ALASKA STATE LEGISLATURE
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE
April 4, 2006
3:05 p.m.
MEMBERS PRESENT
Representative Peggy Wilson, Chair
Representative Paul Seaton, Vice Chair
Representative Carl Gatto
Representative Vic Kohring
Representative Sharon Cissna
Representative Berta Gardner
MEMBERS ABSENT
Representative Tom Anderson
COMMITTEE CALENDAR
HOUSE BILL NO. 346
"An Act relating to child abuse investigations and training."
- MOVED CSHB 346(HES) OUT OF COMMITTEE
HOUSE BILL NO. 468
"An Act relating to disclosure of employment information on a
medical assistance application and a hospital intake report; and
requiring the Department of Health and Social Services to
prepare and publicize a report pertaining to employers who do
not provide health insurance."
- HEARD AND HELD
HOUSE JOINT RESOLUTION NO. 30
Relating to public health and a prevention compact.
- BILL HEARING POSTPONED TO 4/6/06
HOUSE BILL NO. 426
"An Act relating to medical assistance eligibility and coverage
for persons under 21 years of age."
- BILL HEARING POSTPONED TO 4/11/06
HOUSE BILL NO. 467
"An Act relating to the administration of prescribed remedies
and dietary supplements by a nurse."
- BILL HEARING POSTPONED TO 4/6/06
HOUSE BILL NO. 482
"An Act relating to harassment, intimidation, and bullying in
schools."
- BILL HEARING POSTPONED TO 4/6/06
CS FOR SENATE BILL NO. 177(HES)
"An Act eliminating the prohibition on the use by certain
licensed professionals of titles or descriptions of services
that incorporate the terms 'psychoanalysis,' 'psychoanalyst,'
'psychotherapy,' 'psychotherapeutic,' or 'psychotherapist.'"
- BILL HEARING POSTPONED TO 4/6/06
PREVIOUS COMMITTEE ACTION
BILL: HB 346
SHORT TITLE: CHILD ABUSE INVESTIGATIONS
SPONSOR(s): REPRESENTATIVE(s) NEUMAN, LYNN
01/09/06 (H) PREFILE RELEASED 1/6/06
01/09/06 (H) READ THE FIRST TIME - REFERRALS
01/09/06 (H) HES, JUD
03/30/06 (H) HES AT 3:00 PM CAPITOL 106
03/30/06 (H) -- Meeting Canceled --
04/04/06 (H) HES AT 3:00 PM CAPITOL 106
BILL: HB 468
SHORT TITLE: HEALTH CARE DISCLOSURE
SPONSOR(s): REPRESENTATIVE(s) GRUENBERG
02/13/06 (H) READ THE FIRST TIME - REFERRALS
02/13/06 (H) HES, FIN
03/28/06 (H) HES AT 3:00 PM CAPITOL 106
03/28/06 (H) <Bill Hearing Postponed to 03/30/06>
03/30/06 (H) HES AT 3:00 PM CAPITOL 106
03/30/06 (H) -- Meeting Canceled --
04/04/06 (H) HES AT 3:00 PM CAPITOL 106
WITNESS REGISTER
REPRESENTATIVE MARK NEUMAN
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Introduced HB 346, as prime sponsor.
TAMMY SANDOVAL, Deputy Commissioner
Office of Children's Services(OCS)
Department of Health and Social Services (DHSS)
POSITION STATEMENT: Testified on HB 346.
MICHAEL LESMANN, Community Relations Officer
Office of Children's Services
Department of Health and Social Services (DHSS)
POSITION STATEMENT: Testified on HB 346.
JAN RUTHERDALE, Assistant Attorney General
Child Protection Section,
Civil Division (Juneau)
Department of Law (DOL)
POSITION STATEMENT: Answered questions on HB 346.
MICHAEL BUCY, Staff
to Representative Max Gruenberg
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented HB 468 on behalf of the sponsor,
Representative Gruenberg.
REPRESENTATIVE MAX GRUENBERG
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Spoke as the sponsor of HB 468.
WALTER STUART, President
United Food & Commercial Workers Union Local 1496
Anchorage, Alaska
POSITION STATEMENT: Testified on HB 468.
AMY PAIGE
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 468.
ELLIE FITZJARRALD, Chief
Policy & Program Development
Division of Public Assistance
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: During hearing of HB 468, answered
questions.
DWAYNE PEEPLES, Director
Division of Health Care Services
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: During hearing of HB 468, answered
questions.
ACTION NARRATIVE
CHAIR PEGGY WILSON called the House Health, Education and Social
Services Standing Committee meeting to order at 3:05:52 PM.
Representatives Wilson, Seaton, Gatto, Gardner, and Cissna were
present at the call to order. Representative Kohring arrived as
the meeting was in progress.
HB 346-CHILD ABUSE INVESTIGATIONS
3:06:03 PM
CHAIR WILSON announced that the first order of business would be
HOUSE BILL NO. 346, "An Act relating to child abuse
investigations and training."
REPRESENTATIVE SEATON moved to adopt CSHB 346, Version 24-
LS1335\G, Mischel, 3/27/06. There being no objection, Version G
was before the committee.
3:07:38 PM
REPRESENTATIVE MARK NEUMAN, Alaska State Legislature, speaking
as the prime sponsor of HB 346, paraphrased from the written
sponsor statement as follows [original punctuation provided]:
On June 25, 2003, the "Child Abuse Prevention
Treatment Act" (CAPTA) was signed into law in our
nation's capital. This act requires states to
implement two provisions for protecting families
during the child investigative process. Provisions of
this act require states to ensure they have:
(xvii) provisions and procedures to require that a
representative of the child protective services agency
shall, at the initial time of contact with the
individual subject to a child abuse and neglect
investigation, advise the individual of the complaints
or allegations made against the individual, in a
manner that is consistent with laws protecting the
rights of the informant;
(xviii) provisions addressing the training of
representatives of the child protective services
system regarding the legal duties of the
representatives, which may consist of various methods
of informing such representatives of such duties, in
order to protect the legal rights and safety of
children and families from the initial time of contact
during investigation through treatment;
This Bill ensures that as a state we are in compliance
with CAPTA. It is important that the training of child
protective services personnel ensures that they are
knowledgeable in best practices for promoting
collaboration with families and that they are fully
aware of the extent and limits of their legal
authority and the legal rights of parents while
carrying out such investigations.
