Legislature(2009 - 2010)CAPITOL 106

03/18/2010 03:00 PM HEALTH & SOCIAL SERVICES


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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+= SB 13 MEDICAL ASSISTANCE ELIGIBILITY TELECONFERENCED
Moved Out of Committee
+ SB 199 MEDICAID COVERAGE FOR DENTURES TELECONFERENCED
Moved Out of Committee
*+ HB 392 INCENTIVES FOR CERTAIN MEDICAL PROVIDERS TELECONFERENCED
Heard & Held
+ Bills Previously Heard/Scheduled TELECONFERENCED
+= HB 260 MEDICAID: PREVENTIVE CARE/DISEASE MGT. TELECONFERENCED
Heard & Held
              SB 13-MEDICAL ASSISTANCE ELIGIBILITY                                                                          
                                                                                                                                
3:31:47 PM                                                                                                                    
                                                                                                                                
CO-CHAIR KELLER announced  that the next order  of business would                                                               
be  SENATE  BILL   NO.  13,  "An  Act   relating  to  eligibility                                                               
requirements  for medical  assistance  for  certain children  and                                                               
pregnant women; and providing for an effective date."                                                                           
                                                                                                                                
SENATOR  BETTYE   DAVIS,  Alaska  State   Legislature,  expressed                                                               
appreciation  to the  committee and  requested to  have the  bill                                                               
moved out of the committee without any amendments.                                                                              
                                                                                                                                
3:33:42 PM                                                                                                                    
                                                                                                                                
GEORGE BROWN, Doctor, read from  a prepared statement:  [original                                                               
punctuation provided]                                                                                                           
                                                                                                                                
     I  am George  Brown and  reside at  1640 Second  St. in                                                                    
     Douglas,  Alaska.   Thank you  for  the opportunity  to                                                                    
     speak in strong  support of passage of SB 13.   I would                                                                    
     like to  focus on  three themes  today, and  then close                                                                    
     with words from an Alaskan Superior Court Judge.                                                                           
                                                                                                                                
      First, I applaud your ongoing concern with governing                                                                      
     from a responsible budget for all Alaskans.  I enjoyed                                                                     
     sitting at the hearing in this  room on March 9th and I                                                                    
     learned some important information.   We, who pay close                                                                    
     attention  to the  current  domestic  situation in  our                                                                    
     country,  know that  governing is  much more  difficult                                                                    
     than campaigning  - which is  never a cake walk.   Your                                                                    
     questions  on  that  Tuesday kept  returning  to  fears                                                                    
     about  affordability   and  how   can  you   know  such                                                                    
     increased   inclusion  will   eventually  bring   about                                                                    
     savings  in Alaska  health care  costs.   A variety  of                                                                    
     university  studies in  the 1990's  show  how every  $1                                                                    
     invested  in prevention  work for  improving children's                                                                    
     health saves  at least $4.   Dr. Gross spoke  about the                                                                    
     savings  when  children  visit  a  physician  or  nurse                                                                    
     practitioner  office compared  with Emergency  Room and                                                                    
     hospital admissions.  One  of the underlying mechanisms                                                                    
     for this saving is  the gradual, but effective learning                                                                    
     about  how to  wisely use  medical care.   This  begins                                                                    
     with pre-natal  health care and  continues all  the way                                                                    
     through  to  adulthood.   On  every  preventive  visit,                                                                    
     parents  and  children  are   learning  they  are  more                                                                    
     responsible for  their health than  anyone else.   Such                                                                    
     regular attention  to prevention and  wellness prevents                                                                    
     life threatening and  expensive infections, serious and                                                                    
     fatal  physical injuries,  school failure  and dropout,                                                                    
     obesity, family  disruption from  chronic developmental                                                                    
     and health  conditions, substance abuse, and  now early                                                                    
     child behavior problems.   Helping young parents, whose                                                                    
     parents  never  had  a chance  for  such  learning,  to                                                                    
     wisely use  medical care, is a  tedious and challenging                                                                    
     endeavor, but I  have been blessed to  see such changes                                                                    
     in  many Alaskan  families ever  since I  began to  see                                                                    
     children covered  by Medicaid in  the 1970's.   That is                                                                    
     part of the joy of being a pediatrician.                                                                                   
                                                                                                                                
     Please pass SB 13 to increase such cost savings.                                                                           
                                                                                                                                
