Alaska Health Policy Review  comprehensive, authoritative, nonpartisan
January 25, 2008  Vol 2 Issue 3
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Bill Watch
Bill Tracking: Certificate of Need
Bill Tracking: Drugs
Bill Tracking: Education
Bill Tracking: General Health Policy
Bill Tracking: Medical Assistance and Health Insurance
Bill Tracking: Mental Health
Bill Tracking: State Boards and Issues
Bill Tracking: Women's Health Issues
Bill Tracking: Workers Compensation
Guest Commentary: Is Alaska Senate Bill 160 a Raid on Medicaid?
Summary of Senate HES Committee Meeting on SB 212
Amplifications and Corrections
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Alaska Health Policy Calendar
AHPR Staff
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From the Editor  
Dear Reader:

In this issue of Alaska Health Policy Review we are pleased to present a guest commentary by noted author and retired UAA professor Neil Davis. Referring to SB 160 Mandatory Universal Health Care--cosponsored by Senators French, Ellis, and Wielechowski--Davis contends that,

The intent is perhaps commendable, but, if enacted in its present form, this bill will actually increase overall health care costs for Alaskans. It also has the potential to do serious financial damage to the 106,000 Alaskans who now receive Medicaid benefits.

We believe that SB 160 plays a very important role in health care reform in Alaska by highlighting the issues with bold proposed legislation. However, the question of health reform is literally a life or death issue that affects hundreds of thousands of Alaskans, so we believe it is important to critically review these policy proposals as rigorously as possible. Ultimately we want to look at questions such as:
Has the problem been adequately characterized? Will this policy effectively and efficiently address that problem? And, what other related policy alternatives have been reviewed?

Just a reminder, you can easily navigate to any section of this newsletter by clicking on a heading in the panel on the left, at the top of the newsletter. Bill Tracking sections take up most of the navigation panel, but please note that toward the bottom there are additional features such as the guest commentary, the calendar, and periodically other features as well.

Lawrence D. Weiss Ph.D., M.S.
Editor, AHPR
Bill Watch

Bills on the Move

 

Several new bills were introduced and received their first committee assignments in the previous week. First introduced this week are:

�    HB 329 "Abortion Notification"
�    SB 224 "Consumer Health Information Website"
�    HB 337 "Health Care: Plan/Commission/Facilities," introduced by the governor
�    SCR 14 "Perianesthesia Nurses Week: Feb. 2008"
�    SCR 17 "Brain Injury Awareness Month: March 2008"

SB 28 "Limit Overtime for Registered Nurses" moved swiftly through several committees this week. It progressed from Senate Health, Education, and Social Services through Senate Labor & Commerce, finally gaining eight fiscal notes and being referred to the Senate Finance Committee, where it remained as of January 23, 2008. HB 301 "Partial-Birth Abortion" also progressed through the House Judiciary Committee. A new fiscal note was attached to the bill, which was most recently referred to the House Rules Committee.
 
Bill Tracking Methodology

 

The following is a list of all health-related bills currently sitting in various legislative committees. This list represents a combination of old bills from 2007 that were left in committees when the first session ended and new bills that have been introduced during the second session. Bill information is current as of January 23, 2008, at 5 PM.

Bills listed here were selected based on a series of subjective criteria to determine whether they were "health policy-related." All bills currently sitting in the Senate and House Health, Education, and Social Services committees were examined, and any that obviously dealt with non-health-related education or social services issues were eliminated. Every other House and Senate committee was then examined for health-related bills, which were included in the final list.

After determining the full set of health-related bills still in committee or pre-filed for the new session, they were divided into several general categories. This was done to facilitate finding bills that dealt with certain key health policy issues and to make overall navigation of the list easier. The remaining bills were categorized as "general" health policy-related because of the wide range of subjects they covered.

The information listed for each bill includes the bill number, the short title, the primary sponsor or sponsors, the committee in which the last action on the bill took place, and the date on which the last action on the bill took place. A short summary of each bill is also included.

Abbreviations have been used for committee names. The committee names and their abbreviations are:

�    (H) HES: House Health, Education, and Social Services Committee
�    (S) HES: Senate Health, Education, and Social Services Committee
�    (H) L&C: House Labor & Commerce Committee
�    (S) L&C: Senate Labor & Commerce Committee
�    (S) SED: Senate Special Committee on Education
�    (H) FIN: House Finance Committee
�    (S) FIN: Senate Finance Committee
�    (H) RLS: House Rules Committee
�    (S) JUD: Senate Judiciary Committee
Certificate of Need
HB 4 HB MEDICAL FACILITY CERTIFICATE OF NEED
Sponsor: Representative Lynn
Committee/date of last action: (H) HES, 01/16/07

"HB 4 removes the current Certificate of Need requirement for health care facilities in Alaska boroughs having a population of over 25,000 people." -Rep. Lynn

SB 65 MEDICAL FACILITY CERTIFICATE OF NEED
Sponsor: Senator Huggins
Committee/date of last action: (S) HES, 01/26/07

"SB 65 removes the current requirement for a Certificate of Need (CON) for health care facilities, except for nursing homes and residential psychiatric treatment centers, 'in a borough with a population of more than 25,000.' Smaller communities would still require, as a practical matter, the Certificate of Need." -Sen. Huggins
Drugs
HB 81 ALASKA PRESCRIPTION DRUG TASK FORCE
Sponsors: Representatives Guttenberg and Cissna
Committee/date of last action: (H) HES, 01/16/07

"HB 81 will create a Prescription Drug Task Force within the Alaska Department of Health and Social Services. This Task Force will find ways to reduce the cost of prescription drugs and increase affordable access to prescription drugs for Alaskans.

"Ten members representing various entities and business sectors will sit on the task force and will gather information from industry, government, citizens, and other sources. Subsequent present reports to the Governor and to the Legislature will suggest actions to increase access to and reduce the cost of prescription drugs." -Rep. Guttenberg

HB 82 PRESCRIPTION DRUG DISCOUNTS
Sponsors: Representatives Guttenberg, Cissna, and Greunberg
Committee/date of last action: (H) HES, 01/16/07

This bill would affect prescription drug discount pricing, and would place requirements on pharmacies that obtained prescription drugs through discount pricing. It would also require DHSS to conduct a study pertaining to prescription drug discounts, and report the findings to the legislature.

Pharmacies would segregate prescription drugs purchased through discount pricing from other drug stock by physical or electronic means, and maintain records of the acquisition and disposition of the discounted drugs in a way that is separate from other pharmacy records. The purchase of discounted prescription drugs is regulated according to guidelines in the federal Social Security Act. The mandated DHSS report would be a study of the feasibility of providing discounted prescription drug pricing to every person in the state who is not otherwise covered by a prescription drug plan. A report summarizing the findings would be presented to the legislature on or before January 1, 2008.

HB 208 DRUG PRODUCT SUBSTITUTION
Sponsor: House Health, Education, and Social Services committee
Committee/date of last action: (H) HES, 03/19/07

This bill affects the substitution by a pharmacist of an equivalent drug product. With a few specific exceptions, unless a prescription indicates that it is to be dispensed as written, a pharmacist may, with the consent of the patient or the minor patient's parent or guardian, substitute an equivalent drug product.