3:09:25 PM
REPRESENTATIVE NEUMAN explained that the committee substitute
(CS) provides for the addition of three subsections to the
existing statute [AS 47.17.033] which are labeled (j), (k), and
(l), whereas the original bill included only two. He described
the sections respectively: The revised subsection (j) provides
parameters for the training of department representatives for
conducting search and seizure; The existing subsection (k)
becomes the new subsection (l); The new subsection (k) provides
directives regarding a joint investigation conducted by the
department and a law enforcement agency, which ensures that a
family's Fourth Amendment rights will be protected. Under the
new subsection (l) the language from the original subsection (k)
is revised to provide a caveat which allows law enforcement
officials to limit or prohibit notification of an individual
regarding a specific complaint or allegation.
3:11:47 PM
REPRESENTATIVE GARDNER asked how this will change what is
currently in practice.
REPRESENTATIVE NEUMAN responded that this language will bring
Alaska statute in-line with CAPTA, which requires that states
implement these standards. In further response, he noted that
what is not currently in practice is the training requirement
component. Although training does occur, he stressed that
without specific language in statute, it is not necessarily
emphasized, which may result in complaints of procedures not
being followed.
3:13:51 PM
REPRESENTATIVE GATTO pointed out that page 2, line 2, stipulates
that the "complainant may not be revealed". However, he
questioned if that is strong enough language, and he related a
personal experience that illustrated the ease afforded a
perpetrator in identifying a complainant, thus allowing for
confrontation or retribution. He underscored the importance of
protecting the complainant's identity.
3:15:47 PM
REPRESENTATIVE SEATON recalled the recent efforts of rewriting
the child in need of aid (CINA) law. He asked whether the
rights of the families, as stipulated in HB 346, were not
included in the revisions of CINA, and whether this bill
represents a formality for federal purposes to indicate that
particular issues have been placed into state statute.
REPRESENTATIVE NEUMAN acknowledged the CINA revisions, but could
not ascertain whether the issues addressed in HB 346 represent
an overlap. He assured the committee that this bill will bring
Alaska in-line with the required procedures established as
federal standards under CAPTA.
3:17:20 PM
REPRESENTATIVE NEUMAN, in response to Chair Wilson, confirmed
that HB 346 has been included in HB 408, which has been approved
by the Senate Health, Education and Social Services Standing
Committee.
3:18:13 PM
REPRESENTATIVE GATTO restated his personal experience with
Office of Children's Services (OCS), and asked for an
explanation of what measures are taken to ensure that a
complainant's identity is protected. In the situation which he
described earlier, he pointed out that the complainant's name
was not issued by OCS, but the complainant's professional
position in the community was and that made for easy
identification by the perpetrator. He reiterated his question
as to whether there is a need for stricter language in the bill.
TAMMY SANDOVAL, Deputy Commissioner, Office of Children's
Services (OCS), Department of Health and Social Services (DHSS),
expressed distress regarding the experience that Representative
Gatto described. She explained that the standard operating
procedures followed by OCS should never allow for identification
of the complainant or make any identifying information available
that could allow for such a situation to arise. She agreed that
the language would be strengthened by amendment. She pointed
out that the law does provide a legal caveat for when a case is
presented in court, which allows for the complainant to be
identified. However, it should not occur prematurely or outside
of court as in Representative Gatto's situation.
3:21:45 PM
REPRESENTATIVE GATTO opined whether changing the single word
would suffice or if language could be included that would impose
a misdemeanor against any person who reveals the identity of a
complainant.
MICHAEL LESMANN, Community Relations Officer, Office of
Children's Services, Department of Health and Social Services
(DHSS), cited AS 47.17.040(b) and paraphrased from the following
[original punctuation provided]:
(b) Investigation reports and reports of harm
filed under this chapter are considered confidential
and are not subject to public inspection and copying
under AS 40.25.110 and 40.25.120. However, in
accordance with department regulations, investigation
reports may be used by appropriate governmental
agencies with child-protection functions, inside and
outside the state, in connection with investigations
or judicial proceedings involving child abuse,
neglect, or custody. A person, not acting in
accordance with department regulations, who with
criminal negligence makes public information contained
in confidential reports is guilty of a class B
misdemeanor.
CHAIR WILSON stated:
We're really covered .... Unfortunately, once in a
while there is a slip-up, but no one ever does that
intentionally. ... the intent is to not reveal the
person who ... instigated an investigation.
3:23:45 PM
REPRESENTATIVE SEATON asked whether there would be any legal
concerns in amending the language as suggested.
MS. SANDOVAL responded that the word "shall" could be inserted
to replace the word "may", without difficulty.
3:24:16 PM
REPRESENTATIVE GATTO moved Amendment 1, stated as follows:
Page 2, line 2;
Delete "may"
Insert "shall"
Hearing no objection, Amendment 1 was adopted.
3:24:40 PM
REPRESENTATIVE SEATON restated his inquiry regarding the
omission of the HB 346 issues in the CINA bill revision.
MS. SANDOVAL stated that the department supports this bill, and
explained that required training is provided to new OCS
employees via the University of Alaska Anchorage (UAA) academy,
and the DHSS standard operating procedure [SOP] also addresses
the HB 346 issues. However, she said: "Is [the training and is
the SOP] as specific and [do they] give [these issues] as much
emphasis and weight within our own system, no. Do I think that
we have addressed [these issues], yes. I think we could do
better." She conceded that the changes required by HB 53 [CINA
revisions] were extensive and the department is "still trying to
make the tweaks in [routine] practice, ... regulations, ...
policies, and procedures and this is [an area] that we haven't
given specific attention to ... but it hasn't been entirely
missed."