     Second,  I speak  to an  issue that  may irritate  some                                                                    
     medical colleagues.   I have  been outspoken  about the                                                                    
     access to  health care in  these United State  for many                                                                    
     years.  I  learned long ago, in 1969  when working with                                                                    
     a  pediatric resident  who had  trained in  Canada, how                                                                    
     fee for  service is a  major driver of excess  costs in                                                                    
     our health care system.   If a physician gets to decide                                                                    
     how much will be billed  for each visit, the temptation                                                                    
     to select a  lower figure is "sorta  like Eve's apple."                                                                    
     Fee for service must be  eliminated to bring down these                                                                    
     wasteful costs.   There must be added a way  to pay for                                                                    
     the outcomes of service.   Medicaid and other insurance                                                                    
     companies have  begun to examine such  excess charging.                                                                    
     I  urge my  colleagues  to think  carefully about  such                                                                    
     costs every  time we  complete the  coding for  the fee                                                                    
     for service to  be paid for each visit.   For those who                                                                    
     honestly question  this view point, I  would ask, "Have                                                                    
     you ever known a really poor physician?"                                                                                   
                                                                                                                                
     Please support  national health  care reform  to reduce                                                                    
     our wasteful costs.                                                                                                        
                                                                                                                                
     Third,  I   want  us  to  think   about  the  pervasive                                                                    
     atmosphere of  fear in our  time.  The list  just keeps                                                                    
     on  being  broadcast  hourly: Global  warming,  Climate                                                                    
     change,  Worsening  natural disasters,  AIDS,  Economic                                                                    
     recession,    Neighborhood   violence,    Homelessness,                                                                    
     Terrorism,  Illegal immigrants,  Youth drug  addiction,                                                                    
     US government debt,  and not too long  ago, the dreaded                                                                    
     "Spanish  or H1N1  worldwide  pandemic."   Medical  and                                                                    
     public health colleagues all  over Alaska provided care                                                                    
     for thousands  of H1N1 cases  and just as soon  as CDC,                                                                    
     working  with reliable  vaccine manufacturers,  made an                                                                    
     effective vaccine available, gave  thousand of doses of                                                                    
     H1N1 influenza  vaccine.  There  were a few  deaths and                                                                    
     more  hospitalizations,  but  this  pandemic  gradually                                                                    
     passed  with  nowhere near  the  levels  of deaths  and                                                                    
     hospitalizations that  are now  hallmarks of  the three                                                                    
     previous H1N1 influenza pandemics.   We in these United                                                                    
     States, along  with the  World Health  Organization and                                                                    
     numerous  other  national  governments,  did  something                                                                    
     correctly.    I  could  not have  predicted  this  with                                                                    
     certainty last  August and September.   In short,  I am                                                                    
     grateful for this most successful  work of clinical and                                                                    
     public health  medicine and I think  the over-marketing                                                                    
     of  fear is  a  much  larger enemy  than  any of  dozen                                                                    
     listed above.                                                                                                              
                                                                                                                                
     Please pass SB 13 to continue overcoming fear.                                                                             
                                                                                                                                
     In closing,  I read  the wisdom  about children  by the                                                                    
     Alaskan judge to  whom I remain forever  grateful for a                                                                    
     truth that keeps me living in reality.                                                                                     
                                                                                                                                
3:42:30 PM                                                                                                                    
                                                                                                                                
DR. BROWN read the following poem:  [original punctuation                                                                       
provided]                                                                                                                       
                                                                                                                                
     Each of us                                                                                                                 
     must come to care                                                                                                          
     about everyone's children.                                                                                                 
     We must recognize that                                                                                                     
     the welfare of our children and grandchildren                                                                              
     is intimately linked to the welfare                                                                                        
     of all other people's children.                                                                                            
     After all, when one of our children                                                                                        
     need lifesaving surgery,                                                                                                   
     someone else's child will perform it.                                                                                      
     When our children dial 911,                                                                                                
     someone else's child will answer it.                                                                                       
     When our children need a helping hand,                                                                                     
     someone else's child will be there to lend it.                                                                             
     If one of our children is threatened                                                                                       
     or harmed by violence,                                                                                                     
     someone else's child will be responsible                                                                                   
     for the violent act.                                                                                                       
     The good life                                                                                                              
     for our own children                                                                                                       
     can be secured                                                                                                             
     only if a good life                                                                                                        
     is secured                                                                                                                 
     for all other people's children.                                                                                           
                                                                                                                                
