Legislature(2005 - 2006)CAPITOL 106
07/26/2006 08:00 AM House HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
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| Start | |
| Using Health Care Dollars Wisely: Improving Birth Outcomes | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
ALASKA STATE LEGISLATURE
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE
July 26, 2006
8:04 a.m.
MEMBERS PRESENT
Representative Peggy Wilson, Chair
Representative Paul Seaton, Vice Chair
Representative Carl Gatto
Representative Sharon Cissna
Representative Berta Gardner
MEMBERS ABSENT
Representative Tom Anderson
Representative Vic Kohring
COMMITTEE CALENDAR
USING HEALTH CARE DOLLARS WISELY: IMPROVING BIRTH OUTCOMES
- HEARD AND HELD
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
STEPHANIE BIRCH, Chief
Women's, Children's and Family Health
Division of Public Health
Department of Health and Social Services
Anchorage, Alaska
POSITION STATEMENT: Provided information regarding improving
birth outcomes in Alaska.
JERRY FULLER, Project Director
Office of Program Review
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: During discussion of Native health,
provided information.
KARLEEN JACKSON, Commissioner
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Answered questions.
PAT CARR, Health Program Manager
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Provided comments with regard to the
results related to the expansion of the community health center
program.
ACTION NARRATIVE
CHAIR PEGGY WILSON called the House Health, Education and Social
Services Standing Committee meeting to order at 8:04:35 AM.
Representatives Wilson, Seaton, and Gardner were present at the
call to order. Representatives Cissna and Gatto arrived as the
meeting was in progress.
^USING HEALTH CARE DOLLARS WISELY: IMPROVING BIRTH OUTCOMES
CHAIR WILSON announced that the only order of business would be
a discussion related to using health care dollars wisely to
improve birth outcomes. She noted that this meeting and the
upcoming meetings will pull together matters that were discussed
in a conference in Denver, Colorado, regarding spending health
care dollars wisely. The goal is to review programs and
determine whether services can continue and increase while
saving money in the long run.
8:08:02 AM
STEPHANIE BIRCH, Chief, Women's, Children's and Family Health,
Division of Public Health, Department of Health and Social
Services, began by informing the committee of her background as
a nurse. Ms. Birch drew the committee's attention to the
PowerPoint entitled, "Public Health Protecting and Promoting the
Health of all Alaskans." The slides in this PowerPoint review
indicators of performance that is measured by her section as
well as discussion of solutions. Slide one addresses prenatal
care, which is defined as the initiation of care. The current
challenge is that the number of visits that women receive during
pregnancy don't meet the national standard or the Healthy People
(HP) 2010 goals. In fact, data relates that one in five women
didn't receive care as early as desired. Furthermore, nearly
one in three Alaskan women who delivered an infant received less
than adequate prenatal care and nearly one in seven received
nearly no care at all. Therefore, quite a large proportion of
women are coming into labor and delivery without having received
any prenatal care.
8:10:28 AM
CHAIR WILSON asked if the lack of care is due to the woman being
located far away from where the care is located.
MS. BIRCH answered that often the woman has a lack of the
following: knowledge of the pregnancy during the first 12 weeks
of pregnancy, funds, insurance, and access in communities. The
initiation of the community health centers and the federally
qualified health centers will be helpful in regard to a woman
determining whether she is pregnant and receiving early prenatal
care, she said. However, she noted that the number of providers
trained in providing good early prenatal care is limited in
terms of access and thus proves to be a challenge.
MS. BIRCH, in further response to Chair Wilson, specified that
community health aide providers are located in the village
clinics. Those health aide providers are trained in some of the
very basic prenatal care and thus pregnant women would
periodically visit the regional hubs. In the urban centers,
many providers don't want to see a pregnant women until she is
in the second trimester of care because of payment. Therefore,
a window of opportunity to impact behavioral change, such as
with smoking cessation, has been lost. Ms. Birch mentioned that
nationally there is a movement with regard to working with women
prior to them thinking of becoming pregnant as well as care
between pregnancies.
8:13:09 AM
MS. BIRCH related that coverage for insurance increased up until
2002, and then in 2003 there was a statutory freeze of the
Medicaid rate at 175 percent. Furthermore, since there is no
ability to modify that statutory freeze for cost of living
changes, the eligibility level has steadily decreased over time.
