly                                                             
had difficulty.  Unfortunately it is difficult, if not impossible,                                                              
to determine the ultimate cost benefits of these students over the                                                              
course of their academic career and beyond.                                                                                     
MR. CULLEY also mentioned two pregnant women who were considered                                                                
high risk for obtaining prenatal care and eventually had uneventful                                                             
births and healthy babies that otherwise would have been extremely                                                              
expensive.  These expenses are not avoided, but they would have                                                                 
been borne by the hospital.  The good thing about Denali KidCare is                                                             
there is not another option for these monies other than health                                                                  
care.  They are not seeing Denali KidCare being used for                                                                        
catastrophic events, rather it is being used for wellness.  He                                                                  
cautioned it is much easier to show direct monies cut from a budget                                                             
than it is to show the costs that were avoided by the expenditure                                                               
of these same monies.  Denali KidCare is an investment in the                                                                   
future and the future of children in Alaska.                                                                                    
Number 1520                                                                                                                     
KELLIE TALBOT testified via teleconference from Bethel.  She                                                                    
stated:  "We all know or have children who are near and dear to our                                                             
hearts.  I would make the assumption that most of them are safely                                                               
insured, and we can go to bed every evening and not have to worry                                                               
about that.  What is the difference between your children and our                                                               
children here in the Delta.  If you cut Denali KidCare you deny                                                                 
health services to our children.  Health care is a right not a                                                                  
privilege.  If Denali KidCare is cut, programs that are attempting                                                              
to provide for better services will no longer exist.  Thank you."                                                               
Number 1573                                                                                                                     
MARY ANARUK, Vice President, Community Services, Yukon-Kuskokwim                                                                
Health Corporation (YKHC), testified via teleconference from                                                                    
Bethel.  She is in charge of the village based programs such as                                                                 
health aides, substance abuse counselors, home-care workers and so                                                              
forth.  A few years ago YKHC began to focus on a well-child program                                                             
because access to health care is a major problem for most of the                                                                
village residents.  The health aides, which are the primary                                                                     
providers in the village, receive special training which enable                                                                 
them to do all the examinations and immunizations needed for                                                                    
children.  One of the problems has always been enrollment and                                                                   
getting pregnant women to enroll on Medicaid in order to receive                                                                
appropriate care.  She admitted many of the village residents                                                                   
qualify for Medicaid, but there are also many residents who have                                                                
low paying jobs with their respective village corporations, school                                                              
districts or councils who do not qualify for Medicaid, and the                                                                  
Denali KidCare program has facilitated increased enrollment.                                                                    
MS. ANARUK mentioned another positive aspect has been the outreach                                                              
benefit derived from this program.  There has been an increased                                                                 
enrollment of 4 to 5 percent under Denali KidCare this past year                                                                
and those are not the final figures.  One of the more serious                                                                   
concerns in the region is a lack of adequate prenatal care.  She                                                                
agreed that prenatal care is the single, most cost-effective health                                                             
care expenditure, ensures the best birth outcomes of the baby and                                                               
is the best method of assuring a healthy start for the newborn.                                                                 
The people in the Yukon-Kuskokwim region have long wanted to bring                                                              
health care as close to where the people live, and Denali KidCare                                                               
has helped to reach more children and provide the preventative care                                                             
that is needed.  Considering the high statistics of domestic                                                                    
violence, suicide, child abuse and substance abuse in the region,                                                               
decreasing any program reaching out to the entire state and to the                                                              
children seems totally inappropriate.                                                                                           
Number 1675                                                                                                                     
LAURA BAEZ, Mental Health Clinician, Yukon-Kuskokwim Health                                                                     
Corporation, testified via teleconference from Bethel.  She stated                                                              
that many of the children in the villages would be without health                                                               
care if it wasn't for Denali KidCare.  This service is needed and                                                               
people are afraid it will increase the problems of high suicide                                                                 
rates and other mental health problems in the village if it is no                                                               
longer available.                                                                                                               
Number 1768                                                                                                                     
MARY MESSNER, Public Health Nurse, Children with Special Needs                                                                  
Program, North Slope Borough, testified via teleconference from                                                                 
Barrow.  She agrees with previous testimony on prenatal care and                                                                
prevention.  There are many children with neuro-disorders and have                                                              
great needs.  If the needs of these children are met early, they                                                                
can grow up to be productive people.  Some of these children need                                                               
highly specialized services which cost a lot.  It would be                                                                      
devastating to Barrow to cut the support for Denali KidCare in                                                                  
half.  This is a terrible idea.                                                                                                 
Number 1837                                                                                                                     
KIMBERLY MACK, North Slope Borough Counseling Services, testified                                                               
via teleconference from Barrow.  She has been without health                                                                    
insurance during times in her life but she was lucky that nothing                                                               
happened during that interim.  She hoped that luck wasn't the only                                                              
thing to rely on.                                                                                                               
Number 1882                                                                                                                     
ROBIN LUNETTA, Education Coordinator, Cordova Family Resource                                                                   
Center, testified via teleconference from Cordova.  She testified                                                               
to the importance of Denali KidCare in Cordova.  Cordova is                                                                     
comprised mostly of fishing families with little or no insurance                                                                
coverage, and this leaves many children and pregnant women without                                                              
means to pay for essential health, dental and prenatal care.  She                                                               
has assisted several families in applying for Denali KidCare that                                                               
were in desperate situations with nowhere else to turn.  These                                                                  
families either had past medical expenses with no means to pay them                                                             
or had upcoming unavoidable expenses due to pregnancy or ongoing                                                                
treatment.  Denali KidCare has also provided the families of                                                                    
Cordova with a consistent financial means to maintain good health                                                               
by staying current on vaccinations and checkups.  She is frustrated                                                             
that such an important and needed program has fallen victim to the                                                              
political arena.  This is not a republican or democratic issue; it                                                              
is a program greatly needed by Alaskans and its existence should                                                                
not be determined by what political party is in office.  If the                                                                 
Legislature is truly seeking to help Alaskans, it will vote to keep                                                             
this program, not eliminate it.  Please make the right decision for                                                             
