Legislature(2003 - 2004)
04/07/2003 01:33 PM Senate HES
* first hearing in first committee of referral
= bill was previously heard/scheduled
= 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 (CS). 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. Establishing 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 doesn't believe is a plan the federal government will approve. They believe 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 is 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 that which the governor's bill dedicates eligibility standards at. 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 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 the $3.5 to $4 million. 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 a family of eight category could mean a person could making $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 get into some economic analysis of the true impact when those groups aren't covered. 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 and 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 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 represented 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 makes a negative impact on the health of pregnant women and children and others. 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 you. CHAIR DYSON asked for a roll call vote. SENATORS WILKEN, GREEN, AND DYSON voted yea; SENATORS DAVIS AND GUESS voted no; and CSSB 105(HES) passed out of committee.