Legislature(2013 - 2014)CAPITOL 106
03/14/2013 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| Confirmation Hearing(s): Alaska State Medical Board | |
| Presentation: Affordable Care Act | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 14, 2013
3:33 p.m.
MEMBERS PRESENT
Representative Pete Higgins, Chair
Representative Wes Keller, Vice Chair
Representative Benjamin Nageak
Representative Lance Pruitt
Representative Lora Reinbold
Representative Paul Seaton
Representative Geran Tarr
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
CONFIRMATION HEARING(S):
Alaska State Medical Board
Kevin Luppen - Wasilla
Casey Millar - Anchorage
- CONFIRMATION(S) ADVANCED
PRESENTATION: AFFORDABLE CARE ACT
- HEARD
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
KEVIN LUPPEN, Appointee
Alaska State Medical Board
Wasilla, Alaska
POSITION STATEMENT: Spoke as an appointee to the State Medical
Board.
KATHLEEN (CASEY) MILLAR, Appointee
Alaska State Medical Board
Anchorage, Alaska
POSITION STATEMENT: Spoke as an appointee to the State Medical
Board.
DEBORAH ERICKSON, Executive Director
Alaska Health Care Commission
Office of the Commissioner
Department of Health and Social Services
Anchorage, Alaska
POSITION STATEMENT: Presented a PowerPoint, "Overview
Affordable Care Act," during discussion of the Affordable Care
Act.
JOSH APPLEBEE, Health Policy
Office of the Commissioner
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Testified during the presentation on the
Affordable Care Act.
ACTION NARRATIVE
3:33:43 PM
CHAIR PETE HIGGINS called the House Health and Social Services
Standing Committee meeting to order at 3:33 p.m.
Representatives Higgins, Reinbold, Pruitt, and Keller were
present at the call to order. Representatives Nageak, Seaton,
and Tarr arrived as the meeting was in progress.
^CONFIRMATION HEARING(S): Alaska State Medical Board
CONFIRMATION HEARING(S):
Alaska State Medical Board
3:34:31 PM
CHAIR HIGGINS announced that the first order of business would
be the confirmation hearings for the Alaska State Medical Board.
He clarified that signing the confirmation committee report did
not reflect the intent of any member of the committee to vote
for or against an individual in any further sessions for the
purpose of confirmation.
3:35:19 PM
KEVIN LUPPEN, Appointee, Alaska State Medical Board, detailed
his background as a physician assistant for more than 30 years.
He said that he first came to Alaska in 1975, as a member of the
Air Force. He reported that he had worked in various areas of
Alaska, including the Aleutians and the North Slope, for both
corporations and Native organizations. He expressed that his
interest for the State Medical Board had derived from his work
in the bush, in order to ensure that there was quality medical
delivery in the rural areas.
3:37:10 PM
REPRESENTATIVE REINBOLD asked what was the biggest concern for
the future of health care in Alaska and how did he plan to
address this.
MR. LUPPEN, in response to Representative Reinbold, said that
there were constant challenges for attracting and maintaining
quality providers, especially in the bush. He detailed that
many of the issues were for the length of the contract, lack of
support, and time off. He opined that the key was to draw
quality people and to address a way to keep them on-site. He
declared that the initial draw to Alaska was salary, especially
for mid-level providers, but that this was no longer the case.
He declared the necessity to attract quality providers, to give
them the necessary support, and to ensure they "are vetted and
quality people to deliver health care in the rural areas."
3:39:04 PM
CHAIR HIGGINS asked what work Mr. Luppen had done with the
state.
MR. LUPPEN, in response, said that he had worked in the eastern
Aleutians region, southcentral Alaska, and other areas around
the state.
3:39:44 PM
CHAIR HIGGINS asked about the work Mr. Luppen did with the oil
and gas industry.
MR. LUPPEN, in response, stated that he was a health care
provider and had served on local health boards in the Aleutians,
assisting with delivery of the best health care system. In
response to Chair Higgins, he said that he was a physician
assistant, licensed in the State of Alaska.
