Legislature(1997 - 1998)
04/07/1998 03:05 PM House HES
| Audio | Topic |
|---|
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
HOUSE HEALTH, EDUCATION AND SOCIAL
SERVICES STANDING COMMITTEE
April 7, 1998
3:05 p.m.
MEMBERS PRESENT
Representative Con Bunde, Chairman
Representative Joe Green, Vice Chairman
Representative Al Vezey
Representative Brian Porter
Representative J. Allen Kemplen
Representative Tom Brice
MEMBERS ABSENT
Representative Fred Dyson
COMMITTEE CALENDAR
SENATE BILL NO. 17
"An Act creating the crime of criminal transmission of human
immunodeficiency virus (HIV)."
- HEARD AND HELD
* HOUSE BILL NO. 369
"An Act relating to Medicaid coverage for certain eligible children
and pregnant women; relating to primary care case management and
managed care services as optional services and to premiums and
cost-sharing contributions under the Medicaid program; establishing
the Healthy Families Alaska program; and providing for an effective
date."
- PASSED CSHB 369(HES) OUT OF COMMITTEE
* HOUSE JOINT RESOLUTION NO. 58
Proposing amendments to the Constitution of the State of Alaska
relating to the education fund.
- HEARD AND HELD
HOUSE BILL NO. 302
"An Act relating to the University of Alaska; and providing for an
effective date."
- SCHEDULED BUT NOT HEARD
(* First public hearing)
PREVIOUS ACTION
BILL: SB 17
SHORT TITLE: CRIMINAL TRANSMISSION OF HIV
SPONSOR(S): SENATOR(S) TAYLOR, Pearce, Miller, Ward
Jrn-Date Jrn-Page Action
1/13/97 18 (S) PREFILE RELEASED 1/3/97
1/13/97 18 (S) READ THE FIRST TIME - REFERRAL(S)
1/13/97 18 (S) HES, JUD, FIN
4/11/97 (S) HES AT 9:00 AM BUTROVICH ROOM 205
4/11/97 (S) MINUTE(HES)
4/11/97 1099 (S) HES RPT 2DP 1NR
4/11/97 1099 (S) DP: LEMAN, WARD; NR: WILKEN
4/11/97 1099 (S) ZERO FISCAL NOTES (ADM, DPS, LAW)
4/11/97 1099 (S) JUD REFERRAL WAIVED
4/15/97 (S) MINUTE(FIN)
4/22/97 (S) FIN AT 9:00 AM SENATE FINANCE 532
4/22/97 1383 (S) FIN RPT 1DP 4NR 1DNP
4/22/97 1383 (S) DP: TORGERSON; DNP: ADAMS
4/22/97 1383 (S) NR: PEARCE, SHARP, PHILLIPS, DONLEY
4/22/97 1383 (S) PREVIOUS ZERO FNS (ADM, DPS, LAW)
4/25/97 (S) RLS AT 10:45 AM FAHRENKAMP RM 203
4/25/97 (S) MINUTE(RLS)
4/25/97 1478 (S) RULES TO CALENDAR 4/25/97
4/25/97 1485 (S) READ THE SECOND TIME
4/25/97 1485 (S) ADVANCED TO THIRD READING UNAN
CONSENT
4/25/97 1485 (S) READ THE THIRD TIME SB 17
4/25/97 1485 (S) MTN TO REMOVE (ADM, LAW)FN ANALYSES
NOT
4/25/97 1485 (S) ADDRESSING FISCAL IMPLICATION ADP Y14
N6
4/25/97 1485 (S) COSPONSOR(S): MILLER, WARD
4/25/97 1486 (S) PASSED Y14 N6
4/25/97 1486 (S) DUNCAN NOTICE OF RECONSIDERATION
4/28/97 1513 (S) RECON TAKEN UP - IN THIRD READING
4/28/97 1513 (S) PASSED ON RECONSIDERATION Y14 N5 E1
4/28/97 1530 (S) TRANSMITTED TO (H)
4/30/97 1393 (H) READ THE FIRST TIME - REFERRAL(S)
4/30/97 1393 (H) HES, JUDICIARY, FINANCE
3/12/98 (H) HES AT 3:00 PM CAPITOL 106
3/12/98 (H) MINUTE(HES)
4/07/98 (H) HES AT 3:00 PM CAPITOL 106
BILL: HB 369
SHORT TITLE: MEDICAID COVER/HEALTHY FAMILIES AK PROGRA
SPONSOR(S): RULES BY REQUEST OF THE GOVERNOR
Jrn-Date Jrn-Page Action
1/28/98 2158 (H) READ THE FIRST TIME - REFERRAL(S)
1/28/98 2159 (H) HES, FINANCE
1/28/98 2159 (H) ZERO FISCAL NOTE(DHSS)
1/28/98 2159 (H) GOVERNOR'S TRANSMITTAL LETTER
4/07/98 (H) HES AT 3:00 PM CAPITOL 106
BILL: HJR 58
SHORT TITLE: CONST AM: EDUCATION FUND
SPONSOR(S): REPRESENTATIVES(S) COWDERY
Jrn-Date Jrn-Page Action
2/12/98 2306 (H) READ THE FIRST TIME - REFERRAL(S)
2/12/98 2306 (H) HES, JUDICIARY
3/31/98 (H) HES AT 3:00 PM CAPITOL 106
3/31/98 (H) MINUTE(HES)
4/07/98 (H) HES AT 3:00 PM CAPITOL 106
WITNESS REGISTER
MEL KROGSENG, Legislative Administrative Assistant
to Senator Robin Taylor
Alaska State Legislature
Capitol Building, Room 30
Juneau, Alaska 99801-1182
Telephone: (907) 465-6550
POSITION STATEMENT: Presented sponsor statement for SB 17.
