Alaska Health Policy Review

Dear Reader:

I am an unabashed supporter of the Alaska Public Health Association, fondly known as ALPHA. If you are not a member of ALPHA, here is the organization's statement of purpose ... and if you are already a member of ALPHA, I'll bet you have not read the statement of purpose in a long time:

"The Alaska Public Health Association shall promote the advancement of public health to promote improved health and quality of life for Alaskans. It shall exercise leadership with public health professionals and the general public in developing sound health policy, reducing health disparities and improving health outcomes for Alaskans."

Further, "In order to achieve its purpose, the Association shall aim to:

define and influence public health policies, actions and legislation, which affect the health and well being of Alaskans;
promote and coordinate communications among health and health-related professionals throughout the State regarding their public health concerns;
provide an effective forum for members of the Association and other participants to discuss public health issues, and to identify means by which these issues might be resolved to improve the health and well being of our citizens;
serve as an information source for the public;
promote and encourage collection of reliable data which will enable accurate assessments of health and health-care delivery systems in Alaska, and provide a basis for sound public health policy decisions; and
promulgate the principle that health is both a collective responsibility of the state and community and an individual responsibility of its citizens."

And, most significantly, ALPHA's "Core Values:

Equity: All Alaskans have the right to live under conditions that promote and protect health.
Integrity: Our actions will always be ethical and based on the best available information.
Excellence: We will strive to be effective in all our undertakings.
Leadership: We will forward a vision that inspires action."

Now the clincher. The other day I received this in my email from ALPHA:

"We are creating an ALPHA Health Policy Advocacy Listserv. We are contacting you because on the Alaska Public Health Association (ALPHA) survey you noted you are interested in ALPHA's health policy advocacy efforts.

"Your email has been added to this list unless you request otherwise. Many employers prohibit advocacy efforts at work, you may wish to provide your personal (non-work) email by contacting Karolfink@yahoo.com.

"During Alaska legislative session we expect to send 1-3 health policy alert and/or updates per week. ALPHA's Health Policy committee also follows federal and local issues and may issues alerts/updates throughout the year however these alerts will be infrequent.

"If you know others who are interested in joining our listserv, please have them contact me, Karol Fink | ALPHA Board of Directors | Health Policy Committee, Chair | info@alaskapublichealth.org."

Karol wants to hear from you. Perhaps working with ALPHA, you could give critical testimony at future hearings about Denali KidCare, which we report on extensively below. It is all about health care for Alaska's children and pregnant women. What could be more important?

Lawrence D. Weiss PhD, MS
editor, AHPR
ldweiss@gmail.com

Testimony: New Opportunities for Health Care Coverage for Children

Alaska is only one of only a few states that do not offer health insurance to children and pregnant women in families up to 200 percent of the federal poverty level. This means that more of our children are receiving care in emergency rooms as opposed to regular, preventive health care. As you will see from two recent legislative hearings on bills that affect eligibility for Denali KidCare, we are already paying for health care for Alaska children. However, care in an emergency room does not equal periodic well-child visits to a primary care provider.

Increasing Denali KidCare eligibility to 200 percent of the federal poverty level ensures that an additional 1300 children and 225 pregnant women will have access to regular and comprehensive health care. The message from testimony in the hearings summarized below is quite clear: we have a responsibility and must act on new opportunities to improve the lives and health of Alaska children.

The Legislation

Senate Bill 13, sponsored by Senator Bettye Davis, increases the income level for covering children and pregnant women under Denali KidCare to 200 percent of the federal poverty level (FPL), up from 175 percent. It restores eligibility levels to the levels used when the Denali KidCare (DKC) program was originally created twelve years ago.

Senate Bill 87, sponsored by Senator Bill Wielechowski, increases the income standards for covering children and pregnant women under Denali KidCare to 200 percent of the FPL, up from 175 percent. This legislation also provides new Medicaid coverage for children in higher income categories. To qualify, children must be under age 19, have no insurance coverage and their family income must be between 200 percent and 300 percent of the FPL. Families will be required to pay premiums to the state of Alaska ranging between $240 and $1,200 per year, per child. Families with income above 250 percent of the FPL will also be responsible for co-payments equal to 20 percent of the cost of their children's medical service, payable to the provider at the time of service.

Background on Children's Health Insurance

On February 9, Tom Obermeyer, aide to Senator Davis, introduced SB 13. He gave background information on the bill, which would make health insurance accessible to an estimated 1300 more uninsured children and 225 pregnant women in Alaska.

Denali KidCare 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, and 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.

Obermeyer noted that Denali KidCare serves an estimated 7,900 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, funding required for DKC 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 treatment.

"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.