Currently, the Medicaid rate in Alaska is about 164 percent of
poverty.
8:13:49 AM
MS. BIRCH returned to the subject of low birth weight and
related that Alaska has had some success in this area. For
instance, Alaska's proportion of low birth weights is much
better than the national [percentage], but Alaska still doesn't
meet the Healthy People goals. However, Alaska's proportion of
preterm births and very low birth weights, which are smaller
than they once were, is increasing and these babies are very
costly. She related that 75 percent of those babies eventually
qualify for Medicaid. Furthermore, often these babies have
life-long issues for which Medicaid is often responsible to
support.
8:15:53 AM
MS. BIRCH then turned attention to the birth defects and pointed
out that the department has a health data book with 10 years
worth of data regarding birth defects in Alaska. She pointed
out that Alaska's infant mortality rate due to birth defects
looks good as compared nationally, although the state hasn't met
the Healthy People goal. However, the incidence of spina bifida
and other neural tube defects (NTD) [in Alaska is higher than
the national average]. Furthermore, the highest rates of NTD
occur in the Interior and Southwest regions. She informed the
committee that the best way to prevent such defects is to take
an extra dose of folic acid and the knowledge of folic acid by
women is increasing. Ms. Birch specified that approximately 5
percent of Alaska's babies are born with at least one major
congenital defect, most often cardiovascular. She further
specified that 1 in 60 live births have a heart defect and 1 in
150 have congenital urinary defects.
8:19:04 AM
MS. BIRCH moved on to the slide related to fetal alcohol
syndrome (FAS), and confirmed that Alaska continues to lead the
nation in the prevalence of children with FAS. Each year
approximately 126 children are born with FAS. She informed the
committee that FAS is a reportable birth defect, and therefore a
chart review is performed on each child reported as such. Ms.
Birch expressed concern with a survey in which 36 of OB/GYNs and
18 percent of family practice physicians say that it's
acceptable for women to drink alcohol during pregnancy. She
questioned where the message has been lost. She then related
that once women are screened and found to be drinking during
pregnancy, there aren't enough beds or treatment services,
particularly for pregnant women with small children.
8:20:48 AM
MS. BIRCH continued with the slide related to the post neonatal
and infant mortality rate. She explained that the neonatal
period is considered the first 30 days of life and thus post
neonatal time would refer to the time after the first 30 days to
the first year. Unfortunately, Alaska's post neonatal mortality
rate is 2.7 times greater than the Healthy People 2010 target
and 1.6 times that of the national rate, which can be partially
attributed to Alaska's high incidence of sudden infant death
syndrome (SIDS). Significant health disparities exist in this
area, she emphasized. She related that infants born to mothers
less than 20 years of age are significantly more likely to die
within the first year of life. Furthermore, infant mortality
amongst Alaska Natives is twice that of adults despite the fact
that infant mortality has been steadily decreasing. Post
neonatal infant mortality of Alaska Natives has steadily
increased, and is 3.3 times higher than whites. Although much
work has been done in relation to SIDS and the "Back to Sleep"
campaign, the aforementioned health disparity persists.
8:22:32 AM
MS. BIRCH turned to the slide related to the infant sleep
position and co-sleeping. She informed the committee that
Alaska has an increasing number of women and families who report
co-sleeping with their infants. Therefore, the behavioral
change doesn't seem to be working. The aforementioned has lead
to the campaign regarding how to safely sleep with an infant.
In the analyzation of Alaska's death records, the association of
co-sleeping and infant death was found only in cases when the
adult was impaired by alcohol or drugs.
8:23:59 AM
MS. BIRCH concluded by relating solutions to improve birth
outcomes as follows: improved access to preconception and
prenatal care; enhanced funding for education of health care
providers; enhanced fees for providers who offer care
coordination in his/her office. The enhanced fees for providers
offering care coordination in the office is utilized in some
states.
CHAIR WILSON recalled that the conference in Denver brought out
that improving access to [care to] mothers made more difference
than anything else. She then inquired as to how much a normal
insurance company pays for [preconception and prenatal care].