The two exceptions mentioned explicitly in the bill relate to drugs for epilepsy or seizures, and to the substitution of a drug for a registered brand or trade name product. The substitution of drugs for epilepsy or seizure disorders must follow strict guidelines, including a timeframe for how long a pharmacist may dispense an equivalent drug product when supply of the prescribed drug is at issue. The substitution of a drug for a registered brand or trade name product can only be done with permission from the author of the prescription, with a procedure laid out should the pharmacist be unable to get in contact with the author of the prescription.

HB 300 DOCUMENT PRENATAL ALCOHOL EXPOSURE
Sponsor: Representative Doll
Committee/date of last action: (H) HES and (H) L&C, 01/15/08

HB 300 would require health care professionals to document an infant's prenatal exposure to alcohol. The bill intends for such information to be used for the purposes of screening for fetal alcohol syndrome. A person licensed under the statute attending or making a postnatal examination of a mother and infant would, if the mother consents to such information being put in the medical file, document the infant's prenatal exposure to alcohol. Such information would only be used for the purposes of providing medical diagnosis, treatment, or care.

HB 304 CANCER DRUG REPOSITORY
Sponsor: Representative Nelson
Committee/date of last action: (H) HES and (H) FIN, 01/15/08

HB 304 amends the statute covering the Board of Pharmacy to include regulations for the implementation of the cancer drug repository and redistribution program established for recipients of medical assistance. Medical Assistance for Needy Persons statute (AS 47.07) would be amended to define and describe the cancer drug repository and redistribution program, and establishes guidelines that must be followed by dispensing pharmacies.

SB 114 DRUG PRODUCT SUBSTITUTION
Sponsor: Senate Health, Education, and Social Services committee
Committee/date of last action: (S) L&C, 03/12/07

This bill affects the substitution by a pharmacist of an equivalent drug product. With a few specific exceptions, unless a prescription indicates that it is to be dispensed as written, a pharmacist may, with the consent of the patient or the minor patient's parent or guardian, substitute an equivalent drug product.

The two exceptions mentioned explicitly in the bill relate to drugs for epilepsy or seizures, and to the substitution of a drug for a registered brand or trade name product. The substitution of drugs for epilepsy or seizure disorders must follow strict guidelines, including a timeframe for how long a pharmacist may dispense an equivalent drug product when supply of the prescribed drug is at issue. The substitution of a drug for a registered brand or trade name product can only be done with permission from the author of the prescription, with a procedure laid out should the pharmacist be unable to get in contact with the author of the prescription.

SB 196 PRESCRIPTION DATABASE
Sponsor: Senator Green

Committee/date of last action: (S) L&C and (S) FIN, 01/16/08


This bill would amend statutes related to the control and regulation of pharmacy. It would add a provision of the Board of Pharmacy that allows for the establishment and maintenance of a controlled substance prescription database.

The proposed database would contain data regarding every prescription for a IA, IIA, IIIA, IVA, or VA controlled substance under state law, or a schedule I, II III, IV, or V controlled substance under federal law dispensed in the state to any person other than an inpatient at a licensed health care facility. The bill also establishes guidelines for the pharmacist-in-charge of each covered pharmacy to submit certain information regarding such prescriptions to the board for inclusion in the database. Such information would include the names of prescribing practitioners and individuals who receive prescriptions for controlled substances from licensed practitioners and who subsequently obtain dispensed controlled substances from a drug outlet in quantities or with a frequency inconsistent with generally recognized standards of dosage for that controlled substance.
Education
HB 55 WWAMI MEDICAL SCHOOL
Sponsor: Representative Kelly
Committee/date of last action: (H) HES, 01/16/07

"The purpose of HB 55 is to address the severe doctor shortage in Alaska. According to the Alaska Physician Supply Task Force, Alaska would need an increase of 28% (375 doctors) to catch up with the lower 48. Increasing the in-state production of physicians by increasing the number of medical school and residency positions in Alaska is the No. 1 goal according the Task Force." -Rep. Kelly

HB 66 REQUIRE CPR FOR HIGH SCHOOL GRADUATION
Sponsor: Representative Gruenberg
Committee/date of last action: (H) HES, 01/16/07

HB 66 would require certification in cardiopulmonary resuscitation and first aid for the issuance of a secondary school diploma. The requirement may be waived when the governing body of the school district provides proof that a student is incapable of performing the necessary functions for certification. Each district in the state public school system would be responsible for initiating and conducting a program leading to CPR/first aid certification for its students.

SB 32 WWAMI/NURSE EDUC LOAN REPAYMENT PROGRAM
Sponsor: Senator Wilken
Committee/date of last action: (S) HES, 01/16/07

This bill recognizes that there is a shortage of qualified medical doctors and registered nurses in the state, and seeks to establish the Alaska medical doctors and registered nurse recruitment loan repayment programs. The purpose of the programs would be to provide financial incentives through the repayment, in whole or in part, by the state, of education loans for medical doctors and registered nurses completing a term of employment as a medical doctor or a registered nurse in the state. In consultation with the Alaska Commission on Postsecondary Education, standards and criteria would be established for the Alaska medical doctor and registered nurses recruitment loan repayment programs. Rules governing the commission's actions related to these programs are specified.

SB 73 WWAMI MEDICAL SCHOOL
Sponsor: Senator Ellis
Committee/date of last action: (S) SED, 02/02/07

"Under the WWAMI agreement, students pay in-state tuition at the University of Washington and the State of Alaska pays the difference. Students who enter the program must return to Alaska to practice or pay back the state's subsidy. Current statute places a cap on the number of students allowed into the WWAMI program at 10. Senate Bill 73 removes that cap, and establishes a new minimum of 20 students per year be placed into the WWAMI program." -Sen. Ellis
General Health Policy
HB 36 NURSE SUPERVISION OF EMT TRAINING
Sponsor: Representative Kawasaki
Committee/date of last action: (H) L&C, 03/28/07

"House Bill 36 would allow nurses within an EMT training program to teach skills to paramedics in the clinical setting. Qualified nurses would provide training to paramedics in a scope of activities under direct supervision. By allowing nurses to assist in paramedic's training the state [of] Alaska will be able to provide skilled workers with complete understanding of the necessary lifesaving skills." -Rep. Kawasaki

HB 100 AIR AMBULANCE SERVICES
Sponsor: Representative Coghill
Committee/date of last action: (H) HES, 02/15/07

"This legislation exempts for-profit air ambulance services from insurance regulations under AS 21.03 in order that they may solicit membership subscriptions, accept membership applications, and charge membership fees.

"In order to protect consumers this bill establishes that air ambulance services must:
�    have certification under AS 18.08.082
�    be in operation in Alaska for at least two years
�    not deny emergency medical service to any person." -Rep. Coghill

HB 124 INTENSIVE SERVICES FUNDING
Sponsor: Representative Nelson
Committee/date of last action: (H) HES, 02/07/07

This bill seeks to amend AS 14.17.420 to affect intensive services funding. It proposes that when a student who is counted for intensive services funding transfers to another school district within the state, the transferring district would have to pay the district receiving the transfer the unused portion of funds allocated for the transferring student within 30 days of the transfer. The transferring district's payment would be based on a pro rata share of the amount received for the period in which the student attended school in the district.