3:26:24 PM
REPRESENTATIVE SEATON said that Ms. Sandoval's response answered
the family rights aspect, but he requested further clarification
regarding the section of HB 346 that deals with the protection
of the complainant's identity. He asked if this was an area
addressed in HB 53, and, if so, how is it being implemented by
the department.
MS. SANDOVAL explained that when an investigation begins, unless
law enforcement stipulates otherwise, the department's SOP
requires that OCS advise the alleged perpetrator of the
allegations. However, she said, "I don't believe that HB 53
specifically addressed what's now being addressed in HB 346."
MR. LESMANN interjected that Representative Seaton may be
recalling the aspect of HB 53 that referred to feedback to
reporters, if they asked to be notified of a status.
3:28:09 PM
REPRESENTATIVE GARDNER asked, referring to subsection (k), page
1, line 9, whether this language would require OCS to involve
law enforcement prior to OCS having established an incoming
report as representing a well-founded suspicion.
MS. SANDOVAL described what routinely happens when a report is
received, how the validity of a report is established, and how
the decision to coordinate law enforcement occurs. She
explained that often, after OCS determines the safety aspect of
a situation, law enforcement may initiate a criminal
investigation right away.
3:30:29 PM
CHAIR WILSON questioned whether the "shall" [page 1, line 10]
should be amended to "may".
REPRESENTATIVE SEATON pointed out that the "shall" only applies
when a joint investigation has already been initiated.
3:31:13 PM
REPRESENTATIVE GARDNER asked whether the language of subsection
(k) comports with current departmental practice.
MS. SANDOVAL assured the committee that this subsection
represents current SOP.
3:31:39 PM
REPRESENTATIVE CISSNA moved to adopt Amendment 2, labeled 24-
LS1335\A.l, Mischel, 4/4/06, which read [original punctuation
provided]:
Page 1, line 1, following "Act":
Insert "relating to intensive family preservation
and reunification services;"
Page 1, following line 2:
Insert new bill sections to read:
"* Section 1. AS 47.10.080(l) is amended to read:
(l) Within 12 months after the date a child
enters foster care as calculated under
AS 47.10.088(f), the court shall hold a permanency
hearing. The hearing and permanent plan developed in
the hearing are governed by the following provisions:
(1) the persons entitled to be heard under
AS 47.10.070 or under (f) of this section are also
entitled to be heard at the hearing held under this
subsection;
(2) when establishing the permanent plan
for the child, the court shall make appropriate
written findings, including findings related to
whether
(A) and when the child should be returned
to the parent or guardian;
(B) the child should be placed for adoption
or legal guardianship and whether a petition for
termination of parental rights should be filed by the
department; and
(C) the child should be placed in another
planned, permanent living arrangement and what steps
are necessary to achieve the new arrangement;
(3) if the court is unable to make a
finding required under (2) of this subsection, the
court shall hold another hearing within a reasonable
period of time;
(4) in addition to the findings required by
(2) of this subsection, the court shall also make
appropriate written findings related to
(A) whether the department has made the
reasonable efforts required under AS 47.10.086 to
offer appropriate family support services, available
intensive family preservation services, or intensive
family reunification services to remedy the parent's
or guardian's conduct or conditions in the home that
made the child a child in need of aid under this
chapter;
(B) whether the parent or guardian has made
substantial progress to remedy the parent's or
guardian's conduct or conditions in the home that made
the child a child in need of aid under this chapter;
(C) if the permanent plan is for the child
to remain in out-of-home care [OUT-OF-HOME-CARE],
whether the child's out-of-home placement continues to
be appropriate and in the best interests of the child;
and
(D) whether the department has made
reasonable efforts to finalize the permanent plan for
the child;
(5) the court shall hold a hearing to
review the permanent plan at least annually until
successful implementation of the plan; if the plan
approved by the court changes after the hearing, the
department shall promptly apply to the court for
another permanency hearing, and the court shall
conduct the hearing within 30 days after application
by the department.
* Sec. 2. AS 47.10.086(a) is amended to read:
(a) Except as provided in (b) and (c) of this
section, the department shall make timely, reasonable
efforts to provide family support services to the
child and to the parents or guardian of the child that
are designed to prevent out-of-home placement of the
child or to enable the safe return of the child to the
family home, when appropriate, if the child is in an
out-of-home placement. Within appropriations available
for the purpose, the department shall also make
reasonable efforts to refer a child for intensive
family preservation services, or intensive family
reunification services, or both, when those services
are available and, if the child is in the home, the
child's safety in the home can be maintained during
the time the services are provided. The department's
duty to make reasonable efforts under this subsection
to provide family support services includes the duty
to
(1) identify family support services that
will assist the parent or guardian in remedying the
conduct or conditions in the home that made the child
a child in need of aid;
(2) actively offer the parent or guardian,
and refer the parent or guardian to, the family
support services identified under (1) of this
subsection; the department shall refer the parent or
guardian to community-based family support services
whenever community-based services are available and
desired by the parent or guardian; and
(3) document the department's actions that
are taken under [(1) AND (2) OF] this subsection,
including whether intensive family preservation
services or intensive family reunification services,
or both, were appropriate, offered, used, or
available."
Page 1, line 3:
Delete "Section 1"
Insert "Sec. 3"
3:32:23 PM
CHAIR WILSON objected to allow discussion.
3:32:31 PM
REPRESENTATIVE CISSNA explained that this amendment matches the
spirit of the bill in working to ascertain safety issues and by
stipulating the preservation/reunification of the family unit.
She said that the intensive family preservation model is a
program which has been adopted in 33 states and 8 countries with
positive results. She related her understanding that the
department has existing services to support this type of family
preservation and reunification model, which is successful due to
its intensity. She pointed out that the bold type sets out what
action should be taken if services are available, however, the
amendment does not require the department to establish new
services to support the model.
