Legislature(2009 - 2010)BUTROVICH 205

02/09/2009 01:30 PM HEALTH & SOCIAL SERVICES

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Moved SB 13 Out of Committee
Moved SB 87 Out of Committee
+ Bills Previously Heard/Scheduled TELECONFERENCED
              SB 13-MEDICAL ASSISTANCE ELIGIBILITY                                                                          
CHAIR DAVIS announced consideration of SB 13.                                                                                   
1:35:57 PM                                                                                                                    
TOM OBERMEYER, aid to Senator  Davis, introduced SB 13, saying it                                                               
increases   and  restores   the  qualifying   income  eligibility                                                               
standard for the  Denali Kid Care program to  the original levels                                                               
at 200  percent of the  FPL guideline and makes  health insurance                                                               
accessible to an  estimated 1300 more uninsured  children and 225                                                               
pregnant women in Alaska.                                                                                                       
Denali Kid Care  is an enhanced reimbursement program  with up to                                                               
70 percent  matching funds under  the federal  government's State                                                               
Children's Health  Insurance Program  (SCHIP), which  was created                                                               
in 1997. Congress reauthorized the  SCHIP program for five years;                                                               
on  February  4, 2009  President  Obama  signed a  law  expanding                                                               
coverage to four million more children.                                                                                         
Alaska is only  one of five states that fund  SCHIP below the 200                                                               
percent guideline.                                                                                                              
The Kaiser Commission on Medicaid  and the Uninsured provided the                                                               
following  information in  January of  2009: 44  states including                                                               
Washington D.C. cover  children and families with  incomes of 200                                                               
percent  of the  FPL  or  higher; 33  states  cover children  and                                                               
families with incomes between 200 and  250 percent of the FPL; 19                                                               
states including  D.C. cover children  and families  with incomes                                                               
of 250  percent or higher and  10 of those states  cover children                                                               
and families  with incomes of  300 percent  of FPL or  higher; 35                                                               
states  allow  premiums,  enrollment  fees or  co-payments  on  a                                                               
sliding scale for selected services in the SCHIP programs.                                                                      
MR.  OBERMEYER continued;  Denali  Kid Care  serves an  estimated                                                               
7900 Alaska Children and remains  one of the least costly medical                                                               
assistance  programs  in the  state  at  approximately $1700  per                                                               
child  for full  coverage  including dental,  which  is about  20                                                               
percent of the cost of  adult senior coverage. Early intervention                                                               
and preventive care under SB  13 will greatly increase the health                                                               
of Alaska's children  and yield substantial savings  to the state                                                               
in  public and  private  sector hospital  emergency rooms,  which                                                               
must  admit indigent  and  uninsured  patients for  non-emergency                                                               
1:39:44 PM                                                                                                                    
It is estimated  that uninsured children with a  medical need are                                                               
five times  as likely  not to  have a  regular doctor  as insured                                                               
children and  four times as  likely to  use emergency rooms  at a                                                               
much higher cost. There are  still approximately 18,000 uninsured                                                               
children in  Alaska, about nine  percent of the children  aged 18                                                               
and  under.  Private  health  care   coverage  for  children  has                                                               
declined over 30  percent in the last 10 years  and the deepening                                                               
recession is  pulling more children  and families into  the ranks                                                               
of  the uninsured.  The reauthorized  SCHIP program  and stimulus                                                               
package should  help, but  Alaska is encouraged  to do  its share                                                               
and take advantage of the  federal matching funds by insuring its                                                               
low income children up to and  including 200 percent FPL under SB
1:40:30 PM                                                                                                                    
CHAIR  DAVIS advised  the committee  that Jerry  Fuller with  the                                                               
Department of  Health and Social  Services (DHSS) was  online and                                                               
available for questions.                                                                                                        
1:41:39 PM                                                                                                                    
GEORGE BROWN  M.D., Douglas AK, has  practiced pediatric medicine                                                               
in Alaska  since 1965. He said  he is delighted that  the federal                                                               
government has  expanded coverage  for SCHIP  and that  the state                                                               
has bills under consideration related  to increasing coverage. He                                                               
and his pediatric colleagues in Juneau  are very much in favor of                                                               
a 200  percent [qualification for] coverage  for children without                                                               
a co-pay,  and are pleased that  this seems to be  moving forward                                                               
with the governor's support.                                                                                                    
DR. BROWN  said he and  his colleagues have also  been discussing                                                               
the issue  of higher levels  [of coverage] with  co-pays. Whether                                                               
or not  co-pays really work is  a difficult question. One  of his                                                               