ED LINSELL, Prevention and Program Director
Shanti at Southeast Alaska
P.O. Box 22655
Juneau, Alaska 99802
Telephone: (907) 463-5665
POSITION STATEMENT: Testified in opposition to SB 17.
KAREN STURNICK, Former Executive Director
Interior AIDS Association
P.O. Box 22655
Juneau, Alaska 99802
Telephone: (907) 463-5665
POSITION STATEMENT: Testified in opposition to SB 17.
MICHAEL BELLER, M.D.
Epidemiology Section
Division of Public Health
Department of Health and Social Services
P.O. Box 240249
Anchorage, Alaska 99524-0249
Telephone: (907) 269-8000
POSITION STATEMENT: Testified in opposition to SB 17.
ANNE CARPENETI, Assistant Attorney General
Legal Services Section
Criminal Division
Department of Law
P.O. Box 110300
Juneau, Alaska 99811-0300
Telephone: (907) 465-3428
POSITION STATEMENT: Testified in opposition to SB 17.
JAY LIVEY, Deputy Commissioner
Department of Health & Social Services
P.O. Box 110601
Juneau, Alaska 99811-0601
Telephone: (907) 465-3030
POSITION STATEMENT: Testified on proposed committee substitute
for HB 369.
BOB LABBE, Director
Division of Medical Assistance
Department of Health & Social Services
P.O. Box 110660
Juneau, Alaska 99811-0660
Telephone: (907) 465-3355
POSITION STATEMENT: Testified on proposed committee substitute
for HB 369.
PAM MUTH, Chief
Maternal Child & Family Health Section
Division of Public Health
Department of Health & Social Services
1231 Gambell Street
Anchorage, Alaska 99501-4267
Telephone: (907) 269-3400
POSITION STATEMENT: Provided comments on the Healthy Families
Program.
WALTER MAJOROS, Executive Director
Alaska Mental Health Board
Department of Health & Social Services
431 North Franklin Street, Suite 101
Juneau, Alaska 99801-1121
Telephone: (907) 465-3071
POSITION STATEMENT: Testified in favor of proposed committee
substitute for HB 369.
REPRESENTATIVE JOHN COWDERY
Alaska State Legislature
Capitol Building, Room 416
Juneau, Alaska 99801-1182
Telephone: (907) 465-3879
POSITION STATEMENT: Testified as sponsor of HJR 58.
WILLIE ANDERSON, Representative
NEA-Alaska
114 Seward Street
Juneau, Alaska 99801
Telephone: (907) 586-3090
POSITION STATEMENT: Testified in support of HJR 58.
ACTION NARRATIVE
TAPE 98-45, SIDE A
Number 0001
CHAIRMAN CON BUNDE called the House Health, Education and Social
Services Standing Committee meeting to order at 3:05 p.m. Members
present at the call to order were Representatives Bunde, Vezey,
Porter, Kemplen and Brice. Representative Green joined the meeting
in progress at 3:39 p.m. Representative Dyson was absent.
SB 17 - CRIMINAL TRANSMISSION OF HIV
Number 0062
CHAIRMAN BUNDE announced the first bill on the agenda was SB 17,
"An Act creating the crime of criminal transmission of human
immunodeficiency virus (HIV)." He asked Mel Krogseng, Legislative
Administrative Assistant to Senator Robin Taylor to come forward
and speak to SB 17.
Number 0087
MEL KROGSENG, Legislative Administrative Assistant to Senator Robin
Taylor, Alaska State Legislature, said rather than re-reading the
sponsor statement from the last meeting, she would prefer to speak
to a hand-out on the incidents of testing which was a major issue
at the last meeting. She had re-read the testimony on this
legislation and throughout the testimony comments were made
implying that efforts were being made to criminalize the disease,
human immunodeficiency virus (HIV). She said that was not so.
Senate Bill 17 only criminalizes the outrageous behavior of an
individual who knowingly has HIV and then exposes an innocent
victim or victims to this deadly disease under false pretenses -
lack of disclosure.
MS. KROGSENG said there had been testimony that the majority of HIV
sexual transmissions occurred during consensual sexual activities.
She submitted that the consent may very likely not have been given
if the potential partner had known the suitor was HIV positive. At
a previous meeting someone made the comment "just having an
intimate relationship with someone if you knew you were HIV
positive would be a crime." Ms. Krogseng said that is not true.
It would only be a crime if the HIV positive individual didn't
inform the person of the HIV positive status before engaging in the
activity whether it be sex or donating blood or tissue so if the
individual consents, it will be done knowingly.
MS. KROGSENG said testimony had been presented at the last hearing
that "this bill was singling out a specific group of people based
on their sexuality." That is not so; this legislation was prompted
by the incident in New York where the HIV positive male had sex
with several different women. That is not the only incident where
that has occurred.
MS. KROGSENG believed there were many misconceptions about SB 17.
At an outing over the weekend, she had spoken with a Red Cross
nurse to ascertain if the Red Cross had taken a position on SB 17.
The nurse was under the impression this bill criminalized
transmission of HIV - not knowingly, but if individuals not knowing
they were HIV positive had sex would be committing a crime. After
Ms. Krogseng explained that SB 17 dealt with the knowing aspect of
having the disease and not informing the partner, the nurse's
attitude changed substantially. She said this legislation will not
completely solve the problem of HIV transmission for the people who
know they are positive, but it will provide a tool to stop people
from continuing this egregious behavior.