Alaskans not for political affiliation.                                                                                         
Number 1953                                                                                                                     
PATRICIA BOILY testified via teleconference from Homer.  She                                                                    
objected to Representative Coghill's proposed changes to Denali                                                                 
KidCare.  In spite of what he claims, she finds him extremely mean                                                              
spirited.  In a state with 4.7 percent unemployment, she finds it                                                               
significant that over 27 percent of those who are employed are                                                                  
city, borough, state or federal government workers, virtually all                                                               
of whom have the best benefit packages imaginable.  She believes                                                                
the Legislators are included in the state benefits.  There is at                                                                
least another 19 percent of workers who are nonresidents.  Most of                                                              
those don't have their families in Alaska so that leaves about 49                                                               
percent of people employed in the private sector, many of whom have                                                             
either no insurance at all or inadequate insurance because it is                                                                
really hard for small businesses to find affordable health plans.                                                               
MS. BOILY pointed out that Denali KidCare program meets the needs                                                               
of middle income families that are struggling to make it.  There is                                                             
nothing like unforeseen medical bills to blow apart a budget and                                                                
send someone entirely into debt.  Without adequate health insurance                                                             
coverage, working families put off going to family doctors for                                                                  
preventive health care and/or less serious illnesses.  This puts                                                                
them at risk of ending up in the emergency room or hospital with                                                                
huge medical bills that can take months or years to pay.  This                                                                  
affects the doctors and the hospitals to render services they                                                                   
either don't get paid for at all, or they extend credit for so long                                                             
that it costs more to send out the bills than just to write off the                                                             
balances.  This is cost shifting of the most expensive kind.                                                                    
MS. BOILY noted that intervention can prevent more serious medical                                                              
conditions from developing.  The proposal to reduce the income                                                                  
qualifications to even 133 percent of the poverty level will                                                                    
eliminate a significant number of children and pregnant women from                                                              
the Denali KidCare program.  Representative Coghill claims it will                                                              
save the state Medicaid office up to $19 million eventually, but                                                                
she wondered how much of that savings will be shifted to the family                                                             
practitioners and the hospitals in Alaska who will absorb the                                                                   
unpaid outpatient and inpatient costs.  She found Representative                                                                
Coghill's insert of the Wall Street Journal referring to a Heritage                                                             
Foundation study to be offensive.  She hates to see him maintain                                                                
his conservative credentials on the back of those in the health                                                                 
care industry by victimizing the least powerful residents of the                                                                
state.  She believes it is the government's prime directive to                                                                  
supply the solution for people's health care needs, health,                                                                     
education and the well being of its citizens.  With the federal                                                                 
government contributing 72 percent of the cost, it is a bargain for                                                             
the State of Alaska to protect the health and welfare of its                                                                    
youngest citizens.  They deserve to be treated like the assets they                                                             
SCOTT WHEAT testified via teleconference from Homer.  He referred                                                               
to comments made by Representative Coghill and wondered if people                                                               
think that the poor are held in poverty by their own fault or by                                                                
their own choice and to what purpose.  It seems like most folks                                                                 
want a hand up and not a hand out.  The article from the Wall                                                                   
Street Journal talks about defining poverty and ownership of                                                                    
appliances seem to be some measurement of economic viability, and                                                               
he feels that is a specious argument.  He owns quite a few                                                                      
appliances that have come from garage sales, second, third and                                                                  
fourth hand, and some were free; that is not a good measurement.                                                                
The ownership of a car in most of Alaska is not an option but a                                                                 
requirement to get to any sort of appointments.                                                                                 
MR. WHEAT agreed that preventative health care proves to be cost                                                                
effective.  Prenatal and non-emergency room services and keeping                                                                
people out of jail and API [Alaska Psychiatric Institute] proves to                                                             
be cost effective.  He wondered what the private sector provides to                                                             
prime the pump of economic viability of our children and families.                                                              
At this point he doesn't believe that the private sector does very                                                              
much.  He acknowledges some donated dental and some pro bono work                                                               
by the doctors and lawyers, but he believes it is the government's                                                              
function to coordinate that sort of improvement in people's lives.                                                              
Denali KidCare is cost effective, and it would be a big mistake to                                                              
cut the program.                                                                                                                
Number 2156                                                                                                                     
GEORGE MARTIN testified via teleconference from Kenai and                                                                       
expressed his support for HB 260.  He stated it is time to make the                                                             
decision in Alaska whether to continue down the road to socialism                                                               
or to encourage independence while allowing for those with real                                                                 
needs.  He pointed out the misconception in much of the testimony                                                               
that HB 260 is about doing away with the Denali KidCare program,                                                                
and that is not the case.  It is talking about how rich someone                                                                 
needs to be before not qualifying for the program.  He admitted he                                                              
qualifies for this program but chooses to stand on his own feet and                                                             
provide for his family's need.  He could lower his pride and say it                                                             
is owed to him.  He doesn't choose to do that.  In September 1999                                                               
the people of Alaska spoke loudly and clearly that they wanted to                                                               
see a smaller, leaner government.  They don't want to lose their                                                                
permanent fund dividends (PFD), but they'd like to see government                                                               
cut the cost.                                                                                                                   
MR. MARTIN suggested this is a good example of one of the places                                                                
cutting can be done.  He believes those people in remote areas who                                                              
testified strongly against HB 260 voted a loud no to protect that                                                               
permanent fund dividend.  He commented that people could take that                                                              
PFD and spend it on health care.  That $1700 would have gone a long                                                             
way towards providing money for health insurance.  The Denali                                                                   
KidCare at 200 percent covers a lot of people that really are doing                                                             
quite well in their businesses and so forth.  He urged the passage                                                              
of HB 260.                                                                                                                      
Number 2248                                                                                                                     
TOMMY THOMPSON testified via teleconference from Kenai.  He spoke                                                               
in support of HB 260.  He commented many of the people who                                                                      
testified have a vested interest in being part of the program.  He                                                              
reminded people that no one is wanting to cut off medical care to                                                               
the poor, but presently this covers families well into the middle                                                               
class.  A family of four is eligible if they have an income of                                                                  
$43,000 which not a bad income.  This creates a dependency in                                                                   