3:41:06 PM
CHAIR HIGGINS opened public testimony.
3:41:36 PM
REPRESENTATIVE NAGEAK moved to advance the confirmation for
Kevin Luppen from the House Health and Social Services Standing
Committee to the joint session of the House and Senate for
consideration. There being no objection, the confirmation was
advanced.
3:42:01 PM
REPRESENTATIVE SEATON clarified that each member's signature on
the committee report would in no way reflect the member's vote
during the joint floor session.
3:42:33 PM
CHAIR HIGGINS moved to the next confirmation.
KATHLEEN (CASEY) MILLAR, Appointee, Alaska State Medical Board,
explained that her choice to serve on the State Medical Board
had arisen from the recommendation of another board member, who
had suggested that she would be a good addition to the board.
She stated that her first term on the board had been a great
experience, and she opined that it was important to have a
public member on the board. She declared the importance for
board longevity, hence her willingness to serve a second term.
3:44:14 PM
REPRESENTATIVE REINBOLD asked about her current employment as a
nutritionist for the Anchorage School District.
MS. MILLAR, in response, said that she had been with the
district for five years, but was no longer with the school
district. She stated that she was now running a store in
Anchorage.
3:44:44 PM
REPRESENTATIVE REINBOLD, expressing her concern with school
nutrition, stated that there had been home cooked meals during
her attendance at public school. She enquired about the lack of
emphasis on "fresh, good quality food in our cafeterias in our
schools," and asked Ms. Millar for her thoughts.
MS. MILLAR expressed her agreement, stating that it "was a
constant frustration," and that the school food was "somewhat of
a government subsidy, and so it is a little bit out of the
control of the individual schools unless they are a private
school." She allowed that the food had gotten better, as the
soda machine drinks had been replaced with water and vitamin
energy drinks. She pointed out that there were now fresh
vegetables and fresh fruits being served, especially at the
provisional schools.
3:46:46 PM
CHAIR HIGGINS asked how often the State Medical Board members
met during her first term on the board.
MS. MILLAR replied that the board members met four times
annually, with teleconferences more often, if necessary. She
declared, as she had no medical background, that it took her "a
while to get up to speed" and to feel comfortable. She reported
that the health care providers on the board were very
supportive, and she reiterated that longevity is important
because the board is still addressing issues that precede her
time on the board. Therefore, having some history of what has
happened is really valuable. She said that the Federation of
State Medical Boards was also helpful, as it met once a year and
had sessions for public members. She declared that this had
been very valuable to her for learning the duties and
responsibilities of a public member.
3:49:38 PM
REPRESENTATIVE REINBOLD suggested that a home economics or a
culinary arts program could help the school lunch programs, and
she asked Ms. Millar for any suggestions.
MS. MILLAR expressed her agreement, and noted that University of
Alaska Anchorage (UAA) had a culinary department which taught
cooking and supplied meals. She offered her belief that there
were cost effective ways to offer the program in the public
schools, and she suggested that, as more attention was brought
for the lack of nutrition to food currently being served, this
would "bring new ideas to light."
3:51:29 PM
REPRESENTATIVE TARR, noting that Ms. Millar was a volunteer host
for weekly staff meetings for "Young Life Alaska," asked about
her community service activities. She questioned whether some
of the "fairly controversial practices by the organization,"
which included requirements of staff and the statement of non-
negotiables, would interfere with Ms. Millar's unbiased service
on the State Medical Board.
MS. MILLAR said that although her son was the Anchorage area
director for Young Life, she did not see how that would be a
conflict or cause any adverse effect to the health and medical
community. She asked Representative Tarr for a more specific
question which she would answer.
REPRESENTATIVE TARR pointed out that there were difficult
decisions to be made by the State Medical Board, and she
expressed appreciation that Ms. Millar had publicly stated that
there would not be any conflicts.
MS. MILLAR replied that she did not see how there could be any
conflicts, pointing out that she was only one voice on the
voting board.
