ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
April 4, 2013
3:02 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
MEMBERS ABSENT
Representative Geran Tarr
COMMITTEE CALENDAR
CONFIRMATION HEARING(S):
Alaska State Medical Board
Dr. Grant Roderer - Anchorage
- CONFIRMATION(S) ADVANCED
COMMITTEE SUBSTITUTE FOR SENATE BILL NO. 38(FIN)
"An Act extending the termination date of the State Medical
Board; relating to the executive secretary of the State Medical
Board; and providing for an effective date."
- MOVED CSSB 38(FIN) OUT OF COMMITTEE
PRESENTATION: ALASKA HEALTH WORKFORCE COALITION
- HEARD
PRESENTATION: AFFORDABLE CARE ACT
- HEARD
HOUSE BILL NO. 134
"An Act requiring Medicaid payment for scheduled unit dose
prescription drug packaging and dispensing services for
specified recipients."
- SCHEDULED BUT NOT HEARD
PREVIOUS COMMITTEE ACTION
BILL: SB 38
SHORT TITLE: EXTEND STATE MEDICAL BOARD
SPONSOR(s): SENATOR(s) OLSON
01/25/13 (S) READ THE FIRST TIME - REFERRALS
01/25/13 (S) L&C, FIN
02/07/13 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg)
02/07/13 (S) Heard & Held
02/07/13 (S) MINUTE(L&C)
02/19/13 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg)
02/19/13 (S) Moved SB 38 Out of Committee
02/19/13 (S) MINUTE(L&C)
02/20/13 (S) L&C RPT 4DP 1NR
02/20/13 (S) DP: DUNLEAVY, ELLIS, STEDMAN, MICCICHE
02/20/13 (S) NR: OLSON
03/14/13 (S) FIN AT 9:00 AM SENATE FINANCE 532
03/14/13 (S) Moved CSSB 38(FIN) Out of Committee
03/14/13 (S) MINUTE(FIN)
03/15/13 (S) FIN RPT CS 7DP NEW TITLE
03/15/13 (S) DP: KELLY, MEYER, HOFFMAN, DUNLEAVY,
FAIRCLOUGH, BISHOP, OLSON
04/02/13 (S) OLSON CHANGED L&C RECOMMENDATION FROM
NR TO DP
04/02/13 (S) TRANSMITTED TO (H)
04/02/13 (S) VERSION: CSSB 38(FIN)
04/03/13 (H) READ THE FIRST TIME - REFERRALS
04/03/13 (H) HSS, FIN
04/04/13 (H) HSS AT 3:00 PM CAPITOL 106
WITNESS REGISTER
GRANT RODERER, M.D.
Anchorage, Alaska
POSITION STATEMENT: Testified and answered questions during the
confirmation hearing for his appointment to the Alaska State
Medical Board.
DAVID SCOTT, Staff
Senator Donny Olson
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented SB 38 on behalf of the bill
sponsor, Senator Olson, and answered questions.
DON HABEGER, Director
Division of Corporations, Business, and Professional Licensing
Department of Commerce, Community & Economic Development
Juneau, Alaska
POSITION STATEMENT: Answered questions during discussion of SB
38.
ED HALL, Former Chair
Alaska State Medical Board
Anchorage, Alaska
POSITION STATEMENT: Answered questions during discussion of SB
38.
KATHY CRAFT, Coordinator
Alaska Health Workforce Coalition
Fairbanks, Alaska
POSITION STATEMENT: Presented a PowerPoint titled, "Alaska
Health Workforce Coalition."
DELISA CULPEPPER, COO
Alaska Mental Health Trust Authority
Anchorage, Alaska
POSITION STATEMENT: Presented a PowerPoint titled, "Alaska
Health Workforce Coalition."
KATY BRANCH, Director
Alaska's Area Health Education Center (AHEC)
Anchorage, Alaska
POSITION STATEMENT: Presented a PowerPoint titled, "Alaska
Health Workforce Coalition."
ILONA FARR, M.D.
Anchorage, Alaska
POSITION STATEMENT: Presented a PowerPoint titled "ACA Impacts
on Medical Care in Alaska, Exchanges and Medicaid Expansion."