people's minds on governmental handouts; not for folks who are                                                                  
really poverty stricken but for folks who spend their money                                                                     
someplace else.  According to an article in The Anchorage Daily                                                                 
News yesterday, one third of this money is going to psychiatric                                                                 
care.  If that figure is correct, it is a worrisome figure of what                                                              
is going on out there where this much of this money is going to                                                                 
psychiatric care when there are physical cares that need to be met.                                                             
Number 2325                                                                                                                     
SUSAN GIBSON testified via teleconference from Kenai.  She                                                                      
expressed support for HB 260 because the number of expanded                                                                     
taxpayer funded entitlement programs is literally breaking the back                                                             
of taxpayers.  Whether an entitlement program is funded either by                                                               
federal or state dollars, the result is the same.  The burgeoning                                                               
financial burden is borne on the backs of taxpayers.  She has never                                                             
heard any word of concern for the taxpayer who continually is                                                                   
turned to for a few more dollars out of every paycheck to support                                                               
the entitlement programs that only serve to promote a mind set on                                                               
the part of the entitlement recipients that it is someone else's                                                                
duty to carry their load.  She is someone else, and she has carried                                                             
the financial responsibility of raising two children as a single                                                                
parent on far less than $20,000 a year.  She was well below the                                                                 
poverty level rate during the whole time she raised her children,                                                               
but they did have excellent care.  She didn't avail herself of any                                                              
government entitlement, and therefore she raised two children who                                                               
are adults now and have an instilled sense of self responsibility.                                                              
That is a concept that certainly is not being fostered in people                                                                
anymore.  If this were a bill to eliminate Denali KidCare, she                                                                  
would not be in favor of that.  She has heard from a lot of people                                                              
who have a vested interest in job security by virtue of this                                                                    
entitlement program.  She pointed out the other side because the                                                                
taxpayers are just about at their breaking point.                                                                               
Number 2247                                                                                                                     
MARGARET WRIGHT, Public Health Nurse, testified via teleconference                                                              
from Kotzebue.  She reiterated that Denali KidCare is a program                                                                 
that takes advantage of incentives from the federal government to                                                               
leverage state funds to help a large number of working poor                                                                     
families in the state.  Denali KidCare offers poor working families                                                             
health care for their children when they are not insured through                                                                
their workplace.  The children of the state are the most important                                                              
resources and a worthy investment.  Healthy children today are more                                                             
likely to be healthy, productive adults who will contribute to the                                                              
state in meaningful ways over the decades of their lives.                                                                       
MS. WRIGHT sees children daily who receive well-child care and                                                                  
immunizations, as well as children with special needs who receive                                                               
treatment through Denali KidCare program.  Since the implementation                                                             
of Denali KidCare program, the list of eligible children has grown                                                              
significantly.  That means children who previously weren't getting                                                              
well-child care were putting off sick care and were not going to                                                                
the clinic for care just like other children who are insured.                                                                   
MS. WRIGHT noted many people believe that all Bush children are                                                                 
covered by IHS [Indian Health Services] so there is not a real need                                                             
for an insurance program for these people out in the Bush.  She                                                                 
agreed some children are IHS eligible but certainly not all of                                                                  
them.  In many parts of the state no child is IHS eligible.  Rural                                                              
children need this program as much or maybe more than their urban                                                               
cousins.  This is the only insurance available for Bush families.                                                               
When a child has a recurring ear infection or health care condition                                                             
like a cleft lip and palate, and the child is uninsured, often the                                                              
needed care is delayed or not received.  The care is not just a car                                                             
trip away for rural children.  The needed health care services are                                                              
a plane flight and hotel stay away at the very least.  Certainly                                                                
well-child checkups and immunization rates decline when children                                                                
are not insured.  If those same services can prevent much larger                                                                
problems in the future, then Denali KidCare is a long-term                                                                      
investment.  Certainly the children and working families deserve                                                                
more investment than a few months at a low cost insurance program.                                                              
Number 2123                                                                                                                     
MARCI SCHMIDT testified via teleconference from the                                                                             
Matanuska-Susitna (Mat-Su) Legislative Information Office (LIO).                                                                
She thanked Representative Coghill for his work on child protection                                                             
issues but disagreed with him on HB 260.  She will be losing her                                                                
health insurance soon because she can't afford $3500 per year for                                                               
her children, and the Denali KidCare program has been an avenue of                                                              
recourse in order to make sure her children are provided with                                                                   
adequate medical care.  She urged the committee to look elsewhere                                                               
for budget cuts.                                                                                                                
Number 2079                                                                                                                     
KELLI MAHONEY testified via teleconference from the Mat-Su LIO.                                                                 
She is a student at an adolescent drug treatment program, runs a                                                                
program for pregnant teens and is a parent of five children who are                                                             
not insured.  It would have cost her $4,800 a year to insure her                                                                
children with both parents were working.  At the Turnaround                                                                     
Treatment Center, she sees many clients in treatment now because                                                                
Denali KidCare provides for them.  Some of the therapy they receive                                                             
which ensures their successful completion of treatment is part of                                                               
what is paid for, about two-thirds of those kids receive that                                                                   
money.  They need to be in treatment at least three months or more                                                              
in her opinion for significant treatment outcomes to occur.  She                                                                
has up to 70 pregnant teens per year in her program.  Roughly                                                                   
four-fifths of those parents have to rely on Denali KidCare.                                                                    
MS. MAHONEY said she was never able to afford health care for her                                                               
children.  They turn to the state for solutions which is just why                                                               
Representative Coghill thinks the citizens of Alaska are looking to                                                             
the government for health care reform.  The difference between                                                                  
their points of view is in outcome.  If the desired outcome is to                                                               
keep government out of health care provision and save money, then                                                               
it is cut; if the desired outcome is to keep kids and pregnant                                                                  
women healthy and prevent further problems, then it is funded.  If                                                              
there is concern about Alaskans becoming dependent on Denali                                                                    
KidCare changes should be made in the insurance industry and that                                                               
will be a tough battle for government to undertake.  She urged the                                                              
committee not to limit the poverty level unless it goes to 150 or                                                               