REPRESENTATIVE REINBOLD asked Ms. Millar if her son was Trevor
Millar, who she declared to be "a fabulous individual and has
been an incredible role model to my son." She shared her
enthusiasm for Young Life.
3:54:18 PM
CHAIR HIGGINS opened public testimony. Hearing none, he closed
public testimony.
REPRESENTATIVE KELLER moved to advance the confirmation for
Casey Millar from the House Health and Social Services Standing
Committee to the joint session of the House and Senate for
consideration. There being no objection, the confirmation was
advanced.
3:54:58 PM
The committee took an at-ease from 3:54 p.m. to 3:57 p.m.
^Presentation: Affordable Care Act
Presentation: Affordable Care Act
3:57:51 PM
CHAIR HIGGINS announced that the next order of business would be
a presentation on the Affordable Care Act.
3:58:59 PM
DEBORAH ERICKSON, Executive Director, Alaska Health Care
Commission, Office of the Commissioner, Department of Health and
Social Services, said that she would talk about the highlights
of the Patient Protection and Affordable Care Act during the
PowerPoint, "Overview Affordable Care Act," [Included in
members' packets] and would ask that Mr. Applebee answer any
questions regarding the interpretation and implementation of the
act in Alaska.
4:00:00 PM
JOSH APPLEBEE, Health Policy, Office of the Commissioner,
Department of Health and Social Services, said that he would
appreciate for the committee to hold its questions until the end
of the presentation.
4:00:18 PM
MS. ERICKSON introduced slide 3, "Federal Health Reform Law,"
stating that this major law was enacted in March 2010. She
explained that there were 10 Titles within the act,
acknowledging that many people had commented that the act was
more about health insurance reform than health care reform, as
most of the major provisions addressed the expansion of health
care coverage and insurance. She said that the overview would
center on the major functional pieces of the act.
4:02:09 PM
MS. ERICKSON moved on to slide 4, "Health Care Coverage
Strategies," a graph illustrating the strategies for health care
coverage, which she listed: private insurance market reforms,
individual and employer mandates, subsidies for individuals and
small businesses, a health insurance exchange to provide an
electronic marketplace for insurance shopping and purchasing,
and the Medicaid expansion.
4:03:07 PM
MS. ERICKSON directed attention to slide 5, "Individual Mandate
& Subsidies," and stated that the individual mandate required
all individuals to have a qualified health plan, or pay a tax
penalty. She relayed that this requirement would take effect
for the 2014 tax year, after being phased in over three years,
and that the penalty was either $95 per person per year, or 1
percent of the household income, whichever was greater,
increasing to $695 per person per year, or 2.5 percent of
household income, by 2016. She noted that the penalty for
children was half that of adults and that there was a cap on
family penalties. She reported that there were exemptions,
including a religious exemption; an American Indian and Alaska
Native exemption, as there was an assumption of access to Indian
Health Service benefits; and, a financial hardship exemption.
She declared that there were subsidies and federal funding to
assist with the purchase of insurance for low-income
individuals, those people with incomes between 133 percent and
400 percent of the federal poverty level. She noted that the
amount of subsidy varied between regions and income levels.
4:05:22 PM
MS. ERICKSON pointed to slide 6, "Employer Mandate & Subsidy,"
and explained that the employer mandate applied to businesses
that had 50 or more full time employees, working 30 hours or
more each week. She noted that the associated penalty could
apply even to a business that did supply insurance. The way
that this provision had been worded, the employer that did not
offer coverage, must pay a penalty of $2000 per full time
employee per year after an exemption for the first 30 employees.
She said that this was only if one or more employees received a
subsidy through the exchange. She noted that an individual was
not eligible for a subsidy if there was insurance coverage,
which met certain standards, available through their employer.
She reported that an employee's share of the insurance premium
could not exceed 9.5 percent of their household income. She
said there was also a subsidy for businesses with 25 or fewer
full time employees, although there were caveats with this, as
well. She offered examples of how different provisions of the
Affordable Care Act applied in different ways, depending on the
size of the business.