ACTION NARRATIVE
3:02:52 PM
CHAIR PETE HIGGINS called the House Health and Social Services
Standing Committee meeting to order at 3:02 p.m.
Representatives Higgins, Reinbold, and Nageak were present at
the call to order. Representatives Seaton, Pruitt, and Keller
arrived as the meeting was in progress.
^CONFIRMATION HEARING(S): Alaska State Medical Board
CONFIRMATION HEARING(S):
Alaska State Medical Board
3:03:44 PM
CHAIR HIGGINS announced that the first order of business would
be the confirmation hearings for the Alaska State Medical Board.
3:04:49 PM
CHAIR HIGGINS noted that any signing of a confirmation committee
report did not reflect the intent of any member of the committee
to vote for or against an individual in any further session for
the purpose of confirmation.
3:05:08 PM
GRANT RODERER, M.D., said that his medical specialty was for
pain management and prescription opioids, and that he wanted to
assist with public safety in Alaska and the decisions for
licensing and disciplining physicians.
3:07:06 PM
REPRESENTATIVE KELLER moved to advance the confirmation for Dr.
Grant Roderer to the Alaska State Medical Board referred to the
House Health and Social Services Standing Committee for
consideration to the joint session of the House and Senate for
consideration. He noted that each member's signature on the
committee's report in no way reflects the member's vote during
the joint floor session. There being no objection, the
confirmation was advanced.
3:07:45 PM
The committee took a brief at-ease.
SB 38-EXTEND STATE MEDICAL BOARD
3:09:06 PM
CHAIR HIGGINS announced that the next order of business would be
CS FOR SENATE BILL NO. 38(FIN), "An Act extending the
termination date of the State Medical Board; relating to the
executive secretary of the State Medical Board; and providing
for an effective date."
3:09:16 PM
DAVID SCOTT, Staff, Senator Donny Olson, Alaska State
Legislature, explained that SB 38 extended the sunset date for
the State Medical Board through 2020. He reported that the
Legislative Audit Division had reviewed the activities of this
board, concluded that this board was serving in the public
interest, and recommended for an extension to the sunset date.
He detailed that the State Medical Board was responsible for the
licensing, regulation, and discipline of physicians,
podiatrists, physician assistants, and paramedics. He reported
that the Board had two full time employees, and the operating
costs associated with the Board were paid by revenue generated
from license fees. Directing attention to the committee
substitute for the proposed bill, which had been added in the
Senate Finance Committee, he reported that there had been a
request to increase the salary of the executive secretary to the
Board, which was reflected on page 1, lines 7 - 10. He pointed
out that a fiscal note was not necessary as the Board had
unanimously agreed to raise its fees to cover this additional
expense.
3:11:02 PM
REPRESENTATIVE REINBOLD asked if the annual expense of almost
$500,000 requested in the fiscal note was a reflection of past
expenses.
MR. SCOTT replied that this was his understanding.
REPRESENTATIVE REINBOLD offered her belief that it was the same,
but that she wanted confirmation.
3:11:56 PM
REPRESENTATIVE REINBOLD asked to clarify whether the fiscal note
for SB 38 [Included in members' packets] reflected any increase,
and if it was indeed paid by revenue generated by the licensing
fees.
DON HABEGER, Director, Division of Corporations, Business, and
Professional Licensing, Department of Commerce, Community &
Economic Development, in response to Representative Reinbold,
said that "this is a traditional fiscal note for a sunset
review." He stated that fees were collected from licensees for
application and renewal, and were used to pay for supported
services.
CHAIR HIGGINS asked to clarify if "they were paying their way."
MR. HABEGER offered agreement, and, in response to
Representative Reinbold, said that there was a slight increase
to the salary range, which would be covered by an adjustment to
the licensing fees.
3:13:33 PM
CHAIR HIGGINS opened public testimony.
3:13:47 PM
ED HALL, Former Chair, Alaska State Medical Board, said that the
Alaska State Medical Board had unanimously supported the
extension of the sunset, as well as the increase to the salary
of the executive secretary. He pointed out that the Alaska
State Medical Board had annually "rolled over" more than $1
million. He pointed out that the duties of the executive
secretary, as well as the licensing examiner, were expanding
with the increase to the number of licenses in Alaska. He
clarified that he had just retired as chair of the board on
March 1, 2013.