MS. BIRCH answered that the major provider groups generally pay
for a certain number of visits of a regular pregnancy. For a
high risk pregnancy, the insurance company requires approval for
additional visits. However, some package insurance plans
specify a certain amount of money and thus physicians often want
to see the pregnant woman more during the later stages of
pregnancy when potential problems exist. In further response to
Chair Wilson, Ms. Birch indicated that Medicaid is paid on a per
visit basis, but she deferred to others for further detail.
8:27:21 AM
REPRESENTATIVE GARDNER highlighted that many Alaskans have
access to health care through Indian Health Care Services. She
then inquired as to whether Indian Health Care Services cover
prenatal or pre prenatal care.
MS. BIRCH confirmed that Indian Health Care Services do offer
prenatal care. In fact, for the last three years Indian Health
Care Services have had a high risk maternal fetal physician who
cares for the highest risk families. However, the challenge is
tracking Native families who come in and out of population
centers and the village. In reviewing data, it is apparent that
much could be done to work with rural health providers to
educate them regarding new trends and information, such as the
high risk factors of hypertension and diabetes.
8:29:23 AM
REPRESENTATIVE CISSNA asked if there has been any study with
regard to the ties between Alaska's increase in obesity and low
birth weights.
MS. BIRCH said that she didn't know of any studies reviewing the
rate of obesity associated with low birth weight. She related
that some of the most obese patients have some of the smallest
babies because much of an obese woman's blood supply is already
diverted to her own weight. Therefore, sometimes there isn't
enough nutrient value and blood supply to feed the baby.
Another interesting fact is that most very obese women aren't
able to deliver vaginally and thus have a higher rate of
cesarean deliveries. Furthermore, very obese women are also at
greater risk of having pregnancy-induced hypertension and
diabetes, which results in babies that are delivered early.
Therefore, these are often smaller babies with small lungs who
are in the intensive care unit for a long period. This all
supports the need to focus on [health care during] preconception
and the time in between pregnancies.
REPRESENTATIVE CISSNA highlighted the expense, monetarily and
socially, of infants who are hospitalized after birth when they
should be bonding with the mother and others. She suggested the
need to focus on decreasing hospitalization in order to address
[later] social, mental, and physical problems.
MS. BIRCH noted her agreement. She informed the committee that
the newborn intensive care units have dramatically changed, such
that now it's common to have single-room care so that parents
can help care for their infants. The ICU has made many
accommodations to allow parental involvement. Ms. Birch related
that children born with long-term problems are at more than
twice the risk for child abuse and neglect. She highlighted the
stress involved in a situation in which a baby is 1,500 miles or
more away receiving care.
8:34:49 AM
REPRESENTATIVE GARDNER returned attention to the slide regarding
low birth weight and preterm birth, which specifies that Alaska
is doing better than the national average.
MS. BIRCH pointed out that the data regarding the aforementioned
is from 2003. More recent data shows that Alaska's [incidence
of low birth weight and preterm birth] have steadily increased.
One of the reasons Alaska's low birth weight has decreased is
the advent of the newborn intensive care unit in the 1980s.
However, the numbers of smaller and sicker babies are
increasing.
8:36:49 AM
MS. BIRCH, returning to solutions, emphasized the need to review
smoking cessation because data indicates that it's one of the
most important interventions. She attributed the aforementioned
to the fact that no matter a mother's social situation, she
wants to have a healthy baby. Therefore, mothers tend to be
very motivated to change their behavior. She explained that
mothers benefit the most from smoking cessation educators
trained to work with pregnant women. However, there aren't
enough cross-trained individuals to support smoking cessation of
pregnant women. Ms. Birch then reiterated the need to place
greater emphasis on the use of folic acid; support the alcohol
abstinence programs; support the "Back to Sleep Program"; and
provide co-sleeping education. She then informed the committee
that eliminating maternal smoking may lead to a 10 percent
reduction in all infant deaths and a 12 percent reduction from
perinatal conditions such as low birth weight, respiratory
disease, and SIDS.
8:39:40 AM
MS. BIRCH related other solutions including the need for greater
access to intra-conception care such that the use of regular
birth control is encouraged as is birth spacing of two or more
years. She informed the committee that women who qualify for
the Denali KidCare Program for pregnancy receive up to eight
weeks of postpartum care. Therefore, unless such women have a
permanent solution for birth control, they have no birth control
after 60 days. Although public health and community health
centers dispense birth control pills for free or a reduced rate,
that reduced rate is still fairly expensive. She then related
that [data shows] that young women will take birth control pills
correctly the first three months, after which they take them
incorrectly. Therefore, much support and education regarding
the various forms of contraception is necessary.