MS. SANDOVAL described how the department's current levels of
family preservation/reunification coincide with this intensive
family preservation model.
3:36:46 PM
REPRESENTATIVE GATTO asked if statistics are available which
would indicate that family preservation/reunification is a cause
worth pursuing.
MS. SANDOVAL stressed that family preservation is certainly
worth the effort. Philosophically and generally speaking,
children should stay in their home whenever possible, if safety
can be assured, and even while support services are being
administered to a family. She explained that the situation
changes dramatically when a child is removed and the focus
shifts to reunification.
3:38:21 PM
REPRESENTATIVE GATTO inquired why this amendment is necessary if
it reflects what is already a standing alternative.
REPRESENTATIVE CISSNA pointed out that the same could be said
about the bill without the amendment, but she stressed that the
amendment provides legislative intent. She said that this
amendment would also serve to open opportunities for the state
to pursue contracts with private vendors who would provide
services in accordance with this model.
3:40:03 PM
MS. SANDOVAL explained that when DHSS receives funding to
administer the three areas of family support provided under OCS,
a pot of money is created which is then granted to contractors
who have submitted a successful request for proposal (RFP). She
questioned how this amendment would serve to augment the
existing system.
REPRESENTATIVE CISSNA clarified that this would enter the term
"intensive family preservation" into statute to provide a focal
aspect, which does not currently exist. Also, she opined that
entry of this terminology into statute may afford a window of
opportunity for people who provide this type of service to
receive funding through The National Intensive Family
Preservation Association, which locates grant money for
allocation. She stressed the success that other states have
experienced with this program.
3:41:51 PM
REPRESENTATIVE SEATON pointed out that "intensive family
preservation services" is not capitalized in the amendment, but
that it is being discussed in committee as a particular program.
He paraphrased from the amendment Section 1, subparagraph (A),
which states: "... to offer appropriate family support services
..., available intensive family preservation services, or
intensive family reunification services ...", and suggested that
by enacting this language the RFP procedure would be precluded
and the department would be required to provide funds to
whomever operated a program under this model. Further, he
offered questions which would need to be clarified if his
understanding is correct.
REPRESENTATIVE GARDNER stated that these intensive services are
already offered in Alaska, and are currently called "wrap-around
services." She explained her understanding as to how the
intensive model works, and opined that many organizations hold
contracts with the state to provide services of this caliber.
MS. SANDOVAL agreed and further illuminated that the
implementation of methods for intensive family preservation and
intensive family reunification are tools in the OCS "tool kit".
She explained that OCS considers all of these options when
attempting to rehabilitate a family.
3:45:48 PM
CHAIR WILSON noted that by not capitalizing the title it removes
the understanding of it being a specific program and identifies
it as an intensive service model for assisting families.
MS. SANDOVAL named the Home Builder's model as an example of a
specific professional model currently in use which implements
some intensive family preservation techniques. She stated that
OCS staff has worked with a consultant who provides the state
with technical assistance for administering an intensive family
preservation program.
CHAIR WILSON reiterated that by not capitalizing this name in
statute, it would not be construed as a "specific program" but
rather suggest an overall model that OCS could choose to
implement.
3:47:10 PM
REPRESENTATIVE NEUMAN echoed Representative Seaton's concern as
to whether this amendment would create a connection to a
particular company/organization or does it enact a standard
appropriate for state statute. He expressed concern for
including the name of an organization in the bill because it may
complicate matters.
3:49:18 PM
JAN RUTHERDALE, Assistant Attorney General, Child Protection
Section, Civil Division (Juneau), Department of Law (DOL),
clarified that this is not a specific program but rather a
generic model which eliminates any conflict.
3:49:51 PM
REPRESENTATIVE SEATON stated that despite his original concerns,
he now understands, through committee discussion, that this
language pertains in fact to a model versus a specific program,
thus funds would not be channeled to a particular provider. He
requested that the sponsor of the amendment provide a statement
to that effect for the record.
REPRESENTATIVE CISSNA stated that this amendment is to provide a
class of service and to indicate a general service model which
can be provided through various ways and means.
3:51:49 PM
REPRESENTATIVE GATTO established that the "National Family
Preservation Network" is a proper name with a website and
describes itself as using characteristics of the Home Builder's
model which is a registered trademark. However, he agreed that
providing specific terms in lower case would not present a
problem.
3:52:51 PM
CHAIR WILSON withdrew her objection. There being no further
objection, Amendment 2 was adopted.
REPRESENTATIVE KOHRING moved to report CSHB 346, Version 24-
LS1335\G, Mischel, 3/27/06, as amended, out of committee with
individual recommendations and the accompanying fiscal notes.
There being no objection, CSHB 346(HES) was reported out of the
House Health, Education and Social Services Standing Committee.
HB 468-HEALTH CARE DISCLOSURE
3:54:10 PM
CHAIR WILSON announced that the final order of business would be
HOUSE BILL NO. 468, "An Act relating to disclosure of employment
information on a medical assistance application and a hospital
intake report; and requiring the Department of Health and Social
Services to prepare and publicize a report pertaining to
employers who do not provide health insurance."
CHAIR WILSON provided that this bill would not be moved today.
3:55:07 PM
MICHAEL BUCY, Staff to Representative Max Gruenberg, Alaska
State Legislature, paraphrased from the following written
statement [original punctuation provided]:
House Bill 468 is modeled after bills introduced in
other states to help deal with the growing problem of
corporate misuse of state welfare systems.
It would require that hospitals report annually to the
state the name of the employer of any person, or the
dependents of that person, unable to pay or needing
public assistance to pay for their health care.
It would also require that those results be reported
on an annual basis to inform the legislature and the
public.