3:15:31 PM
MR. HALL, in response to Chair Higgins, said that he did not
know the amount of the fee increase, and that the current fees
varied for each professional occupation.
3:16:14 PM
CHAIR HIGGINS closed public testimony.
3:16:43 PM
REPRESENTATIVE KELLER moved to report CSSB 38(FIN) out of
committee with individual recommendations and the accompanying
fiscal notes. There being no objection, CSSB 38(FIN) was
reported from the House Health and Social Services Standing
Committee.
3:17:00 PM
The committee took a brief at-ease.
^Presentation: Alaska Health Workforce Coalition
Presentation: Alaska Health Workforce Coalition
3:18:42 PM
CHAIR HIGGINS announced that the next order of business would be
a presentation by the Alaska Health Workforce Coalition.
3:19:20 PM
KATHY CRAFT, Coordinator, Alaska Health Workforce Coalition,
said that the Alaska Health Workforce Coalition was a public and
private partnership with both government and industry entities.
She listed the membership to include: Alaska State Hospital &
Nursing Home Association, the Alaska Workforce Investment Board,
the Alaska Mental Health Trust Authority, the University of
Alaska, the Alaska Health Education Center, and the Department
of Health and Social Services, slide 3, "Alaska Health Workforce
Coalition, Leadership." She stated that this policy group met
to assist workforce efforts. She shared slide 4, "Coalition
Approach," depicting the infrastructure, which was built around
a base of workforce data. She noted that the group had focused
on six occupational priorities, and six systems change and
capacity building issues to help build a qualified health work
force.
3:21:35 PM
MS. CRAFT addressed slide 5, "Priority Occupations
Determination," which listed the plan adopted by the Workforce
Investment Board in 2010, with a subsequent action agenda from
2012 - 2015. She shared that there were 43 objectives, with 31
currently on target, and 6 already completed. She noted that
the majority of the action agenda would be completed prior to
2015, and a new tier of priorities would be selected based on
the vacancy study.
3:22:26 PM
MS. CRAFT directed attention to slide 6, "Environmental
Factors," and stated that several environmental factors affected
health, including growing industries, an aging population and
workforce, and a national recession.
3:23:08 PM
DELISA CULPEPPER, COO, Alaska Mental Health Trust Authority,
introduced slide 7, "Value-Added Health Services," noting that
it was a large industry with a long history of working together.
She pointed out that, as Alaska did not have the economy of
scale, focus was necessary to meet health care needs in the most
efficient, effective way. She declared the need for a trained,
accessible, quality workforce in all of the communities, noting,
however, that the training was not always available in Alaska
and that recruitment was often difficult. She stated that
health service needed to be safe, effective, efficient,
personalized, timely, and equitable across the state.
3:24:34 PM
MS. CULPEPPER presented slide 8, "Value-Added Health Services,"
stating that it was necessary to have the appropriate, available
workforce, which was also prepared for the future with
continuing education. She explained that, although it was not
always possible to be served by the doctor, there were other
professionals and technicians who were equally qualified for
many health care needs.
3:25:58 PM
MS. CULPEPPER offered slide 9, "Employment Growth," and she
defined health care as the largest growing sector in Alaska and
the nation for the past 10 years, and also projected to be for
the next 10 years. She furnished slide 10, "Fast-Growing Jobs,"
and noted that although the overall growth in Alaska was
projected to be more than 12 percent from 2010 to 2020, the
growth in the health care industry was projected to be far
greater. She shared slide 11, "Health Care Industry Impact,"
which noted the health care employment and total wages in
various regions of Alaska.
3:27:14 PM
MS. CULPEPPER indicated slide 13, "Preparing Health Care
Workers," and discussed the training by required education level
for health care jobs. She listed short term, on the job
training, vocational training, and advance level degrees, both
academic and non-academic training.
3:28:08 PM
MS. CRAFT called attention to slide 14, "Action Agenda, 2012-
2014," which listed the six occupational priorities that the
coalition had focused on over the past eighteen months.