Number 0365
CHAIRMAN BUNDE said he had considered similar legislation in the
past, but there had been a concern with the passing of HIV from
mother to child at birth. He understands that if a mother would
take a regimen of AZT the child's chance of being HIV positive are
greatly diminished. He asked, "Under this bill, would a mother who
knows she has HIV gives birth to a child without going through the
regimen to diminish the chances of passing this on or even if she
does, would she be subject to at least child abuse ...."
MS. KROGSENG said she was unable to answer that question but
offered to research the question and provide Chairman Bunde with an
answer.
Number 0470
REPRESENTATIVE J. ALLEN KEMPLEN noted comments had been made at the
last hearing regarding existing laws that address the criminal act.
He understands a person who transmits HIV to another individual can
be prosecuted for first degree murder under AS 11.41.100 if there
was intent to kill another person through infection, or a person
could be charged under AS 11.41.200 with attempted assault if there
was intent of serious injury and not death, or charged with
reckless endangerment if a person engaged in behavior that could
transmit the virus but where such transmission was not intentional
or knowing under AS 11.41.250. He asked if these laws were
inadequate to address this issue and if so, why?
MS. KROGSENG responded that intent must be proven with a felony
offense and she submitted it is difficult to prove that a person
with HIV perhaps, intended to kill someone. She said under the
existing statute, an individual's defense could very easily be that
he didn't intend to kill the person, didn't intend to harm the
person, but wanted to make love to them. Based on a 1990 Attorney
General's Opinion, there is a possibility an individual could be
charged with a misdemeanor offense, but in her mind contracting HIV
is much more serious than a misdemeanor.
CHAIRMAN BUNDE noted there were a number of individuals waiting to
testify. He asked Ed Linsell to come forward to present his
remarks.
Number 0655
ED LINSELL, Prevention and Program Director, Shanti at Southeast
Alaska, testified that Shanti's mission is to reduce the
transmission and acquisition of HIV. He was appearing before the
committee not to argue the language of SB 17 or to quote
statistics, but to testify as the prevention program director of
Shanti who has sat on many occasions across the table from people
who are afraid to be tested for HIV. His job is to present the
facts to these people, offer them an easy way to be tested and to
be there when the results are determined. Shanti has worked for
years to increase the number of people making the decision to be
tested. It's not an easy task and after many years of hard work by
agencies such as Shanti and the Alaska Public Health Division, it's
finally paying off. The public is beginning to understand that HIV
acts like many other diseases such as hepatitis B and hepatitis C
and are more willing to be tested because there's less of a chance
of being labeled. The public is also beginning to understand in
increasing numbers that it is rightfully a public health issue
alone. In Shanti's effort to have people tested to slow the
transmission of HIV, they have never thought of passing a law that
"adds a criminal spin to being tested" which is what he believes SB
17 will do in Alaska.
MR. LINSELL said there are already a lot of people who are afraid
to be tested because of something that may have happened years
before. The treatment of this disease is changing and the face of
HIV is changing; this disease that has made it's way into
mainstream Alaska through people straight and gay, male and female,
young and old, who have either little knowledge of their risk
behaviors or are afraid to be tested. Knowing the nature of HIV
and that it takes years for a person to show recognizable signs,
Shanti has instead realized that getting people tested before
getting sick is the best way to slow the transmission. This is a
public health issue, not a penal issue. The Division of Public
Health and Shanti of Southeast Alaska have spent years demystifying
this disease and putting into effect elaborate and costly
prevention efforts to convey to individuals that it's okay to be
tested. Shanti of Southeast Alaska supports efforts of the
Division of Public Health to have HIV reportable; currently, only
AIDS is reportable. This reporting indicates that it's like any
other reportable disease and should be treated as such - a public
health issue, not a penal issue.
CHAIRMAN BUNDE thanked Mr. Linsell for his comments and asked Karen
Sturnick to come forward to testify at this time.
Number 0842
KAREN STURNICK, Former Executive Director, Interior AIDS
Association, testified in opposition to SB 17 and all other efforts
to criminalize HIV transmission. She stated existing laws already
provide for criminal prosecution and punishment of intentional
transmission of HIV. Criminalizing HIV will certainly take Alaska
backwards in efforts to address all aspects of this public health
issue. As pointed out by Dr. Middaugh, Chief of the Section of
Epidemiology, public health has had experience over many decades
that illustrates criminalization of infections is a bad idea and
harms the public health efforts to control disease transmission.
She said SB 17 will certainly discourage testing. Every community
in Alaska has worked endlessly to develop education and prevention
programming, part of which encourages testing, notification of
partners, and treatment. For over ten years, public health
agencies, HIV/AIDS service agencies and Native organizations have
worked hand-in-hand to educate the public. This bill, if passed,
will undermine all those statewide efforts and will further
discriminate against those people living with HIV and AIDS.
CHAIRMAN BUNDE thanked Ms. Sturnick for her comments and asked Dr.
Michael Beller to come forward to the witness table.
Number 0935
MICHAEL BELLER, M.D., Epidemiology Section, Division of Public
Health, Department of Health and Social Services, thanked the
committee for the opportunity to clarify several pieces of
information relevant to SB 17. He restated it is very clear the
Alaska Medical Association, the Public Health Association, and the
Alaska Native Health Board are all very much opposed to SB 17. He
said it is not correct, as the committee had heard previously, that
27-30 other states have adopted legislation similar to what's being
proposed in SB 17. Of the 27-30 states that do have laws regarding
HIV and criminalization, six of these laws pertain to very limited
situations such as prostitution. Laws in six other states make
certain acts a misdemeanor or an infraction and he is aware of only
14 states, not 27-30, that have a law similar or comparable to SB
17. It is also not correct that the Coburn bill, HR 1062, pending
in the U.S. House of Representatives, supports SB 17; in fact, the
Coburn bill calls for the states to make intentional transmission
of HIV a felony, which is not the same as SB 17. Senate Bill 17
makes exposure a felony even when there's no evidence of
transmission. He said it is also not correct that the American
Medical Association (AMA) endorses laws similar to that proposed in
SB 17. The AMA supports the Coburn bill which differs from SB 17
in that it deals with actual transmission; SB 17 refers to
exposure. Also, it is not correct that the public health response
to Typhoid Mary in New York in the early part of this century is
similar to what's being proposed by SB 17. In New York, Typhoid
Mary was confined and quarantined not because she had transmitted
or exposed people to the bacteria that causes typhoid fever; the
reason she was confined and quarantined was that she failed to
follow a public health order that was given to her. There were
many other - hundreds of other people identified who transmitted
typhoid fever and when they followed the public health orders,
there was no further need for any action or confinement on those
individuals.