HB 136 DENTAL HYGIENISTS
Sponsor: Senator Stoltze
Committee/date of last action: (S) FIN, 05/04/07

"The provisions of House Bill 136 follow the expanded functions of dental hygienists in other states to improve access to preventative oral health care. Specifically, HB 136:
�    Allows a licensed dental hygienist to place "fillings" into a cavity prepared by a licensed dentist.
�    Authorizes a licensed dental hygienist to administer local anesthetic agents under the general supervision of a licensed dentist.
�    Permits a licensed dental hygienist to enter into a collaborative agreement with a licensed dentist in which the dentist authorizes the dental hygienist to perform certain duties stipulated under HB 136 without the supervision of the dentist." -Rep. Stoltze

HB 319 DENTAL HYGIENISTS/DENTAL PRACTICE
Sponsors: Representatives Ramras, Salmon and Thomas

Committee/date of last action: (H) HES) and (H) L&C, 01/22/08

HB 319 would amend the statute regulating the use of dental radiological equipment. The bill would specify the prohibitions under the statute to include the dentist's "direct or indirect" supervision of the use of such equipment. HB 319 would also extend the "direct or indirect" supervision clause to the grounds for discipline, suspension, or revocation of license. New sections are added to the statute regarding dental assistants, including certain certifications and delegation to dental assistants; and definitions of certain terms used in the legislative language.


HB 329 ABORTION NOTIFICATION

Sponsor: Representative Doogan
Committee/date of last action: (H) HES and (H) JUD, 01/17/08

HB 329 would amend several aspects to the current statute governing parental notification of an abortion on a minor, as well as repeal the judicial bypass provisions relating to abortions. Specifically, the bill would lower the age of notification from 17 to 16, and would more clearly define who is capable of giving consent. The bill would also redefine "medical necessity" for abortions and amends the duties of the Office of Public Advocacy in cases involving minors' abortions.


HJR 26 CONST AM: CONTROL OF MINOR'S MEDICAL CARE
Sponsor: Representatives Coghill and Lynn
Committee/date of last action: (H) HES and (H) JUD, 01/15/08

HJR 26 proposes an amendment to the Alaska Constitution. It would grant a parent or guardian the right to direct and control the medical care and treatment of the parent or guardian's minor child. This right would be subject only to emergency exceptions and judicial bypass. The judicial bypass procedure would be narrowly tailored to protect the rights and health of the minor child and be consistent with standards established by the United States Supreme Court. The proposed amendment would be placed before the voters in the next general election as determined by the state's constitution and election laws.

SB 28 LIMIT OVERTIME FOR REGISTERED NURSES
Sponsor: Senator Davis
Committee/date of last action: (S) FIN, 01/23/08

"SB 28, hereafter also to be known as "The Alaska Safe Nursing and Patient Care Act," prevents Alaska registered and licensed practical nurses from being forced to work mandatory overtime, i.e., compulsory as opposed to voluntary work in excess of an agreed to, predetermined, regularly scheduled shift, and it protects patients from the dangers caused by overworked nurses ... This legislation also protects nurses from discrimination and retaliation by employers who continue to force them into working hours beyond what they believe safe for quality care. SB 28 requires that health care facilities monitor, document, and report overtime semiannually and face penalties for knowing violations." -Sen. Davis

SB 29 MEDICAL PATIENT BILLING DISCLOSURES
Sponsor: Senator Dyson
Committee/date of last action: (S) HES, 01/16/07

SB 29 would affect certain aspects of patient billing disclosures. The bill adds a new section to the existing statute (AS 18.20) that specifies what licensing a hospital must have to be regulated under the proposed law. The bill also adds a new section to the existing statute that specifies what information hospitals that received government money for the purchase, construction, repair, equipping, or operation of the hospital would have to disclose on each patient billing. Several terms that would be related to this information are also defined, including "government money," "hospital," and "patient billing."

SB 98 DENTAL HYGIENISTS
Sponsor: Senator Davis
Committee/date of last action: (S) HES, 02/28/07

"SB 98 allows Alaskans better access to professional training, skills, and technology available to meet their oral health care needs with expanded services provided by dental hygienists licensed under AS 08.32. Many Alaskans either cannot afford regular oral health care, do not understand the need for it, or live in areas or facilities not served by oral health care professionals. SB 98 also will help stem what the Surgeon General reported as a 'silent epidemic of oral diseases ... affecting our most vulnerable citizens ... No one should suffer from oral diseases or conditions that can be effectively prevented and treated.'" -Sen. Davis

SB 107 NATUROPATHS
Sponsor: Senator Davis by request
Committee/date of last action: (S) L&C, 03/07/07

"For purposes of expanding allowed procedures and regulating the growing practice of naturopathic medicine in Alaska, SB 107 establishes required licensing fees, a Naturopathic Advisory Committee, and an Alaska Naturopathic Formulary Council ... New naturopathic procedures under SB 107 allow minor surgery, including operative, electrical, and other methods of repair to superficial lacerations and abrasion or lesions, and removal of foreign bodies in superficial tissues. The bill also allows naturopaths to use antiseptics and local anesthetics in connection with allowed procedures. The law prohibits naturopaths from performing major surgery, and spinal and general anesthetics." -Sen. Davis

SB 181 ANATOMICAL GIFTS
Sponsor: Senator McGuire
Committee/date of last action: (S) HES, 05/15/07

This bill would affect anatomical gifts; donations to the anatomical gift awareness fund; a registry of anatomical gifts; and the organizations that handle the procurement, distribution, or storage of all or a part of an individual's body. The majority of changes proposed in SB 181 are to change the particular Alaska statutes that govern anatomical gifts issues to the most current statutory number. The bill would also add a number of sections to the existing statute in order to address several issues, including who may make an anatomical gift before the donor's death; the manner of making an anatomical gift before the donor's death; and the rights and duties of procurement organizations and others. The bill would also address the need for uniformity of the law with regard to the subject matter, and also defines the terms used in the text. 


SB 224 CONSUMER HEALTH INFORMATION WEBSITE

Sponsor: Senator Dyson
Committee/date of last action: (S) HES and (S) FIN, 01/19/08

SB 224 would establish a consumer health information website to be operated by the Alaska Department of Health and Social Services. Included in the information to be made available would be a list of preferred drugs approved by DHSS for reimbursement; a list of the 100 most commonly prescribed medications in the state and the source and price, updated monthly; available hospital ratings, including the rates of hospital acquired infection and mortality occurring at each hospital in the state; and a list of primary care clinics that cater to uninsured and self-pay patients.