The Problems That Prompt This Bill Are:
Cost of Health Care, Possible Misuse of State
Medicaid, Lack of Information
The Cost of Health Care is a Huge Problem Nationally.
According to the Dept. of HSS, Medicaid costs for the
state were $278,000,000 in 2006 and $384,009,000 was
requested for 2007. Including Federal monies, the
total Medicaid amount spent in Alaska was
$1,031,384,000 in 2006. $1,221,421,000 is requested
for 2007.
The Possibility of Misuse of State Medicaid is
a Growing Concern.
Some large, healthy employers in the State of Alaska
may be using the Medicaid system, to provide health
insurance for their workers. This is a growing
practice that has been quantitatively measured in
other states.
There is Currently a Lack of Information
According to the State Department of Health and Social
Services, "the state does not maintain a database of
employers who do not provide health insurance benefits
for their workers."
A well-publicized case we might consider in this
context is Wal-Mart.
Wal-Mart is a large, worldwide retail store chain,
which made $11.2 billion in net profit last year, in
the U.S. alone.
Wal-Mart is Alaska's third largest employer: 2,725
employees (2004 AK DOL)
Nationally, Wal-Mart's employees are substantially
more likely to be on public health care than most
other employees of large companies.
In one of its own recent memos, Wal-Mart acknowledged
that 46% of it's employee's dependent children are
uninsured or on Medicaid.
Results of recent studies in 13 states, where the
extent employers' workers utilized public health
programs to secure health coverage for themselves and
their families showed:
In Alabama, 1 in 5 of Medicaid insured children are
dependents of Wal-Mart employees.
California, a 2004 study by UC Berkeley found WM(Wal-
Mart) employee's reliance on public assistance
programs, including public health care programs, costs
the state $86 million annually, with health-related
costs accounting for $32 million.
Texas, children of WM workers are 30% of all children
participating in CHIP whose parents work for the top
20 employers on the state's list.
Washington, WM topped the list of employers with
workers in the state's Basic Health Plan. In a Seattle
Times article this year, it was noted that the state
provided $12 million in government-subsidized health
care to WM employees. That's a $12 million subsidy to
one of the most profitable corporations in the
country.
What Course of Action, If Any, Should the State
Take?
The first step toward a possible course of action is
to first consider questions such as:
How much does this sort of behavior cost the state of
Alaska every year?
Who are the employers that are easily able, but
unwilling, to help pay for their employee's health
care ?
Should there be a law addressing this sort of
corporate behavior?
Again, according to the State Department of Health and
Social Services, "the state does not maintain a
database of employers who do not provide health
insurance benefits for their workers."
A reporting procedure should be put in place to shed
light on this subject and answer these questions that
we cannot accurately answer today.
In order to consider legislation that is fair,
appropriate and part of a solution for high state
Medicaid costs and possible corporate abuses, such
information collection as House Bill 468 would mandate
would be very useful and a step in the direction of
ensuring responsible corporate behavior in Alaska for
the future.
4:00:41 PM
CHAIR WILSON inquired as to how many other states ask for this
information.
MR. BUCY answered that currently Illinois, Hawaii, and
Massachusetts have similar legislation. In further response to
Chair Wilson, Mr. Bucy said that he has spoken with Providence
Hospital but has yet to hear the reaction.
CHAIR WILSON mentioned that she is trying to pass legislation to
have hospitals report overtime, which has not been well received
by the hospitals.
4:02:10 PM
REPRESENTATIVE CISSNA inquired as to whether any data on the
uninsured has been collected by other states. She related her
understanding that other states have taken advantage of federal
money to perform surveys [to collect data on the uninsured
population]. Representative Cissna opined that Alaska is one of
the few states without such a survey.
MR. BUCY said that he didn't know where Alaska stands with the
survey, but offered to find out.
4:03:23 PM
REPRESENTATIVE GARDNER highlighted that whenever one incurs
medical expenses, the provider always inquires as to who the
employer of the patient is in order to remain fiscally solvent.
Therefore, it would seem that the information is already
collected and thus it's merely a matter of providing it to the
state.
CHAIR WILSON noted her agreement, but reiterated the difficulty
there may be in obtaining the information.
4:04:23 PM
REPRESENTATIVE GATTO turned attention to the data in the
committee packet that specifies that the children of Wal-Mart
employees are either uninsured or receiving taxpayer-funded
public health. However, he noted that many of the Wal-Mart
employees he thinks of are 60 years of age and thus he
questioned whether the reference to "children" includes adult
children of seniors. Therefore, he encouraged the committee to
be somewhat suspicious of backup material from the unions.
MR. BUCY explained that the information was provided in a
confidential memorandum from a Wal-Mart corporate planning
session that was leaked to the unions and the press. The
information was taken from the company's review of how to
decrease the company's health care liabilities while improving
the company's public image. Interestingly, the memorandum did
recognize that the company did have a number of elderly
employees that probably cost them in the health insurance arena
and that perhaps sending elderly employees to collect shopping
baskets in inclement weather would be a strategy to reduce the
role of the elderly employees. Mr. Bucy offered to share the
memorandum with the committee.
4:06:51 PM
CHAIR WILSON pointed out most of [Wal-Mart's] employees are
part-time employees and thus they probably aren't working enough
hours to receive insurance.
4:07:20 PM
REPRESENTATIVE MAX GRUENBERG, Alaska State Legislature, speaking
as the sponsor, explained that HB 468 is based on model
legislation by the National Caucus of Labor Legislators. Such
legislation has been introduced in other states, although it's
quite new and Alaska is on the forefront of this. He noted that
the model legislation hasn't passed yet. Representative
Gruenberg explained that he introduced this legislation to
obtain data and determine whether a problem exists in Alaska,
and if so, what can be done to address it. He mentioned that he
has an interest in the matter because a Wal-Mart is scheduled to
go into his district and it has sparked much controversy.
4:08:41 PM
REPRESENTATIVE GATTO asked if employees who are eligible for
Medicaid would be listed as uncovered workers in data. He
expressed the need to clarify the data.