DR. BELLER further stated that likewise it is not correct that
Illinois did not experience any adverse effects after adopting a
similar law to SB 17 in 1989. Although it is true the number of
HIV tests did not go down after the Illinois law was passed, there
are many factors that determine how many people will be tested,
such as media attention, the availability of free or low cost
testing, and other legal requirements. In 1989 when Illinois
adopted a law similar to SB 17, there was intense media interest in
the HIV epidemic; in fact, he recalled it was about that same time
a number of celebrities disclosed their HIV positive status,
including Magic Johnson, and as a result of this kind of attention,
there was a very large increase in testing nationwide and Illinois
was part of that. He pointed out it's very simplistic to conclude
that if testing volumes did not go down, there was no adverse
effect. Finally, the Division of Public Health HIV prevention
program is built around the concept of personal responsibilities.
He said it is their work to educate citizens on how HIV is
transmitted and can therefore protect themselves; Senate Bill 17
will not do that. Existing laws already provide for
criminalization and prosecution of intentional HIV transmission.
Senate Bill 17 is unnecessary and is not supported by science or by
professional, medical or public health organizations. He requested
the committee not support this legislation.
Number 1222
REPRESENTATIVE KEMPLEN noted Dr. Beller had indicated that
education of various viruses and other public health issues was one
of the agency's activities. He asked if this legislation could be
characterized as promoting ignorance; ignorance being defined as
someone who is not aware or not knowing. However, an individual
could be charged with a felony for their actions after becoming
aware they are HIV positive. In other words, if an individual
suspects they may be HIV positive, it would be to their benefit not
to get tested and in effect, promoting that ignorance is bliss.
DR. BELLER said it's fair to say that's a very serious concern. On
the other side of that is with legislation of this sort, people may
get the idea of somehow being protected from getting HIV because
a law exists that will protect them if they have unsafe sex. The
law will not protect them; they need to protect themselves by
learning what unsafe sex is and not engaging in unsafe sex.
Number 1320
CHAIRMAN BUNDE commented that several times he's heard that
existing law would cover people who intentionally infect another
individual with HIV. With that in mind, doesn't that address the
issue people are concerned about that there's already a huge
incentive not to get tested.
DR. BELLER reiterated that it's very difficult to actually measure
the effect of one particular change in terms of what happens to
testing, but the expectation is that a law such as this is much
more likely to impede testing than to promote testing. It's
difficult to measure in the real world exactly the effect of one
law versus media coverage, versus changes in funding, et cetera.
He referred to the incident in New York where an HIV positive
individual transmitted infection and disease to a number of young
women and said New York had no specific law similar to SB 17 and
that individual was prosecuted under criminal statutes with
existing laws. He couldn't verify that New York's existing laws
are comparable to Alaska's existing laws, but New York does not
have a specific law stating that HIV transmission, as an entity, is
a felony. Furthermore, the Section of Epidemiology has been in
contact with Chautauqua County where the incident occurred and
there is no interest or need for additional legislation.
CHAIRMAN BUNDE reflected the parents of the young women probably
have a different view. He thanked Dr. Beller for his testimony and
called Anne Carpeneti to the witness stand.
Number 1435
ANNE CARPENETI, Assistant Attorney General, Legal Services Section,
Criminal Division, Department of Law, testified it is the
department's position this is an issue of spreading a disease; it's
not an issue involving a criminal law. Public Health officials
have testified that making it criminal to expose others to HIV is
counterproductive to their efforts to control the spread of this
disease; the Department of Law agrees with that position. She
added that in the case of an angry individual who is intentionally
spreading the disease to others, such as in Chautuaqua County,
Alaska has laws on the books that are generic to criminal law.
These laws do not specifically address HIV transmission, but they
do work. Those laws are attempted murder in the first degree which
would require evidence to prove intent to cause death; attempted
assault if there is evidence to prove the person intended to cause
serious physical injury; and reckless endangerment for conduct
where a person is aware of a risk and disregards it. With regard
to Chairman Bunde's comment regarding the parents of the young
women in New York, she didn't think it would make a difference to
the parents if the man was prosecuted under a specific HIV statute
or attempted murder statute, as long as he was successfully
prosecuted.
CHAIRMAN BUNDE said he did not disagree with her. He felt there
was already some incentive with the laws she mentioned to not be
tested if an individual wants to live a promiscuous lifestyle and
have zero personal responsibility.
CHAIRMAN BUNDE inquired if there were other individuals wishing to
testify. There being none, he announced SB 17 would be held in
committee until all members were present.
HB 369 - MEDICAID COVER/HEALTHY FAMILIES AK PROGRAM
Number 1570
CHAIRMAN BUNDE announced the next item on the agenda was HB 369,
"An Act relating to Medicaid coverage for certain eligible children
and pregnant women; relating to primary care case management and
managed care services as optional services and to premiums and
cost-sharing contributions under the Medicaid program; establishing
the Healthy Families Alaska program; and providing for an effective
date." He noted the committee had a proposed committee substitute
to adopt.