HB 252 LEAVE FOR ORGAN/BONE MARROW DONATIONS
Sponsor: Senator LeDoux
Committee/date of last action: (S) HES, 05/15/07

"The Richard Foster and Alec Cesar Donor Act would require the State of Alaska to grant a paid leave of absence to an employee for the purpose of making a personal organ or bone marrow donation. The employer is not required to provide more than 80 hours of leave, however the leave may not be less than 40 hours unless the employee requests fewer hours. Verification may be required and the State may not retaliate or sanction an employee for requesting this leave." -Rep. LeDoux

Medical Assistance and Health Insurance
HB 140 MEDICAL ASSISTANCE ELIGIBILITY
Sponsor: Representative Gara
Committee/date of last action: (H) HES, 02/28/07

"HB 140 raises the eligibility level for Denali Kid Care to 200 percent of the federal poverty guideline. It extends optional coverage to children of families that earn between 200 and 350 percent of the federal poverty guideline by offering coverage at a sliding scale fee of between $200 and $1200. Families that earn above 200 percent of the federal poverty guideline would have to certify that health insurance is not offered through their work." -Rep. Gara

HB 198 SENIOR BENEFITS/MED. ASSISTANCE ELIG.
Sponsor: Representative Hawker
Committee/date of last action: (H) RLS, 04/10/07

"HB 198 establishes the Alaska Senior Assistance Program to provide cash assistance payments to low-income Alaska seniors.

"The existing Senior Care Program, which is scheduled to sunset June 30, 2007, is amended to remove the little used prescription drug benefits and increase monthly cash payments to Alaskans, age 65 and older, based on their incomes related to federal poverty level guidelines adjusted for Alaska (FPL-A). Monthly payments are:
�    $250 per month to individuals with income less than 75% of FPL-A
�    $175 per month to individuals with income from 75% to less than 100% of FPL-A
�    $125 per month to individuals with income from 100% to less than $135% of FPL-A

"The Alaska Senior Assistance Program combines desirable features of both the Longevity Bonus and Senior Care programs into a single needs based structure that delivers real help to low-income seniors across Alaska. Program enrollment is open to all qualifying seniors.

"The new Alaska Senior Assistance Program sunsets June 30, 2011 if not reauthorized." -Rep. Hawker

HB 231 MEDICAL ASSISTANCE: KIDS/DISABLED/PREGNANT
Sponsor: Representative Doll
Committee/date of last action: (H) HES, 04/02/07

This bill would amend the eligibility guidelines for medical assistance for needy persons (AS 47.07.020 [b]). Specifically, the bill seeks to change language that affects eligible disabled persons by specifying the official poverty line in question would be Alaska-specific, and clarifies that such information would come from the United States Department of Health and Human Service. The bill would also specify that persons under 19 years of age and pregnant women who are not otherwise covered under other sections of the law would only be eligible for assistance if household income does not exceed 200 percent of the federal poverty line for Alaska, as set by the US DHHS.

HB 242 MANDATORY UNIVERSAL HEALTH CARE
Sponsor: Representative LeDoux
Committee/date of last action: (H) HES, 04/26/07

"This bill establishes a framework mandating and ensuring affordable health coverage for all Alaskans. A board of 11 stakeholders will oversee the plan, making certain that residents are able to choose and purchase coverage that provides adequate care. The bill also provides:
�    A framework for personal choice: This bill facilitates a relationship between health insurance providers and individuals, and doesn't assume that a one size fits all solution will meet the health care needs of all Alaskans.
�    A unique voucher system: By pooling money from all stakeholders, a sliding scale voucher system will ensure that every Alaskan can take personal responsibility for acquiring health insurance coverage. The system will also make it easy for multiple entities to contribute towards a health plan for an individual.
�    A health care clearinghouse: The clearinghouse will disseminate information about quality health care products, assisting Alaskans who are utilizing vouchers under the Alaska health care plan.
�    The Alaska health care fund: This fund will receive contributions from individuals, businesses and government to ensure that all interested parties contribute to the health of Alaskans." -Rep. LeDoux

HCR 2 HEALTH INFORMATION & REFERRAL SYSTEM
Sponsor: Representative Cissna
Committee/date of last action: (H) HES, 01/22/07

This resolution seeks to recognize the need for an integrated state-wide health-related information and referral system. It addresses the need for basic and accurate information in an effective market-based health care system, and it recognizes need for consumers and residents of the state to have accurate, informed information about health care costs in order to make accurate decisions on health-related expenditures.

The resolution also recognizes certain growing health care trends: that a growing number of Alaskans cannot afford or access health insurance; that a growing number of people over the age of 65 who are covered by Medicare are having trouble finding doctors who will keep or accept them as patients; and that the state already has a shortage of physicians and that the percentage of medical doctors over the age of 50 is increasing, a trend that will worsen as the state's population continues to age.

In an effort to address these issues, this resolution seeks government and private sector partners to investigate and build an integrated statewide information and referral system using like systems created in other states that use state-of-the-art software and well-maintained databases so state residents can maximize their health purchases within the state. This integrated statewide information and referral system be used to create an information system for health volunteerism options and a network of community health contacts that in times of natural disasters or statewide emergencies could be used to coordinate services and to disseminate information.

HJR 10 MEDICAL ASSISTANCE FOR CHILDREN
Sponsor: House Health, Education, and Social Services committee
Committee/date of last action: (H) FIN, 03/05/07

This joint resolution would formally ask the Alaska Legislature to urge the Alaska Congressional delegation to "work diligently to achieve a timely reauthorization of the State Children's Health Insurance Program (42 U.S.C. 1397aa - 1397jj, Title XXI of the Social Security Act) to continue federal medical assistance percentages for the Denali KidCare program," and to also urge "Governor Palin to work with the Alaska Congressional delegation to ensure reauthorization of the State Children's Health Insurance Program in a timely manner." The resolution would also proclaim that "all components of state government should work together with educators, health care providers, social workers, and parents to ensure that all available public and private assistance for providing health benefits to uninsured children in the state be used to the maximum extent possible," and that the Alaska Legislature would urge Governor Palin to "work to provide meaningful assistance to help identify and enroll children who qualify for medical assistance or Denali KidCare." -House HESS
 
SB 87 MEDICAL ASSISTANCE ELIGIBILITY
Sponsor: Senator Wielechowski
Committee/date of last action: (S) FIN, 03/14/07

"SB 87 raises the eligibility limit for participation in the Denali KidCare program to 200% of the federal poverty level (FPL), currently $27,000/year for a single parent and child ... SB 87 would also allow families with incomes up to 350% of the FPL to buy into Denali KidCare using a sliding fee scale for premiums and a 20% co-pay. Those with the greatest means would reimburse the state roughly 90% of its costs. Participants would have to certify that they don't have access to health insurance at work." -Sen. Wielechowski

SB 106 APPROP: COMMUNITY HEALTH CENTERS
Sponsor: Senator Davis
Committee/date of last action: (S) FIN, 03/07/07

This bill would give a special appropriation to DHSS for payment of a grant to the Alaska Primary Care Association to create a community health centers program. APCA is a non-profit organization.

SB 160 MANDATORY UNIVERSAL HEALTH CARE
Sponsor: Senator French
Committee/date of last action: (S) HES, 04/23/07

"This bill establishes a framework mandating and ensuring affordable health coverage for all Alaskans. A board of 11 stakeholders will oversee the plan, making certain that residents are able to choose and purchase coverage that provides adequate care. The bill also provides:
�    A framework for personal choice: This bill facilitates a relationship between health insurance providers and individuals, and doesn't assume that a one size fits all solution will meet the health care needs of all Alaskans.
�    A unique voucher system: By pooling money from all stakeholders, a sliding scale voucher system will ensure that every Alaskan can take personal responsibility for acquiring health insurance coverage. The system will also make it easy for multiple entities to contribute towards a health plan for an individual.
�    A health care clearinghouse: The clearinghouse will disseminate information about quality health care products, assisting Alaskans who are utilizing vouchers under the Alaska health care plan.