Obermeyer continued, "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 13."

Public Testimony: Access to Health Care Means More than Good Health

The meeting turned to open testimony. George Brown, M.D., of Douglas, Alaska has practiced pediatric medicine in Alaska since 1965. 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 legislative support.

Dr. Brown said he and his colleagues have also been discussing the issue of higher levels [of coverage] with co-pays. One of his colleagues has seen a problem with co-pays in Washington; families get behind in their co-pays and then become 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.

Dr. Brown added, "In my experience ... working with these programs with families who have not had insurance before, it sometimes takes them many years to learn that they are welcome in a doctor's office because they have been shut out for so long. I have seen this happen over and over again. When they come in, they are treated with respect. They see other families, because they know about the importance of prevention and health care for children, who are in the waiting room. They learn a whole lot from them, and they come to realize that this is more important than buying more cigarettes or going to a movie. 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.

Rod Betit, president, Alaska State Hospital and Nursing Home Association (ASHNHA), expressed his excitement 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. Betit 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.

Nancy St. John-Smith of Peninsula Community Health Services in Kenai, AK, said that their community 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 KidCare they can offer preventive medical and dental care to many children who would not otherwise receive it. "Because of DKC we can offer preventive medical and dental care to many children who would otherwise not 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.

Jodyne Butto M.D., president, Alaska Chapter, American Academy of Pediatrics in Anchorage mentioned that SCHIP has made a huge difference in the health of children across the United States. "It is important that here in Alaska ... we provide our children with the best care possible, and that means access to care. That access to care is insurance."

Dr. Butto also stressed the importance of health to children's school performance. Although difficult to quantify, " ... the kids who have good health and especially good dental health perform better in school, have fewer missed days, have better behavior all around and perform better academically."

Dahna Graham, school and parish nurse for Anchorage Faith and Action Congregations Together (AFACT) in Anchorage, stated that AFACT is thrilled that Alaska is finally getting back to the 200 percent [eligibility level]. "There are a lot of children and a lot of families out there rejoicing ... these families came forward to talk about their pain in not being able to keep their children healthy and waiting until things have really unraveled until they seek help."

Jorden Nigro, residential director, Juneau Youth Services, and president, Alaska Homes for Children (AHFC) spoke next. She said they are excited to see all of the bills coming forward for Denali KidCare. She added to the previous testimony that, "If a sliding co-pay goes into effect, I hope it won't affect those at 200 percent or less of the FPL. Behavioral health for youth is primarily funded through Denali KidCare and there are many kids and families that could use the services that are unable to access them because they are right on the cusp of eligibility."

Laverne Demientieff, president, National Association of Social Workers (NASW), Alaska Chapter, and clinical assistant professor at the University of Alaska Fairbanks gave testimony. She said NASW strongly supports the efforts of this committee to raise the Denali KidCare eligibility requirement to 300 percent of the FPL. "We are 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."

Legislative Debate: Impact of Federal Legislation and Increased Staffing Requirements

The discussion began around the fiscal notes of Senate Bill 13, and 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.

Jon Sherwood, medical assistant administrator, Department of Health and Social Services (DHSS), 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 KidCare.

The hearing continued with the introduction of SB 87, sponsored by Senator Bill Wielechowski. He explained that this is a bill he first introduced two years ago, which was not passed. He decided to introduce it again this year due in part to the opportunity represented by the increase in federal funds to Alaska from about $10 million to over $22 million. "We feel that gives us an opportunity to expand Denali KidCare well beyond the 200 percent poverty level threshold."

"This bill increases the base eligibility for Denali KidCare to 200 percent of the federal poverty level. It goes a step further, and allows people to buy in up to the level of 300 percent of FPL. What we think this bill does is make health insurance available to every child in the state of Alaska." It is the people of the working class, those between 200 and 300 percent of the FPL, whom this expansion is intended to help.

Senator Wielechowski expressed his concern for the fiscal note, which he feels is very questionable. When he filed this bill two years ago, the fiscal note said it would require the addition of another seven [DHSS] staff members. In the new fiscal note, the number has increased to 17. In addition, SB 13, which adds about 1300 people [to Denali KidCare], requires the addition of two staff members. This bill, which adds 2000 to 2500 people through increased eligibility, requires another 15 staff. A fiscal note like this greatly undermines the credibility of the department.

Senator Ellis asked how this legislation would comport with the bill just signed by President Obama.

Michelle Sydeman, legislative aide to Senator Wielechowski responded. "The current [federal] bill as we understand it would provide funding to Alaska to 200 percent of FPL. We have also heard assurances from Speaker of the House Nancy Pelosi and others that it is the intent of Congress to provide sufficient funding to cover all states' efforts to ensure that children are insured. The funding Alaska has received so far gets them up to 200 percent, but there are indications that they can go higher. All Alaska would have to do is revise its plan and its allotment should increase as well."

