Legislature(2003 - 2004)

04/07/2003 01:33 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. 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                                                               
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                                                                    
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.                                                                      

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