The Alaska health care fund: This fund will receive contributions from individuals, businesses and government to ensure that all interested parties contribute to the health of Alaskans." -Sen. French

SB 170 INSURANCE COVERAGE FOR WELL-BABY EXAMS
Sponsor: Senator McGuire
Committee/date of last action: (S) HES, 05/10/07

SB 170 would require any health care insurer that offers health insurance that covers a dependent of a covered individual to, initially and at each renewal, provide coverage for the cost of well-baby exams. Such coverage would still be subject to the standard policy provisions applicable to other benefits. The bill also defines certain terms: health care insurer, health care professional, and well-baby exam.

SB 179 DEPENDENT HEALTH INSURANCE; AGE LIMIT
Sponsor: Senator Davis
Committee/date of last action: (S) L&C, 05/14/07

SB 179 would prevent health care insurers who provide coverage of a child through family care insurance from denying enrollment for a dependent child of the insured who is less than 26 years of age. Such insurers would also be prohibited from denying enrollment and disenrolling or eliminating coverage for such dependent children.

SB 212 MEDICAL ASSISTANCE ELIGIBILITY
Sponsor: Senator Davis
Committee/date of last action: (S) HES Heard and held, 01/23/08
 
This bill would raise the eligibility level for Denali KidCare from 175 percent of the federal poverty level (FPL) to 200 percent FPL. It would affect eligible persons under 19 years of age and eligible pregnant women. SB 212 would also affect cost-sharing mechanisms for certain eligible recipients by raising the upper eligibility limit from 175 percent FPL to 200 percent FPL.

SJR 11 SUPPORTING U.S. VETERANS' HEALTH CARE
Sponsor: Senator Wielechowski
Committee/date of last action: (S) HES, 05/09/07

This resolution calls for the Alaska State Legislature to ask the federal government for "adequate" funding for veterans' health care.

"The press has documented the neglect of Walter Reed Army Medical Center, and former Secretary of Veterans Affairs Anthony Principi has publicly stated that the Department of Veterans Affairs has been struggling to provide health care to the rapidly rising number of veterans who require it.

"As the state with the largest per capita number of veterans, it is essential that we send a clear signal of our commitment to care for our military personnel both on active duty and as veterans. While our legislature tries to do all we can for our vets and returning soldiers, our federal government has the primary responsibility of meeting the needs of our veterans. We need to call on Congress, as a state, to adequately fund critical veteran services." -Sen. Wielechowski
Mental Health
HB 173 INVOLUNTARY PSYCHOTROPIC DRUG TREATMENT
Sponsor: Alaska Department of Health and Social Services
Committee/date of last action: (H) HES, 03/05/07

This bill would allow courts to approve the involuntary use of psychotropic drugs on patients after strict guidelines for such administration had been met. The bill would also make it so that the court's approval applies to the patient's initial period of commitment if the decision was reached during the initial period. If the decision is made during a period for which the initial commitment has been extended, then the court's approval would apply to the period for which the commitment was extended.

HB 239 SUBSTANCE ABUSE/MENTAL HEALTH PROGRAMS
Sponsor: Representative Dahlstrom
Committee/date of last action: (H) HES, 04/17/07

"House Bill 239 proposes several changes to Alaska's statutes concerning drug and alcohol abuse improving the quality of and access to treatment and prevention programs. The legislation:
�    mandates priority treatment for pregnant women seeking help in overcoming addiction. This will hopefully have a positive impact by reducing the incidents of Fetal Alcohol Spectrum disorders and in turn save money;
�    gives priority to state grantees who utilize evidence-based programs, as well as programs that address substance abuse prevention and addiction within prisons;
�    supports the Department of Health and Social Services in their efforts to identify people with co-occurring mental and substance abuse disorders so this population can be better served; and
�    ensures faith-based strategies for treating substance abuse are not discriminated against in statute." -Rep. Dahlstrom

SB 8 MENTAL HEALTH PATIENTS RIGHTS: STAFF GENDER
Sponsor: Senator Davis
Committee/date of last action: (S) FIN, 05/02/07

"SB 8 provides that a mental health patient 18 years of age or older who is receiving mental health treatment and being provided intimate care at a hospital shall have the right to have care provided by a staff member who is the gender that the patient requests ... The supervisor or manager employed by a hospital shall post notice of this right in a conspicuous place, so patients know they may exercise this right when they are concerned about the gender of staff responsible for their personal intimate care ... the bill requires that the facility document the non-compliance in the patient record that the intimate care was provided by a licensed or unlicensed staff member of a gender opposite that requested by the patient ... Lastly, this bill will preserve information for inquiry into grievance procedures at mental health facilities under Title 47." -Sen. Davis

SB 51 APPROP: MENTAL HEALTH BUDGET
Sponsor: Rules by request of the governor
Committee/date of last action: (S) FIN, 01/19/07

This bill, written at the request of Governor Palin, makes appropriations for the operating and capital expenses of the state's integrated comprehensive mental health program.

SB 186 MENTAL HEALTH PATIENT GRIEVANCES
Sponsor: Senator Davis

Committee/date of last action: (S) HES and (S) FIN, 01/16/08


SB 186 would repeal and reenact the patient grievance procedure. It would clarify and expand the current statute, including the definition of who is a mental health patient under the statute, and would clarify the grievance procedure at facilities subject to the statute. The bill lays out what information a grievance form must include.

The bill also sets up three levels of review for grievances: an initial review by a supervisory staff member to attempt to reach a mutually agreed-upon resolution of the grievance; if a resolution is not reached, then the grievant must initiate a review by either the chief executive officer if it is a private facility or the commissioner's designee if it is a public facility within 20 days; the grievant may finally appeal the written decision from level two to the Office of Administrative Hearings within 20 days of the level two decision.

The bill also defines several terms used in the legislative language.

SB 195 MENTAL HEALTH CARE INSURANCE BENEFIT
Sponsor: Senator Davis

Committee/date of last action: (S) HES, (S) L&C, and (S) FIN, 01/16/08


This bill would affect how health care insurance policies treat certain mental health issues, including alcoholism and substance abuse. It would change certain requirements placed on insurers, including prohibiting the insurer from placing a greater financial burden on an insured for diagnosis or treatment of alcoholism or drug abuse than for other medical care. It also defines certain terms related to the changed statute. SB 195 changes language in certain places that clarifies covered medical care, and clarifies definitions of certain terms used in the bill.

SB 222 APPROP: MENTAL HEALTH BUDGET
Sponsor: Rules by request of the governor
Committee/date of last action: (S) FIN, 01/16/08

This bill, written at the request of Governor Palin, makes appropriations for the operating and capital expenses of the state's integrated comprehensive mental health program.
State Boards and Issues
HB 50 CHILD PLACEMENT COMPACT
Sponsor: Representatives Coghill and Neuman
Committee/date of last action: (H) HES, 01/16/07

This bill affects the Interstate Child Placement Compact by seeking to establish an interstate commission for the placement of children. It also seeks to amend Rules 4 and 24 of the Alaska Rules of Civil Procedure.