colleagues  has  seen  a  problem  with  co-pays  in  Washington;                                                               
families get behind in their  co-pays and then are ineligible. On                                                               
the other  hand, if  the care  is all free,  some people  seem to                                                               
think they  don't need to  keep appointments and  become careless                                                               
of  their responsibility  as parents;  perhaps a  simple, uniform                                                               
co-pay  of  $10  or  $15   per  visit  would  provide  the  right                                                               
incentive. He stressed  that there should be  no punitive results                                                               
[for failure to keep or  cancel appointments] however, because it                                                               
sometimes takes many  years for families who have  not had health                                                               
insurance  before  to realize  they  are  welcome in  a  doctor's                                                               
office.  As those  families continue  to come  in and  be treated                                                               
with respect, to see other  families there who are being treated,                                                               
they become good users of the preventive medical system.                                                                        
In closing,  he said that the  whole idea of SCHIP  is ultimately                                                               
prevention; for  every dollar  we invest  in prevention,  we save                                                               
from six to ten dollars in the long-run.                                                                                        
1:45:22 PM                                                                                                                    
CHAIR DAVIS  advised that  Jennifer Saunders  and Martha  King of                                                               
the  National Conference  of State  Legislatures (NCSL)  are also                                                               
online and available to answer questions.                                                                                       
1:46:03 PM                                                                                                                    
ROD  BETIT, President,  Alaska State  Hospital  and Nursing  Home                                                               
Association (ASHNHA), Juneau, AK, said  he is very excited to see                                                               
this bill before the committee.  ASHNHA represents 28 health care                                                               
providers  throughout  the   state  including  tribal,  military,                                                               
private  and city  owned organizations  and all  of them  support                                                               
this  legislation,   which  has  been  unanimously   approved  by                                                               
ASHNHA's  legislative  committee.  He added  that  bringing  [the                                                               
qualifying limit]  to the 200  percent level is  appropriate even                                                               
though  the health  care commission  process hasn't  started yet,                                                               
because  he  believes this  is  one  of  the first  actions  that                                                               
commission would  recommend. This  action was recommended  by the                                                               
Health Care Strategies Planning Council last year.                                                                              
1:47:33 PM                                                                                                                    
NANCY  ST.  JOHN-SMITH,   Peninsula  Community  Health  Services,                                                               
Kenai, AK,  said that  their community  health center,  which was                                                               
formerly  called  Central  Peninsula   Health  Center,  has  been                                                               
offering  medical and  dental care  to communities  on the  Kenai                                                               
Peninsula  since   2002.  They  merged  with   Central  Peninsula                                                               
Counseling Services  in October 2008 and  are offering behavioral                                                               
health care  under their new  name. She urged the  legislature to                                                               
pass  this  bill  increasing the  eligibility  guideline  to  200                                                               
percent  of FPL  because  with  Denali Kid  Care  they can  offer                                                               
preventive medical  and dental  care to  many children  who would                                                               
not  otherwise receive  it. For  example, she  said, many  people                                                               
they see on an emergency basis  have not received any dental care                                                               
as children;  by the time they  come to the clinic,  the tooth or                                                               
teeth have to be pulled,  which can affect their nutrition, heart                                                               
health and other future health  issues. She agreed with Dr. Brown                                                               
that the  ability to  offer preventive  services is  important to                                                               
improve the quality of life  and to teach people about prevention                                                               
so they  will raise  their children in  good health.  She thanked                                                               
the  committee  for  hearing  her   testimony  and  stressed  how                                                               
important this legislation is to people on the Kenai.                                                                           
1:49:53 PM                                                                                                                    
JODYNE BUTTO  M.D., President,  Alaska Chapter,  American Academy                                                               
of  Pediatrics,  Anchorage,  AK,  said  SCHIP  has  made  a  huge                                                               
difference in  the health of  children across the  United States.                                                               
It is  important that  Alaska provide the  best care  possible to                                                               
its children;  that means  providing access to  care and  part of                                                               
that access  is insurance. She  agreed with prior  testimony that                                                               
the  program cost  is outweighed  by the  savings in  health care                                                               
costs represented by preventive care.                                                                                           
MS. BUTTO  also stressed the  importance of health  to children's                                                               
school performance.  Although it  can't be easily  quantified, it                                                               
is well known  that children with good  health, particularly good                                                               