3:43:25 PM                                                                                                                    
                                                                                                                                
CO-CHAIR KELLER expressed gratitude for Dr. Brown's sincerity.                                                                  
                                                                                                                                
3:44:12 PM                                                                                                                    
                                                                                                                                
PATRICE  GRIFFIN, Head  Start  Director,  Rural Alaska  Community                                                               
Action Program, stressed  that Denali Kid Care  coverage was very                                                               
important for  the children  and prenatal  women in  its program.                                                               
She  stated that  Denali  Kid Care  allowed  children to  receive                                                               
important  medical services  and screenings.   She  reported that                                                               
Head Start  and Early Head  Start served 868 children  in Alaska,                                                               
of whom  397 were enrolled  in Denali  Kid Care, but  she pointed                                                               
out that  76 children had no  medical coverage.  She  shared that                                                               
Head Start helped children and  families access medical services,                                                               
and  it used  program dollars  to help  children receive  medical                                                               
service.  She expressed support for SB 13.                                                                                      
                                                                                                                                
3:46:59 PM                                                                                                                    
                                                                                                                                
CO-CHAIR KELLER  asked how many  of the 76 non  medically covered                                                               
children would have been covered by proposed SB 13.                                                                             
                                                                                                                                
MS. GRIFFIN replied that she would find that information.                                                                       
                                                                                                                                
3:47:56 PM                                                                                                                    
                                                                                                                                
ELIZABETH RIPLEY,  Executive Director, Mat-Su  Health Foundation,                                                               
explained that the Mat-Su Health  Foundation was a non-profit and                                                               
part owner of the Mat-Su  Regional Medical Center, which had been                                                               
built to  provide better  access to acute  care for  the borough.                                                               
She  reported  that  the  Foundation  was  an  overseer  for  the                                                               
hospital  policies.   She declared  that  this included  ensuring                                                               
that  indigents  had equal  access  to  top  quality care.    She                                                               
directed   attention   to   the   growing   uninsured   community                                                               
population, and  the rise  in uncompensated  care and  bad debts.                                                               
She  pointed  out  that  the number  of  uninsured  children  had                                                               
declined nationally, but had increased  in Alaska.  She said that                                                               
there was an increase of  3000 uninsured children, despite a zero                                                               
percent  population growth.   She  said  that it  was the  middle                                                               
income households  that were suffering, as  these households were                                                               
becoming  uninsured  at  a  faster rate  than  any  other  income                                                               
levels.  The average cost of  a family's insurance policy rose 81                                                               
percent between 2000 and 2008,  while the median household income                                                               
fell 2.5 percent.  She stated support for SB 13.                                                                                
                                                                                                                                
3:52:24 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  T. WILSON  asked how  many more  kids would  have                                                               
been covered if coverage were for 200 percent FPL.                                                                              
                                                                                                                                
MS. RIPLEY estimated 1530 children in Mat-Su.                                                                                   
                                                                                                                                
CO-CHAIR KELLER  allowed that his statistics  reflected that 1277                                                               
children would be eligible statewide.                                                                                           
                                                                                                                                
3:53:00 PM                                                                                                                    
                                                                                                                                
MS. RIPLEY  clarified that  this would  include all  eligible but                                                               
uninsured  people in  Mat-Su, and  noted that  some were  already                                                               
qualified but not enrolled.                                                                                                     
                                                                                                                                
3:53:59 PM                                                                                                                    
                                                                                                                                
MS. RIPLEY,  in response  to Co-Chair Keller,  said that  she did                                                               
not have the regional information.                                                                                              
                                                                                                                                
3:54:57 PM                                                                                                                    
                                                                                                                                
DONNA GRAHAM,  Nurse, said  that there  was a  lack of  access to                                                               
health  care.   She listed  the FPL  rates for  many states,  and                                                               
noted  that only  Alaska and  North  Dakota were  175 percent  or                                                               
below.  She  stated support for SB 13 and  urged the committee to                                                               
take immediate action.                                                                                                          
                                                                                                                                