8:41:15 AM
REPRESENTATIVE CISSNA recalled that last year when she visited
public health offices in rural areas, she was informed that they
were having difficulty obtaining birth control pills.
Therefore, she questioned whether access to birth control is a
problem.
MS. BIRCH responded that some types of birth control is more
difficult to obtain than others. Therefore, another project is
attempting to work on the access to birth control. She pointed
out that sometimes the high cost of birth control is caused by
the prices of the pharmaceutical companies. Ms. Birch then
related that for every $1 spent in family planning $3 in
Medicaid for prenatal and newborn care is saved. Therefore,
access to family planning could be very helpful.
8:42:45 AM
REPRESENTATIVE GATTO inquired as to whether high birth weight
infants are increasing.
MS. BIRCH related that women with diabetes are monitored
heavily. The challenge is that as babies are larger in a
diabetic mother, they aren't necessarily healthier. Therefore,
these babies are often delivered earlier through cesarean and
have many problems. She reminded the committee that babies born
to women who are obese are often smaller because the blood
supply from the mother is diverted to supporting the mother's
weight. All of the aforementioned carries a cost and often
carries long-term effects.
REPRESENTATIVE GATTO commented that folic acid is really cheap.
He then inquired as to whether it would be valuable to take
folic acid prior to conception. He also inquired as to whether
there is any impact on males who take folic acid prior to
conception.
MS. BIRCH agreed that folic acid is inexpensive. She explained
that the department has encouraged even young women to take
multi-vitamins with 400 micrograms of folic acid. However, she
noted that access to and cost of multi-vitamins can be difficult
in rural areas. With regard to men taking folic acid, there are
studies related to the importance of folic acid in the
prevention of heart disease and some cancers. She mentioned
that folic acid has been added to cereals and bread.
8:46:28 AM
REPRESENTATIVE SEATON recalled an advertisement regarding a new
long-term implant for birth control, and asked if it's in use in
Alaska.
MS. BIRCH informed the committee that this new long-term implant
was just FDA approved, and therefore has limited availability.
She surmised that the department will have to review it in terms
of cost as well as access to mid-level nurse practitioners who
would be required to insert this new implant. Through an
agreement with the Division of Public Health, funds were
provided to help purchase contraceptives other than birth
control pills, including two long-term IUDs and a vaginal ring.
REPRESENTATIVE SEATON requested that Ms. Birch provide the
committee with the information regarding the cost effectiveness
of the implant, as well as the cost of the failure of taking the
pill incorrectly.
8:49:10 AM
MS. BIRCH, in response to Chair Wilson, said this new implant
has just been approved and hasn't had much usage. She offered
to provide any data that comes forward in relation to this new
implant. She then related the downside of other birth control
methods that came to light after usage.
8:51:35 AM
REPRESENTATIVE GATTO returned to the issue of co-sleeping, which
would seem to be natural, and asked if there is any research
regarding the benefits of co-sleeping.
MS. BIRCH answered that there is much research with regard to
the benefits of co-sleeping, especially with regard to breast
feeding. In fact, there is a study that specifies that SIDS may
be reduced by co-sleeping. In Alaska the approach is to educate
folks with regard to how to safely co-sleep with an infant.
8:54:35 AM
MS. BIRCH then reminded the committee that Alaska has a Maternal
Infant Morbidity and Mortality Review Committee. In reviewing
10 years worth of data, it was found that alcohol was a
contributing factor in 28 percent of the deaths of mothers
occurring at the time of delivery up to a year later. The data
also found that 23 percent of those deaths were related to
socioeconomic factors while 10 percent of those deaths were
attributed to inappropriate medical care. The data ultimately
showed that 60-77 percent of those deaths for women were
preventable by better patient education, more aggressive
tertiary referrals, and improvements in medical management.
8:56:03 AM
REPRESENTATIVE GARDNER inquired as to whether the medical
factors leading to mothers' death were related to the postpartum
condition.