Ellie Fitzjarrald, director, Division of Public Assistance, Department of Health and Social Services responded to the increased staffing requirement in the fiscal note: "We can say that we're treading new ground. The workload that goes into calculating costs and premiums for families up to 300 percent of FPL is something that we've not done before. The states that have done it have found that it is very [labor] intensive."

Fitzjarrald recognized that the previous fiscal note showed a need for fewer staff. However, as they become more familiar with what this work will entail, they think more staff will be needed than previously estimated. She also noted that on page two of the fiscal note, where they have included four "lead worker positions" that would provide statewide outreach. The lead workers would contact health providers and clinics in the communities to ensure awareness of the program and how it works. This includes how to apply for eligibility and the calculation of premiums. Additionally, as there are interruptions in coverage when people are unable to pay their premiums and benefits are suspended, how to get them reinstated.

Senator Davis asked if the four lead worker positions were included in the fiscal note last year. Fitzjarrald responded that she didn't think so but wasn't sure. Other legislators had questions regarding the fiscal details of the bill, such as telephone costs and other maintenance operations. Additionally, it was asked how the numbers compare with other states that have similar programs. In general, Fitzjarrald admitted that they have not checked with other states, and that their analysis is based primarily on the work, as they know it here in Alaska.

Support from the Administration?

Senator Wielechowski asked if the administration supports SB 87. Mr. Sherwood answered that, "There are several proposals under discussion and the governor has supported expansion to 200 percent of FPL. In looking at the proposals, the administration has a preference for cost-sharing through premiums and an asset test."

Senator Wielechowski reiterated that they [the administration] do support the fundamental philosophy of what SB 87 is attempting to do with the cost-sharing component.
Mr. Sherwood agreed. Senator Wielechowski asked, "Did the administration work on any amendments at the congressional level to stop the federal increase above 200 percent?"

Mr. Fuller answered, "I have responded to questions and comments from the senatorial delegation as they were working through the SCHIP reauthorization. So I believe the answer is yes to your question."

Senator Wielechowski said his understanding was that requiring premiums or enrollment fees as a cost-sharing provision is fairly common and asked the National Conference of State Legislatures (NCSL) representatives (on the phone) if that is correct.

Jennifer Saunders of the NCSL in Denver responded that, "Twenty-four states charge co-payments and 35 states have premiums or enrollment fees." Additionally, 46 states and the District of Columbia do not require an asset test.

Senator Paskvan asked at what level the other states require co-payments or premiums.

Ms. Saunders said that nine states impose premiums on children and families with incomes below 150 percent of the federal poverty guidelines; 26 states charge premiums at an income level over 150 percent; 24 states charge premiums at 200 percent; 18 states charge at 250 percent of the federal poverty guidelines.

Martha King, also of the NCSL, added that there is a difference in the states' ability to charge co-pays depending on whether the state has a Medicaid expansion for its SCHIP program as Alaska does, or has a stand-alone insurance-like SCHIP program.

Senator Davis asked if that means Alaska cannot go down to 150 percent. Saunders answered that below 150 percent, cost-sharing requirements are very restrictive under Medicaid rules; but above that, they are not as restrictive.

Senator Ellis asked Ms. Fitzjarrald and Mr. Sherwood about the percentage of time spent on the program by the new staff, to which Ms. Fitzjarrald replied, "Right now our DKC office is operated out of Anchorage, primarily ... and that is the work, it is determining eligibility for these higher income groups. Because Medicaid is so large, if applicants do not qualify for this program, like children with disabilities, they [lead workers] do look to see if they qualify for other types of coverage that would not be SCHIP coverage, but their work will be related primarily to Denali KidCare."

Senator Wielechowski stated that Alaska could go to 300 percent eligibility and provide insurance for most of the children in the state for an additional $1.3 million, according to the department's estimate. He expressed concern regarding the large increase in staff relative to the number of new enrollees. " ... To add 1,500 more to go from 200 to 300 percent, a position we know the administration fought against at the congressional level, you now need 15 staff? It stretches the imagination to say that this is accurate." However, he continued, even if that is accurate, the amount is more than reasonable for the outcome.

Build a Solid Foundation First: Public Testimony for Senate Bill 87

As with SB 13, support for this bill was unanimous from the public. However, many felt that increasing eligibility to 200 percent of the federal poverty should be the state's foremost priority. Jorden Nigro, president of the Alaska Association of Homes for Children in Anchorage said she supports this bill and urged its passing. Laverne Demientieff, president, National Association of Social Workers (NASW), said her association also supports SB 87.

