Capitol Live: Dunleavy’s proposed Medicaid cuts would be made in two phases

Capitol Live: Dunleavy’s proposed Medicaid cuts would be made in two phases

Follow along with live updates from Alaska’s Capitol.

3 p.m.

Steward says the entire process of eliminating preventative dental care would take about six months after it goes through.

“Because we are eliminating one of those services that is optional service, the regulation and the state plan change could go through at the same time… it could be a compressed timeline,” Steward says.

Seven hospitals would be subject to a 5 percent rate reduction, she says.

Phase one reductions would total $186 million.

— Mollie Barnes

2:40 p.m.

“If we send people out of state we’re not going to have as many providers here… but there may be a bigger cost savings. I just want to put everything on the table,” Wilson says regarding looking at possibilities of sending people to the Lower 48 for medical care.

Steward says Alaska will join 18 other states in which emergency dental care is provided. But preventative will not care.

Rep. Dan Ortiz says it’s safe to say there will be an increase in emergency dental care costs based on the fact preventative care will no longer be provided.

“Teasing out what that change would be would be difficult,” Steward says. Josephson wants to know what other states we are joining.

“Are the states we think of typically poor like Mississippi? Are they affluent states?”

Steward says there are eight states that do not even provide emergency dental care, either. So she can provide the list of 26 states.

“This is a retreat of some sort, isn’t it?” Josephson says.

“It is a policy decision,” Efird says. “I’m sure you’ve heard the governor’s tenant. Our direction was to meet our core services… we are trying to protect the core services for low income Alaskans for their health care coverage. Yes, cutting the adult preventative dental could increase costs in other areas… however it is an optional service under our Medicaid program and it is a more recent service that has been covered in Medicaid.”

Steward says dental is not required under the Affordable Care Act, so it is truly optional.

— Mollie Barnes

2:20 p.m.

“We attempted to apply any other rate adjustment across other providers (besides primary care and critical access hospitals) as fairly as possible,” Steward says.

She says there has been an increase in payments to hospitals from 2015 to 2019, some of which is due to the expansion of eligibility of Medicaid.

She says direct comparisons really can’t be done to hospitals in the Lower 48 due to the system that Alaska uses for payments.

“Across the board in their state Medicaid program they pay all providers, services below Medicaid rates,” Steward says of Washington state hospitals.

Rep. Tammie Wilson, R-North Pole, says that Alaska’s system incentivizes people to go out of state to have procedures done.

“Our insurance tries to push you out, and Medicaid they try to keep you in,” Wilson says.

Steward says she has not looked at whether it would be cheaper to send patients out of state for certain services. But there are certain things that aren’t available in Alaska, so they do send patients out of state for those types of services.

Wilson says she thinks something needs to be done to look at whether or not it’s cheaper to send certain patients out of state for certain services.

— Mollie Barnes

1:55 p.m.

There’s a big slide in their presentation that says “The Department is not recommending any adjustments to Medicaid program eligibility.”

That’s been a big question when people hear about cuts to the Medicaid program.

Steward says this applies to phase one as well as phase two.

“We wanted to make sure no matter what we do we protect primary care, small hospitals, access to services and to make sure we align payment with other public payers,” Steward says, other public payers being the Medicare program.

Rep. Ortiz is asking for clarification about protecting small hospitals because he’s heard from hospitals in his district that they might be in jeopardy if Dunleavy’s budget is enacted.

Steward says critical access hospitals are ones they will be protecting.

“Critical access is a specific designation for hospitals,” Steward says. “It is typically due to the size. By size I mean the number of in patient beds… the threshold is 25 beds. So a critical access hospital has 25 or fewer beds available for service.”

— Mollie Barnes

1:45 p.m.

The House Finance committee is meeting today and receiving an overview of Medicaid services from the Administrative Services Director Sana Efird and Deputy Commissioner for the Department of Health and Social Services Donna Steward.

They’re discussing a proposed 32 percent reduction to the Medicaid budget.

The proposed budget would eliminate adult dental medicaid benefits (about $8.2 million of state funds and $18.7 million federal funds), but Steward says emergency dental procedures would still be covered.

“A budget is our plan, it’s our best estimate…but claims might not come in to the exact number that we’ve aligned,” Efird says.

To implement the Medicaid program adjustments, Steward says they will be implementing the changes over two phases. Phase one is attainable in fiscal year 2020, Steward says. It involves familiar strategies plus new approaches, she says.

— Mollie Barnes

12:20 p.m.

Coghill says there’s 80 different sections of the ethics code that they need to deal with.