MS. CULPEPPER declared that a strength of the coalition was to
recognize the commonalities of the workforce, and that the
systems that served them needed the correct policies for
support.
3:29:16 PM
REPRESENTATIVE NAGEAK asked if the professional training,
workforce recruitment, and information for Alaska youth would be
on-going.
MS. CRAFT replied that, as systems change, it became necessary
for capacity building to be ongoing, across all the occupations.
She said that training and professional development would be
ongoing to engage and prepare Alaska youth for health careers.
MS. CULPEPPER emphasized the need to "grow our own."
MS. CULPEPPER, in response to Representative Nageak, said that
Alaska needed a system to make the ongoing certification and
accreditation available. She said that there were strategies to
make this happen.
3:32:06 PM
MS. CRAFT assessed slide 15, "Action Agenda Scoreboard," and
slide 16, "FY12 Successes," which listed the status of the
objectives and the successes of the coalition.
3:32:24 PM
KATY BRANCH, Director, Alaska's Area Health Education Center
(AHEC), addressed slide 18, "Health Workforce Vacancy Study,"
and declared that the decisions and focuses relied on the
relevancy and accuracy of the available data. She said that
this was the third vacancy study and it incorporated the newly
developed Alaska Standardized Health Occupations Taxonomy (AK
SHOT), which correlated the myriad health occupations with the
federal Department of Labor Standardized Occupation
Classification (SOC) System. She defined the health workforce
to include occupations relevant to primary care, behavioral
health, dental, long term care, and other allied health
occupations. She noted that the SOC system yielded a lot of
data which was used to project workforce needs and allowed
planning for an adequately trained and highly qualified
workforce. It was also possible to compare the data with other
available data sets for a broader, more comprehensive picture of
the needs and projections. She reported that the AK SHOT
identified 164 occupations allowing comparison of "apples to
apples across data sets."
3:34:44 PM
MS. BRANCH moved on to slide 19, "Magnitude of the Data,"
stating that the health force vacancy study reviewed health
occupations across the regions of the state, and not just by
industry. Slide 20, "Magnitude of the Data," reflected data
from the industries which represented 90 percent of the health
care workers in Alaska.
3:36:03 PM
REPRESENTATIVE NAGEAK asked if the data was concentrating on
occupations in Rural Alaska, stating that several health care
disciplines were needed for the prevalence of illnesses, which
included diabetes, cancer, and dental. He asked for a program
to relieve these problems, as few health care professionals
stayed very long in the villages.
3:38:13 PM
MS. BRANCH opined that it was necessary to keep the data
separate for rural and urban areas. She noted that it was also
possible to compare the separation rates by occupation and
region, in order to determine the work force need. She reported
that one question from the vacancy study queried the number of
workers by occupation who were working on a temporary basis,
even though the employer preferred a regular employee. She
relayed that temporary employees were often paid at a higher
rate to meet the needs of that region, especially when a regular
employee was not available.
3:39:25 PM
MS. BRANCH referred back to slide 20, "Magnitude of the Data,"
which listed health related occupations within the grand total
of workers statewide, by industry type.
CHAIR HIGGINS directed attention to slide 19, and asked about
the difference in the grand total count and the count of health
care workers in the sample.
MS. BRANCH explained that, as the employers reported to the DOL
the number of workers, the sample had invited all the employers
with at least 50 health care workers to respond. For companies
having fewer than 50 health care workers, the Coalition had
polled a random sample, which reflected in the lower number.
3:41:04 PM
MS. BRANCH said that data collection had ended at the beginning
of March, and they were in the process of reviewing and running
the data analysis, slide 21, "Anticipated Outcomes." She stated
that subsequently a report and a presentation would be
available, and the Department of Labor & Workforce Development
and the Alaska Health Care Workforce Coalition would use it
extensively to drive resource allocation, program development,
and identification for high needs occupations.
3:42:40 PM
MS. BRANCH declared that they were working to make AK SHOT
replicable in other industries, and to develop even closer
communication between industry and the Department of Labor &
Workforce Development. She noted, as there was a need to
protect the identity of the respondents to the survey, that
small sample bases were suppressed, and reported at a higher
level.
3:43:28 PM
CHAIR HIGGINS asked about the funding source.