Rod Betit, president of the Alaska State Hospital and Nursing Home Association (ASHNHA), said he also supports SB 87. "Having been a state health worker for 12 years, I understand the difficulty of going forward with this kind of proposal. However, our [ASHNHA's] membership supports the bill. While we really want to see the state get [eligibility] to 200 percent, this is a well-constructed piece of legislation. Let me just give you a few reasons why. It doesn't have cost sharing below 200 percent, which we think is important, because we don't think you'll see it. It will end up being on the backs of physicians and they won't collect the full fee that they are needing in order to serve this population. Second, there is significant cost sharing above 200 percent. It isn't a 'give away' program, so there is a real attempt to have individual responsibility as part of this expansion into the program. Let me give you a couple examples.

"There is annual contribution of $20 to $100 per child above 200 percent, based on income. And there is a requirement to set that sliding fee schedule so that it is sensitive to income. But again, that's a significant contribution per child for families at this income level. Above 250 percent, there are also co-payments of 20 percent. If you look at physician, hospital, other charges in this state, that is again another sizeable out-of-pocket expense for these families. There is also a strong anti-crowd out measure in the bill. 'Crowd out' refers to when you build a public program, people come from private coverage into public coverage and it ends up shifting who pays for it rather than who gets covered.

"Again, there are provisions in this legislation that would require the state to make sure that doesn't happen. And there are many tools available nationwide for assuring that doesn't happen. Massachusetts, which just implemented their universal health coverage program, didn't have significant crowd out because they built provisions like that in there. Yet they cut their uninsured rate from about nine percent to about four and a half percent in 18 months. So again, I think that is a very important component in this bill." Finally, he said if there are federal and state dollars available, this is a good next step after going to 200 percent and he would really urge the committee to consider it.

Senator Ellis responded that coming from someone who watches the bottom line, he said, it is great testimony to carry through the process. "So I'm hoping you'll work all your important connections through the capital to ensure that we get this bill passed."

Senator Paskvan asked if the administration would be more efficient to request a flat fee charge rather than a percentage of income. Betit answered that typically those fees would be predetermined during the eligibility process and would be provided to the providers when the patient comes in for service. The hospitals and physicians would not have to do the calculation.

Senator Thomas asked if, as a humanitarian gesture, the hospitals would be interested in support of an incremental discount for every $50 increment in the federal poverty level increase as it is applied. Betit explained that the hospitals are giving significant discounts already, because Medicaid and other federal programs are paying well below the going rate. They would come under the protection of the Medicaid rules, which say that once a person has been billed as a Medicaid patient, that is all the provider can charge. They cannot be billed for anything above that.

Dahna Graham, school and parish nurse for Anchorage Faith and Action Congregations Together (AFACT) in Anchorage, agrees that Senate Bill 87 is very important. "We must get to 200 percent of the federal poverty level. But this is a wonderful bill and it is very fiscally responsible, as we read it. Being able to keep kids healthy and to work on the wellness end makes so much more sense than spending our money getting them well after they come apart."

Administrative Solutions: Using Examples from the Field

Jodyne Butto MD, American Academy of Pediatrics (AAP) in Anchorage asked if anyone has considered "thinking a little outside of the box" to find solutions that would not require 15 additional positions. She said it seems as if there ought to be a better way to quantify eligibility for a longer period of time to reduce the amount of work required by the patient and the department. She encouraged some "brainstorming" to find ways to streamline the process.

Senator Davis commented that a lot of the work Dr. Butto referred to will take place in Finance rather than in the Health and Social Services Committee. She also pointed out that there are other bills in the works this session that don't come up to this mark and, if Alaska is going to have health care for all of the children, this is the piece of legislation she would like to see passed.

Tom Obermeyer, aide to Senator Davis, referred everyone to the packet from the Kaiser Commission on Medicaid and the Uninsured. Specifically, that it indicates that 11 states have taken steps to reduce procedural barriers to coverage for children. The cost-saving arrangement included in the document should look at these steps. These states were able to eliminate the requirement for families to participate in face-to-face interviews to obtain health coverage for children. Colorado adopted administrative verification and renewal, meaning that the state no longer requires families to provide paper documentation of their income and eligibility workers obtain that information from existing databases. Thus, there are examples among other states for how to reduce the administrative costs included in the fiscal note of the two bills.

Senator Davis added that the administration is working on some regulations to extend the time between personal interviews for eligibility. She admitted that there is a lot of work to be done, but reiterated that the Finance Committee might be the most appropriate avenue. She expressed her desire to move both bills out today and asked the will of the committee.