HB 114 EXTEND STATE MEDICAL BOARD
Sponsor: House Labor & Commerce committee
Committee/date of last action: (H) HES, 01/30/07

This bill would extend the termination date of the State Medical Board through June 30, 2013.

HB 263 CITIZEN HEALTH ADVISORY BOARD
Sponsor: Representative Cissna
Committee/date of last action: (H) HES, 05/15/07

This bill proposes the formation of the Citizen's Health Advisory Board. It would be created within the Department of Health and Social Services and consist of the following commissioners or commissioners' designees: administration; health and social services; commerce, community, and economic development; corrections; environmental conservation; education and early development; public safety; labor and workforce development; and the attorney general or the attorney general's designee. The board would also consist of 32 persons nominated by all health units or districts who would represent the interested parties in the Alaska health care discussion, including but not limited to insurance companies, Native health care, legislators, and consumers. The stated purpose of the board is to develop strategies and recommendations to improve public health and health care, and to reduce health care costs for state businesses and residents.

HB 276 EXTEND ALASKA COMMISSION ON AGING
Sponsors: Representative Doll

Committee/date of last action: (H) HES and (H) FIN, 01/15/08


HB 276 would extend the termination date of the Alaska Commission on Aging to June 30, 2016.

HB 279 COMMISSION ON AGING
Sponsors: Representatives Doll and Kerttula

Committee/date of last action: (H) HES and (H) FIN, 01/15/08


This bill would make changes to the duties and powers of the Alaska Commission on Aging and DHSS. Added to the duties of DHSS would be the ability to establish state policy relating to and administering federal programs subject to state control as provided under the Older Americans Act of 1965, and to administer the older Alaskans service grants under certain state statutes and the Adult Day Care and Family Respite Care grants. HB 279 would also affect the role of the Executive Director of the Commission, and would also affect various grants and programs administered by DHSS.

HB 337 HEALTH CARE: PLAN/COMMISSION/FACILITIES
Sponsor: Rules by request of the governor
Committee/date of last action: (H) HES and (H) FIN, 01/22/08

HB 337 would establish the Alaska Health Care Commission and the Alaska health care information office, and would repeal or annul certain regulations of the Certificate of Need program. The Alaska Health Care Commission would exist within the Alaska Department of Health and Social Services and would promote the development of a statewide plan to address the quality, accessibility, and availability of health care in the state, and would review and approve facility health care information to be placed in a database maintained by the Alaska health care information office. The Alaska health care information office would be responsible for maintaining an internet database of all health care facilities in the state to provide objective, unbiased, and factually-based information on such facilities.

HCR 1 PUBLIC HEALTH AND HEALTH COMPACT
Sponsor: Representative Cissna
Committee/date of last action: (H) HES, 01/22/07

"Alaska faces a health crisis. The availability of accessible and affordable health care in our great state is challenged by a forecast of shrinking provider ranks and increased need for care, rising costs and limited funds to meet them."

"The Health Compact encourages all Alaskans to make healthy choices to promote their own health and well being, and to share their experiences and ideas with one another. It dedicates the remainder of the year 2007 as a time to join the Compact, and dedicates 2008 as a year for sharing ideas and taking action." -Rep. Cissna

SB 188 EXTEND ALASKA COMMISSION ON AGING
Sponsor: Senator Therriault
Committee/date of last action: (S) L&C and (S) FIN, 01/16/08

SB 188 would extend the termination date of the Alaska Commission on Aging to June 30, 2016.

SB 209 EXTEND ALASKA COMMISSION ON AGING
Sponsor: Senator Davis
Committee/date of last action: (S) L&C and (S) FIN, 01/16/08

SB 209 would extend the termination date of the Alaska Commission on Aging to June 30, 2016.
Women's Health Issues
HB 190 NURSING MOTHERS IN WORKPLACE
Sponsor: Representative Cissna
Committee/date of last action: (H) HES, 04/25/07

This bill would add a new section to AS 23.10 Employment Practices and Working Conditions to specifically address break time in the workplace for nursing mothers. HB 190 calls for reasonable unpaid break time each day for employees who are the nursing mothers of children to either breastfeed or express milk. The timing of such activities must occur at times during the workday that would reasonably ensure the health and comfort of the mother and child, and would allow the employee to maintain breast milk supply. The bill also calls for the employer to provide a private, secure, and sanitary room, or other location in close proximity to the work area, other than a toilet stall, where the employee can express milk or breastfeed the child, only so long as this provision would not create a substantial and undue hardship on the employer. The Department of Labor would enforce this section, and would be responsible for regulating the process by which an employee may register a complaint, and would also be able to issue civil fines to employers.

HB 301 PARTIAL-BIRTH ABORTION
Sponsors: Representatives Keller and Coghill
Committee/date of last action: (H) JUD, 01/22/08

This bill would define the term "partial-birth abortion," as well as define several acts which are related to the larger definition.

SB 58 JURY DEFERRAL FOR BREAST-FEEDING WOMEN
Sponsor: Senator Elton
Committee/date of last action: (S) JUD, 01/19/07

SB 58 would excuse breastfeeding women from jury duty. A woman may claim such legal exemption provided the child is less than three years of age. The bill would amend Rule 15 (1) of the Alaska Rules of Administration.

HB 270 MEDICAL FACILITY LICENSING/ABORTION
Sponsor: Representative Coghill

Committee/date of last action: (H) HES and (H) JUD, 01/15/08


This bill would add a type of facility to the list of permissible locations in which to perform abortions. It would add facilities licensed as ambulatory surgical centers that are approved for the purpose by DHSS. HB 270 would also clarify issues regarding the payment for abortion services used by DHSS for such a purpose, and would also clarify what is meant by "ambulatory surgical center" for the purposes of performing abortions.

SB 113 NURSING MOTHERS IN WORKPLACE
Sponsor: Senator Ellis
Committee/date of last action: (S) L&C, 03/12/07

SB 113 would require employers to "provide reasonable, unpaid break time to nursing mothers for the purposes of breastfeeding or expressing breast milk. The bill also requires employers to provide a sanitary and safe place for the employee to do so, unless doing it would create an undue hardship for the employer." -Sen. Ellis
Workers Compensation
HB 200 WORKER'S COMP: DISEASE PRESUMPTION
Sponsor: Representative Dahlstrom
Committee/date of last action: (H) FIN, 05/05/07

HB 200 would grant "benefits to firefighters stricken with certain types of cancer and heart disease due to their exposure to toxic chemicals, and high levels of carbon monoxide ... The requirements of this bill are that the claims must be made within five years after the last day of employment ... HB 200 also includes a presumption that compensation for certain disabilities resulting from blood born pathogens be covered." -Rep. Dahlstrom

SB 117 WORKER'S COMP: DISEASE PRESUMPTION
Sponsor: Senator French
Committee/date of last action: (S) L&C, 03/14/07

"Senate Bill 117 would create a presumption in the Workers' Compensation program that a firefighter with at least seven years on the job who has passed health screening exams earlier in their careers will be provided with benefits if they contract certain forms of pulmonary or heart disease or cancers, as it will be presumed to be a result of their occupation. This presumption is restricted to diseases known to occur with greater frequency among firefighters, and is also capped so that claims cannot be made after sixty months from the firefighter's last date of employment." - Sen. French

SB 147 WORKER'S COMP EMPLOYER LIABILITY
Sponsor: Senator French
Committee/date of last action: (S) L&C, 03/28/07

This bill seeks to remove the phrase "potentially liable" from the worker's compensation statute. Changes in 2004 to the statute allowed employers who are "potentially liable" for buying worker's compensation policies, but who do not actually do so, can still get the benefit of "exclusiveness of remedy," which means that employers who buy a policy know that there won't be court cases arising out of workplace accidents.
Guest Commentary: Is Alaska Senate Bill 160 a Raid on Medicaid?

