Legislature(2003 - 2004)

04/07/2003 01:03 PM Senate HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
        SB 105-MEDICAID:CHILDREN/PREGNANT WOMEN/FACILITY                                                                    
CHAIR FRED DYSON  called the Senate Health,  Education and Social                                                             
Services Standing  Committee meeting  to order  at 1:33  p.m. All                                                               
members  were  present.  He  announced   SB  105  to  be  up  for                                                               
consideration and that there was  a proposed committee substitute                                                               
COMMISSIONER  JOEL GILBERTSON,  Department of  Health and  Social                                                               
Services  (DHSS),  explained that  SB  105  would lock-in  FY  03                                                               
administrative standards at 200 percent  of the poverty level for                                                               
Denali Kid Care clients and  pregnant women under Medicaid and at                                                               
300  percent  of  the  special  income standard  for  the  FY  03                                                               
administrative  standards  for  seniors  in long  term  care  and                                                               
individuals receiving  home or  community based  waiver services.                                                               
He explained:                                                                                                                   
     The  administration's position  is  that the  standards                                                                    
     that are applied  in the bill are those  that are being                                                                    
     currently  utilized by  the  program.  Locking them  in                                                                    
     will remove  the inflation factor in  the coming years.                                                                    
     We  believe  it's a  responsible  step  to control  the                                                                    
     growth  in  the  knowledge  that we  have  reached  the                                                                    
     maximum  carrying  capacity  for our  Medicaid  program                                                                    
     under current financial constraints.                                                                                       
COMMISSIONER  GILBERTSON said  that the  standards are  very high                                                               
and that  the chairman has  an amendment to lower  them. However,                                                               
the governor supports the high standards.                                                                                       
CHAIR DYSON  said he struggled  because he  wanted to cut  to the                                                               
lowest levels. He asked why the [commissioner] didn't do that.                                                                  
COMMISSIONER  GILBERTSON  replied  that   the  application  of  a                                                               
uniform  standard across  various  family sizes  is necessary  to                                                               
meet some  of the  equal protection  concerns within  the program                                                               
itself. DHSS  doesn't believe that  the federal  government would                                                               
approve  a  plan  to establish  a  differentiating  standard  for                                                               
individuals who  are technically under the  same economic status,                                                               
though  it is  adjusted in  terms of  the income  level based  on                                                               
number  of children.  DHSS believes  that  there needs  to be  at                                                               
least  some uniform  standard,  even  if it  is  a locked,  fixed                                                               
dollar amount.                                                                                                                  
CHAIR  DYSON asked  if this  bill were  amended, would  he prefer                                                               
that it  be amended  to a  percentage level  or to  fixed numbers                                                               
under that percentage level.                                                                                                    
COMMISSIONER GILBERTSON replied that it  would be hard for him to                                                               
say  at this  stage whether  to use  a fixed  dollar amount  or a                                                               
percentage. Either  approach would lead to  a reduced eligibility                                                               
standard  from   the  eligibility  standards  dedicated   in  the                                                               
governor's bill.                                                                                                                
CHAIR  DYSON  explained  if  they  go  to  a  fixed  amount,  the                                                               
mechanism  the governor  supports (letting  inflation reduce  the                                                               
impact in  the out-years)  would be accomplished.  If they  use a                                                               
percentage amount, it  could be argued that  inflation would take                                                               
it back up  to the nominal value  it's been at and  it would need                                                               
to be revisited in two or three years.                                                                                          
COMMISSIONER GILBERTSON replied that  he understood that, but the                                                               
governor's concern is  the inability of some people  to remain in                                                               
the program. The governor is  interested in seeing standards that                                                               
resemble  the 200  percent of  poverty standard  for FY  03 going                                                               
into the future.  Looking at the chart now, he  didn't think they                                                               
would be capturing the same group of individuals.                                                                               
SENATOR GARY  WILKEN asked  if they  have an  idea of  what every                                                               