He’s encouraging legislators to vote for the bill, imperfect as it is.

The bill passes 15-4, with Kiehl, Kawasaki, Olson and Wielechowski voting nay.

— Mollie Barnes

12:10 p.m.

Kiehl says he thinks a reset on HB 44 is too far. Kawasaki says that HB 44 never even mentions official action, which is something the lawmakers are really “spun up” about.

He says they can easily cure the issues by simply redefining what official actions mean.

“We can do that simply without undermining the people’s intent to put (a legislator’s accountability initiative) on the ballot,” Kawasaki says. “This goes a step too far.”

They’re taking a brief at ease now.

— Mollie Barnes

12:05 p.m.

“It really comes to your constitutional duty to be able to speak freely as a member of Alaska’s Senate or House,” Coghill says. “When do you throttle back the 32,000 people and their voice? And when is it a real conflict with you? I don’t know that we’ve got the perfect balance… It’s meant to be accountability structures… that if you’re grandizing yourself at the state expense with your authority, you should be held accountable.”

He says last year the definition was too broad and it put a cloud over legislators’ heads. This new bill up for vote would “reset” that.

This bill goes back to some of the original language that the state had before HB 44.

Majority Leader Mia Costello says the reason this bill is before the senate today because senators realized they need to return some common sense to unintended consequences of HB 44.

She says she’s unable to have conversations about aviation in her office because he husband works for the industry.

“My representing the district that has the Ted Stevens International Airport… means that I need to be able to talk about aviation,” Costello says. She says people knew her husband worked for the aviation industry when they voted for her, so it’s not a conflict of interest.

Hughes says she had to halt her work on health care issues because her spouse works in the field. Read more about that in our story here.

“These are flaws that surfaced, we all understand they need to be fixed,” Hughes says. “I’m just grateful I get to take this vote today.”

— Mollie Barnes

11:55 a.m.

Kiehl says it’s a policy choice.

“If it’s in your financial interest, peculiarly to you, to your household, for something to pass, or stop something from passing, that has potential to be a genuine conflict of interest,” Kiehl says.

His amendment fails 14-5, with Begich, Kawasaki, Kiehl, Olson and Wielechowski voting yay.

Now Kiehl is introducing a third amendment.

Before only an equity or ownership interest was considered a conflict of interest, his amendment would broaden that to include anything that puts more money in your pocket or leaves more money in your pocket to a greater extent than others, he says.

“In the past we have seen … the ethics committee apply different standards, this would set a thousand dollar line,” Kiehl says. “Amendment three draws a nice bright line.”

Coghill is taking issue with the language in the amendment he thinks might be too ambiguous. The amendment says a legislator must declare a conflict of interest if action on the question could affect a legislator by a financial loss or gain that is “greater than the resulting financial loss or gain by a substantial class of persons to which the legislator belongs as a member of a profession, occupation, industry or region.”

He says it’s hard to quantify “substantial.”

Sen. Peter Micciche, R-Soldotna, says he finds the amendment redundant and that it softens the requirements to declare conflicts of interest. He says right now you should declare any impact on finances, not just when it reaches $1,000.

Kiehl says the substantial class of persons language has been used in the past, so it’s not a constitutional question.

“Without amendment No. 3, we have a real gap,” Kiehl says. “Amendment three is a good change and a good split between status quo law.”

The amendment fails 14-5, with Begich, Kawasaki, Kiehl, Olson and Wielechowski voting yay.

“Thanks to the members who proposed amendments, because they highlighted the need for the passage of (this bill),” Coghill says. “Part of the discussion that led up to us getting this on the floor is how much do we want to work on the ethics code… As we read the code it gets pretty arcane.”

— Mollie Barnes

11:42 a.m.

Sen. David Wilson, R-Wasilla, is introducing an amendment. He says he wasn’t in a committee that worked on the bill, that’s why he’s introducing the amendment today.

“Despite multiple constitutional issues that were raised… the legislature passed the bill. This amendment would erase which passed in HB 44…which we used before,” he says. This would get rid of the constitutionality issues that he says the bill has.

He says he’s received emails from constituents wondering why some legislators declare conflicts of interest and other legislators do not.

“A person can not be a little bit ethical… it seems that the legislature was hoping common sense would be used when interpreting our new ethics laws,” he says.

SB 89 is not a fix, Wilson says, adding that he believes the legislature needs to start over and take a deeper dive into the ethics laws. His amendment would bring the ethics laws back to the way they were before HB 44.