Neil DavisA UAF emeritus professor of geophysics, Neil Davis has several fiction and nonfiction works published by the University of Alaska Press and McRoy & Blackburn Publishers. Mired in the Health Care Morass, his newest book (due March 2008), is about the US health care situation and how to fix it. He writes Dose of Reality, a column about health care and insurance, for The Ester Republic. You can read more about his books at his website, www.neildavisalaska.com. We wish to thank Professor Davis and the Ester Republic for giving us permission to republish this commentary. The views expressed by Professor Davis are his own and do not necessarily reflect those of the Alaska Center for Public Policy or the Alaska Health Policy Review.

Touting it as a means to provide all Alaskans with health care insurance, Anchorage Democrat Senator Hollis French (D) has introduced Senate Bill 160, titled "Affordable Health Insurance for All Alaskans." The intent is perhaps commendable, but, if enacted in its present form, this bill will actually increase overall health care costs for Alaskans. It also has the potential to do serious financial damage to the 106,000 Alaskans who now receive Medicaid benefits.

The cost of supplying Alaskans with health care in 2005 was $5.3 billion, an amount equal to one-third the value of North Slope oil exported that year. That is a lot of money, and it amounted to about $8,000 per Alaskan. Of that amount, nearly $1 billion was dispersed to hospitals and other medical providers through the Alaska Medicaid program, almost $10,000 per Medicaid beneficiary.

Medicaid is a joint federal-state public insurance program intended to pay the full cost of health care for eligible low-income parents, children, seniors, and people with disabilities. It is the largest source of funding for medical and health-related services for people with limited income. Medicaid provides insurance coverage for 38 million Americans, including 106,000 Alaskans. The federal government pays about 60 percent of the cost in Alaska, and state government pays the rest.

The Alaska Medicaid insurance program is highly efficient in that its administrative cost is only about three percent; that is, about 97 percent of the program money goes directly to pay for medical care. Of that 97 percent, 62 percent pays for acute medical care, 37 percent pays for long-term care, and 1 percent goes to what are called "Disproportionate Share Hospital (DSH) Payments." The DSH payments, amounting to about $7 million in fiscal year 2006, go to hospitals serving more than usual numbers of low-income and uninsured patients. So the purpose of the DSH funds is to go beyond just paying directly for care to Medicaid beneficiaries; it provides general support to certain hospitals located in areas where incomes are low and have abnormal uninsured populations. Because of the state's higher average salaries, Alaska does not fare as well in the distribution of DSH payments as other parts of the country. On average, DSH payments amount to six percent of the total Medicaid payout, but Alaska gets only one percent.

Now, in addition to those 106,000 Alaskans covered by Medicaid insurance, there are another 114,000 Alaskans not eligible for Medicaid and who do not have other insurance. The stated purpose of Senate Bill 160 is to provide those people with insurance issued by the private insurance industry. The bill will require every Alaskan to have some form of insurance. Those already insured will be able to keep the insurance they already have if they choose, but if they have none they will, by law, be forced to buy health insurance from the insurance industry, whether they want to or not.

The idea is to require participating Alaskans (those who have no other insurance) to buy vouchers to be used only to purchase health insurance--not to purchase health care. To help low-income Alaska residents pay for the insurance vouchers, the bill calls for subsidies using funds from various sources. These sources include required contributions from employers, legislative appropriations, federal funds, premiums, contributions, and "state money appropriated to subsidize uncompensated care."

What is that last-mentioned source; that is, what money does Alaska appropriate to subsidize uncompensated care? Senate Bill 160 is vague on this point but bill sponsor Senator Hollis French, in an article published in the Anchorage Daily News on March 16, 2007, stated that the intent was "to take the Medicaid dollars currently being spent to reimburse hospitals and other providers for the free care they provide to the uninsured, and use the money instead to subsidize health insurance for those who cannot afford it ... Take the money spent on hospital bills each year for the uninsured, and buy health insurance instead."

Reading that statement, warning bells clanged in my head. Did Senator French mean that Senate Bill 160 would raid Medicaid of all its funding and use it to help buy health insurance? Was he considering the Alaskans on Medicaid to be uninsured? No, not at all, Senator French responded when I queried him about this; I had the wrong idea altogether, he said. He meant that only the Medicaid Disproportionate Share Hospital (DSH) funds would be taken away from Medicaid.

That is an interesting thought when one looks at the Alaska DSH payments in 2006: $7 million. Of that amount, the state appropriates only 40 percent, just under $3 million. That's coffee money compared to the $5 billion cost of health care for Alaskans, or even the $1 billion in the Alaska Medicaid program. Yet, Senator French featured this source over all others in his newspaper article promoting Senate bill 160.

The truth is that any money diverted from government health insurance to private insurance drives up overall health care costs. That is because so much private insurance money is consumed by administrative costs, advertising costs, and shareholder profit. Government programs like Medicaid and Medicare pay 96 to 97 percent of the money taken in directly to health care providers, whereas the payout from the private insurance industry averages only 73 percent, and some policies pay out as low as 45 percent.

Senate Bill 160 as now written is a boon to the private insurance industry, but of questionable value to the 114,000 uninsured Alaskans it supposedly helps. They will, by law, have to buy some form of health insurance, but they will also be stuck with the deductibles and co-pays required by the policies they buy. On top of that, they will themselves have to pay for any health care not covered by the policies. For those persons needing the most health care, that extra cost will be substantial and in many cases unbearable.

It would be a different matter if SB 160 called for providing uninsured Alaskans with vouchers that would buy health care rather than just health insurance policies that pay only part of the cost of health care. That could bring down the overall cost of health care for all Alaskans while simultaneously improving access to needed health care for Alaskans now uninsured.

Summary of Senate HES Committee Meeting on SB 212
On January 23, 2008, the Senate Health, Education and Social Services Committee met to hear testimony regarding SB 212 Medical Assistance Eligibility. Senator Bettye Davis chaired the meeting. Other committee members present were Senators Thomas, Elton, and Dsyon, and telephonically, Senator Cowdery. The following summary includes highlights of the meeting.

Senator Davis explained that this bill is identical to SB 27, passed in the last legislative session, with one exception: SB 212 would provide medical assistance to pregnant women and children in families whose household income does not exceed 200% of the federal poverty level (FPL).

Tom Obermeyer, legislative aide to Senator Davis, presented an overview of the bill. He explained the need for increasing the income level for eligibility to 200% from its current level of 175%. He added that SB 212 increases allowable premiums or cost sharing by families whose incomes are between 150% and 200% of FPL. Fiscal notes detail the additional costs anticipated with the implementation of the bill, but he countered that the fiscal notes do not reflect the savings anticipated by fewer emergency room visits and avoided long term illnesses. Expected enrollment includes 218 pregnant women and 1,277 children, essentially the number of people eliminated when the guidelines were previously frozen.