185 percent and requires a small co-pay.  She asked how much hidden                                                             
cost is there in ignoring health care for a young child over time                                                               
and who will supply this need.  She doesn't want to live in a state                                                             
that doesn't want to provide health care for its working poor.                                                                  
Number 1994                                                                                                                     
JERI LANIER, Family Centered Services of Alaska, testified via                                                                  
teleconference from Fairbanks.  One of the things that got her                                                                  
attention was a quote in the newspaper that Representative Dyson                                                                
was concerned with the number of dollars being spent on mental                                                                  
health care through Denali KidCare.  She pointed out in private                                                                 
health insurance there is usually little or no mental health                                                                    
coverage unless the Legislature wants to take up HB 149.  The needs                                                             
are being identified at younger ages which would account for a lot                                                              
of it.  Early detection of SED [seriously emotionally disturbed]                                                                
kids or mentally ill children allows for intervention with a much                                                               
higher treatment success rate.  There is a difference between                                                                   
enabling a system and providing necessary services to children.                                                                 
Nobody is looking for a way to enable the state to save more and                                                                
more on taxpayers' backs or rake in the big bucks.  Health care                                                                 
doesn't get paid to the parents, it gets paid to the providers.                                                                 
Number 1919                                                                                                                     
ELAINE LANDON, Health Operations Administrator, Tanana Chiefs                                                                   
Conference Inc., testified via teleconference from Fairbanks.  The                                                              
Tanana Chiefs Conference is the primary health care provider for                                                                
Alaska Natives in the Interior, and they take strong opposition to                                                              
HB 260.  Eliminating Denali KidCare jeopardizes gains made in                                                                   
public health by reducing access to preventative services for the                                                               
working poor.  A few years ago there was a measles outbreak in                                                                  
Anchorage which was attributed to low immunization rates.  When                                                                 
budget cuts are to be made whether at the state or family level,                                                                
prevention efforts are often sacrificed for more immediate needs.                                                               
If you have to chose between fixing the car and immunizations for                                                               
the kids, most people fix the car so they can continue to work.                                                                 
Unfunded federal mandates are often burdensome on states.  However,                                                             
Denali KidCare provides two ways for Alaskans to benefit.  The                                                                  
tremendous return on the state's matching share of CHIP [Children's                                                             
Health Insurance Plan] funds is a good investment in itself.                                                                    
Additionally a cost savings is realized when Indian Health Service                                                              
beneficiaries are seen at tribal facilities.  In these cases, the                                                               
state pays nothing because the cost of care is reimbursed 100                                                                   
percent by the federal government.  Moreover, Denali KidCare                                                                    
revenue is often used to enhance programs funded primarily by the                                                               
Indian Health Service and with token state funds.  Mental health                                                                
services are a good example.  In parts of the Interior, Indian                                                                  
Health Service pays for approximately 75 percent of mental health                                                               
services while the state only pays about 25 percent.  Services are                                                              
minimal yet the state is not meeting its obligation to provide                                                                  
services equitably statewide.  These programs serve all Alaskans                                                                
and just not tribal members.                                                                                                    
Number 1842                                                                                                                     
CHERYL KILGORE, Interior Neighborhood Health Clinic, testified via                                                              
teleconference from Fairbanks.  She said the clinic is virtually                                                                
the sole agency in the Fairbanks North Star Borough that delivers                                                               
primary health care services to eligible patients on a schedule of                                                              
discount.  Schedule of discount is based on household incomes and                                                               
size.  The number of patients they saw in 1998-1999 was 3,242, and                                                              
47 percent were living at or below 200 percent of federal poverty                                                               
guidelines.  Thirteen percent didn't have health insurance and the                                                              
overwhelming majority of those individuals were working.  Seventeen                                                             
percent of those individuals have Medicaid.  With Denali KidCare,                                                               
they have seen an increase to about 21 percent.  In terms of total                                                              
numbers, it doesn't represent a huge increase for the budget, but                                                               
it does represent a very important investment in the health care                                                                
for children and pregnant women.  Health care costs money, but the                                                              
investment and the money provided with Denali KidCare also saves                                                                
money.  It saves money by providing prevention services and                                                                     
screening services to children and pregnant women.  As a society,                                                               
however it is defined, government, local state or national ends up                                                              
picking up the cost of health care and the lack of health care                                                                  
access.  If people do not have access to health care, they are                                                                  
going to wait until they have a complication and then receive                                                                   
emergency care which will be more expensive and will be borne by                                                                
the individual with insurance.  Denali KidCare is a cost effective                                                              
ERIN CASTLE testified via teleconference from Anchorage.  Six years                                                             
ago her daughter was ill and almost died.  She was encouraged not                                                               
to admit her daughter to the hospital because the family didn't                                                                 
have health insurance.  She was working full time at the time, and                                                              
her company did not provide insurance.  With the help and kindness                                                              
of others, her family had people come into their home and take care                                                             
of the daughter, and the doctor provided his services free of                                                                   
charge.  Over the years she has become in debt by paying for her                                                                
health care.  Denali KidCare program has given her the ability to                                                               
give her daughter good health care and allowed her to pay on some                                                               
of her debts which will take a long time to pay off.  She does not                                                              
agree with this bill.  People who are receiving services under AFDC                                                             
[Aid to Families with Dependent Children] that do get off the                                                                   
program, get off because Denali KidCare is provided.  If this bill                                                              
goes through, she believes people will go back on AFDC.  More money                                                             
will be spent providing for them on a full-time basis than letting                                                              
them get out into the real world and work and have the health care                                                              
that they are given.                                                                                                            
Number 1652                                                                                                                     
VIANA STAM testified via teleconference from Anchorage.  She is a                                                               
college graduate and works full-time in Alaska as does her husband,                                                             
but they have no insurance.  They have two children, one has a                                                                  
disability, and she is pregnant with their third.  They have always                                                             
had medical insurance, but her husband recently left military                                                                   
service, and they have none nor can they afford it.  Health                                                                     
insurance would cost them $1000 per month, so using the permanent                                                               
fund dividend wouldn't go far.  The Denali KidCare helps the                                                                    
working class children and pregnant women with affordable health                                                                
care.  Before she was on the prenatal program, she had to seek                                                                  