There were no objections, and so Senator Paskvan moved to report SB 87 and SB 13 from committee with individual recommendations and attached fiscal note(s). There being no objection, the motion carried and the meeting was adjourned.

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Alaska Children's Health Insurance: The Debate for Coverage Continues

Alaska Health Policy Calendar

Bill Watch: Bills on the Move

It was another exciting week for health policy in the legislature. Four new health policy bills were introduced, and many bills were scheduled for hearings in committees. Additionally, several bills were heard in committee meetings, and one resolution was transmitted to the governor. Bills are current as of March 11 at 3 PM.

SB 139 Incentives for Certain Medical Providers was introduced by Senator Olson and others and referred to (S) HSS on March 9. HB 168 Trauma Care Centers/Fund, sponsored by Representative Coghill, was introduced and referred to (H) HSS on March 9. HB 176 Nursing Mothers in the Workplace was introduced by Representative Cissna and referred to (H) HSS on March 9. SB 133 Electronic Health Info Exchange System was introduced by Senators Paskvan and Davis and referred to (S) HSS on March 2.

SB 11 Dependent Health Insurance; Age Limit was heard in (S) HSS on March 11. SB 32 Medicaid: Home/Community Based Services was heard in (S) FIN on March 11. SB 12 Limit Overtime for Registered Nurses was heard ad held in (S) HSS on March 9.

The HB 83 Approp: Mental Health Budget hearings in (H) FIN on March 9, 10, and 11 were canceled. The SB 52 Salvia Divinorum as a Controlled Substance hearing in (S) JUD on March 13 was canceled.

HB 35 Notice & Consent for Minor's Abortion was heard and held in (H) JUD on March 9, and is scheduled to be heard in (H) JUD on March 11, 13 and 16. HB 2 Birth Certificate for Stillbirth was scheduled to be heard (H) HSS, March 12, and heard in (H) JUD on March 16.

HB 63 Council Domestic Violence: Members, Staff was referred to (S) STA on March 9. HB 26 Medicaid for Adult Dental Services was moved out of (H) FIN on March 11. HB 104 Worker's Comp. Medical Treatment Fees was referred to (H) RLS on March 5. SB 13 Medical Assistance Eligibility was heard for the second time in (S) FIN and referred to (S) RLS on March 11. SB 79 Med Benefits of Disabled Peace Officers was referred to (S) FIN on March 5.

SCR 1 Brain Injury Awareness Month March 2009 was transmitted to the governor on March 11.

Bill Tracking Methodology

Bills listed here were selected based on a series of subjective criteria to determine whether they were "health policy-related" or not. 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) HSS: House Health and Social Services Committee
(S) HSS: Senate Health and Social Services Committee
(H) L&C: House Labor & Commerce Committee
(S) L&C: Senate Labor & Commerce Committee
(H) EDC: House Education Committee
(S) EDC: Senate Education Committee
(H) FIN: House Finance Committee
(S) FIN: Senate Finance Committee
(H) JUD: House Judiciary Committee
(S) JUD: Senate Judiciary Committee
(H) STA: House State Affairs Committee
(S) STA: Senate State Affairs Committee
(S) RLS: Senate Rules Committee

Bill Watch: Drugs

HB 17 PROHIBIT TOBACCO USE UNTIL AGE 21
Sponsor: Representative Crawford
Committee(s) and date of last action: Read and referred to (H) L&C, 01/20/09
Description: This bill requests to change the legal age from 19 to 21 for the purchase, sale, exchange, and possession of tobacco. Specifically, it requests that any statute listing the legal age as 19 for the above activities be amended to the age of 21.

SB 52 SALVIA DIVINORUM AS A CONTROLLED SUBSTANCE
Sponsor: Senator Therriault
Committee(s) and date of last action: Scheduled hearing in (S) JUD on 03/13/09, CANCELED
Description: Salvia divinorum and Salvinorin A are compounds of a plant used for medicinal purposes and with hallucinogenic properties. There has been an increase in its use, and has the potential for misuse and abuse. This bill requests that it be listed as a controlled substance.

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Bill Watch: Education

HB 58 EDUC LOAN REPAYMENT PROGRAM
Sponsors: Representatives Thomas, Wilson, Millett, Harris
Committee(s) and date of last action: Heard and held in (H) EDC, 03/02/09
Description: This bill requests that general funds be set aside for incentive use to recruit individuals in occupations facing a shortage. Dentists and licensed practical nurses are among the occupations listed that would have access to these funds and incentive programs. Allocation of these funds is grouped by geographical location, with more funding available to professionals who are employed in rural areas of the state. A minimum of one year of employment is required for eligibility, and the amount of funding increases incrementally with the number of years of employment.