3:57:47 PM                                                                                                                    
                                                                                                                                
MELINDA MYERS,  Senior Manager,  Best Beginnings,  explained that                                                               
Best  Beginnings  was  "a  public   -  private  partnership  that                                                               
mobilizes  people and  resources  to ensure  all Alaska  children                                                               
begin  school ready  to  succeed."   She stated  that  SB 13  was                                                               
critical to ensure that children  and pregnant mothers had access                                                               
to  quality health  care.   She stated  support for  SB 13.   She                                                               
offered a  personal anecdote about  medical costs and  its impact                                                               
on a low income family with small children.                                                                                     
                                                                                                                                
3:59:27 PM                                                                                                                    
                                                                                                                                
FRANK BOX  relayed a  personal story of  the devastating  cost of                                                               
medical bills  even with  good health insurance.   He  stated his                                                               
support for  SB 13.  He  reported that $89.5 million  was paid by                                                               
the  state  and  the  federal  government  for  unpaid  Anchorage                                                               
emergency room visits in 2005.                                                                                                  
                                                                                                                                
4:01:52 PM                                                                                                                    
                                                                                                                                
ELENA MARCIL, Rural Alaska Community  Action Program, stated that                                                               
SB 13 would help the program to better serve families.                                                                          
                                                                                                                                
4:03:02 PM                                                                                                                    
                                                                                                                                
AMBER SAWYER  said that she had  been insured by Denali  Kid Care                                                               
as a child.   She explained that her father  was in the military,                                                               
and while  stationed in  Alaska, the Tri  Care insurance  did not                                                               
offer  all  the necessary  services  so  that her  family  needed                                                               
Denali Kid  Care.  She offered  a personal story of  her need for                                                               
therapy as a  child, and that Tri Care could  not accommodate her                                                               
need.   She related that  Denali Kid  Care met her  therapy needs                                                               
and  that she  did  not think  that she  "would  be sitting  here                                                               
before you today if it weren't  for Denali Kid Care."  She stated                                                               
that the therapy  and the support which she  received from Denali                                                               
Kid Care  had turned her  life around.   She relayed  that Denali                                                               
Kid Care had  influenced her decision to become  an attorney, and                                                               
that  she  was currently  working  as  a  legal assistant.    She                                                               
testified that  more than half the  cases in her law  office were                                                               
medically related.  She relayed  that the inclusion of Denali Kid                                                               
Care within a case would often  result in a settlement outside of                                                               
court.                                                                                                                          
                                                                                                                                
4:07:37 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  T.  WILSON asked  how  many  of the  cases  would                                                               
include people  in the  175 to  200 percent  FPL for  approval to                                                               
Denali Kid Care.                                                                                                                
                                                                                                                                
MS.  SAWYER replied  that she  worked most  often with  motorized                                                               
vehicle accidents and she estimated  that Denali Kid Care was the                                                               
insurance in at least 12 of the 100 accident cases.                                                                             
                                                                                                                                
4:08:51 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE T. WILSON asked if  this was because there was not                                                               
any auto insurance.                                                                                                             
                                                                                                                                
MS. SAWYER replied  that auto insurance would not  always pay for                                                               
it.                                                                                                                             
                                                                                                                                
4:10:38 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  T. WILSON  asked if  co pay  for Denali  Kid Care                                                               
could be included without a burdensome administrative cost.                                                                     
                                                                                                                                
JON   SHERWOOD,  Medicaid   Special  Projects,   Office  of   the                                                               
Commissioner, Department  of Health  and Social  Services (DHSS),                                                               
replied that  SB 13  only included  children and  pregnant women.                                                               
He said  that there would be  an administrative cost to  both the                                                               
DHSS and the  providers.  He pointed out that  there were federal                                                               
limits to co-pay.                                                                                                               
                                                                                                                                
4:12:14 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  T.  WILSON  asked   who  set  the  standards  for                                                               
qualification to Denali Kid Care.                                                                                               
                                                                                                                                
MR. SHERWOOD  replied that it  was a federal policy  for enhanced                                                               
funding  of  children through  Medicare  which  set the  coverage                                                               
limits when  other insurance was  also included.  He  pointed out                                                               
that any  increase above these limits  would result in a  loss of                                                               
the  federal State  Children's Health  Insurance Program  (SCHIP)                                                               
enhanced funding for kids without insurance.                                                                                    
                                                                                                                                
4:13:41 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE T. WILSON asked about  the combinations of various                                                               
coverages.                                                                                                                      
                                                                                                                                