4:08:19 PM
MS. ERICKSON shared slide 7, "Health Insurance Exchange," the
electronic market place for purchasing insurance. She said that
these exchanges were to be a state-based electronic site, but
that multiple states could together form a health insurance
exchange. She explained that there was an opt-out provision
which required a federal exchange for any state that did not set
up an exchange. She said that the insurance exchange was to be
operational by October, 2013, in order to enroll people for
2014. One requirement was for the state exchange program to
have an interface with the state Medicaid for eligibility and
enrollment. She noted that the health insurance exchanges had
to be self-sustaining by 2015.
4:10:07 PM
MS. ERICKSON reviewed slide 8, "Medicaid Expansion," explaining
that the state had the option to expand eligibility to Medicaid
for those individuals who had income under 138 percent of the
federal poverty level, and that the federal government would pay
100 percent of the medical claim portion until 2017, at which
time the state share would phase in to a maximum of 10 percent
by 2020. She referenced the recent Supreme Court decision that
had allowed states to make the Medicaid expansion an option, as
it had been determined to be overly coercive by the federal
government to require the expansion. She affirmed that,
although the federal government clarified that a partial
expansion of Medicaid was not allowed, there was no deadline for
the expansion decision, so states had the option to discontinue
the expansion at a later date. She mentioned that the law had
shifted the methodology for eligibility determination to
modified adjusted gross income, which would have a significant
impact on all the state Medicaid programs, in 2014. She
observed that states were required to coordinate eligibility
determination with the Health Insurance Exchange.
4:13:24 PM
MS. ERICKSON indicated slide 9, "Payment Reform," and spoke
about provisions which were intended to drive reform for the way
health care services were delivered. She listed many
provisions, some of which were changes for Medicare payment
services, and some demonstration projects for Medicaid programs.
She mentioned there were also some multi-payer initiatives which
encouraged states to partner the Medicaid and the Medicare
programs with private insurance companies. These payment
reforms were designed to drive the usual fee-for-service
mechanism toward a payment for outcomes and value.
4:14:42 PM
MS. ERICKSON considered slide 10, "How the Act Pays for Itself,"
and spoke about the savings through payment reform provisions,
and fraud and abuse provisions. She noted that there were
limits to the increase of Medicare rates, as well as a series of
"New Fees & Taxes," slide 11. She said that most of the fees
and taxes would be taking effect in 2013. She listed the tax on
indoor tanning, and the annual fee on the pharmaceutical
industry as already having been implemented; whereas, the tax on
some medical devices, and the Medicare payroll tax increase for
high income individuals and unearned income would all take
effect in 2013. She reported that an $8 billion annual tax on
the health insurance industry would take effect in 2014; and, in
2018, an excise tax on high value employer sponsored insurance
plans would also go into effect.
4:17:05 PM
MS. ERICKSON provided slide 12, "Alaska Impact 2019," which was
calculated by an Institute of Social and Economic Research
(ISER) study for the net increase in health care spending by the
federal government, and the high level economic impact, up to
$700 million in Alaska. She noted that the federal government
would also collect more than $500 million in taxes in Alaska.
4:18:37 PM
MS. ERICKSON indicated slides 13 - 14, "Legal Challenges &
Political Realities," noting the significance of the Supreme
Court Ruling in June, 2012, as it upheld the constitutionality
of the individual mandate, but limited the Medicaid expansion
and made it an option for states. She offered an anecdote about
the roles of state governments in implementation of the
Affordable Care Act and the subsequent political ramifications.
4:21:32 PM
MS. ERICKSON furnished slide 15, "Legal Challenges & Political
Realities," and stated that the federal budget constraints which
resulted in the Fiscal Cliff and the March 1 sequester were
having some effect on the Affordable Care Act. She said that
the Co-Op program, a consumer operated non-profit health
insurance plan, had its not-yet-awarded available funding
eliminated, and that Title VIII, the CLASS Act which created a
new, public, long term care insurance program, was also
repealed. She listed other examples of provisions which
affected the health care industry with direct impacts to the
Affordable Care Act.