ratchet down is worth in general fund money.                                                                                    
COMMISSIONER GILBERTSON replied that one  estimate he has is a 25                                                               
percent reduction going from 200  percent to 175 percent (150% is                                                               
the lowest  they can go  and still  be eligible for  the enhanced                                                               
federal match rate under the  children's health insurance program                                                               
with the Denali Kid Care's  Alaska component). They are expecting                                                               
a true general fund savings of  roughly $2 million. Going down to                                                               
150  percent of  poverty level  would be  going from  $3.5 to  $4                                                               
SENATOR WILKEN  moved to adopt amendment  2 as follows:   on page                                                               
4,  line 7  insert $1,635;  on line  8 insert  $2,208; on  line 9                                                               
insert $2,782;  on line 11 insert  $3,355; on line 13  (family of                                                               
5) insert  $3,928; on line  14 insert  $4,501; on line  15 insert                                                               
$5,074; on line  17 insert $5,647; and on line  19 insert $5,647,                                                               
plus an additional $574.                                                                                                        
SENATOR GRETCHEN GUESS objected.                                                                                                
SENATOR  WILKEN  explained  that  he   didn't  have  a  frame  of                                                               
reference other than  dollars per hour. So, this was  very much a                                                               
judgment call. His  numbers do not use a  permanent fund dividend                                                               
component.  They need  to  get  the numbers  "nailed  down" as  a                                                               
matter of finance. At 200 percent,  they picked up people who are                                                               
making $9  per hour and  yet, in the  family of four  category, a                                                               
person could  have a  job at $19  per hour and  in the  family of                                                               
eight category,  a person could make  $32 per hour. At  the other                                                               
end of the  spectrum, at 150 percent, you're at  $7 per hour, $14                                                               
per hour or $24  per hour. He just took the  middle number to get                                                               
a sense of where  they are. Now, a family of one  can make $8 per                                                               
hour and that  seemed appropriate to him. A family  of four would                                                               
make a little over $17 per hour.                                                                                                
SENATOR  GUESS  explained  that she  objected  because  they  are                                                               
talking about  pregnant women  and kids  and, therefore,  need to                                                               
have some economic analysis of  the true impact when those groups                                                               
aren't covered. She pointed out:                                                                                                
     We  know  the  amount  of  pressure  there  is  on  our                                                                    
     emergency rooms, especially with  kids. And I know from                                                                    
     the  research I  did,  and I  think  all the  committee                                                                    
     knows  that when  pregnant women  don't have  access to                                                                    
     health  care, they  have more  low birth  weight babies                                                                    
     who cost  society more and  that abortion rates  go up.                                                                    
     I'm not  going to be a  part of any bill,  whether it's                                                                    
     the governor's  bill or any other  bill personally...if                                                                    
     it pulls pregnant women off.                                                                                               
She said  she pays all the  bills and budgets for  her family and                                                               
tried  to make  a budget  to actually  be able  to afford  health                                                               
care. She said:                                                                                                                 
     Although $17  or $32  might sound like  a lot,  Gary, I                                                                    
     would actually  challenge the  committee and  Senate to                                                                    
     see now -  after taxes - on  rent, utilities, insurance                                                                    
     and try  to find the  room where  you can have  $600 to                                                                    
     $700 so you can afford  insurance and that's what we're                                                                    
     talking about in the trade offs with families.                                                                             
CHAIR DYSON asked for a roll call vote.                                                                                         
SENATORS GREEN, WILKEN,  and DYSON voted yea;  SENATORS GUESS and                                                               
DAVIS voted nay; and amendment 2 was adopted.                                                                                   
SENATOR  WILKEN moved  to  pass CSSB  105(HES)  and its  attached                                                               
fiscal note with individual recommendations out of committee.                                                                   
SENATOR BETTYE DAVIS objected.                                                                                                  
CHAIR DYSON asked if anyone else wanted to testify.                                                                             
MS.  MARIE  LAVIGNE,  Executive Director,  Alaska  Public  Health                                                               