REPRESENTATIVE GRUENBERG agreed to the need to collect
meaningful data and indicated the need to amend the legislation
so that the data doesn't refer to employees who have insurance
from other sources, such as Medicare.
REPRESENTATIVE GATTO provided that employees who receive health
insurance through a spouse could be listed in a survey
suggesting that those employees aren't covered by the employer.
4:10:36 PM
REPRESENTATIVE GARDNER referred to page 1, line 13, which
specifies "a patient who is not covered by insurance."
Therefore, the information is only being gathered about
employers of patients who are not covered by insurance no matter
the type.
REPRESENTATIVE GRUENBERG related his desire for the legislation
to be meaningful, and therefore he said he was open to
suggestions.
4:11:27 PM
WALTER STUART, President, United Food & Commercial Workers
(UFCW) Union Local 1496, informed the committee that UFCW
negotiates for health and welfare for 3,000 members that are in
Alaska. The UFCW negotiates with Providence Hospital and other
area hospitals and Providence Hospital collects about $.64 of
every dollar it bills. "This is a crisis for Alaska and the
United States; this isn't just about whether or not we might
step on somebody's toes to get some information," he opined. He
further opined that hospitals would like to have more insured
patients come to town. With regard to Wal-Mart, it plans to
open another 11 super centers in Alaska by 2008. As Wal-Mart is
currently the third largest employer, the aforementioned will
make Wal-Mart the largest employer. He indicated that Wal-Mart
provides its employees with information as to how to receive
subsidized health care. Furthermore, these aren't just part-
time jobs, the corporation is choosing to work its employees
part-time and not provide benefits. If something isn't done to
obtain information, the state will be far behind, and therefore
he thanked the sponsor for introducing HB 468.
4:13:40 PM
MR. STUART, in response to Representative Seaton, clarified that
UFCW represents most of the retail grocery, hardware, and
furniture stores. He noted that the organization used to be
called the Retail Clerks. In further response to Representative
Seaton, Mr. Stuart said that UFCW's health plan changed three
years ago when Wal-Mart entered Alaska. He related that UFCW's
members used to have insurance for the employee and the
employee's family after 90 days. However, now it takes 16
months before the dependents become eligible for coverage with
the employers and thus for the first 16 months the employee only
is covered.
4:14:58 PM
CHAIR WILSON surmised then that although the UFCW wants Wal-Mart
[to spend a percent of its payroll on health care or contribute
to a state fund], the employers covered under UFCW don't even do
that.
MR. STUART opined that it didn't used to be this way, but now
new employers have entered the market. One employer can't pay
half the health care coverage another employer is providing and
stay in business. The aforementioned diminishes [UFCW
employers'] health care plan, which he said is still better than
what Wal-Mart offers. In further response to Chair Wilson, the
change in the UFCW employers' health care was an attempt to even
the playing field. Mr. Stuart opined, "I know I represent a
union, but I'm an Alaskan first. And being Alaskan, I think
Alaskan employers have some obligation, particularly the
employers that can afford levels of health care coverage that
Wal-Mart, as an example, is not covering." He opined that the
hospital would be more than glad to provide information on those
patients for whom the hospital doesn't receive compensation or
receive compensation from a subsidized program.
4:18:01 PM
AMY PAIGE testified in support of HB 468. She paraphrased from
the following written document [original punctuation provided]:
I would like to testify in favor of HB 468 relating to
disclosure of employment information on those seeking
assistance for hospital medical services. This bill
would make it possible for the State of Alaska to
begin to gather information on the burden the state
faces due to employers who do not make affordable
health care coverage available to their employees.
The bill would require the hospital intake form to ask
for this information from the person receiving
services, and would require the hospital to report the
name and address of these employers. The bill would
apply to employers of 25 or more employees or
contractors.
This information is basic to a full understanding of
the extent to which employers pass along their costs
to the taxpayers. Some of the largest businesses in
the country are the ones most likely to fail to
provide affordable health care coverage for their
employees. We have seen this in many of the lower 48
states, and it is likely true here. At present there
is no reporting system requirement, so the state does
not know the extent of these costs to Alaskans.
Until we have a universal single-payer health care
system in Alaska, employers are carrying the costs of
health care for their employees and families. It is
important that these costs are covered equitably, so
that there is a "level playing field" in this regard
for all businesses doing business in Alaska. This
bill will allow the State to begin to document the
employers whose health care benefits are inadequate
and result in their employees seeking public
assistance for health care and other services.
4:19:52 PM
MS. PAIGE concluded by relating that knowing the employers of
those who don't receive coverage in other ways would be a good
idea for all social services provided by the state. She pointed
out that many people are making such low wages that even if a
plan is offered, the employee can't afford it. This situation
draws everyone down; when Wal-Mart enters a community it draws
down the standard of living. She recommended that the committee
view the video exposing Wal-Mart's practices.
4:20:59 PM
REPRESENTATIVE GATTO asked if organizations such as Wal-Mart are
required to supply health insurance.
MS. PAIGE answered that she didn't know, although the
organization WakeUp Wal-Mart reports that part-time employees,
any employee who works less than 34 hours a week, must wait two
years before he/she can enroll in the health insurance program.
However, she related her understanding that Wal-Mart says it
will change that to one year as of January 2007. She further
related her understanding that part-time employees are
ineligible for family health care coverage.
4:21:46 PM
REPRESENTATIVE GATTO opined that in a free market an employer
offers wages and benefits and it's left to potential employees
to make a decision. Therefore, he asked whether potential
employees can control part of the employer's offer by insisting
on benefits or can employers simply say it's not the employer's
problem.
MS. PAIGE relayed that large employers such as Wal-Mart don't
allow unions, so the potential employees have very little power
to change the large employers' way of operating. Furthermore,
many of those who apply for a position for wages [such as
offered at Wal-Mart] don't really have choices and thus are
forced into the situation, she opined.