Karleen Jackson, Commissioner of the Department of Health and Social Services, thanked the committee for working on last year's bill that increased the eligibility limits to 175% of FPL for Denali KidCare. She also commended Senator Davis and Rod Betit, president and CEO of the Alaska State Hospital and Nursing Home Association (ASHNHA) for their work on the Alaska Health Care Strategies Planning Council. One of the council's recommendations was to move to the 200% FPL.

Senator Elton asked Karleen Jackson to clarify her understanding of the governor's support for the bill. Jackson responded that the governor expressed neither support nor non-support for the increase to 200%; their conversation centered on the federal environment and the overall recommendations of the council. Senator Elton asked the commissioner to try and determine the governor's position on the bill. Karleen Jackson stated that she believed the governor's position depends on the federal piece that has not yet been decided.

Senator Elton expressed his concern that waiting until the federal piece is decided before proceeding may not be beneficial for Alaskans, and he thinks the decision should be based on what is right for Alaska -- and to be ready if we have the opportunity to provide the services.

Senator Cowdery asked how the proposed disbursement of energy rebates would affect eligibility. Ellie Fitzjarrald, director of Public Assistance, explained that there is a proposed $250 energy dividend for Alaskans who have received Permanent Fund Dividends. In a similar situation, it was determined that the money, because it was a one-time payment, did not affect Medicaid eligibility.

After hearing from the committee and administrative representatives, Senator Davis invited interested parties to speak. Overall, approximately ten people presented supportive testimony. No negative testimony was presented at the committee meeting.

Brad Ohs, administrator from Northstar Behavioral Health Systems at the Palmer residential treatment center, spoke in support of SB 212. Northstar is also a member of the Alaska Association of Homes for Children. Northstar serves 124 youth in psychiatric residential treatment centers in Alaska. One hundred percent of them rely on Denali KidCare for payment of at least part of their services.

In response to a request for more information from Senator Thomas, Ohs said typically five percent of children are from working families with insurance. Insurance maximums are generally exhausted between 14 and 20 days after treatment begins, and then payment reverts to Denali KidCare. The average length of stay at Northstar, and for most psychiatric level five facilities, is about 10 to 12 months. 

Rod Betit, president and CEO of AHSNHA and a member of the governor's council, spoke in support of SB 212. He mentioned the goal is not to move children from parental insurance to Denali KidCare. He also stated that while an income level of $53,000 might seem high, it is a gross figure, not available income after deductions.

Senator Elton mentioned that in 2003, over 2,500 children and 400-500 pregnant women were dropped from Denali KidCare. He asked Rod Betit to project the number of people that can be added by adopting the 200% level. Betit did not feel comfortable attesting to any particular amount because he did not have the data to do so. Senator Davis said the figures are available and offered to get the information.

Meghan Johnson, chair of the statewide advocacy coalition "Voices for Alaska's Children and Youth," spoke on behalf the organization and the 1,800 children the member agencies serve. She challenged Alaska to join the movement toward "universal, continuous, affordable, effective, preventative and sustainable health care for all children." She stated that SB 212 would support the future and well being of Alaska. Job market recruitment and retention depends on the availability of a healthy workforce. She added, "Perhaps we should think of health care being a basic human right, not a privilege."
 
Dr. Lawrence D. Weiss, editor of the Alaska Health Policy Review, discussed the economic contribution of Medicaid to Alaska. The health industry in the state has been the fastest growing segment of the economy for well over a decade. He pointed out that a study completed in 2002 found that Medicaid contributed over $1 billion to the Alaskan economy in FY 2001, supported about 9,000 jobs, and paid a payroll of about a third of a billion dollars. Well over half of the Medicaid expenditures were federal match dollars, so expanding Denali KidCare is an excellent investment by the State of Alaska, particularly in light of an increasingly evident slowdown of the economy.

Senator Davis concluded by stating she was not going to call for a vote to move it forward today, but she will bring this bill back to the Senate Health, Education and Social Services Committee meeting on Friday, January 25, when SB 245 Health Care: Plan/Commission/Facilities will also be discussed.
Amplifications and Corrections

An incorrect word was published in the interview with Rosalie Nadeau in the January 14, 2008 issue. The last sentence of the answer following the question, "Is this the FMAP?" should have stated:

We did not increase the funding to those programs dramatically, what we did was supplement general fund money with Medicaid money.

We apologize to Ms. Nadeau and to our readers for the error.
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Alaska Health Policy Calendar
This calendar of health policy-related legislative meetings is current as of January 23, 2008 at 5 PM. Please visit the Alaska State Legislature's list of committee hearings for the most current listings, as they are subject to change.

January 25, 2008, 7:30 AM
What: House Health & Social Services Committee finance subcommittee
Where: House Finance 519, Capitol, Juneau
Other information: Alaska Pioneer Homes; Division of Public Assistance; teleconferenced

January 25, 2008, 1:30 PM
What: Senate Health, Education, and Social Services Committee
Where: Butrovich 205, Capitol, Juneau
Other information: SB 245 "Health Care: Plan/Commissions/Facilities"

January 28, 2008, 7:30 AM
What: House Health & Social Services Committee finance subcommittee
Where: House Finance 519, Capitol, Juneau
Other information: Division of Public Health; teleconferenced

January 30, 2008, 7:30 AM
What: House Health & Social Services Committee finance subcommittee
Where: House Finance 519, Capitol, Juneau
Other information: Office of Children's Services; Division of Juvenile Justice; teleconferenced

February 1, 2008, 7:30 AM
What: House Health & Social Services Committee finance subcommittee
Where: House Finance 519, Capitol, Juneau
Other information: Departmental Support Services; Office of Faith-Based & Community Initiative; teleconferenced

February 4, 2008, 7:30 AM
What: House Health & Social Services Committee finance subcommittee
Where: House Finance 519, Capitol, Juneau
Other information: Alaska Mental Health Trust Authority; teleconferenced

February 6, 2008, 7:30 AM
What: House Health & Social Services Committee finance subcommittee
Where: House Finance 519, Capitol, Juneau
Other information: Division of Behavioral Health; teleconferenced

February 8, 2008, 7:30 AM
What: House Health & Social Services Committee finance subcommittee
Where: House Finance 519, Capitol, Juneau
Other information: topic TBA; teleconferenced

February 11, 2008, 7:30 AM
What: House Health & Social Services Committee finance subcommittee
Where: House Finance 519, Capitol, Juneau
Other information: topic draft closeout; teleconferenced

February 13, 2008, 7:30 AM
What: House Health & Social Services Committee finance subcommittee
Where: House Finance 519, Capitol, Juneau
Other information: topic TBA; teleconference

February 15, 2008, 7:30 AM
What: House Health & Social Services Committee finance subcommittee
Where: House Finance 519, Capitol, Juneau
Other information: closeout; teleconference
AHPR Staff
Lawrence D. Weiss Ph.D., M.S., Editor
Jacqueline Yeagle, Marketing and Communications Manager
Elizabeth Agi, Associate Policy Analyst

 
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