medical care, and the expenses were outrageous.  She was                                                                        
misdiagnosed, and private physicians were skeptical or refused to                                                               
see her because she had no medical insurance.  If these children                                                                
are phased out, this is what they are going to be going through.                                                                
Pregnant women will not be receiving prenatal care, and the infant                                                              
and mother mortality rate in Alaska will rise.  Many families use                                                               
the Denali KidCare program on a temporary basis until they can find                                                             
employment with health insurance or some other means of accessing                                                               
health insurance.  Please do not take away this preventive care                                                                 
program away from the children of working class families.                                                                       
JENNIFER DEFORD testified via teleconference from Anchorage.  She                                                               
urged the committee to vote down HB 260.  Do not place the burden                                                               
of balancing the state's budget on the shoulders of the children.                                                               
Denali KidCare is a highly efficient and effective program.  The                                                                
federal government pays for over 70 percent of the program.  The                                                                
remainder of the program should be funded by the federal                                                                        
government's increased Medicaid reimbursement to the state by a                                                                 
lower welfare roll and by the tobacco settlement.  Of the $25                                                                   
million per year that the state is receiving from the tobacco                                                                   
settlement, only $1.4 million is designated for tobacco awareness                                                               
and cessation programs.  The entire amount should be used for                                                                   
health programs.  This was the reason the state received the money                                                              
in the first place.                                                                                                             
MS. DEFORD said while she and her husband have always worked but                                                                
never been on public assistance, they have lived without health                                                                 
insurance.  One of the times they were without health insurance was                                                             
when they started their own company.  They couldn't afford medical                                                              
insurance for themselves much less their ten employees.  It was a                                                               
very scary situation.  Each time when one of the children got sick,                                                             
they wondered how much the doctor's bill would cut into their tight                                                             
budget.  They gave up their business in part because of the lack of                                                             
medical insurance.  Therefore, she believes that eliminating Denali                                                             
KidCare will hurt economic development.  The elimination of Denali                                                              
KidCare will also hurt welfare reform.  A person who now sits home                                                              
and receives a variety of state-supported benefits will have no                                                                 
incentive to go to work.  A single parent in this situation may                                                                 
have to spend $800 per month on child care and another $800 a month                                                             
for family health insurance.                                                                                                    
MS. DEFORD asked where the benefit of working is.  Many of the jobs                                                             
people hold are low paying and lack fringe benefits.  Alaska is the                                                             
only state economy where growth in state product has dropped in the                                                             
past five years.  Per capita personal income dropped from the                                                                   
highest in the country to below average.  Alaska's economy is not                                                               
great.  Denali KidCare families are taxpayers.  She believes that                                                               
200 percent is a good level because health care is extremely                                                                    
expensive, and health care may be the only thing one of these                                                                   
families cannot afford.  If they have a pre-existing condition, no                                                              
health insurance company is going to pick them up.  She believes                                                                
health insurance is an important issue.                                                                                         
Number 1388                                                                                                                     
NORMA PERKINS, Director of Business Services, SEARHC [Southeast                                                                 
Alaska Regional Health Consortium] Sitka, came forward to testify.                                                              
She noted that SEARHC is made up of 20 tribal communities                                                                       
throughout southeast Alaska.  She said SEARHC does compact with the                                                             
federal government to provide Indian Health Services in southeast                                                               
Alaska.  In 1999 SEARHC saw Denali KidCare as an opportunity to                                                                 
increase enrollment for children and pregnant women who had                                                                     
financial barriers in accessing health care delivery systems                                                                    
especially in the rural and hard to reach areas.  A quick                                                                       
comparative analysis from March to September of 1998 shows there                                                                
were 393 visits in the pediatric/ambulatory unit.  In that same                                                                 
time frame in 1999, there was an increase of 2,223 visits.  This is                                                             
a tremendous impact.  She reiterated that tribal beneficiaries who                                                              
are enrolled under Denali KidCare and are seen at the tribal                                                                    
facility, the federal Medicaid program reimburses the facilities at                                                             
100 percent.  It literally costs the State of Alaska nothing when                                                               
the tribal members are seen.  She expressed shock and surprise to                                                               
hear that the legislature wants to eliminate a very vital program                                                               
for children and pregnant women.                                                                                                
Number 1231                                                                                                                     
PATRICIA MACPIKE, Children's Coordinator, Sitka Mental Health                                                                   
Clinic, testified via teleconference from Sitka.  She expressed                                                                 
dismay that the committee is discussing discontinuing vitally                                                                   
needed medical insurance and assistance for the children of Alaska.                                                             
In funding Denali KidCare, the state is investing in prevention.                                                                
She works with 14 severely emotionally disturbed children who would                                                             
not be able to receive therapeutic services and interventions                                                                   
without the Denali KidCare program.  Without these services, many                                                               
of these children would be required to be institutionalized at some                                                             
point in their young lives.  These are children who at nine years                                                               
old have violent outbursts in their schools, home and community.                                                                
She asked if the committee wants to see how these children will act                                                             
at the age of 15 without any intervention.  Research from many                                                                  
fields shows the earlier the intervention, the higher the success                                                               
rate for children.  Children who carry weapons to school and shoot                                                              
their peers are emotionally disturbed.  She urged the committee to                                                              
support the Denali KidCare program.  By supporting the program,                                                                 
they are not only investing in the children, but all Alaskans.                                                                  
Please maintain a fair level of funding.                                                                                        
Number 1152                                                                                                                     
JEAN FRANK testified via teleconference from Sitka.  She stated no                                                              
dentist in Sitka serves Denali KidCare kids.  She wondered how the                                                              
passage of this bill will serve the needs of those kids.                                                                        
Number 1120                                                                                                                     
COMMISSIONER PERDUE spoke both as Commissioner of Health & Social                                                               
Services and as a person who has devoted her career to trying to                                                                
figure out health care financing in Alaska and how to improve it.                                                               
Whether a child has health insurance in this state almost entirely                                                              
revolves around the profession the parent has chosen.  That is the                                                              
inequity the committee is hearing.  If people are self-employed, or                                                             
if they work in the resource economy as fishers, loggers,                                                                       
seasonally, part-time, they have difficulty accessing the private                                                               