4:22:43 PM
REPRESENTATIVE GATTO inquired as to whether supplying health
insurance and workers' compensation is an obligation required by
statute.
REPRESENTATIVE GRUENBERG offered that perhaps some of the later
witnesses may be able to answer that question. As a practical
matter, in many communities these are the only jobs and the
individual employee doesn't have much choice.
CHAIR WILSON opined that for some, part-time positions may be
exactly what they are seeking and such individuals might even
have insurance elsewhere.
4:24:01 PM
REPRESENTATIVE GARDNER recalled an e-mail that she received from
Wal-Mart which reported that about 40 percent of its full-time
employees have access to health care coverage. However, when
she asked how many of the full-time employees "in your building"
are employees of Wal-Mart, Wal-Mart never responded.
Representative Gardner opined that there are many ways companies
can have full-time employees who aren't necessarily the
employees of the company. For instance, gift card company
employees don't work for Wal-Mart, but Wal-Mart is allowed to
claim [such employees] in Wal-Mart's percentage of full-time
employees.
4:24:58 PM
REPRESENTATIVE SEATON recalled that Massachusetts or New
Hampshire passed a law requiring any employer with a certain
amount of employees to pay a minimum of 8 percent of the
employees' wages in health care or to the state for compensation
for the health care that would be provided to the state. He
asked if the sponsor has information on the aforementioned that
he could provide to the committee.
REPRESENTATIVE GRUENBERG replied yes. He informed the committee
that Representative Seaton is referring to the Fair Share Act,
the other model act by the National Labor Caucus. He noted that
Representative Croft introduced such legislation, which was
referred to the House Labor and Commerce Standing Committee. He
informed the committee that Representative Croft's legislation
was similar to Maryland legislation that was vetoed by the
Maryland governor, although the Maryland legislature recently
overrode the veto. He mentioned that Maryland was the first
state to pass the Fair Share Act.
4:27:07 PM
ELLIE FITZJARRALD, Chief, Policy & Program Development, Division
of Public Assistance, Department of Health and Social Services
(DHSS), related that DHSS performed some preliminary fiscal
analysis on HB 468, which is contained in the fiscal notes
provided to the committee. She offered to answer questions.
4:27:47 PM
REPRESENTATIVE SEATON, referring to the $25,000 fiscal note from
DHSS dated 3/28/06, asked if that fiscal note is for setting up
the network for a report.
MS. FITZJARRALD explained that DHSS has an automated eligibility
information system (EIS) that is used to determine eligibility
for Medicaid and other public assistance benefits. Currently,
wage information is collected as part of the financial
eligibility, although the employer's name and address isn't
collected. Therefore, the $25,000 is the cost associated with
reprogramming the system to add the aforementioned data fields
so that the employer's name and address can be included in the
data, which would be included in a report that would be compiled
at the end of the year.
4:28:47 PM
MS. FITZJARRALD, in response to Representative Seaton, explained
that information is collected on the application for assistance
that includes the employer's name, whether health insurance is
received by the applicant, and the applicant's wage. However,
that information is not placed into the EIS and thus [the fiscal
note] refers to funds required to record the information in the
EIS in order that it can be extracted electronically. Ms.
Fitzjarrald clarified that the information only refers to
Medicaid applicants, and therefore doesn't include the hospital
reports that would be received at the end of the year from the
hospitals. In further response to Representative Seaton, Ms.
Fitzjarrald said the information is available on the
applications that Medicaid applicants have filled out. However,
this fiscal note refers to from this point forward. To
retroactively collect this data would require a much larger
administrative cost.
4:31:36 PM
CHAIR WILSON surmised then that once the system can accept the
information, it would take $130,000 per year for staff to input
the address.
MS. FITZJARRALD explained that the $130,000 fiscal note is the
equivalent of two full-time staff. She informed the committee
that in any given month, there are well over 50,000 Medicaid
cases of which there is often more than one individual and
dependents. Ms. Fitzjarrald further explained that eligibility
is determined monthly. With the seasonality of Alaska's
workers, people start and stop work every month and presumably
every eligibility worker working on the eligibility for a family
receiving Medicaid would need to enter employer information as
changes occur to the financial eligibility every month. The
estimate of the time it would take over the course of the year
is equivalent to two full-time staff for all the cases
statewide.
4:32:51 PM
REPRESENTATIVE SEATON inquired as to the number of staff the
division currently has performing data input for Medicaid.
MS. FITZJARRALD answered that there are over 300 staff who
administer all public assistance programs, including Medicaid.
She noted that Medicaid is the largest public assistance
program. She also noted that many of the Medicaid beneficiaries
who are in long-term care and seniors wouldn't have employers,
which was taken into consideration with the fiscal note.
4:33:38 PM
MS. FITZJARRALD, in response to Representative Gardner,
clarified that all of the information currently collected is on
paper, while part of it is input electronically. Specifically,
the gross amount of monthly earnings and the hours of work is
input in the system in order to calculate an applicant's
financial eligibility. However, the employer of the applicant
isn't in the electronic system. Therefore, in order to
determine the number of employees by employer with the
employer's name and address, it would have to be data recorded
in the system.
REPRESENTATIVE GARDNER said that she was stunned that it would
take two full-time employees to add two more fields of
information to a system in which data is already being entered.
MS. FITZJARRALD pointed out that often these are children who
have insurance with parents who aren't in the home. Therefore,
while the division may have information regarding the insurance
coverage of the child, the division doesn't know the employer
name or address of the parent with the coverage. Moreover, many
of the applications are done long distance through the mail,
which is time consuming.
4:36:09 PM
REPRESENTATIVE GARDNER surmised that currently for an individual
receiving public assistance, the division doesn't ask whether
the parent responsible for the child is employed and where.
MS. FITZJARRALD responded, "We do ask information to the extent
that we can for the program that they're on about who is living
with them." However, if it's a parent outside of the home, the
case is referred to the Child Support Services Division in order
to enforce medical support with information rather than as part
of the eligibility determination in public assistance.