MR.  SHERWOOD, in  response to  Representative Wilson,  said that                                                               
coverage through Indian Health Services  (IHS) was not considered                                                               
insurance for the  purposes of eligibility.  He  pointed out that                                                               
an  IHS  provider could  also  bill  Medicaid for  any  uncovered                                                               
amounts and was reimbursed at 100 percent of federal funds.                                                                     
                                                                                                                                
4:15:16 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  T. WILSON  asked about  the earlier  reference to                                                               
coverage through military insurance and Denali Kid Care.                                                                        
                                                                                                                                
MR. SHERWOOD replied that he would  need to check if Tri Care was                                                               
considered insurance.                                                                                                           
                                                                                                                                
4:16:10 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  KELLER noted  that 1277  additional  children would  be                                                               
covered  by SB  13, and  an additional  200 pregnant  women.   He                                                               
asked if any  of these were included in the  Indian Child Welfare                                                               
Act (ICWA) projections.                                                                                                         
                                                                                                                                
MR.  SHERWOOD replied  that some  of  the children  would be  IHS                                                               
eligible,  and he  pointed to  the  fiscal note  which showed  an                                                               
assumption for 100 percent funding for some of the services.                                                                    
                                                                                                                                
CO-CHAIR KELLER asked for a percentage.                                                                                         
                                                                                                                                
MR. SHERWOOD replied that, overall,  35 percent were eligible for                                                               
IHS, but  he could not  state positively about the  percentage of                                                               
eligibility for the income level stated in SB 13.                                                                               
                                                                                                                                
4:17:54 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  T. WILSON  asked if  there  was a  wait list  for                                                               
Denali Kid Care.                                                                                                                
                                                                                                                                
MR. SHERWOOD,  in response, said  there was  not a wait  list for                                                               
entry due  to limitations  of capacity, but  that there  had been                                                               
processing  backlogs  to  verify citizenship  and  identity  with                                                               
original  documents.    He  explained  that  if  eligibility  was                                                               
granted, then coverage was offered  for three months prior to the                                                               
date of application.                                                                                                            
                                                                                                                                
4:19:24 PM                                                                                                                    
                                                                                                                                
REBECCA   LEVENSON,  Senior   Policy  Analyst,   Family  Violence                                                               
Prevention  Fund, said  that Alaska  had the  highest per  capita                                                               
rates  of sexual  and  domestic  violence in  the  country.   She                                                               
explained that the Family Violence  Prevention Fund worked on the                                                               
impact  of  violence  on  health  outcomes.    She  said  it  was                                                               
important  to  consider  the  issue   of  perinatal  health  when                                                               
increasing to  200 percent of  FPL.  She explained  that pregnant                                                               
women experiencing  violence were  much less  likely to  carry to                                                               
term,  which  would  cost  the  state a  lot  more  money.    She                                                               
suggested consideration  of the cost  benefit to the  increase to                                                               
FPL  percentages  versus  the  cost  of  negative  outcomes  from                                                               
decreased perinatal care.                                                                                                       
                                                                                                                                
4:22:52 PM                                                                                                                    
                                                                                                                                
CO-CHAIR KELLER closed public testimony.                                                                                        
                                                                                                                                
4:23:04 PM                                                                                                                    
                                                                                                                                
CO-CHAIR KELLER moved  to adopt Amendment 1,  labeled Version 26-                                                               
LS0076\A.12, Mischel, 3/17/10, which read:                                                                                      
                                                                                                                                
     Page 4, line 3:                                                                                                            
          Delete "200"                                                                                                      
          Insert "210"                                                                                                      
                                                                                                                                
     Page 4, line 14:                                                                                                           
          Delete "may"                                                                                                          
          Insert "shall [MAY]"                                                                                              
                                                                                                                                
     Page 4, line 16:                                                                                                           
          Delete "150 and 200"                                                                                              
          Insert "185 [150] and 210"                                                                                    
                                                                                                                                
     Page 4, lines 16 - 17:                                                                                                     
          Delete "if the department requires premiums or                                                                        
     cost-sharing contributions under this subsection, the"                                                                     
          Insert "The [IF THE DEPARTMENT REQUIRES PREMIUMS                                                                  
      OR COST-SHARING CONTRIBUTIONS UNDER THIS SUBSECTION,                                                                      
     THE]"                                                                                                                      
                                                                                                                                
4:23:22 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE T. WILSON objected for discussion.                                                                               
                                                                                                                                