4:22:58 PM
MS. ERICKSON presented slide 16, "Federal Implementation to
Date," and highlighted that four new federal offices had been
established, as well as the establishment of new boards,
commissions, committees, and regulations. She noted that many
grants had also been awarded.
MS. ERICKSON shared slides 17 - 19, "Summary of December 2012 to
March 2013 Updates," which summarized the changes, impacts,
regulations, and guidance documents during that time period.
Concluding with slides 20 - 21, "Timeline," she highlighted that
a number of private insurance market reforms had been
implemented in 2010, and that the grants and planning activities
were also quickly available. She reported that the cornerstone
pieces of the Affordable Care Act, Medicaid expansion, the
Health Insurance Exchange, and the mandates and subsidies, would
all take effect in 2014, while additional provisions would
continue to take effect all the way into 2018.
4:26:53 PM
REPRESENTATIVE SEATON asked to clarify that the Affordable Care
Act was dealing more with insurance, and not as much with health
care. He asked if the overview emphasis of the Alaska Health
Care Commission had been for access and payment, instead of
health.
MS. ERICKSON, in response, said that the commission had
attempted to track all of the provisions. She directed
attention to the commission's website, which contained a
detailed overview of the Affordable Care Act, as well as
provisions in which the state and health care providers had
participated.
REPRESENTATIVE SEATON offered his belief that the Affordable
Care Act was simply about paying for access to care. He asked
if there was anything on the website which talked about health.
MS. ERICKSON replied that the website listed a more specific
overview for the provisions to the Affordable Care Act which she
had not discussed, as well as more detailed information about
specific implementation in Alaska.
4:29:09 PM
MR. APPLEBEE said that several divisions within the Department
of Health and Social Services were involved with the overview,
to ensure focus on all the different sections of the Affordable
Care Act.
4:29:50 PM
REPRESENTATIVE REINBOLD asked for an explanation to the $2.8
billion annual fee on the pharmaceutical industry, which would
increase over time.
MR. APPLEBEE asked to clarify whether Representative Reinbold
was asking about the intent of the federal government to
increase taxes, noting that this gave the federal government the
ability to pay for the Affordable Care Act.
REPRESENTATIVE REINBOLD offered her belief that "driving the
cost just ends up spreading it around more. To me, I mean, it
seems 100 percent illogical." She asked about the collection
process for this tax, and she opined that it was driving up the
cost of pharmaceuticals.
MR. APPLEBEE stated that many people had expressed agreement
that the rising cost of health care was the primary concern,
along with access and the ability to deliver the right care at
the right time.
4:31:12 PM
REPRESENTATIVE PRUITT asked how much had been collected from the
10 percent sales tax on indoor tanning, and whether this had met
the revenue expectation.
MR. APPLEBEE replied that he did not know, as implementation of
the Affordable Care Act was still in its early stages. He
declared that there were still many questions to be answered.
REPRESENTATIVE PRUITT expressed his concern that assumptions had
been made by the federal government regarding the amounts of
money available to pay for the Affordable Care Act. He asked
how the state could be assured of federal funding to provide for
this requirement.
MR. APPLEBEE opined that this was the crux for the decision
making by the State of Alaska, as the future federal funding
levels were unknown.
4:34:04 PM
CHAIR HIGGINS, stating that the governor was now going to agree
to Medicaid expansion, asked for an explanation to this
expansion.
MR. APPLEBEE clarified that the governor had stated on February
28, 2013, that he would not submit any plans concerning Medicaid
expansion to the Legislature. He shared that the next decision
point by the governor would be during the budget submittal in
December. He reported that HHSS had been discussing the impact
from Medicaid expansion for services provided and costs. He
declared that the Commissioner of HHSS had stated that he wanted
to make the correct decision, and, as this was not a simple
answer, it would require a lot of time and analysis.