REPRESENTATIVE GARDNER opined then that a child with an absent
parent who is a millionaire could receive public assistance
under the current system.
MS. FITZJARRALD reiterated that the information about the
child's absent parent would be obtained and would be referred to
the Child Support Division for enforcement of child support and
medical support. Still, the information about the millionaire
parent not living in the home with the child isn't considered in
the child's application for assistance. She further reiterated
that the information regarding the medical insurance coverage
would be available, but the details of the employer and the
employer's address wouldn't be.
4:38:29 PM
REPRESENTATIVE CISSNA asked if data on this issue is collected
and made available.
4:38:49 PM
DWAYNE PEEPLES, Director, Division of Health Care Services,
Department of Health and Social Services (DHSS), said that he
didn't know of any central database on this existing
information. He noted that the state's Medicaid management
information system (MMIS) does some matching with regard to
eligibility. The eligibility information from the Division of
Public Assistance is matched with the Medicaid claims. The
Division of Health Care Services also does some coordination of
benefits through what has been identified through the Division
of Public Assistance. A contractor reviews other databases for
health insurance in order to match as many databases as
possible, but the scope of this legislation isn't readily
available in any of the databases of which he is aware.
4:39:42 PM
MR. PEEPLES, in response to Representative Cissna, said that he
didn't know the level to which the hospitals are underwriting
uninsured care. Within the Medicaid system and through
coordination of benefits and deferring costs to other insurance
companies, about $25 million a year is being collecting. "We
can identify certain individuals who have other insurance, but
the vast majority of what else is going on out there I could not
put a dollar value on it. It is a contributor to health care
costs that the state's picking up, but I have no way of
quantifying that," he said. In further response to
Representative Cissna, Mr. Peeples related his belief that the
state will be spending in excess of $1.2 billion for Medicare
services.
4:41:21 PM
REPRESENTATIVE GARDNER asked if it's correct that of the $384
million requested for FY 07 that the state doesn't know how much
is incurred by employed individuals.
MR. PEEPLES offered to review information from the Division of
Public Assistance and the MMIS in order to provide an
approximate number. In further response to Representative
Gardner, Mr. Peeples suspected that the division wouldn't be
able to determine the employer after determining that an
individual is employed if the information isn't recorded in the
database. Such information would require manual efforts to
obtain, he indicated. In regard to a better way than HB 468 to
obtain the information, he said that he hasn't scrutinized
possible alternatives.
4:43:06 PM
REPRESENTATIVE SEATON asked if the information collected per
this legislation would be useful to the department in any way.
MR. PEEPLES opined that for claims processing for Medicaid most
of the information is being collected, although it may help the
division identify potential third-party payers with which to
coordinate benefits and defer costs. Mr. Peeples related his
belief that the major intention of this legislation is to be
utilized in policy making and analysis of what is occurring in
the health care sector for the uninsured.
4:43:59 PM
CHAIR WILSON related her belief that legislators are going to be
forced to review ways in which to cut the money being spent by
the state. Therefore, if the department has any suggestions,
this committee would entertain them, she said.
4:44:35 PM
REPRESENTATIVE CISSNA opined that although the fiscal note seems
like a lot, it would be cost effective because the wage of those
employees entering the data are at the low end of the pay scale
for state employees.
MR. PEEPLES deferred to the Division of Public Assistance.
MS. FITZJARRALD confirmed that those doing the data input would
be eligibility technician staff, which would be at an entry
level wage.
4:46:02 PM
REPRESENTATIVE SEATON asked if the language on page 1, line 13,
will generate the data sought. Representative Seaton further
asked if there is any way in which to constrain the data such
that all the information needed would be obtained while
eliminating some of the burdensome requirements of data
identification.
MS. FITZJARRALD said that this legislation is adequate for
gathering the Medicaid information. However, in terms of the
hospital reports she deferred to the hospitals. She said that
she visualized that the department would request a report from
the hospitals' intake forms of the names and addresses of each
employer for the uninsured and their dependents. Although it
seems to be fairly straightforward information, she said she
didn't know how the hospitals would accomplish it.
4:49:08 PM
REPRESENTATIVE SEATON surmised then that from the hospital the
information would be adult information because children would be
covered under DenaliKid Care.
MS. FITZJARRALD clarified that DenaliKid Care is one coverage
under Medicaid and the division seeks any third-party coverage
for any Medicaid applicant. If the desire is to identify the
parts of the rising costs of health care, the information of any
individual seeking hospital care with a parent/legal guardian
who is employed and doesn't have health insurance coverage
[should be covered]. In further response to Representative
Seaton, Ms. Fitzjarrald explained that the hospital intake
reports would be for any individual who didn't have health
insurance coverage, presumably Medicaid wouldn't be considered
health insurance coverage. As this legislation is drafted,
there wouldn't be a match or any sort of investigation as to the
type of health insurance coverage from the hospital report but
rather it would be an amount of uninsured individuals who came
to the hospital.
4:52:15 PM
CHAIR WILSON requested that Representative Gruenberg provide
results from the other states that have implemented this.
REPRESENTATIVE GRUENBERG offered to provide the committee with
charts relating the results of similar legislation in other
states.
4:53:52 PM
CHAIR WILSON expressed the need to hear from the hospitals the
next time this legislation comes before the committee.
4:54:11 PM
REPRESENTATIVE GRUENBERG requested that if the committee members
would like to include any additional information in the report
specified in the legislation, they should inform him.
4:54:58 PM
REPRESENTATIVE GARDNER suggested that the committee members
think of HB 468 in relation to the certificate of need because
it seems to tie in with what the state pays for medical
coverage.
[HB 468 was held over.]
ADJOURNMENT
There being no further business before the committee, the House
Health, Education and Social Services Standing Committee meeting
was adjourned at 4:55 p.m.