dental health,  perform better  in school,  miss fewer  days, are                                                               
better behaved and enjoy greater  academic success than those who                                                               
do not. She applauded the legislature for tackling this issue.                                                                  
1:53:15 PM                                                                                                                    
DONNA GRAHAM,  Anchorage Faith and Action  Congregations Together                                                               
(AFACT), Anchorage, AK,  is a school nurse and  parish nurse. She                                                               
said AFACT  is thrilled  that Alaska is  finally getting  back to                                                               
the 200  percent [eligibility  level]. This is  the right  way to                                                               
go; Alaska is  a rich state and  can show it by not  being at the                                                               
bottom  of the  list  of states  that put  their  kids first.  In                                                               
summary, she said,  this is a great step forward!  Let's put more                                                               
kids  back  into  fitness  and   health  to  promote  energy  and                                                               
1:55:30 PM                                                                                                                    
JORDEN  NIGRO,  Residential   Director,  Juneau  Youth  Services,                                                               
President,  Alaska Homes  for Children  (AHFC), Juneau,  AK, said                                                               
they are  really excited to see  all of the bills  coming forward                                                               
for Denali  Kid Care. The  only comment she  cared to add  to the                                                               
previous  testimony  was that,  if  a  sliding co-pay  goes  into                                                               
effect, she  hopes it won't affect  those at 200 percent  or less                                                               
of  the FPL.  Behavioral  health for  youth  is primarily  funded                                                               
through Denali Kid Care and many  kids and families are unable to                                                               
access the services because they  are on the cusp of eligibility;                                                               
Alaska  has a  high  number of  people  on the  cusp  due to  the                                                               
fishing and subsistence lifestyles that are prevalent here.                                                                     
1:57:17 PM                                                                                                                    
LAVERNE  DEMIENTIEFF, President,  National Association  of Social                                                               
Workers  (NASW), Alaska  Chapter,  Clinical Assistant  Professor,                                                               
University  of   Alaska  Fairbanks,  Fairbanks,  AK,   said  NASW                                                               
strongly  supports the  efforts of  this committee  to raise  the                                                               
Denali Kid  Care eligibility  requirement to  300 percent  of the                                                               
FPL.  Alaska  is  one  of   only  nine  states  with  eligibility                                                               
requirements below  200 percent. This  makes us the  fourth least                                                               
responsive  state  to  children  who  live  in  poverty.  Raising                                                               
eligibility to  200 percent will  restore vital  health insurance                                                               
to 1300 children and 225  pregnant women; imagine what raising it                                                               
to 300 percent would achieve for Alaskan families.                                                                              
MS.   DEMIENTIEFF  recognized   that  fiscal   responsibility  is                                                               
everyone's  priority, but  noted that  Alaska won't  shoulder the                                                               
majority  of the  cost  associated with  this  program; with  the                                                               
passing  of SCHIP,  the  federal  government will  pay  70 to  75                                                               
percent of it. Finally, she  said this is an important investment                                                               
Alaska and in the future of Alaska's children and families.                                                                     
1:59:02 PM                                                                                                                    
CHAIR DAVIS  announced that she  was closing public  testimony on                                                               
SB 13.                                                                                                                          
SENATOR THOMAS asked what the other referrals are for SB 13.                                                                    
CHAIR DAVIS answered that it will go to Finance next.                                                                           
SENATOR THOMAS asked  if she intends to leave  the explanation of                                                               
the fiscal note to Finance.                                                                                                     
CHAIR DAVIS  said they can discuss  it if he wishes;  but she had                                                               
not intended to get into it today.                                                                                              
SENATOR  THOMAS said  he wondered  whether the  savings that  are                                                               
expected to  accrue from intervention  and prevention  were taken                                                               
into consideration when preparing the fiscal note.                                                                              
2:01:55 PM                                                                                                                    
JON  SHERWOOD,  Medical  Assistant Administrator,  Department  of                                                               
Health  and Social  Services (DHSS),  Juneau, AK,  explained that                                                               
their assumptions  on the fiscal  note did not  specifically take                                                               
those  preventive  aspects into  account,  but  they based  their                                                               
costs on the cost of care  for children in the next lowest income                                                               
group,  which is  covered [by  Denali Kid  Care]. Those  children                                                               
experience  the same  preventive  effects from  being covered  by                                                               
Denali  Kid   Care  and  they   assumed  the  impacts   would  be                                                               
SENATOR PASKVAN moved to report SB 13 from committee with                                                                       
individual recommendations and attached fiscal note(s). There                                                                   
being no objection, the motion carried.                                                                                         

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