Number 1585
REPRESENTATIVE BRIAN PORTER made a motion to adopt proposed
committee substitute 0-GH2008\E, Lauterbach, 3/26/98, as the
working draft. There being no objection, that version was before
the committee.
CHAIRMAN BUNDE explained the proposed committee substitute scales
down the scope of the bill to focus on helping those people who are
within 200 percent of poverty by allowing them to have access to
health care.
CHAIRMAN BUNDE recessed the meeting at 3:32 p.m. to allow
individuals an opportunity to review the current draft.
CHAIRMAN BUNDE reconvened the committee meeting at 3:39 p.m. He
asked Jay Livey to present his comments.
Number 1662
JAY LIVEY, Deputy Commissioner, Department of Health & Social
Services, explained that last fall Congress passed the Kennedy-Hatch bill which
program which makes federal money available to states to expand
health care coverage for children. Alaska's allotment in the first
year will be $5.6 million and the state's required match is $2.2
million. Current estimates indicate about 23,000 children are
uninsured and of that group, approximately 11,500 are under 200
percent of poverty. He pointed out the background materials
previously distributed didn't include a table that converts poverty
level to both annual salary and wages, but 200 percent of poverty
for a family of three is about $33,000 or $16 per hour. Like all
federal laws, there's a combination of prescriptions in this
legislation that must be accompanied by a child health expansion as
well as several options provided to the states.
MR. LIVEY wanted to address those because it has an impact on how
the department implements this legislation. He said first,
federal law requires any child health program must meet certain
standards. There are standards laid out in federal law as to what
constitutes a child health insurance package; primarily, those
restrictions have to do with the program being comprehensive in
terms of preventative services for kids - healthy child exams,
immunizations and such. Second, children applying for coverage
under a child health insurance program must be screened for
Medicaid eligibility. Additionally, the law requires any child
also eligible for the Indian Health Service has to be served under
the child health program. In other words, just because a child is
eligible for Indian Health Service doesn't mean they can be
excluded from coverage under this program. Finally, any health
insurance provided under a child health program can only be
provided to kids who don't have any other source of insurance, so
there is no attempt to supplant private coverage or existing
governmental coverage.
MR. LIVEY said those are fairly specific restrictions, but the law
allows the state quite a bit of flexibility in two very important
areas - the first being the state has the ability to decide the
eligibility level in terms of providing this new coverage and
secondly, the state has a choice in which delivery system to use to
apply this coverage. Federal law allows states to use Medicaid as
a delivery system, private insurance sector or some combination of
the two. Taking all these issues into account within the framework
of HB 369, the department's proposal which corresponds to the
committee substitute is to raise the poverty level to 200 percent.
He explained that currently under the state's Medicaid program, the
department is at the state minimum and the poverty level for which
a person is eligible depends on the age of the person, but being at
the state minimum would allow the department to go to 200 percent.
Secondly, through CSHB 369, the department has chosen to deliver
the child health insurance through the Medicaid Program. He said
that choice was made for a couple of reasons. Generally, the state
gets a lot more "bang" for the general fund dollar expended which
is largely due to the treatment of Indian Health Service children
who are treated in the Medicaid Program as 100 percent funding from
the federal government. Secondly, the Medicaid program is an
existing administrative program so the start up costs are minimal.
The department can use the existing Medicaid payment system to pay
claims, the current claims system, current enrollment and current
benefit package. There is a certain economy of scale in just
plugging into a program that's already covering 50,000 kids.
Number 1904
MR. LIVEY wanted to talk about the link between child health
expansion and welfare reform. Under welfare reform, the department
is in the process of putting families to work; many into low wage
jobs that do not have health coverage. He explained that an
individual coming off welfare is eligible for transitional Medicaid
the first year. So the individual is eligible for the regular
Medicaid Program for 12 months, after which the individual is on
their own. Individuals who haven't either gotten a better job or
moved into a job with health care coverage will be without health
care coverage and the department doesn't want to give them an
incentive to come back onto cash assistance if their children get
sick. Therefore, expanding the child health coverage under the
proposed program helps protect some of the individuals from coming
back onto the cash assistance program. Secondly, the department
sees a connection between child health and the federal matching
assistance percentage (FMAP) change made last year. He pointed out
that last year the Medicaid matching rate was changed by Congress
which essentially allowed the Medicaid Program to free up about $32
million of general funds. He said, "The FMAP change that Congress
made is a three year deal essentially, and we believe Congress made
that change on the FMAP because they believed that health care
costs in Alaska were high compared to other states and that was the
reason why Alaska was not expanding its health care programs. And
we think that doing this to child health care gives us an
additional benefit of being able, after three years, to go back to
Congress and say to Congress, 'You gave us this FMAP change - you
increased our federal allocation of money and with that money we
went out and we served more kids' and we think three years from now
that will be a useful argument to have as the FMAP comes up for
reauthorization."
Number 2035
MR. LIVEY said one difference between the proposed committee
substitute and the original bill is the proposed committee
substitute does not include coverage for pregnant women. The
original bill covered pregnant women up to 200 percent of poverty
because better birth outcomes are expected when women have prenatal
care and if the child is going to be covered once its born, it only
makes sense to do the preventative care up-front to reduce the
possibility of bad outcomes which are very expensive later on.
This federal law requires the approval of a state plan by
September 30, but the federal government has indicated that any
state plan submitted by July 1 is guaranteed to be acted upon prior
to September 30. He reminded the committee that Alaska's plan must
be submitted by July 1 or the state loses its first year allocation
of money or $5.6 million. He asked Bob Labbe to discuss some of
the specific provisions of the proposed committee substitute.