health care insurance market.  If the parents work for a large                                                                  
company or large public entity, such as the state of Alaska, they                                                               
can access health insurance.  Just because someone is working in a                                                              
profession where it is not efficient or easy for them to access the                                                             
health care market, she does not believe that means their children                                                              
are not entitled to some kind of access to health insurance.                                                                    
COMMISSIONER PERDUE has served on four health care task forces in                                                               
her professional career in Alaska trying to solve this problem.  No                                                             
one has solved it.  No private sector solution has come forward.                                                                
No other kind of governmental solution has been acceptable to the                                                               
issue of disparity.  It would be a mistake to think that solution                                                               
is easy.  The state is not willing to mandate that private                                                                      
employers offer this kind of coverage, nor willing to turn over the                                                             
health care dollars to a foundation or a single payer.  Most                                                                    
employers are not willing to do that.  A lot of smart people in                                                                 
Alaska and across the nation have looked at this issue over a long                                                              
period of time.  Congress finally decided to fill some of these                                                                 
holes two years ago when they enacted the CHIP program.  It was a                                                               
bipartisan reform; it was an incremental reform.  It did not solve                                                              
all the health care financing problems of this nation, but it did                                                               
say that children and pregnant women should have some kind of                                                                   
targeted access to health care coverage no matter where their                                                                   
parents worked.  That is where they are trying to straighten out                                                                
the inequity in the market.                                                                                                     
COMMISSIONER PERDUE noted that Medicaid was called socialistic when                                                             
it began in the 1960s.  Denali KidCare will have its first birthday                                                             
March 1.  People don't like the fact that government changes its                                                                
mind.  This program needs to be given a chance to settle out.  Some                                                             
6,000 private doctors and hospitals as well as the people using the                                                             
program need to see some assurance there.  The Legislature enacted                                                              
this law two years ago, and she believes it needs time to make it                                                               
REPRESENTATIVE BRICE said Denali KidCare was a reinvestment of                                                                  
dollars saved by changes in the federal Medicaid matching program.                                                              
The change was predicated on the fact that those dollars would be                                                               
invested into children's health care services.  This is the year                                                                
the congressional delegation will have that debate again.  If the                                                               
Administration and Congress find that Alaska is backing off on its                                                              
commitment to reinvesting those dollars, he asked what is the                                                                   
likelihood of getting that matching rate taken away and what would                                                              
the cost be to the state for that.                                                                                              
COMMISSIONER PERDUE replied a lot has been said about the                                                                       
instability of the program from the federal government funding it.                                                              
In actual fact, the federal government authorized their portion of                                                              
the money for ten years.  Alaska paid for its match through the                                                                 
savings from the Medicaid match rate change which is $30 million.                                                               
The state invested a small portion of that in this program.                                                                     
Senator Murkowski addressed the Legislature recently and indicated                                                              
that he wanted a full accounting of what the state was doing with                                                               
the match rate savings because he is having to back to the Senate                                                               
Finance Committee and get that reauthorized this year.  The State                                                               
of Alaska would lose $30 million if the match rate were not                                                                     
reauthorized, a small portion of which has been put into Denali                                                                 
Number 0713                                                                                                                     
PAT AAMODT, Arctic Slope Native Association, Member, Barrow Tribal                                                              
Council, came forward to testify.  She urged the committee to                                                                   
continue the Denali KidCare as it is.  This is one investment that                                                              
the state has made where for $2 million per year from the general                                                               
fund, the state gets about $7 million, and that is quite a bit of                                                               
money.  She urged the committee to consider that and the employment                                                             
opportunities it provides for people who are professionals, but                                                                 
mostly consider it on behalf of the children in her region as well                                                              
as the whole state of Alaska.  The people in the Barrow region, in                                                              
addition to the statewide organizations such as ANTHC [Alaska                                                                   
Native Tribal Health Consortium] and ANHB [Alaska Native Health                                                                 
Board], fully support this because it benefits all children who are                                                             
in need.  The cost of living is high, and the 200 percent above the                                                             
poverty level fits well for the state.  She encouraged the                                                                      
committee to reconsider and know that this affects a lot of                                                                     
families in her region where unemployment is high, and there are                                                                
pockets of unemployment statewide.                                                                                              
Number 0575                                                                                                                     
DOROTHY BUNTI REED came forward to testify.  She spoke against HB
260 for many of the same reasons already heard.  She read this                                                                  
portion of the sponsor statement:  "First, it brings the definition                                                             
of poverty back to the basic assumption that a family is poor if                                                                
they do not have the resources to provide for essential needs such                                                              
as food, clothing and shelter."  She said that the $19,000 that a                                                               
family of four is defined at 133 percent of the poverty level would                                                             
not provide those things in this state.  She read another portion                                                               
of the sponsor statement:  "Second, it tell the federal government                                                              
that we disapprove of its move to instill socialized medicine as                                                                
status quo..."  She suggested that this tells the federal                                                                       
government that Alaska doesn't care about its children.  She                                                                    
believes that the logic of the argument in the last paragraph on                                                                
that page is also flawed.                                                                                                       
MS. REED said she comes from a family of two working parents, both                                                              
of whom had health insurance.  They were visited by a very                                                                      
catastrophic medical condition that "maxed out" their insurance.                                                                
It is easy to "max" it out when a life flight to Seattle costs                                                                  
$30,000; her family has had three such life flights.  It is easy to                                                             
"max" it out when one parent has to stay home to care for a                                                                     
disabled child as a result of an accident.  Her family was                                                                      
fortunate, or not, that her son's disability was such that he was                                                               
able to access disabled Medicaid funds.  Her other children didn't                                                              
have that luxury.  When she found herself owing over a half-million                                                             
dollars in medical fees, she doesn't believe she could have found                                                               
someone to give her a loan to make payments for the rest of her                                                                 
life.  Her family sold their home to try to make those payments.                                                                
In her family the parents worked opposing schedules to try to make                                                              
those payments.  Her family declared bankruptcy; had Denali KidCare                                                             
been there at that time, it might have been an option to prevent                                                                
that.  She and her husband still work; neither of them quit.  She                                                               
and her husband still have health insurance albeit with new                                                                     