SB 18 POSTSECONDARY MEDICAL AND OTHER EDUC PROG
Sponsors: Senators Wielecheowski, Thomas, Ellis
Committee(s) and date of last action: Scheduled to be heard in (S) EDC on 03/13/09
Description: This bill proposes to raise the number of new students enrolled in medical education through the WWAMI program from 20 to 24 by 2010, and from 24 to 30 by 2012.

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Bill Watch: General Health Policy

SB 139 INCENTIVES FOR CERTAIN MEDICAL PROVIDERS
Sponsors: Senators Olson, Wielechowski, Meyer, Davis
Committee(s) and date of last action: Read for the first time and referred to (S) HSS, 03/09/09
Description: "An Act establishing a loan repayment program and employment incentive program for certain health care professionals employed in the state; and providing for an effective date."

HB 168 TRAUMA CARE CENTERS/FUND
Sponsor: Representative Coghill
Committee(s) and date of last action: Read and referred to (H) HSS, 03/09/09
Description: "An Act relating to state certification and designation of trauma centers; creating the uncompensated trauma care fund to offset uncompensated trauma care provided at certified and designated trauma centers; and providing for an effective date."

SB 133 ELECTRONIC HEALTH INFO EXCHANGE SYSTEM
Sponsors: Senators Paskvan and Davis
Committee(s) and date of last action: Read for the first time and referred to (S) HSS, 03/02/09
Description: This bill proposes the creation of a statewide electronic health exchange system that does the following:

ensures that the confidentiality of individually indentifying health information of a patient is secure and protected;
improves health care quality, reduces medical errors, increases the efficiency of care, and advances the delivery of appropriate, evidence-based health care services;
promotes wellness, disease prevention, and management of chronic illnesses by increasing the availability and transparency of information related to the health care needs of an individual for the benefit of the individual;
ensures that appropriate information needed to make medical decisions is available in a usable form at the time and in the location that the medical service is provided;
produces greater value for health care expenditures by reducing health care costs that result from inefficiency, medical errors, inappropriate care, and incomplete information;
promotes a more effective marketplace, greater competition, greater systems analysis, increased choice, enhanced quality, and improved outcomes in health care services; and
improves the coordination of information and the provision of health care services through an effective infrastructure for the secure and authorized exchange and use of health care information.

Bill Watch: Medical Assistance and Health Insurance

HB 118 MEDICAL ASSISTANCE ELIGIBILITY
Sponsor: Representative Gara
Committee(s) and date of last action: Referred to (H) HSS, 02/25/09
Description: "An Act expanding, and relating to advertising about, medical assistance coverage for eligible children and pregnant women; relating to the poverty guideline and cost sharing for certain recipients of medical assistance; having the short title of the 'No Child Left Uninsured Act'; and providing for an effective date."

HCR 9 HOME HEALTH AIDES FOR SENIORS
Sponsors: Representatives Cissna and Gruenberg
Committee(s) and date of last action: Introduced and referred to (H) HSS, 02/25/09
Description: This bill promotes the expansion of home health services to older Alaskans and adults with disabilities by requesting that the governor direct the Department of Health and Social Services to apply to the federal government for additional waivers under the home and community-based waiver program to better serve older Alaskans and adults with disabilities through a federally reimbursable service either as a separate service or as a service that may be combined with other waivers.

SB 79 MED BENEFITS DISABLED PEACE OFFICERS
Sponsors: Senators McGuire, Paskvan
Committee(s) and date of last action: Referred to (S) FIN, 03/05/09
Description: This bill proposes waiving payment of premiums for major medical insurance for disabled peace officers who have at least 20 years of credited service as peace officers of the public.

SB 87 MEDICAL ASSISTANCE ELIBILITY
Sponsor: Senator Wielochowski
Committee(s) and date of last action: Heard and held in (S) FIN, 02/25/09
Description: This bill proposes an additional eligibility category for Medicaid services. Specifically, it adds children, pregnant women, and other specified individuals in families with incomes between 200% and 300% of the federal poverty level. Additionally, individuals in this income category would be required to pay a yearly premium for medical assistance. The premiums would be determined by a sliding scale based on annual income. The range for premiums would be set at no less than $240 per year and no more than $1200 per year.

SB 65 MEDICAID FOR ADULT DENTAL SERVICES
Sponsors: Senators Davis and Ellis
Committee(s) and date of last action: Heard and Held in (S) HSS, 02/02/09
Description: This bill is "An Act repealing the repeal of preventative and restorative adult dental services reimbursement under Medicaid; providing for an effective date by repealing the effective date of sec. 3, ch. 52, SLA 2006; and providing for an effective date."