MR. APPLEBEE explained that Medicaid expansion under the
Affordable Care Act meant that Medicaid services would be
provided to all patients with an income level up to 138 percent
of the federal poverty level (FPL). He clarified that this
would be offered to everyone under that income level, and not
just to families with children or pregnant women, as in the
past. He clarified that the newly eligible population were
those who were not currently enrolled but would be eligible with
this expansion. He described another eligible group which he
deemed as the woodwork effect. These were people who were
currently eligible for Medicaid, but had not enrolled. If they
enrolled after the Medicaid expansion, they would still only be
covered under the current participation rate, which was about 50
percent of cost to the state.
REPRESENTATIVE SEATON asked to clarify that those who would be
covered under the "woodwork effect" were only those who were
currently eligible but had not yet applied.
MR. APPLEBEE expressed agreement that those who would currently
qualify would also qualify under the expansion, but for a lower
federal reimbursement rate.
4:39:14 PM
REPRESENTATIVE KELLER asked if there was any deadline for the
Medicaid expansion.
MR. APPLEBEE explained that the Supreme Court ruling to make the
Medicaid expansion decision optional had clarified that there
was not a deadline for expansion. He pointed out that the 100
percent federal reimbursement was only effective from January
2014 through December 2016. If a state decided to enroll at a
later date, it would forego reimbursement for any time already
lapsed.
4:40:20 PM
REPRESENTATIVE KELLER asked if there were more talks about block
grants to the states as an option to the Medicaid expansion. He
declared that the state was "far more capable of figuring out
who needs it than the federal regulations that are gonna come
from afar." He commented that although the state could legally
rescind after its expansion of Medicaid, this would be a very
contentious political decision, and would not really be an
option for the legislature. He asked if the state would have
more control of the money from the expansion of Medicaid.
MR. APPLEBEE replied that the Supreme Court decision for the
option of Medicaid had raised the national conversation for
block grants to pay for entitlement programs.
4:42:31 PM
REPRESENTATIVE NAGEAK asked to clarify the funding of Medicaid
expansion for three years.
MR. APPLEBEE replied that the 100 percent federal reimbursement
for Medicaid expansion would be offered for the three calendar
years of 2014, 2015, and 2016. He explained that any delay for
state expansion would not receive an extension, and that a
sliding scale of reimbursements would begin in the calendar year
of 2017.
4:44:26 PM
REPRESENTATIVE KELLER asked if there was a calculation for the
10 percent cost to the state after the Medicaid expansion.
MR. APPLEBEE replied that DHSS was working on the actuarial
analysis, and he cited several studies, including an estimate
and analysis by the Urban Institute. He pointed out that DHSS
was reviewing all the possible information to make its decision.
He offered to provide the range of cost, although he did not
know whether the exact cost would be available.
4:45:17 PM
REPRESENTATIVE TARR cited her discussions with small business
owners for their needs and shared that she had "warmed up to the
Affordable Care Act" after having initial concerns. She
reported on a documentary about the implementation and drafting
of the Affordable Care Act, and the involvement of the
pharmaceutical industry. She announced that 138 percent of the
federal poverty level in Alaska would be about $40,000 for a
family of four. She pointed out that Arkansas had now applied
for a waiver to Medicaid expansion, and was planning to use
those funds to buy private health insurance for the population
that would have been covered by the expansion. She asked if
this was an idea for Alaska to consider.
MR. APPLEBEE, in response, shared that he had had numerous
conversations with the Director of Health and Social Services in
Arkansas, since its announcement, and had asked Arkansas to
share any details. He clarified that currently there was only a
verbal agreement with the federal government and not yet
anything in writing, as the details were still being worked out.
He opined that, should this be a sign of increased federal
flexibility, that Alaska would be very excited to review the
potential opportunities. He observed that currently the federal
government had stated that this was an all or nothing
proposition.