Number 2060
BOB LABBE, Director, Division of Medical Assistance, Department of
Health & Social Services, said the proposed committee substitute
basically parallels the original bill with the exception of some
deletions. He said currently Alaska's Medicaid coverage for
children is at the minimum level required under federal law so
those kids that are required to be covered as opposed to the state
electing to cover them as an expansion. The proposed committee
substitute for HB 369 proposes as an option to go higher or up to
200 percent of the poverty level. Currently, children under the
age of 6 are covered to 133 percent of the poverty level; kids 6-14
years of age are covered if the family income is below 100 percent
of the poverty level; and kids over 14 years old are covered if
their family receives cash assistance which is about 70 percent of
the poverty level. While the current system has somewhat of a
stair step, CSHB 369 proposes a uniform line across the eligibility
which will allow more children to have coverage and simplify to
some extent, the administration of a fairly complicated program.
He said most states are doing better than Alaska on their coverage
level, which he believed spoke to the FMAP change that Alaska
hasn't been able to move up as much as other states. Forty-one
states were identified prior to this new block grant as having
coverage above the federal minimum required level. He noted that
approximately 21 states have submitted their state plan to move
ahead with these expansions and he assumed Alaska will be further
down than the 41 if we don't act. He said, "We believe it's
important that we make an effort to improve and I think with the
funding that Senator Murkowski was able to secure the (indisc.)
change we have an opportunity here that's sort of like the federal
is paying both sides, although it's freed up general fund but it's
kind of a no cost expansion compared to other states who are having
to struggle to find the matching funds to even do these
expansions."
Number 2205
MR. LABBE pointed out another part of the block grant legislation
is that it will allow states under their Medicaid Program to
provide guaranteed eligibility for children for up to a year. He
explained currently when an individual is on Medicaid, it's sort of
month to month which makes continuity of care problematic and
creates a lot of administrative confusion as to who is on and who
isn't. The idea is to provide some longer period of guaranteed
eligibility; the department is proposing 6 months rather than 12
months as a reasonable start. So a child eligible the month coming
into the program would be covered for the next 6 months, without
regard to changes that may be going on, and would then be reviewed
to see if they qualify for another 6 months. That's what is
referred to as continuous eligibility and it would apply not only
to the expansion group but to the current 50,000 kids. One thing
that's tied up with the Title 21 block grant program that hasn't
been mentioned is an outreach effort. He said, "Because I think of
welfare reform activities around the country, there is concern that
children are losing some benefits because the families are not
pursuing like health care coverage, we've changed the tone of the
welfare model to be a temporary assistance and although you're
still eligible for health care benefits, they may not perceive it
that way so what we're looking at also as other states are, is more
outreach - simplify the process, make it more customer friendly,
maybe different access points and really focus on it's important to
have coverage for your kids and if you're unable to afford it, we
have this program and not get it too tied up in all the other
bureaucracy."
MR. LABBE said that Section 4 of the proposed committee substitute
contains provisions that parallel some things that happened with
the block grant which permit some cost sharing for families between
150 percent and 200 percent of the federal poverty guidelines. He
explained that when the legislation was developed last fall, the
department had anticipated having some flexibility under Medicaid
to do this, but at this point in time the federal government is
indicating it can't be done even above the 150 percent level. A
number of states have expressed concern about this and cost sharing
between the 150 percent and 200 percent level could probably be
done if the state elected not to go through the Medicaid Program,
although there is a certain amount of prescription about what a
state can do and in looking at size of population and costs
involved, it's probably not all that effective at this level. He
added, "But it's still in here with the idea that it was our
feeling that it was reasonable to expect some contribution about
some income level in terms of purchasing coverage and that is in
fact some change is made at some point at the federal level, then
we would have that ability."
TAPE 98-45, SIDE B
Number 0001
MR. LABBE said sections that were dropped out of the proposed
committee substitute, such as the coverage of pregnant women are
very important to the department. Typically, the department
prefers to keep the eligibility level comparable and coverage for
a pregnant woman is generally viewed as coverage for the child. He
pointed out it is not something that is fundable out of this block
grant - the block grant was only for kids, not for pregnant women
which the department thought was a bit of an oversight at the
federal level. He added, "And again, since we're at the minimum
level for coverage - we do cover pregnant women to 133 along with
the kids under 6 - we would like to bring them up at the same time
to whatever level we ultimately get ...."
REPRESENTATIVE BRICE asked if there was a correlation between the
amount of service a pregnant woman gets and the cost savings that
can be expected after giving birth.
MR. LABBE recalled a study on the issue of cost effectiveness of
prenatal care he thought indicated $1 spent saved $3 in terms of
future expenditures. He added, "I know that delayed - for women
that are uninsured, and this was the case here and I've talked to
some of the emergency room folks about this awhile back when I was
down in Soldotna, they were saying before we did the expansions to
133 they were seeing a lot more women presenting for delivery that
had no prenatal care and the outcomes are not real great frequently
and of course, that drives a lot of our costs. In fact, national
data will show about 10 percent of the health care costs are
neonatal costs - a very expensive proposition. So we believe we
should make that investment as well and I would urge you to
consider that."
REPRESENTATIVE KEMPLEN inquired if someone from the department
could talk about the Health Families Program contained in the
original bill.