MS. BIRCH answered that some of [the deaths] were related to the
lack of recognition of high blood pressure. She explained that
typically mothers who delivered vaginally are seen six weeks
postpartum while those who delivered via cesarean are seen eight
weeks postpartum. Sometimes, she related, a woman with high
blood pressure will see a climb in that blood pressure after
delivery and that's not recognized. The aforementioned was the
case for some of the deaths. A high contributing factor to the
deaths of the mothers was drug use. Therefore, [the medical
factors leading to mothers' death] are related to the chronic
conditions of the mother that weren't well controlled after
delivery.
8:57:08 AM
MS. BIRCH continued to relate that these deaths were preventable
with alcohol and drug abuse treatment, mental health counseling,
[recognition of and treatment for] postpartum depression, and
greater availability of shelters and safety management plans for
women experiencing domestic violence. She noted that a number
of these women "died by their partners."
8:57:47 AM
CHAIR WILSON pointed out that domestic violence increases during
pregnancy, and inquired as to whether domestic violence
continues after the pregnancy.
MS. BIRCH replied yes. In fact, domestic violence tends to
escalate after the pregnancy because the baby becomes the focus
of attention rather than the batterer.
8:58:57 AM
CHAIR WILSON referred to the [health data] book, which related
that almost double the children with disabilities are located in
northern and southwestern Alaska where most Natives are located.
Therefore, she suggested that it's an area on which the
committee should focus, although those populations receive their
health care for free. She mentioned that education could be
helpful. Chair Wilson encouraged the committee members to
review ways in which to save funds in the area of health care in
Alaska.
9:01:04 AM
JERRY FULLER, Project Director, Office of Program Review,
Department of Health and Social Services, said that although
it's technically correct that Alaska Natives receive health care
free, the Indian Health Service (IHS) grant to the Alaska Tribal
Health Corporation isn't all that encompassing. In fact,
nationally it's estimated that it funds about 57 percent of the
need. The aforementioned funds aren't nearly sufficient to
provide all the services that are available to those with a
private insurance plan. He opined that Alaska Natives have very
inadequate systems for meeting the needs of the membership.
Therefore, [Alaska Natives] look to Medicaid as the first payer
for some services. Mr. Fuller stated that the care system isn't
funded adequately to meet all of the needs.
9:02:50 AM
REPRESENTATIVE SEATON returned to the issue of prenatal care,
and asked if IHS provides adequate funding for prenatal
services.
MR. FULLER said it's hard to say. However, he opined that
tribal corporations do spend their federal funds to support
prenatal care and birthing services, although the ability to do
so may vary with the corporation. He indicated that there may
be deficiencies due to other factors beyond funding, such as
inability to obtain certain health professionals.
CHAIR WILSON recalled her time working in the clinic in Tok that
also housed a physician's assistant who was in charge of the
five health clinics for the nearby villages. She suggested that
perhaps training for the villages would be appropriate. She
then inquired as to the cost to the state for prenatal and
postnatal care costs.
MR. FULLER offered to provide that information to the committee.
9:06:07 AM
KARLEEN JACKSON, Commissioner, Department of Health and Social
Services, related that per prenatal visit Medicaid will pay
$77.61, for delivery Medicaid will pay $1,207, and per delivery
post care Medicaid will pay $2,428. Therefore, although there
may be Medicaid funding such that a woman doesn't have to pay
for prenatal care, there are still issues with regard to
reimbursement related to Medicaid. The aforementioned requires
review, she said.
9:07:13 AM
COMMISSIONER JACKSON, in response to Chair Wilson, offered to
obtain budget information for the committee.
CHAIR WILSON expressed the need to review the budgets as changes
are made in order to determine whether those have cut costs and
address any new problems.
REPRESENTATIVE GARDNER commented that the challenge is in
demonstrating the savings.
9:08:27 AM
PAT CARR, Health Program Manager, Department of Health and
Social Services, related that over the past 6 years the number
of federally funded community health centers has increased in
number from 2 to over 23 such organizations that receive federal
health center funding. These grants are usually at least
$650,000 per year, although many of the health centers receive
more funding than that. She noted that this program includes a
definition of a more comprehensive range of care. About half of
the community health centers are tribally managed, which has
resulted in a partnership between tribal delivered services and
traditional nontribal services. Alaska, she related, was one of
the first states to have such a partnership across systems. She
suggested that perhaps the committee may want to review the
results of this partnership. Although there are 24 funded
organizations, the funding is disseminated between 75-100 of
Alaska's health centers. With the increase in federal funding
for health centers, only a few new health centers have surfaced.