SB 82 MEDICAID FOR ADULT DENTAL SERVICES
Sponsors: Rules by request of the governor
Committee(s) and date of last action: Referred to (S) HSS Finance, 02/04/09
Description: This bill is "An Act providing for an effective date by delaying the effective date of the change of coverage of adult dental services under Medicaid; and providing for an effective date."

HB 87 MED BENEFITS OF DISABLED PEACE OFFICERS
Sponsors: Representatives Millett, Dahlstrom, Gardner, Gara, Kerttula, Kawasaki
Committee(s) and date of last action: Heard and held in (H) L&C, 02/02/09
Description: This bill proposes waiving payment of premiums for major medical insurance for disabled peace officers who have at least 20 years of credited service as peace officers of the public.

SB 61 MANDATORY UNIVERSAL HEALTH INSURANCE
Sponsors: Senators French, Ellis
Committee(s) and date of last action: Scheduled to be heard in (S) HSS on 03/13/09
Description: This bill proposes the establishment of the Alaska Health Care Program (AKCP), a program given the task of ensuring that all Alaskans have access to affordable health care insurance covering all essential services. The AKCP will be monitored and managed by an Alaskan Health Care Board of 13 members, 12 of which are to be appointed by the governor. Similar to SB 160 (25th legislative session), this bill includes

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

If passed, this bill is to take effect by January 1, 2010.

HB 62 MEDICAL ASSISTANCE ELIGIBILITY/PREMIUMS
Sponsors: Representative Hawker
Committee(s) and date of last action: Read and referred to (H) HSS, 01/20/09
Description: This bill, also known as the "Denali Kid Care Accountability Act," amends a previous Alaska Statute on medical assistance eligibility requirements. Specifically, it adds sections requiring recipients of medical assistance in families whose income is between 175 and 250 of the federal poverty level to pay premiums, on a sliding scale, for medical assistance. The Department of Health and Human Services is required to set the premium at no less than 2% of the recipient's income, and establish a system of collecting premiums from recipients. This bill requests that these changes go into effect following the approved revisions and funding to make these changes.

HB 61 MEDICAL ASSISTANCE COVERAGE
Sponsors: Representatives Cissna and Gruenberg
Committee(s) and date of last action: Read and referred to (H) HSS, 01/20/09
Description: This bill requests many changes to medical assistance eligibility for Alaskans. Among the changes are 1) disabled persons: increasing the eligibility for those in a family whose income does not exceed 250% of the official poverty level for Alaska; 2) individuals under the age of 19: increasing the family income eligibility from 175% to 200% of the federal poverty level for Alaska; 3) pregnant women: increasing the family income eligibility from 175% to 200% of the federal poverty level for Alaska.

SB 10 MEDICAID/INS FOR CANCER CLINICAL TRIALS
Sponsor: Senator Davis
Committee(s) and date of last action: Scheduled to be heard in (S) L&C, 03/12/09
Description: This bill requests that a health insurance company be required to provide coverage for any medical expenses incurred during the course of participation in an approved clinical trial.

SB 11 DEPENDENT HEALTH INSURANCE; AGE LIMIT
Sponsor: Senator Davis
Committee(s) and date of last action: Heard in (S) HSS, 03/11/09
Description: This bill requests that among health insurance policies covering dependents of enrollees, the defined age for "dependent child" be raised from 23 to 26 years of age.

SB 13 MEDICAL ASSISTANCE ELIGIBILITY
Sponsor: Senator Davis
Committee(s) and date of last action: Heard for the second time in (S) FIN and referred to (S) RLS, 03/11/09
Description: This bill requests that the family income eligibility requirements for medical assistance among children and pregnant women be raised from 175% to 200% of the federal poverty level, effective immediately.

SB 32 MEDICAID: HOME/COMMUNITY BASED SERVICES
Sponsor: Senator Ellis
Committee(s) and date of last action: Heard in (S) FIN, 03/11/09
Description: This bill requests an amendment to a previous statute outlining medical assistance among health facilities, adding medical assistance eligibility for home and community-based services.

SB 38 PHARMACY BENEFITS MANAGERS; MANAGED CARE
Sponsor: Senator Elton
Committee(s) and date of last action: Read and referred to (S) HSS, 01/21/09
Description: This bill proposes to change language in a previous statute, amending "managed care entity" to "health care insurer."

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Bill Watch: Mental Health

HB 83 APPROP: MENTAL HEALTH BUDGET
Sponsor: Rules by request of the governor
Committee(s) and date of last action: Postponed hearings on 3/09, 03/10, and 03/11. No rescheduled hearing as of 03/11/09
Description: This bill outlines the specific appropriations for each component of the state's mental health program.