PAM MUTH, Chief, Maternal Child & Family Health Section, Division
of Public Health, Department of Health & Social Services, stated
the Healthy Families Program is a proven prevention program to
prevent child abuse and neglect. The original version of HB 369
was giving the Healthy Families Program official status which by
being in statute would allow the department to set standards for
training, promulgate regulations which would open the program up to
more public process and so forth. At this point, the department is
running the Healthy Families Program under general statute. The
statutes are a way to assure the public about the kinds of services
being offered, the standards and how the services will become
available. She encouraged the committee to either draft a new
version that includes the Healthy Families Program or to add it to
the proposed committee substitute.
CHAIRMAN BUNDE understood the program was not funded by this
specific federal program so in his mind, it would require a new
bill as a stand alone issue.
REPRESENTATIVE KEMPLEN inquired if the department had funding
allocated in its current budget for the Healthy Families Program.
MS. MUTH responded affirmatively; the program was funded at the
status quo for FY 98 which means for programs there will be no new
growth. For the eight programs that are funded in the department's
budget, there won't be any availability for adding new clients, no
availability to expand beyond the eight programs. The bottom line
is that children and families currently enrolled will continue to
receive services and newborns will be put on a wait list which
means those newborns probably will never receive services. She
explained that children stay on this program for three to five
years, so in order for new children to come into the program, it
would take either some children dropping out of the program, some
children leaving the service area, or graduating out of the program
at five years of age.
REPRESENTATIVE KEMPLEN understood the Healthy Families Programs
language in the original bill allowed the department to improve the
delivery of its services by addressing standards and regulations
and to increase the overall effectiveness of operating the eight
Healthy Families Programs.
MS. MUTH said the department believes so, yes.
REPRESENTATIVE PORTER asked how long the program had been in
existence.
MS. MUTH explained it's been phased in; several programs have been
in existence for about three years. One program in Kenai, funded
through a federal grant, has been in existence for longer than
three years and there were several programs added just last year.
REPRESENTATIVE PORTER asked if the eligibility was birth to five
years of age or five years in the program.
MS. MUTH said the program requires that a child enter the program
in the first three months of life. Children outside that three-month window wo
why the wait list is such a concern to us because if we need to
shut down the enrollment right now, that means that in let's say
two years - if we're able to grow a little bit in two years - we
won't ever be able to touch those children that are between four
months of age and two years of age."
REPRESENTATIVE PORTER inquired if there was a residency
requirement.
MS. MUTH responded the parents need to reside in the geographic
areas for the program.
REPRESENTATIVE PORTER surmised then that if someone moved into an
area and qualified within 30 days or whatever it takes, but their
children were over four months of age, they too would not be
eligible.
MS. MUTH confirmed that.
CHAIRMAN BUNDE thanked Ms. Muth for her comments and asked Walter
Majoros to present his testimony at this time.
WALTER MAJOROS, Executive Director, Alaska Mental Health Board,
Department of Health & Social Services, testified in support of the
proposed committee substitute for HB 369, but somewhat less
enthusiastically than the original version. He said the Alaska
Mental Health Board does support the expansion of children's health
insurance as well as the services for pregnant women and the
Healthy Families codification. The board has noted the incredible
importance of prevention in early intervention services with regard
to mental health and all three of these expansions would assist in
early intervention and prevention activities. He said one of the
things being seen is earlier and earlier onset of emotional and
mental health problems with youth. This is especially true for
children coming from families experiencing multiple forms of abuse
and neglect. They are at an incredibly high risk for developing
emotional and mental health problems and the longer it goes without
intervention, the more serious the problems become. It's now
becoming apparent that kids who have endured these problems are now
requiring various intensive mental health services under the
Medicaid mental health program. He said the expanded Medicaid
offers a tool to have an array of mental health services available
to children as well as to pregnant women and to help low income
families make the move from welfare to work. It appears this could
be done in a very cost effective way through the Medicaid Program.
He said it's unfortunate the proposed committee substitute dropped
pregnant women from the eligible population because the Alaska
Mental Health Board contends that access to early intervention with
kids begins with prenatal care. With respect to the Health
Families Program, he said the board has come out with an incredible
endorsement of this program and has heard nothing but praise about
the services offered through the Healthy Families Program
throughout the state. Again, it's so important to identify high
risk families as early as possible and provide the needed services.
The Healthy Families Program is having a lot of success in reducing
and preventing abuse and neglect; it's a service that's important
to offer as early as possible and can reduce or prevent long term
mental health problems. He could understand the committee's
rationale for wanting it in a separate piece of legislation, but
codifying the program could give validity to a very important
prevention approach, allow for some standardization in the program
and some statewide consistency in the services provided. He
thanked the committee for putting forth the committee substitute to
expand the children's health insurance but he requested the
committee reconsider the expansion provisions for pregnant women as
well as the codification of the Healthy Families Program.
CHAIRMAN BUNDE asked the wish of the committee.
REPRESENTATIVE KEMPLEN made a motion to amend the proposed
committee substitute on page 1, line 2, following ";" insert
"establishing the Healthy Families Program" and page 2, line 23,
insert language from the original version of HB 369 beginning at
page 4, line 18, which is the Healthy Families Alaska Program
component.
REPRESENTATIVE PORTER objected.
CHAIRMAN BUNDE said he could understand both the testimony and
Representative Kemplen's point of view; however, that portion is
not funded from the particular money being discussed. He viewed it
as the glass being half full rather than half empty and therefore,
opposes the amendment.
REPRESENTATIVE KEMPLEN stated the program is already funded from
general funds and is proposed to be funded at the status quo in FY
99. There is an anticipated expansion of the program as soon as
the department initiates a control group to measure the results of
this initiative, so it appears that funding is not really an issue
for the Healthy Families Program. Based on the testimony, having
the program codified would result in the department being able to
produce better results and increase the effectiveness of the
program. There has been testimony in support of the Healthy
Families Program and it is producing good results, but that it
could do even better with the reinsertion of this language into the
proposed committee substitute. He is of the opinion the
legislature should take advantage of any opportunity to do things
better.