Ms. Carr said that she couldn't specify how many of these
community health centers provided prenatal care or how many are
able to increase the level of prenatal care with the increased
funds.
9:11:19 AM
REPRESENTATIVE GARDNER opined that it seems obvious to partner
with tribally managed organizations. However, she asked whether
there are any disadvantages to doing so.
MS. CARR informed the committee that one of the requirements of
the community health center program is that there has to be a
community board. However, the tribal organizations aren't
required to do so. She noted that there have been some
situations in which there has been perceived competition within
the communities. Ms. Carr opined that through this [community
health center] program, more care has been provided in the local
communities.
9:12:58 AM
REPRESENTATIVE CISSNA related that one of the huge concerns is
that the state may make changes or mandate changes in a
community for which the state doesn't come through with its end
of the bargain. She also highlighted the concern that villages
may experience with regard to having decisions made from those
outside of the area.
CHAIR WILSON recalled 1993-1997 when it was difficult to find a
health aide willing to be responsible and available at all
hours.
9:15:58 AM
COMMISSIONER JACKSON related that the department has had to work
on developing a trusting relationship with the tribal
organizations in order to develop the aforementioned
partnership. Then it takes time to establish the bureaucratic
pieces. Therefore, these partnerships aren't easy to establish.
9:16:37 AM
MS. BIRCH returned to the issue of prenatal care and related
that an avenue for delivery of prenatal care locally using the
community health centers and the federally qualified health
centers is a terrific area upon which to focus attention. She
related that she has found providers to be very interested in
providing care. She indicated that [some of the difficulty with
providing prenatal care in the aforementioned centers] is that
most of the providers are generalists and face a wide population
to serve. In fact, heavy users in villages are those with
chronic illness, which is what many of the village providers
have to focus. Ms. Birch suggested that her section may need to
develop a needs assessment in order to determine what would be
helpful for providers in providing for early prenatal care and
in between pregnancy care.
9:18:05 AM
CHAIR WILSON suggested that perhaps schools could have good
health day curriculum.
9:19:22 AM
MS. BIRCH related that most school districts require health
education at both the elementary, middle school, and high school
levels. However, the information provided is dependent upon the
level of comfort of the instructor.
9:20:24 AM
REPRESENTATIVE GATTO mentioned that the Mat-Su School District
does have school nurses in each school. Although the school
nurses are an important part of the curriculum, the school is
doing so many other things that it may be difficult to fit into
the school day. He suggested that school nurses are becoming
adjunct parents to a great many kids.
9:23:22 AM
REPRESENTATIVE CISSNA opined that the state could develop
curriculum modules for health education through various
subjects.
9:24:53 AM
CHAIR WILSON pointed out that each district has its own
curriculum and thus such an endeavor would require including the
school board.
9:25:31 AM
COMMISSIONER JACKSON reminded the committee that Northwest and
Interior Alaska have higher instances of substance abuse, mental
health issues, and suicide. Therefore, perhaps specific school
districts could be targeted to promote health around multiple
issues.
REPRESENTATIVE CISSNA discussed getting involved with local
school districts.
CHAIR WILSON expressed her desire that by the end of this
process, the committee would be able to determine what areas of
the state need the most help and what help can be provided. She
reviewed ideas for addressing issues that arise, such as using
public service announcements and faith-based initiatives.
9:29:09 AM
REPRESENTATIVE SEATON recalled testimony that Denali KidCare is
really 164 percent of poverty rather than 175 percent, which has
been attributed to inflation. However, he said he understood
that the poverty rate is inflation indexed. If that's the case,
he questioned why the percentage hasn't remained 175 percent.
COMMISSIONER JACKSON related that the legislation specified the
dollar amount of what was 175 percent of poverty at 2003.
Therefore, the dollar amount doesn't change.
MR. FULLER agreed, adding that the legislation eliminated the
inflation factor and froze the income level at a certain dollar
amount in statute.