Association,   said  she   represents   over   200  health   care                                                               
professionals  across   Alaska  who   are  deeply   committed  to                                                               
developing sound public health policies  to improve the health of                                                               
all Alaskans including  access to health care. She  urged them to                                                               
continue  eligibility for  the  Denali Kid  Care  program at  the                                                               
fullest   level  possible   and  stated   that  SB   105  reduces                                                               
eligibility. This  will have a  negative impact on the  health of                                                               
pregnant women and children and others. She explained:                                                                          
     Public  health research  on the  health impacts  of the                                                                    
     uninsured  is noteworthy.  Uninsured children  who need                                                                    
     medical [indisc.]  care, are four times  more likely to                                                                    
     go without the care they  need than insured children of                                                                    
     the  same health  needs.  As  Senator Guess  mentioned,                                                                    
     when they  do get  care, they are  sicker and  are more                                                                    
     likely  to be  seen  in the  emergency room.  Uninsured                                                                    
     children are  four and a  half times more likely  to do                                                                    
     without  needed  prescriptions  and eye  glasses;  five                                                                    
     times  more   likely  to   not  receive   dental  care.                                                                    
     Uninsured  children  are  one  and a  half  times  more                                                                    
     likely   to  arrive   to  kindergarten   without  their                                                                    
     vaccinations; they  are eight times more  likely not to                                                                    
     have  had  a  well child  visit  [recommended  periodic                                                                    
     check up by a physician]  before they arrive at school.                                                                    
     Uninsured  pregnant women  are less  likely to  receive                                                                    
     prenatal care,  placing them at risk  to deliver early,                                                                    
     low  birth  weight babies  and  the  greatest risk  for                                                                    
     fetal maternal deaths.                                                                                                     
     In the governor's transmittal  letter he states, 'while                                                                    
     the cost  savings associated with this  bill are modest                                                                    
     in  the short  term,  this  measure will  significantly                                                                    
     reduce  future  year  costs.' From  the  public  health                                                                    
     perspective, any  short term  savings, if  not compared                                                                    
     to the  greater loss  in terms of  the health  and well                                                                    
     being  of  pregnant  women   and  children  and  others                                                                    
     impacted  under this  bill -  we urge  you to  consider                                                                    
     this  issue from  a different  perspective.  SB 105  is                                                                    
     seeking to  lower the enrollment of  medical assistance                                                                    
     programs   by  reducing   eligibility.  Yet   the  most                                                                    
     effective  approach the  Legislature could  take is  to                                                                    
     assist   employers   and   working  families   to   get                                                                    
     affordable health insurance....                                                                                            
     While there are many factors  that contribute to one in                                                                    
     five Alaskan's  lack of health insurance  coverage, one                                                                    
     of the  greatest barriers remains access  to affordable                                                                    
     health insurance.  A study by  the Anchorage  Access to                                                                    
     Health  Care  coalition  released this  fall  indicated                                                                    
     that 16,000  adults in Anchorage are  uninsured; 71% of                                                                    
     those  are   working  adults.   The  majority   are  in                                                                    
     businesses  with less  than 10  employees. We  need the                                                                    
     Legislature to  take steps to  join with  businesses in                                                                    
     addressing   the  issue   of  affordable   health  care                                                                    
     insurance. In  the meantime,  we urge  you to  keep the                                                                    
     eligibility for  this program at  the full 200%  of its                                                                    
        federal poverty level to maximize the health of                                                                         
       pregnant women and children who are covered. Thank                                                                       
CHAIR DYSON asked for a roll call vote.                                                                                         
SENATORS WILKEN, GREEN,  and DYSON voted yea;  SENATORS DAVIS and                                                               
GUESS voted nay; and CSSB 105(HES) passed out of committee.                                                                     

Document Name Date/Time Subjects