Legislature(2009 - 2010)BUTROVICH 205
02/09/2009 01:30 PM Senate HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| SB13 | |
| SB87 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 13 | TELECONFERENCED | |
| *+ | SB 87 | TELECONFERENCED | |
| + | TELECONFERENCED |
SB 13-MEDICAL ASSISTANCE ELIGIBILITY
CHAIR DAVIS announced consideration of SB 13.
1:35:57 PM
TOM OBERMEYER, aid to Senator Davis, introduced SB 13, saying it
increases and restores the qualifying income eligibility
standard for the Denali Kid Care program to the original levels
at 200 percent of the FPL guideline and makes health insurance
accessible to an estimated 1300 more uninsured children and 225
pregnant women in Alaska.
Denali Kid Care is an enhanced reimbursement program with up to
70 percent matching funds under the federal government's State
Children's Health Insurance Program (SCHIP), which was created
in 1997. Congress reauthorized the SCHIP program for five years;
on February 4, 2009 President Obama signed a law expanding
coverage to four million more children.
Alaska is only one of five states that fund SCHIP below the 200
percent guideline.
The Kaiser Commission on Medicaid and the Uninsured provided the
following information in January of 2009: 44 states including
Washington D.C. cover children and families with incomes of 200
percent of the FPL or higher; 33 states cover children and
families with incomes between 200 and 250 percent of the FPL; 19
states including D.C. cover children and families with incomes
of 250 percent or higher and 10 of those states cover children
and families with incomes of 300 percent of FPL or higher; 35
states allow premiums, enrollment fees or co-payments on a
sliding scale for selected services in the SCHIP programs.
MR. OBERMEYER continued; Denali Kid Care serves an estimated
7900 Alaska Children and remains one of the least costly medical
assistance programs in the state at approximately $1700 per
child for full coverage including dental, which is about 20
percent of the cost of adult senior coverage. Early intervention
and preventive care under SB 13 will greatly increase the health
of Alaska's children and yield substantial savings to the state
in public and private sector hospital emergency rooms, which
must admit indigent and uninsured patients for non-emergency
treatment.
1:39:44 PM
It is estimated that uninsured children with a medical need are
five times as likely not to have a regular doctor as insured
children and four times as likely to use emergency rooms at a
much higher cost. There are still approximately 18,000 uninsured
children in Alaska, about nine percent of the children aged 18
and under. Private health care coverage for children has
declined over 30 percent in the last 10 years and the deepening
recession is pulling more children and families into the ranks
of the uninsured. The reauthorized SCHIP program and stimulus
package should help, but Alaska is encouraged to do its share
and take advantage of the federal matching funds by insuring its
low income children up to and including 200 percent FPL under SB
13.
1:40:30 PM
CHAIR DAVIS advised the committee that Jerry Fuller with the
Department of Health and Social Services (DHSS) was online and
available for questions.
1:41:39 PM
GEORGE BROWN M.D., Douglas AK, has practiced pediatric medicine
in Alaska since 1965. He said he is delighted that the federal
government has expanded coverage for SCHIP and that the state
has bills under consideration related to increasing coverage. He
and his pediatric colleagues in Juneau are very much in favor of
a 200 percent [qualification for] coverage for children without
a co-pay, and are pleased that this seems to be moving forward
with the governor's support.
DR. BROWN said he and his colleagues have also been discussing
the issue of higher levels [of coverage] with co-pays. Whether
or not co-pays really work is a difficult question. One of his
colleagues has seen a problem with co-pays in Washington;
families get behind in their co-pays and then are ineligible. On
the other hand, if the care is all free, some people seem to
think they don't need to keep appointments and become careless
of their responsibility as parents; perhaps a simple, uniform
co-pay of $10 or $15 per visit would provide the right
incentive. He stressed that there should be no punitive results
[for failure to keep or cancel appointments] however, because it
sometimes takes many years for families who have not had health
insurance before to realize they are welcome in a doctor's
office. As those families continue to come in and be treated
with respect, to see other families there who are being treated,
they become good users of the preventive medical system.
In closing, he said that the whole idea of SCHIP is ultimately
prevention; for every dollar we invest in prevention, we save
from six to ten dollars in the long-run.
1:45:22 PM
CHAIR DAVIS advised that Jennifer Saunders and Martha King of
the National Conference of State Legislatures (NCSL) are also
online and available to answer questions.
1:46:03 PM
ROD BETIT, President, Alaska State Hospital and Nursing Home
Association (ASHNHA), Juneau, AK, said he is very excited to see
this bill before the committee. ASHNHA represents 28 health care
providers throughout the state including tribal, military,
private and city owned organizations and all of them support
this legislation, which has been unanimously approved by
ASHNHA's legislative committee. He added that bringing [the
qualifying limit] to the 200 percent level is appropriate even
though the health care commission process hasn't started yet,
because he believes this is one of the first actions that
commission would recommend. This action was recommended by the
Health Care Strategies Planning Council last year.