employers who had them wait for coverage for their son for a                                                                    
certain waiting period.  Her other son did get Denali KidCare for                                                               
a time but when she was made eligible for insurance and could                                                                   
purchase it at a reasonable rate, she purchased the insurance, thus                                                             
making her ineligible unless her level of income goes below poverty                                                             
level.  Please consider that a loan program is not realistic given                                                              
real people and real medical needs and consider that when making                                                                
your decision.                                                                                                                  
Number 0328                                                                                                                     
LARAINE DERR, Executive Director, Alaska State Hospital and Nursing                                                             
Home Association (ASHNHA), came forward to testify.  She noted that                                                             
Mr. Culley from the hospital in Valdez virtually testified from the                                                             
hospital standpoint.  She indicated that ASHNHA opposes HB 260.                                                                 
Number 0275                                                                                                                     
JEROME SELBY, Providence Health System in Alaska, came forward to                                                               
testify.  He urged the committee to keep the income level                                                                       
eligibility guidelines for Denali KidCare at the 200 percent of                                                                 
poverty level.  It is his understanding that dropping from 200 to                                                               
100 percent would cause about 7,000 children and about 800 pregnant                                                             
women currently enrolled to lose their benefits.  It would also                                                                 
mean Alaska is the only state not offering health insurance to more                                                             
children, and that is not a good idea.  Research has clearly shown                                                              
that children with health insurance see the doctor for regular                                                                  
well-baby checkups, they receive immunizations, and they are more                                                               
likely to have health problems discovered early, thus saving                                                                    
millions of dollars in total health care.  Denali KidCare does                                                                  
exactly that by providing health insurance to more lower income                                                                 
working families who for whatever reason are uninsured.  According                                                              
to recent data reported by the Anchorage Access to Health Care                                                                  
Coalition, about 38,000 people in Anchorage have no health                                                                      
insurance and more than two-thirds of those work.  In Alaska the                                                                
estimated number of children without insurance was about 12,000.                                                                
That was a three-year enrollment goal for the Denali KidCare                                                                    
program.  However, the need is apparently greater since more than                                                               
12,000 children were enrolled in less than one year.                                                                            
MR. SELBY stated that since Denali KidCare started, parents don't                                                               
use the emergency room as frequently for primary care, and fewer                                                                
children are seen for more costly treatment resulting from delays                                                               
in seeing a doctor.  This is cost-effective health care delivery                                                                
under this program.  One way to ensure a healthy birth is to                                                                    
provide pregnant women with prenatal care.  This too is the very                                                                
best cost-effective health care expenditure made.  He submits the                                                               
fact that everyone is going to help pay for this publicly whether                                                               
admitted or not.  The difference is, through the Denali KidCare                                                                 
program, it is known how much is spent, who the recipient is and a                                                              
program is defined.  When the uninsured people move over into                                                                   
uncompensated care, the cost won't go away.  These people still                                                                 
aren't going to be able to pay, but everyone else is going to pay                                                               
indirectly.  When paying indirectly, there is no idea what it costs                                                             
and there is no way of trying to control or be involved in                                                                      
determining that expense.  It will cost more because these people                                                               
won't come in for care until much later in the development of a                                                                 
disease.  Society will pay more if this program is dropped.  He                                                                 
urged the committee to consider that.  It is far wiser to go with                                                               
this defined program, get early intervention and take better care                                                               
of people.  If the program is kept at the 200 percent of poverty                                                                
level, there will be healthier children and therefore healthier                                                                 
TAPE 00-10, SIDE A                                                                                                              
Number 0029                                                                                                                     
LINCOLN BEAN, Alaska Native Health Board, came forward to testify                                                               
and greeted the committee in Tlingit and then he said, "Honorable                                                               
leaders, respectful friends, ladies and gentlemen, it is an honor                                                               
to be here to testify on behalf of the Denali KidCare."  He raised                                                              
this issue with Representative Coghill to preserve this service                                                                 
that is so vital and important to communities that may have 80                                                                  
percent unemployment.  "How could we be talking about taking a                                                                  
service for a small child.  This isn't for everyone.  It's for                                                                  
those who are in need, and that's how we look at it.  I support the                                                             
Denali KidCare and I oppose HB 260.  Thank you."                                                                                
Number 0145                                                                                                                     
MORISSA WILLIAMS came forward to testify.  She introduced her son                                                               
Noah who is a Denali KidCare kid.  She said they are incredibly                                                                 
grateful for the program.  She mentioned that she had spoken to                                                                 
Representative Coghill and believes he is sincere in his regard to                                                              
children, they just differ on what they each believe the children                                                               
need in the long term.  The Denali KidCare program is vital and                                                                 
urged the committee to keep it.  She left her written testimony                                                                 
with committee members.                                                                                                         
Number 0248                                                                                                                     
WILSON JUSTIN, Health Director, Mount Sanford Tribal Consortium,                                                                
Member, Alaska Native Health Board, came forward to testify.  He is                                                             
sympathetic to what he has heard about not ever using medical                                                                   
facilities by people who are self-sufficient.  His family was                                                                   
raised isolated and in a small business environment, and they                                                                   
fortunately never had to worry about medical bills.  He regards                                                                 
that as a blessing, and that does not give him the right to judge                                                               
the level of need of those who are less fortunate.  He read the                                                                 
following testimony:                                                                                                            
     Mr. Chairman, members of the Committee.  My name is                                                                        
     Wilson Justin.  I am the Health Director for the Mount                                                                     
     Sanford Tribal Consortium and a member of the Alaska                                                                       
     Native Health Board.  The Alaska Native Health Board                                                                       
     appreciates the opportunity to provide testimony                                                                           
     regarding HB 260.  We urge that you do not move this                                                                       
     The bill will result in 6,696 children and 780 pregnant                                                                    
     women losing access to Medicaid.  If Medicaid is lost,                                                                     
     most of these children will receive health care only                                                                       
     after they are sick, and, all too often, only when the                                                                     
     child is brought to a hospital emergency room.  such care                                                                  
     is most expensive in dollars and loss of quality of life.                                                                  
     Follow-up is lost; prevention does not occur.  School                                                                      
     days are missed and parents miss work to care for their                                                                    