4:48:15 PM
REPRESENTATIVE SEATON, noting that there were two hospitals in
his district, stated that they were supportive for Medicaid
expansion, as they were cost shifting for an increase to those
patients who had insurance. He asked that should the Medicaid
expansion be rescinded, would only Alaskans bear the cost shift,
or would treatment be withheld until people were extremely sick,
with its corresponding cost increase.
MR. APPLEBEE asked to clarify whether Representative Seaton was
referring to the Medicaid expansion, with a subsequent pull
back. He offered his agreement with Representative Keller, that
it would be a far easier decision to expand Medicaid than to
rescind at a later date.
4:50:30 PM
REPRESENTATIVE SEATON replied that his conversations had been
with those people who were doing all the paying, and not with
those who would be recipients of the Medicaid expansion.
MR. APPLEBEE replied that the decision would require a review of
all the information, as "the Medicaid program touches a lot of
what we do in the state in terms of health care delivery."
4:51:23 PM
REPRESENTATIVE REINBOLD, referencing slide 11, "New Fees &
Taxes," offered her belief that these fees and taxes were
"hurting successful couples, businesses, and really gonna
penalize those older people who need medical devices." She
stated that she had never liked the Affordable Care Act, and
that she was "alarmed. I'm getting much colder towards this
plan than I ever imagined." She asked if all the fees were
being paid to the federal government, "so this is just a,
basically, just a grab of money and power and control of
something that's so powerfully important to us." She asked to
clarify if the federal legislators had been exempted, and she
requested to know all of the exemptions from the plan.
MR. APPLEBEE, in response to Representative Reinbold, stated
that the taxes were being paid to the federal government. He
offered to respond with the list of exemptions.
4:53:09 PM
REPRESENTATIVE PRUITT asked to clarify that an additional 52,000
Alaskans would be covered by the Affordable Care Act. He asked
if the assessment was correct that many companies would cease to
provide, or limit, [health care] insurance.
MR. APPLEBEE, in response, said that it was unclear for how
people would act or how premiums would change. He cautioned
that there were many pieces still to be clarified before any
such statements, and he offered his belief that the Affordable
Care Act assumed that businesses, and business owners, wanted to
continue to offer health insurance coverage.
4:55:31 PM
REPRESENTATIVE PRUITT asked how the state and federal health
care plans would be affected, and he opined that these would be
defined as "cadillac" plans. He asked for the probability that
states would merge plans in order to cut costs.
MR. APPLEBEE, clarifying that this was for state employee plans,
said that these plans would not be impacted, as the intent of
the Affordable Care Act was to maintain existing insurance and
add to them, observing that the "cadillac" plans were not
affected until 2018. He opined that there would not be any
change for state employees, "certainly not in the short term,"
as most of the changes in Alaska were for the 17 percent of
uninsured Alaskans.
4:58:02 PM
CHAIR HIGGINS suggested - as there were still many questions and
only a short amount of time - that the presenters return at a
later date.
4:58:45 PM
REPRESENTATIVE KELLER, asking about eligibility, requested to
know the income for a traditional family of four in Alaska at
138 percent of the federal poverty level.
MS. ERICKSON expressed his agreement with the earlier figures
from Representative Tarr that the current federal poverty income
guideline for a family of four in Alaska was $40,627.
CHAIR HIGGINS added that this figure was equivalent to about 70
percent of the average income in Alaska. He asked that the
presenters return at an agreed upon date to continue the
discussion with the committee.
MR. APPLEBEE offered for any committee member to contact him
with any questions.
5:01:22 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 5:01 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| Medical Board - Luppen #3.pdf |
HHSS 3/14/2013 3:00:00 PM |
Referral for Confirmation - State Medical Board |
| Medical Board - Millar #3.pdf |
HHSS 3/14/2013 3:00:00 PM |
Referral for Confirmation - State Medical Board |
| PPACA Overview for HHSS 3-14-13.pdf |
HHSS 3/14/2013 3:00:00 PM |
Affordable Care Act |