MS. CULPEPPER, in response, said that it had been started by the
coalition, ASHNA, and the University of Alaska, but that
currently the Trust was the sole funder. She shared that a
merger and new agreements were being discussed, so that federal
grants, and the corresponding agendas, would not have to be
depended upon.
3:44:44 PM
CHAIR HIGGINS asked about the distribution of the information
which the group collected.
MS. CRAFT explained that there were three levels of involvement:
a core of eleven policy leaders, which met monthly; a coalition
of champions for the various objectives, which met quarterly;
and, a larger independent stakeholder base who were invited to
the coalition meetings and would vary its individual involvement
depending on the immediate action agenda for occupations and
systems.
MS. CULPEPPER clarified that the group was also working on
issues that were not directly represented by the core group.
3:47:12 PM
CHAIR HIGGINS asked if the coalition would advocate for
preventive measures, if that was what the data suggested. He
offered an example of items available for purchase under the
federal food stamp program, which, he opined, should not be
included in that program.
3:47:59 PM
MS. CULPEPPER replied that the coalition only worked with the
work force issues.
MS. CRAFT, in response to Chair Higgins, said that the core team
met on the fourth Wednesday of every month, and that the
coalition would next meet on June 13. She explained that the
meetings were also video and tele-conferenced.
3:48:53 PM
CHAIR HIGGINS asked if the House Health and Social Services
Standing Committee members could attend.
MS. CULPEPPER replied that the meetings were open to the public,
and that the group was trying to embrace new stakeholders and
new priorities.
3:49:50 PM
MS. CRAFT declared that the director position was necessary to
keep the program focused and moving forward.
MS. CULPEPPER expressed her support for dedicated staffing.
3:51:17 PM
MS. CRAFT offered to include the House Health and Social
Services Standing Committee to the contact list.
MS. CULPEPPER shared that an additional 152 page report with all
the details of the strategies and objectives was available.
3:51:49 PM
The committee took an at-ease from 3:51 p.m. to 3:57 p.m.
^Presentation: Affordable Care Act
Presentation: Affordable Care Act
CHAIR HIGGINS announced that the next order of business would be
a presentation by Dr. Ilona Farr on the Affordable Care Act.
3:57:30 PM
ILONA FARR, M.D., directed attention to a PowerPoint titled,
"ACA Impacts on Medical Care in Alaska, Exchanges and Medicaid
Expansion," and presented slide 1, "Access to Care." She read
that Medicare would no longer pay for services ordered by un-
enrolled providers. She expressed concern for the possibility
for lack of coverage to other services for Medicare patients.
DR. FARR, in response to Chair Higgins, said that this ruling
had been made by the federal Department of Health and Human
Services, and started on March 1. She explained that an un-
enrolled provider could no longer include laboratory services,
x-rays, durable medical goods, consultations, and some
pharmaceuticals for reimbursement.
CHAIR HIGGINS clarified that an un-enrolled provider to Medicare
would not be reimbursed for billings. He asked to clarify that
it was necessary for a provider to be enrolled with Medicare to
get reimbursed.
DR. FARR said that physicians who were licensed providers in the
State of Alaska, but not enrolled in Medicare, were paid
directly by the patient.
3:59:39 PM
DR. FARR said that lab tests by an un-enrolled provider had
previously been paid by Medicare, but this was no longer the
case. She spoke about the [health] exchanges, stating that
there was now a 15 - 60 page application, with limits on
eligibility, and limits to which insurance companies could
participate. She expressed her concern for the limitations to
the current insurance companies in Alaska. She acknowledged
that there would be incremental repayments for any subsidies for
which the personal income becomes higher than estimated in the
initial application.
4:00:46 PM
DR. FARR reported that employers with more than 50 employees
were cutting back on hours or days of employee work time, in
order to avoid the payment for health insurance. She opined
that there would be penalties or fines for not having the
appropriate insurance. She suggested that health savings
accounts be modeled after the Healthy Indiana Program, as it
offered a much better option for less cost and less fraud with
better outcomes, and that these be linked to the permanent fund
as a way to less expensively cover more people, and allow them
to be in charge of their own health care.