CHAIR WILSON recalled that at the time it was a way of
controlling costs when cuts were necessary. If the price of oil
wasn't at its current level, the state would still be facing the
need to make cuts. Therefore, as was stated at the Denver
conference, whatever the state does needs to be sustainable over
the long-term. Chair Wilson opined that the [specified dollar
amount in statute] shouldn't be changed.
9:32:41 AM
COMMISSIONER JACKSON reminded the committee that the Federal
Medical Assistance Percentage (FMAP) rate is only held harmless
through 2008, after which the state will face a large [increase]
in the amount of the percent of Medicaid that the state has to
provide from general funds.
CHAIR WILSON commented that the more that can be done with
regard to prevention provides savings "at the other end."
9:33:55 AM
MR. FULLER highlighted that certain [health care] investments
early can also impact savings in the juvenile and education
budgets.
CHAIR WILSON announced that tomorrow the Blue Ribbon Committee
on Early Childhood Development study and its recommendations
will be released.
9:35:14 AM
REPRESENTATIVE GARDNER noted her agreement with Mr. Fuller and
recalled two years ago the committee agreeing to look at
everything with the alcohol filter. She suggested that if the
state can get a handle on alcohol abuse, then maternal child
health can be discussed and savings can be seen across a wide
range of areas.
CHAIR WILSON indicated that perhaps the general public may not
realize the aforementioned connections.
REPRESENTATIVE GARDNER interjected that everyone knows it.
CHAIR WILSON expressed the need to have the research and
information ready for next year to be prepared for the budget
deliberations on these matters. She highlighted that it will
take some time to realize any savings.
COMMISSIONER JACKSON, in response to Chair Wilson, announced
that the topic of the next committee meeting is behavioral
health, which should address alcohol, substance abuse, and
mental health issues as well as faith-based and community
issues.
9:38:20 AM
REPRESENTATIVE SEATON provided the committee with an e-mail
dated June 1, 2006, from a former Alaska Psychiatric Institute
(API) nurse who resigned because she believed that working at
API jeopardized her license. He suggested the need for the
committee to review this situation at a future meeting, perhaps
next week.
9:42:36 AM
CHAIR WILSON recalled that this past session the budget included
raises for state employed nurses. However, the funds only
covered the raises for nine months. She mentioned that API
doesn't pay as much as the private sector, which she indicated
as one of the problems with API.
COMMISSIONER JACKSON informed the committee that the Department
of Administration is performing a wage study for the family of
nurse job categories, which should be complete around the end of
July. The state's nurses receiving a salary increase will be
retroactive to July 1st. Commissioner Jackson said that she may
not have all the pertinent information next week for a meeting,
but she offered to have a preliminary discussion.
CHAIR WILSON emphasized that this is an important issue to
address because if API loses enough nurses, it will have to shut
down beds due to the lack of staff to cover the beds.
Therefore, she said she didn't have a problem calling a meeting
next week.
9:44:49 AM
REPRESENTATIVE CISSNA commented that throughout discussions
regarding the shortage of nurses there has been a lack of focus
on retention issues. Recent studies, she related, specify that
a nurse's wage isn't as important as the conditions of
employment. She pointed out that the e-mail refers to some of
the conditions at a state institute and if the state can't set a
high bar with regard to the environment, one can't expect
private sector to do so either. Without establishing better
working environments, nurses will be lost to other states and
countries.
9:46:17 AM
COMMISSIONER JACKSON suggested that perhaps she could contact
the involved parties in order to schedule this meeting.
9:47:05 AM
REPRESENTATIVE SEATON clarified that he doesn't want the meeting
to be merely a wage discussion. The e-mail discusses lower
standards of care that need to be reviewed and perhaps addressed
with rapid adjustments.
9:48:49 AM
COMMISSIONER JACKSON expressed the desire to address the issues
brought forth in the e-mail.
9:49:12 AM
REPRESENTATIVE GATTO, drawing from discussions with his daughter
who works in the State of Washington treating troubled children,
related his suspicion that underfunded and understaffed [mental
health facilities] is a nationwide problem.
9:49:58 AM
REPRESENTATIVE CISSNA opined that ultimately cutting costs in
the short-term means large costs later.
9:50:11 AM
ADJOURNMENT
There being no further business before the committee, the House
Health, Education and Social Services Standing Committee meeting
was adjourned at 9:50:13 AM.
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