CHAIRMAN BUNDE reiterated that he doesn't view the Healthy Families
Program as a bad program, but he believes the chances of this
specific piece of legislation passing are increased without
expanding it at this point.
CHAIRMAN BUNDE asked for a roll call vote. Representatives Brice
and Kemplen voted in support of the amendment. Representatives
Porter and Bunde voted against it. Therefore, the amendment failed
on a 2-2 vote.
REPRESENTATIVE BRICE made a motion to amend the proposed committee
substitute to include coverage at the 200 percent of federal
poverty level for pregnant women.
CHAIRMAN BUNDE objected. He said from the same point of view, it's
not covered under this pot of money, although it's an applaudable
goal.
REPRESENTATIVE BRICE disagreed and said the fiscal notes are
directly related; both are Medicaid programs and both programs
decrease the costs to state government as the level of service for
pregnant women increases. He added, "I think by expanding to 200
percent for pregnant women, not only are we fulfilling the intent
of the federal mandates with the changes in FMAP, but also the
letter of the negotiated terms by which the FMAP changes were
vetoed - I mean, if it's hand in glove, absolutely, between
prenatal and postnatal care. I think if you want to address the
question such as fetal alcohol syndrome (FAS), fetal alcohol
effects (FAE), you want to address the questions such as
developmental delays, you've got to address them in the prenatal
level essentially otherwise you are throwing good money after bad
unfortunately. When we're talking about prevention, you're talking
about getting to these women - in a sense, the earlier the better.
It is precisely the same type of program in which we expanded to
200 percent for children - it is precisely the same argument for
pregnant women as it is for the children and you want to talk about
saving state dollars in the future, that's a serious place where we
should be looking at."
CHAIRMAN BUNDE agreed the programs are similar, but there had been
testimony that the children's federal program does not cover the
pregnant woman.
REPRESENTATIVE PORTER said, "I don't disagree that there's logic in
providing that to pregnant women, I guess it begs the question if
the statistics are true and it sounds like there's pretty well
documented information on it, one would think there could be a
resultant reduction in the state impact from the program one to
one, let alone three to one as I understood the difference was, I
would entertain it if there was that kind of reduction in the cost
of the other part of the program from birth to five, but I don't
see that reflected."
CHAIRMAN BUNDE called for a roll call vote. Representatives Brice
and Kemplen voted in favor of the amendment. Representatives
Porter and Bunde voted against it so the amendment failed on a 2-2
vote.
REPRESENTATIVE BRICE made a motion to move proposed committee
substitute for HB 369 with revised fiscal notes. There being no
objection, CSHB 369(HES) moved from the House Health, Education and
Social Services Standing Committee.
HJR 58 - CONST AM: EDUCATION FUND
CHAIRMAN BUNDE announced the next bill on the agenda was HJR 58,
Proposing amendments to the Constitution of the State of Alaska
relating to the education fund. He asked Representative Cowdery,
the bill sponsor, to come forward.
REPRESENTATIVE JOHN COWDERY, Alaska State Legislature, sponsor,
said HJR 58 would place a constitutional amendment on the ballot
that would designate 40 percent of revenues from Arctic National
Wildlife Refuge (ANWR) lease sales and royalties to fund education.
He said the intent of this bill is twofold. First, he thinks it's
in the best interests of Alaska that our natural resources be
developed reasonably and responsibly. The current status of the
ANWR is contrary to the well-being of Alaska's economy and
consequently Alaska's ability to fund education. Some years ago,
he met with a number of people involved with the permanent fund to
discuss the criteria needed to spend the permanent fund when the
time came. Even at that time when there was lots of money
available to spend, the group was unable to come to a decision.
Therefore, the intent of this resolution is twofold - to get people
thinking about ANWR again and to help stabilize educational
funding.
CHAIRMAN BUNDE asked if Representative Cowdery would be interested
in expanding this to PET-4 as well.
REPRESENTATIVE COWDERY said he would consider that as a friendly
amendment, but he had been thinking along the lines of a separate
piece of legislation for that.
REPRESENTATIVE PORTER said, "Are we not greatly restrained from
revenue in PET-4 as opposed to what we would be in ANWR?"
REPRESENTATIVE COWDERY directed the committee's attention to the
chart depicting potential state ANWR revenues. He viewed this as
a type of mini permanent fund for education for the future.
REPRESENTATIVE KEMPLEN commented he favored the idea of an
education fund.
CHAIRMAN BUNDE asked Representative Cowdery to do research
regarding the PET-4 revenues and come before the committee at a
later date for further discussion.
REPRESENTATIVE PORTER understood the state's potential from revenue
and taxation is grossly less in PET-4 because it is a naval
petroleum reserve outside the normal federal distribution. He said
the motivating thing about this resolution is that it doesn't do
anything unless ANWR works and that is at least half of his
interest in the bill.
CHAIRMAN BUNDE offered that PET-4 is far from a done deal.
REPRESENTATIVE COWDERY said in terms of ANWR, he thought if all the
communities would get behind the development of ANWR, there may be
more support for this.
WILLIE ANDERSON, Representative, NEA-Alaska, testified in support
on this constitutional amendment. He said HJR 58 is a forward
looking bill and NEA-Alaska offered their help in getting this
piece of legislation passed. He said having a dedicated fund for
education is good idea that's long overdue.
CHAIRMAN BUNDE remarked that HJR 58 would be held in committee and
heard at a later date.
ADJOURNMENT
CHAIRMAN BUNDE adjourned the House Health, Education and Social
Services Standing Committee at 4:31 p.m.
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