DR. FARR moved on to slide 2, "Increasing Costs," and stated her
concern that a state could not opt out once it expanded
Medicaid. She shared that attorneys general from other states
had also expressed concerns. She stated that federal funding
was only guaranteed for the first three years, and expressed her
concern for the current federal unfunded liability. She
estimated that annual costs to the state could range from $68
million to $278 million with Medicaid expansion. She stated her
support for health coverage, but she offered her belief that an
increase to Medicaid coverage would increase private sector and
private insurance costs, because of cost shifting. She reported
that Blue Cross had estimated a 30 - 70 percent increase of
premiums. She offered her belief that, by 2018, private
insurance in Alaska would be taxed 40 percent. She declared
that the Patient Protection and Affordable Care Act (PPACA)
would require more coverage of services by the insurance
companies, so that premiums would increase. She summarized that
the expansion of Medicaid would increase the cost to the state
and the federal government, which would be paid by an increase
in taxes, fees, and penalties. She opined that this would be a
burden on taxpayers, companies, and private individuals. She
reported that Rhode Island was researching the use of block
grants as an alternative, and a means for savings.
4:06:25 PM
DR. FARR presented slide 3, "Problems with Medicaid," stating
that a problem with Medicaid was that "many who need help fall
through the cracks." She offered a personal anecdote. She
cited a recent study which determined that Medicaid patients had
poorer outcomes than the uninsured.
4:07:57 PM
DR. FARR reported that many people were choosing not to get
married in order to maintain Denali KidCare, even though the
father of the child often had a high paying job. She said that
some of her patients were deliberately unemployed, or under
employed, to obtain Medicaid, although others who needed
Medicaid were not able to qualify for it. She said that some
people were moving to Alaska because of its robust Medicaid
program, which covered more services.
4:08:36 PM
DR. FARR stated that 60 percent of Alaskans were now dependent
on the federal government for services. She offered her belief
that this was not sustainable. She noted that a smaller number
of people were paying the actual cost of health care. She said
that PPACA was transferring $700 billion from Medicare to fund
the health exchanges, which would require the coverage of
elective procedures, as well as sex-change operations. She
offered an anecdote about a discrepancy in the system for
necessary services. She noted that there were confusing rules
and regulations. She said that both the state and the federal
government were removing decision making from patients and
providers. She offered another anecdote about physicians
closing their practices in Colorado because of low reimbursement
rates.
4:10:49 PM
DR. FARR moved on to slide 4, "Exchanges," and said that the
mandated exchanges had confusing requirements and a 60-page
application. She opined that the health care exchanges would be
expensive to set up and to run, and that there would be
duplicative administrative costs. She indicated that Medicaid
and the health exchange would restrict participation to those
within 400 percent of the [federal] poverty level. She opined
that, although there were not any penalties under the federal
exchange to private companies for not meeting insurance
requirements, there were penalties under the state exchanges, so
that "it was smarter for us to go with federal exchanges." She
stated that it was unclear for the cost or savings from the
health exchanges.
4:13:06 PM
DR. FARR reviewed slide 5, "Providers," stating that there would
soon be a shortage of providers in Alaska, as 50 percent of
physicians were over the age of 50. She reported that it was
necessary for 32 new doctors to practice in the Anchorage area
annually, whereas there were currently only 8 new doctors each
year. She offered her belief that an eventual goal of PPACA was
for individual physician decisions for patients to be superseded
by government protocols. She expressed her concern for the
security and the efficiency of the electronic health records,
while necessitating more staff. She observed that the number of
medical codes would increase by 2014. She ascertained that she
could now be audited and fined by 18 organizations, and she
expressed her support for educational rather than punitive
audits.
4:16:29 PM
REPRESENTATIVE REINBOLD asked her sister, Dr. Farr, for a
definition to RAC and ACA.
DR. FARR replied that RAC were commission based audits and ACA
was the Affordable Care Act.
REPRESENTATIVE REINBOLD asked when the coding changes would go
into effect, and if there was concern for them driving up the
costs of health care.
DR. FARR replied that the coding changes would go into effect
for Medicare on October 1, 2014, while the insurance codes would
go into effect on January 1, 2015. She opined that it would
increase the costs of health care.