4:24:18 PM                                                                                                                    
                                                                                                                                
The committee took a brief at-ease.                                                                                             
                                                                                                                                
4:24:51 PM                                                                                                                    
                                                                                                                                
[Due to technical  difficulties, the audio was  not recorded from                                                               
4:24:51 until 4:25:21.]                                                                                                         
                                                                                                                                
4:25:53 PM                                                                                                                    
                                                                                                                                
CO-CHAIR KELLER  repeated that SB  13 was not about  coverage for                                                               
children,  but about  who  would pay  for it.    He declared  the                                                               
intent  for  state  programs  was  to  help  people  become  self                                                               
sufficient once again.   He preferred the message to  be that the                                                               
state would  help out,  not to  pay for as  much as  possible for                                                               
everyone.                                                                                                                       
                                                                                                                                
4:28:19 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON asked to clarify  that there were no steps,                                                               
percentages, or  amounts for  co pay in  the amendment,  but that                                                               
these would be whatever the DHSS determined.                                                                                    
                                                                                                                                
4:30:01 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE LYNN asked  about the expense to  implement the co                                                               
pay.   Pointing to the  intent of the  amendment, he asked  if it                                                               
was  to  save  money,  or  to  teach  parents  to  be  more  self                                                               
sufficient.                                                                                                                     
                                                                                                                                
4:31:30 PM                                                                                                                    
                                                                                                                                
CO-CHAIR KELLER replied  that his intent was for the  will of the                                                               
committee to  happen.  He noted  that his intent was  for greater                                                               
self  sufficiency for  parents, but  that the  issue was  for who                                                               
would pay.                                                                                                                      
                                                                                                                                
REPRESENTATIVE LYNN  asked if the  children would  suffer because                                                               
of this.                                                                                                                        
                                                                                                                                
CO-CHAIR KELLER  said that it  was necessary  to draw a  line for                                                               
support.                                                                                                                        
                                                                                                                                
4:34:38 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  HOLMES,  in  response to  Representative  Seaton,                                                               
pointed to page 4,  lines 18 and 19, and said  that DHSS would be                                                               
required to adopt "a sliding  scale for premiums or contributions                                                               
based on household income."                                                                                                     
                                                                                                                                
4:35:27 PM                                                                                                                    
                                                                                                                                
MR.  SHERWOOD said  that  the bill  language  usually provided  a                                                               
great deal of flexibility for levels of cost sharing.                                                                           
                                                                                                                                
4:35:56 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE HOLMES asked  how the co pay would  be shared with                                                               
the  federal  government,  and  also asked  about  the  cost  for                                                               
administrative  overhead.   She referred  to the  current statute                                                               
which allowed  for a  department option to  premiums or  co pays.                                                               
She asked  Mr. Sherwood  how much  money was  really going  to be                                                               
saved.                                                                                                                          
                                                                                                                                
4:37:12 PM                                                                                                                    
                                                                                                                                
MR.  SHERWOOD  replied that  any  income  from co-pays  would  be                                                               
shared  with the  federal  government  at the  same  rate as  the                                                               
expenses.  He agreed that  there were administrative costs for co                                                               
pays and premiums.  He opined  that there could be a savings from                                                               
deterrence,  in that  some people  would just  not apply,  though                                                               
neither co  pay or premium  would contribute to a  large savings.                                                               
He   clarified  that   the  administration   supported  a   clean                                                               
expansion,  without  co-pays, to  200  percent  FPL for  pregnant                                                               
women and children.   He expressed a desire for  a simple program                                                               
for DHSS and the providers.                                                                                                     
                                                                                                                                
4:40:47 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE CISSNA said  there was a shortage  for health care                                                               
providers which  accepted Medicaid.   She asked  if co  pay would                                                               
create  a necessity  for more  personnel,  and would  the co  pay                                                               
create a hardship for the health care provider network.                                                                         
                                                                                                                                
MR.  SHERWOOD, in  response,  offered his  belief  that the  DHSS                                                               
workload  would increase,  but he  did not  know if  it would  be                                                               
necessary to  hire more  staff.   He shared that  co pay  was not                                                               
uncommon,  but  that he  could  not  speak  for the  health  care                                                               
providers.                                                                                                                      
                                                                                                                                
4:44:20 PM                                                                                                                    
                                                                                                                                
CO-CHAIR KELLER asked for clarification about the co pay.                                                                       
                                                                                                                                
