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