     sick children.                                                                                                             
     I know that some of you are wondering why the Alaska                                                                       
     Native Health Board cares about this issue since our                                                                       
     member health providers receive funding from IHS [Indian                                                                   
     Health Services.]  First, as health providers we cannot                                                                    
     sit quietly by while any child loses access to health                                                                      
     care.  It is not good for our communities or our state.                                                                    
     Secondly, the assumption that Native children and                                                                          
     families are unaffected is simply wrong.  The IHS direct                                                                   
     appropriations, based on recent federal studies, provide                                                                   
     only about 25 percent of needed funds to provide care for                                                                  
     Alaska Natives and American Indians.                                                                                       
     Congress relies on the Medicaid program to supplement the                                                                  
     IHS direct appropriations.  It authorizes the state to                                                                     
     recover 100 percent of its Medicaid payments to IHS and                                                                    
     tribal health providers.  However, payment is only made                                                                    
     for services to eligible children.  If this bill is                                                                        
     enacted into law, no reimbursement will be available for                                                                   
     the services we provide to approximately 2,200 Alaska                                                                      
     Native children whose family income is between 100                                                                         
     percent and 200 percent of poverty.  This means that our                                                                   
     very limited direct funding is stretched even more                                                                         
     thinly.  Village visits by health professions will                                                                         
     diminish, more children will become ill unnecessarily,                                                                     
     and resources will be diverted from prevention to acute                                                                    
     care.  This is the poorest use of limited resources.                                                                       
     We know that state resources are limited, however this is                                                                  
     not where cuts should occur.  This cut will make Alaska                                                                    
     the only state in the United States that is not                                                                            
     implementing the federal Children's Health Insurance                                                                       
     Program.  It will reduce federal spending in Alaska by                                                                     
     more than $7 million in the first year and $12 million in                                                                  
     the second year.  It will lead to increased uncompensated                                                                  
     emergency room costs.  Most important, it will lead to                                                                     
     increased preventable health problems and inevitably to                                                                    
     some preventable deaths.                                                                                                   
     We urge each of you to cast your vote in support of                                                                        
     Alaska's most valuable natural resource, our children;                                                                     
     vote "do not pass" on HB 260.                                                                                              
Number 0573                                                                                                                     
SHERRY OLSON, Clinical Social Worker, came forward to testify.  She                                                             
testified against HB 260.  Denali KidCare benefits Alaska children.                                                             
She understands the worry of this program fostering dependency, but                                                             
this is not an issue of dependency.  Parents who qualify for Denali                                                             
KidCare are working now, and they will continue to work.  The issue                                                             
is whether or not their children can get appropriate and needed                                                                 
health care, including mental health care.  She cited two examples                                                              
of children with complex mental health needs through this program.                                                              
One boy was an aggressive kindergartner last year who needed daily                                                              
intervention to ensure his safety and other students' safety.  He                                                               
would stab children with pencils, strike out at teachers, throw                                                                 
furniture, scream inconsolably and so on.  With comprehensive                                                                   
services, his behavior has turned around in one year.  He has had                                                               
one aggressive incident in the last 90 days, as opposed to daily                                                                
aggressive incidents, and his services are being decreased.  Both                                                               
of his parents work, but they cannot afford health care.  He is                                                                 
succeeding as a first grader and is doing well.                                                                                 
MS. OLSON told of another boy, who at the age of 11, was setting                                                                
fires, burglarizing and doing drugs and alcohol.  He was on his way                                                             
to McLaughlin Youth Center where the cost of treatment is                                                                       
expensive.  Comprehensive services have again turned him around.                                                                
He is succeeding in high school and has had no legal involvement                                                                
for over a year.  His mother is a professional single mom who is                                                                
raising five children.  Denali KidCare has benefited these two                                                                  
children mentioned and many others.  Please do not damage this                                                                  
resource to this state.  Early intervention is cheaper each time it                                                             
is used.                                                                                                                        
Number 0715                                                                                                                     
MS. LARE' came forward to testify.  She is a grandparent from                                                                   
Anchorage and a long time advocate for young children and their                                                                 
families.  She told the committee about a family who had problems                                                               
during a pregnancy.  The family sold their house to pay for the                                                                 
care of the expectant mother.  Every month it got worse, but the                                                                
child now is very healthy, as are the mom and dad.  She thanked the                                                             
committee for Denali KidCare on behalf of one family.                                                                           
WALTER MAJOROS, Executive Director, Alaska Mental Health Board                                                                  
(AMHB), came forward to testify.  He expressed strong opposition to                                                             
HB 260 on behalf of the AMHB.  The AMHB remains strong advocates                                                                
for Denali KidCare.  He pointed out that the program is critical to                                                             
children's mental health in preventing more serious mental health                                                               
conditions from developing later on and for serving children who                                                                
have more serious emotional disorders.  The program helps children                                                              
and families live more successfully and independently in the                                                                    
community.  It helps parents from losing custody of their children.                                                             
The AMHB board has heard testimony from parents who had to give up                                                              
custody of their children in order to enroll them in the Medicaid                                                               
program.  It helps prevent involvement with the juvenile justice                                                                
system; it helps prevent institutionalization and higher cost                                                                   
services.  A significant amount of the expenditures go to mental                                                                
health services, and this is necessary and appropriate.                                                                         
MR. MAJOROS noted Denali KidCare is seen as an issue of a basic                                                                 
support program.  About 120 organizations across the state have                                                                 
gotten together since last session when HB 161 was being considered                                                             
to oppose to that bill.  Those organizations believe that basic                                                                 
support programs such as Medicaid, the adult public assistance, and                                                             
the Alaska temporary assistance program provide needy Alaskans with                                                             
consistent means to meet their fundamental living expenses such as                                                              
food, shelter, medical care and transportation.  Denali KidCare is                                                              
a critical part of the safety net for vulnerable Alaskans.  He                                                                  
urged the committee to vote no on HB 260.                                                                                       
CHAIRMAN DYSON announced the committee would continue hearing HB
260 next Tuesday, February 15.  [HB 260 was heard and held.]                                                                    

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