MR. SHERWOOD  replied that the co  pay was paid to  the provider,                                                               
which would  reduce the  payment to the  provider from  the state                                                               
and  the  federal government.    He  clarified  that the  co  pay                                                               
benefit to the state would be  to the same percentage as the cost                                                               
payment for the service.                                                                                                        
                                                                                                                                
4:44:55 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE T.  WILSON asked  if the co  pay process  could be                                                               
similar to the current system used by clinics in her district.                                                                  
                                                                                                                                
MR. SHERWOOD replied that degrees of  co pay could be set up, but                                                               
he explained  the necessity to  categorize all the  recipients by                                                               
qualifications, and then to notify  all the health care providers                                                               
of each recipient's category.                                                                                                   
                                                                                                                                
4:46:09 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE T.  WILSON asked  about the  current adult  co pay                                                               
system.                                                                                                                         
                                                                                                                                
MR. SHERWOOD  reported that  providers were aware  of the  co pay                                                               
services and the  eligibility categories, so that the  co pay was                                                               
requested at the time of payment.                                                                                               
                                                                                                                                
4:47:26 PM                                                                                                                    
                                                                                                                                
MR. SHERWOOD,  in response to  Representative T.  Wilson, offered                                                               
an example of buying a prescription at a pharmacy.                                                                              
                                                                                                                                
REPRESENTATIVE T.  WILSON asked if  this was the same  system for                                                               
children.                                                                                                                       
                                                                                                                                
MR.  SHERWOOD explained  that it  was necessary  to identify  the                                                               
individuals subjected to co pay,  and to identify any differences                                                               
in co pay amounts.                                                                                                              
                                                                                                                                
4:49:21 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE LYNN  expressed his concern  for any impact  of co                                                               
pay on  the children.  He  asked if this could  be studied during                                                               
the interim.  He asked about the cost for a premium.                                                                            
                                                                                                                                
MR. SHERWOOD, in response, said  that premiums could not exceed 5                                                               
percent  of  the  household  income,  based on  a  monthly  or  a                                                               
quarterly income.                                                                                                               
                                                                                                                                
4:52:36 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  KELLER  withdrew  his   amendment.    He  declared  his                                                               
philosophical differences with the federal government.                                                                          
                                                                                                                                
4:53:41 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE CISSNA  agreed that  it was necessary  to maintain                                                               
awareness of the  program costs.  She stressed  the importance of                                                               
"dealing  with one  part  of  a generation"  and  she voiced  her                                                               
support for a better system.                                                                                                    
                                                                                                                                
4:54:53 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  T.  WILSON  expressed her  frustration  with  the                                                               
inequity to small businesses which offered a health care plan.                                                                  
                                                                                                                                
4:57:16 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  CISSNA offered  her  belief that  Alaska did  not                                                               
encourage small  businesses.  She  stated that a large  number of                                                               
uninsured in Alaska were employed  by small businesses.  She said                                                               
that SB  13 would  allow these employees  to keep  their children                                                               
healthy,  while  it supported  the  small  businesses ability  to                                                               
remain in business.                                                                                                             
                                                                                                                                
4:58:45 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  HERRON moved  to report  SB  13 out  of committee  with                                                               
individual recommendations and the accompanying fiscal notes.                                                                   
                                                                                                                                
CO-CHAIR  KELLER objected.    He  said that  he  cared about  the                                                               
children.   He  offered his  belief  that the  committee had  the                                                               
wrong understanding  and he  directed attention  to a  pie graph,                                                               
titled  "Children  in  Alaska."     [Included  in  the  committee                                                               
packets.]  He opined that SB  13 would send a message to families                                                               
that the government  was there to take care of  them.  He offered                                                               
his  belief that  SB  13  would only  affect  a  small number  of                                                               
children, and  that these  were not the  children who  needed the                                                               
most support.                                                                                                                   
                                                                                                                                
5:02:07 PM                                                                                                                    
                                                                                                                                
A  roll  call vote  was  taken.   Representatives  Lynn,  Seaton,                                                               
Cissna,   Holmes,  and   Herron  voted   in  favor   of  SB   13.                                                               
Representatives   T.  Wilson   and  Keller   voted  against   it.                                                               
Therefore, SB  13 was reported  from the House Health  and Social                                                               
Services Standing Committee by a vote of 5 -2.                                                                                  
                                                                                                                                

Document Name Date/Time Subjects