HB 52 POST-TRIAL JUROR COUNSELING
Sponsor: Representative Kerttula
Committee(s) and date of last action: Read and referred to (H) JUD, 01/20/09
Description: This bill proposes to make available up to 10 hours of psychological counseling for any juror serving in a criminal trial where graphic images or content are presented.

SB 21 MENTAL HEALTH CARE INSURANCE BENEFIT
Sponsor: Senators Davis and Ellis
Committee(s) and date of last action: Read and referred to (S) HSS, 01/21/09
Description: This bill proposes to implement parity in the types of medical services covered under existing health insurance plans. Specifically, it proposes that health care insurance policies be prohibited from denying coverage or discriminating health care services related to mental health, alcoholism or substance abuse; that there be no difference in coverage between physical and mental health coverage; and that these changes take effect no later than July 1, 2009.

Bill Watch: State Boards and Issues

HB 75 HEALTH COMMISSION/PLANNING
Sponsors: Representatives Cissna and Gruenberg
Committee(s) and date of last action: Read and referred to (H) HSS, 01/20/09
Description: This bill requests the establishment of the Alaska Health Commission, whose purpose is to provide policy recommendations ensuring quality, accessibility, and affordability of health care throughout the state. The commission is to have 15 members, of the following composition: one member from the Alaska Mental Health Trust Authority, one member from the University of Alaska Health Education and Training Program, one member representing the Alaska Native Tribal Health Consortium, one member from the Alaska Primary Care Association, one member from the Alaska State Hospital and Nursing Home Association, one member from the health industry, one member from the Alaska Nurses Association, two health care consumer members/advocates, and six members of the Alaska legislature. This act is to take effect by July 1, 2009.

HB 63 COUNCIL DOMESTIC VIOLENCE: MEMBERS, STAFF
Sponsors: Representatives Fairclough, Holmes, Coghill, and Wilson
Committee(s) and date of last action: Referred to (S) STA, 03/09/09
Description: This bill requests that the number of members of the Council on Domestic Violence and Sexual Assault be changed from three to four, and that at least one of the four members is a representative of a rural area of the state. In addition, this bill amends the length of term for public members from two to three years of eligible service. Other changes include adding the Department of Corrections as a regular collaborator with the council.

HB 25 HEALTH REFORM POLICY COMMISSION
Sponsor: Representative Hawker
Committee(s) and date of last action: Read and referred to (H) HSS, 01/20/09
Description: This bill proposes that issues related to health care and health care policy be given high priority among government officials. Specifically, it proposes the addition of a new chapter in the Alaska Statute 18, establishing the Alaska Health Reform Policy Commission, outlining the composition and duties of that commission, to be effective immediately.

SB 35 EXTEND SUICIDE PREVENTION COUNCIL
Sponsors: Senator, Davis, Ellis, Therriault
Committee(s) and date of last action: Moved out of (S) HSS and referred to (S) FIN on 02/27/09
Description: This bill amends a previous act to extend the termination of the Statewide Suicide Prevention Council from June 30, 2009 to June 30, 2013.

HB 123 EXTEND SUICIDE PREVENTION COUNCIL
Sponsor: Representative Flairclough
Committee(s) and date of last action: Referred to (H) STA, 02/11/09
Description: This bill proposes to extend the Suicide Prevention Council to June 30, 2013, effective immediately.

SB 40 EXTEND SUICIDE PREVENTION COUNCIL
Sponsor: Senator Therriault
Committee(s) and date of last action: Read and referred to (S) HSS, 01/21/09
Description: This bill is identical to SB 35.

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Bill Watch: Family Health Issues

Bill Watch: Worker's Compensation

HB 104 WORKER'S COMP. MEDICAL TREATMENT FEES
Sponsor: (H) Labor and Commerce
Committee(s) and date of last action: Referred to (H) RLS, 03/05/09
Description: This bill is "An act adjusting certain fees for treatment or services under the Alaska Workers' Compensation Act to reflect changes in the Consumer Price Index; and providing for an effective date.

SB 20 WORKER'S COMP MEDICAL/REHAB RECORDS
Sponsors: Senators French and Thomas
Committee(s) and date of last action: Read and referred to (S) L&C, 01/21/09
Description: This bill proposes that any documents containing personal and confidential information of an employee that is receiving, or has received, worker's compensation, are kept in a confidential location away from the public's view.

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AHPR Staff and Contributors

Lawrence D. Weiss, PhD, MS, Editor
Kelby Murphy, Associate Policy Analyst
Keith Liles, Project Coordinator
Jacqueline Yeagle, Newsletter design and editing

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