1:47:33 PM
NANCY ST. JOHN-SMITH, Peninsula Community Health Services,
Kenai, AK, said that their community health center, which was
formerly called Central Peninsula Health Center, has been
offering medical and dental care to communities on the Kenai
Peninsula since 2002. They merged with Central Peninsula
Counseling Services in October 2008 and are offering behavioral
health care under their new name. She urged the legislature to
pass this bill increasing the eligibility guideline to 200
percent of FPL because with Denali Kid Care they can offer
preventive medical and dental care to many children who would
not otherwise receive it. For example, she said, many people
they see on an emergency basis have not received any dental care
as children; by the time they come to the clinic, the tooth or
teeth have to be pulled, which can affect their nutrition, heart
health and other future health issues. She agreed with Dr. Brown
that the ability to offer preventive services is important to
improve the quality of life and to teach people about prevention
so they will raise their children in good health. She thanked
the committee for hearing her testimony and stressed how
important this legislation is to people on the Kenai.
1:49:53 PM
JODYNE BUTTO M.D., President, Alaska Chapter, American Academy
of Pediatrics, Anchorage, AK, said SCHIP has made a huge
difference in the health of children across the United States.
It is important that Alaska provide the best care possible to
its children; that means providing access to care and part of
that access is insurance. She agreed with prior testimony that
the program cost is outweighed by the savings in health care
costs represented by preventive care.
MS. BUTTO also stressed the importance of health to children's
school performance. Although it can't be easily quantified, it
is well known that children with good health, particularly good
dental health, perform better in school, miss fewer days, are
better behaved and enjoy greater academic success than those who
do not. She applauded the legislature for tackling this issue.
1:53:15 PM
DONNA GRAHAM, Anchorage Faith and Action Congregations Together
(AFACT), Anchorage, AK, is a school nurse and parish nurse. She
said AFACT is thrilled that Alaska is finally getting back to
the 200 percent [eligibility level]. This is the right way to
go; Alaska is a rich state and can show it by not being at the
bottom of the list of states that put their kids first. In
summary, she said, this is a great step forward! Let's put more
kids back into fitness and health to promote energy and
learning.
1:55:30 PM
JORDEN NIGRO, Residential Director, Juneau Youth Services,
President, Alaska Homes for Children (AHFC), Juneau, AK, said
they are really excited to see all of the bills coming forward
for Denali Kid Care. The only comment she cared to add to the
previous testimony was that, if a sliding co-pay goes into
effect, she hopes it won't affect those at 200 percent or less
of the FPL. Behavioral health for youth is primarily funded
through Denali Kid Care and many kids and families are unable to
access the services because they are on the cusp of eligibility;
Alaska has a high number of people on the cusp due to the
fishing and subsistence lifestyles that are prevalent here.
1:57:17 PM
LAVERNE DEMIENTIEFF, President, National Association of Social
Workers (NASW), Alaska Chapter, Clinical Assistant Professor,
University of Alaska Fairbanks, Fairbanks, AK, said NASW
strongly supports the efforts of this committee to raise the
Denali Kid Care eligibility requirement to 300 percent of the
FPL. Alaska is one of only nine states with eligibility
requirements below 200 percent. This makes us the fourth least
responsive state to children who live in poverty. Raising
eligibility to 200 percent will restore vital health insurance
to 1300 children and 225 pregnant women; imagine what raising it
to 300 percent would achieve for Alaskan families.
MS. DEMIENTIEFF recognized that fiscal responsibility is
everyone's priority, but noted that Alaska won't shoulder the
majority of the cost associated with this program; with the
passing of SCHIP, the federal government will pay 70 to 75
percent of it. Finally, she said this is an important investment
Alaska and in the future of Alaska's children and families.
1:59:02 PM
CHAIR DAVIS announced that she was closing public testimony on
SB 13.
SENATOR THOMAS asked what the other referrals are for SB 13.
CHAIR DAVIS answered that it will go to Finance next.
SENATOR THOMAS asked if she intends to leave the explanation of
the fiscal note to Finance.
CHAIR DAVIS said they can discuss it if he wishes; but she had
not intended to get into it today.
SENATOR THOMAS said he wondered whether the savings that are
expected to accrue from intervention and prevention were taken
into consideration when preparing the fiscal note.
2:01:55 PM
JON SHERWOOD, Medical Assistant Administrator, Department of
Health and Social Services (DHSS), Juneau, AK, explained that
their assumptions on the fiscal note did not specifically take
those preventive aspects into account, but they based their
costs on the cost of care for children in the next lowest income
group, which is covered [by Denali Kid Care]. Those children
experience the same preventive effects from being covered by
Denali Kid Care and they assumed the impacts would be
comparable.
SENATOR PASKVAN moved to report SB 13 from committee with
individual recommendations and attached fiscal note(s). There
being no objection, the motion carried.
| Document Name | Date/Time | Subjects |
|---|