4:18:04 PM
REPRESENTATIVE NAGEAK stated that he had had a desire to say
something since Dr. Farr began her presentation. He asked
whether anyone would be speaking about the redeeming qualities
of the PPACA and the Medicaid Expansion. He pointed out that
Dr. Farr had not expressed any redeeming qualities for the
legislation, and he opined that there must be something,
"otherwise the government wouldn't be giving it to us, or
offering it." He stated that he wanted to hear something
positive, "instead of all this," and he offered his belief that
what she was saying was not happening. He asked for information
as to what exactly the legislation would accomplish. He
emphasized, "I don't think the federal government is gonna jam
something down our throat that's bad for the state or the United
States of America." He assessed that Rural Alaska would be
impacted and hurt if this legislation was not accepted, as Rural
Alaska depended on the federal government "because there's
nothing else in the state. Who's taking care of these people in
the villages, he asked. Nobody's taking care of those villages
because there's no doctors, since there's a shortage of doctors
in the villages." He expressed his desire to hear something
positive, and reiterated "I don't think the federal government
is gonna be jamming something down the throat that's gonna be
bad for us."
4:20:21 PM
CHAIR HIGGINS said that he had "seen both sides of the story,"
and that it was necessary to listen to the presented information
and personally debate it. He offered his belief that Dr. Farr
was telling the truth.
REPRESENTATIVE NAGEAK stated his desire to hear an opposing
opinion to Dr. Farr.
CHAIR HIGGINS said that there had already been two presentations
from the other side, and that it was necessary to now listen to
this side, to "keep an open mind, and we continue to move
forward."
4:21:02 PM
CHAIR HIGGINS asked if state legislation could prevent the
proposed commission based audits.
DR. FARR replied that these were federally mandated audits, and
that many federal organizations were exempt from many of these
regulations. She said that Medicare would soon require that
physicians bill directly to hospitals in certain circumstances
surrounding hospital visits, even if the physician visit was
unrelated to the hospital visit, and that this would create
confusion for billing. She assessed that underpayment by
Medicare, Medicaid, insurance, and large corporations was
driving independent practitioners out of business.
4:23:00 PM
DR. FARR indicated that federal mandates, limits on services,
and required, but unnecessary, services had created ethical
concerns with compliance. She suggested that many pro-life
physicians would choose not to participate in the mandates, and
that the need for additional pre-authorizations and increasing
regulations would create problems.
4:24:22 PM
DR. FARR reviewed slide 6, "Summary," and stated that "ACA is a
very expensive tax and regulatory bill, it's gonna drive private
practitioner providers out of business, it's gonna increase
insurance premiums and have a very detrimental impact on the
economy of Alaska, especially in the private sector." She
suggested that it would be necessary to limit Medicaid, and
encourage the use of health savings accounts. She declared that
the state health insurance exchanges were not a good idea, and
that it was necessary to limit the rules, regulations, and
punitive audits in order to control the costs. She declared
that it was necessary to support programs for the training of
medical providers, continue efforts toward liability reform,
pass legislation to allow boutique practices, and support health
care freedom acts that put the patient back in charge of their
health care. She offered her belief that the PPACA was directed
primarily toward the private sector.
DR. FARR offered slide 7, "Better Solutions than ACA," and
indicated that block grants for Medicaid, educational audits,
preventive care, school and Internet educational programs, and
health savings accounts were all good directions. She advocated
to allow tax right-offs for waivers for charity care, and to
pass legislation to allow boutique practices. She reported a
need to increase the vocational education programs for home care
and other professional medical programs. She opined that
payment of medical bills with VISA or debit cards would reduce
costs. She stated that it was necessary for a health care
freedom act in Alaska.
DR. FARR acknowledged that the PPACA was favorable to funding
the Alaska Native Medical Center and its healthcare, and to "a
subset of the Alaskan population, it really is a boon, and it
really is going to help that subset." She shared that she had
grown up in Rural Alaska, had worked with Indian Health Service,
and that she wanted to see "good care for all people of Alaska."
4:28:55 PM
The committee took a brief at-ease.
CHAIR HIGGINS brought the committee back to order.
4:29:29 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 4:29 p.m.