Sen. John Coghill, R-North Pole, says a simple repeal is not the way to go about reworking the ethics laws, so he will not be supporting the amendment.

The amendment failed 17-2, with Wilson and Sen. Donny Olson voting yay.

Kiehl is introducing a second amendment to the bill, which would change the scope of the requirements for declaring a conflict of interest. The bill states a person has to declare a conflict of interest for anyone in a person’s immediate family. Kiehl’s amendment would change that to only require declaring conflicts of interest for dependent children or nondependent children living with the legislator, effectively removing the need to declare conflicts of interest for children who are older and moved out of the legislator’s household.

— Mollie Barnes

11:24 a.m.

The Senate Finance committee has introduced a substitute to a bill that renews the vaccine assessment program. The main addition would be a change in the way money is given out for the program.

Sen. Natasha Imhof, R-Anchorage, says that the new fund allows the department to react quicker in case of an outbreak, such as the recent measles outbreak.

“It reauthorizes the vaccine assessment program which is set to expire in early 2021,” said Sen. Donny Olson, D-Golovin. “It was established in 2014… the program monitors, purchases and distributes all childhood vaccines as well as selective adult vaccines.”

He encourages passage of this important bill.

The bill passed unanimously 19-0. Sen. Elvi Gray-Jackson is excused from the session today.

Now they’re looking at a bill related to the ethics policy for the legislature. The Judiciary Committee has proposed a substitute to the bill.

“This change will require legislators to declare a conflict of interest before voting on a question in committee,” says Sen. Shelley Hughes, R-Palmer.

They’re now taking a brief at ease.

— Mollie Barnes

11:15 a.m.

The Senate has gaveled in. They’re doing their introductions now.

There’s lots of guests this morning visiting from NAMI, the National Alliance on Mental Illness. Sen. Jesse Kiehl, D-Juneau, is hosting a lunch and learn later called Sharing Hope: Stories from Alaskans Affected by Mental Illness by the NAMI Board of Directors.

— Mollie Barnes

9:30 a.m.

Members of both parties of Alaska’s Legislature have formed a new caucus focused on innovation and entrepreneurship.

“For thousands of years, Alaskans have demonstrated a spirit of innovation and resourcefulness from ingenious traditional uses of local resources for clothing, tools, and weapons to modern Arctic engineering,” said Representative John Lincoln, D-Kotzebue, co-chair. “Innovation Caucus members are united in our desire to understand, celebrate, and facilitate our state’s ongoing legacy of innovation and entrepreneurialism for the benefit of all Alaskans.”

They’re calling it the Alaska Innovation Caucus (AKIC) and the official press release said the group aims to foster a culture of entrepreneurship, support small business development across Alaska, and solve Alaska’s challenges through innovation.

The bipartisan, bicameral caucus includes: Rep. John Lincoln (D-Kotzebue) Co-Chair, Sen. Mia Costello (R-Anchorage) Co-Chair; Southwest: Rep. Neal Foster (D), Rep. Tiffany Zulkosky (D); Southeast: Rep. Jonathan Kreiss-Tomkins (D); Kenai Peninsula: Rep. Ben Carpenter (R), Rep. Gary Knopp (R), Eagle River; Rep. Kelly Merrick (R), Sen. Lora Reinbold (R); Anchorage: Sen. Tom Begich (D), Rep. Matt Claman (D), Rep. Zach Fields (D), Rep. Jennifer Johnston (R), Rep. Gabrielle LeDoux (R), Rep. Sara Rasmussen (R), Rep. Chris Tuck (D), Sen. Bill Wielechowski (D); Mat-Su Valley: Rep. David Eastman (R), Sen. Shelley Hughes (R), Rep. DeLena Johnson (R), Rep. Colleen Sullivan-Leonard (R), Rep. Cathy Tilton (R); Fairbanks: Sen. Click Bishop (R), Rep. Grier Hopkins (D).

Research by the National Bureau of Economic Research shows that net job creation is driven by business start-ups, according to the press release. Innovation is a central driver of high-growth startups, allowing companies to form around new products and services.

The caucus will research and discuss policy options, including encouraging growth of globally competitive startups and greater access to venture capital; simplifying, and helping startups navigate regulatory frameworks within the state; supporting development of startup mentorship networks; and supporting entrepreneurship in schools and universities, including encouraging technology transfer and commercialization, according to the press release.

“Innovation is at the heart of economic development,” said Senator Mia Costello, co-chair. “All new job growth was created through small business startups, Alaska’s entrepreneurs, and innovators.”

— Mollie Barnes

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