February 8, 2013

Legislative Notes for ASHNHA members; compiled from hearings, reports, news accounts and good old fashioned face to face discussion in the Capital City

Kenai Peninsula Borough Assembly endorses Medicaid Expansion

At the urging of Central Peninsula Hospital and South Peninsula Hospital, the Kenai Peninsula Borough Assembly passed a resolution urging the Governor and Kenai Peninsula legislative representatives to, “Weigh heavily the great benefits that would accrue to the residents of the borough and to the borough economy while deciding whether to expand our Medicaid program.”

Rick Davis, Central Peninsula Hospital’s CEO, mentioned in his letter to the Borough Assembly that he believes it is in the best interest of the Borough and the State of Alaska to look favorably on Medicaid expansion.  “Expansion will ensure coverage for economically challenged Alaskans, many of whom are employed but simply cannot afford healthcare,” he said.  In addition, Rick pointed out that during the healthcare reform debate that in exchange for reduced payments, hospitals were reassured that a higher percentage of patients with Medicaid (versus no insurance) would help mitigate some of the lost revenues.  Without the Medicaid expansion benefits, the economic compression will be even more substantial.

ASHNHA would like to commend both Rick Davis and Robert Letson, South Peninsula Hospital's CEO, for their efforts in bringing Medicaid expansion to their Borough Assembly.  Good job!

Click here to download CPH & SPH letters of support and the Kenai Borough Assembly’s resolution.

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Medicaid expansion significant boost to Alaska health care

ASHNHA member Alaska Native Tribal Health Consortium (ANTHC) rolled out two more blockbuster reports on the Medicaid expansion this week. The reports are packed with data about job generation and  the demographics of newly covered patients in Alaska.
One thing is very clear, this would be the largest expansion of Medicaid since the program first began in Alaska in the 1960s and probably the biggest bang for the buck we have ever seen with Alaska gaining $12-$15 in federal dollars for every one dollar in state money. (See article below titled "Can we achieve the nirvana of cost neutrality?").
The expansion would add up to 40,000 adults ages 21-65 to the program in January 2014, if Governor Parnell agrees.  The Governor has said he is waiting for information from DHSS in order to make an informed decision.
At the ASHNHA Winter meeting on Feb 18-19 we will walk through the reports and have them available for hard copy review.  Former Alaska DHSS Commissioner/Deputy Commissioner and Medicaid expert Jay Livey will synthesize the reports.  Jay has just finished a several year gig working for Senate Finance Co-Chair Lyman Hoffman (Bethel).
Meanwhile you can access these reports on the ANTHC website:

What is the bottom line on Medicaid Expansion in Alaska?

A modest investment to expand Medicaid coverage could boost the economy in all regions of Alaska, while improving access to health care for more than 40,000 Alaskans, reported the Alaska Native Tribal Health Consortium (ANTHC), which commissioned the most comprehensive independent studies to date of the Medicaid expansion option in Alaska.
The studies estimate that the State of Alaska net expenditure of $23.4 million over the next seven years would yield:
  • Basic health care for 40,000 uninsured Alaskans;
  • $1.1 billion in new federal revenue for Alaska;
  • 4,000 new jobs;
  • $1.2 billion more in wages and salaries paid to Alaskans; and
  • $2.49 billion in increased economic activity throughout Alaska.
ANTHC actually commissioned two reports and each report has slightly different numbers due to differing methodology.  We await the Lewin Report from the State which will likely provide another set of estimates.

Can we achieve the nirvana of cost neutrality?

Yes, possibly. Pundits and some experts think it might be possible to achieve cost neutrality with the Medicaid expansion or actual cost savings to the state treasury.  Many states have identified large savings in state funds.
The ANTHC summary report describes the situation in Alaska. Click here for the report.

"While state expenditures for Medicaid would increase by 2 percent to support Medicaid expansion, the additional $90.7 million over seven years would be largely offset by at least $67.3 million in savings to the State of Alaska budget. Other potential savings are still under review."
Eligible expenditures would include current state health programs to serve the poor, inpatient costs for those in corrections, substance abuse, detox and other grants that serve adults between 21-65 years.  According to Commissioner Streur, the department is performing a deep dive of the potential cost savings in grant programs and other state programs.

Urban Institute comes to Alaska!

One of the Medicaid reports on Alaska has been performed by the Urban Institute—a familiar and prestigious think tank which specializes in health and social policy analysis. This likely marks the first time the Institute has undertaken a project in Alaska.

According to their website, The Institute was established in 1968 to study the nation’s urban problems and evaluate the Great Society initiatives embodied in more than 400 laws passed in the prior four years.

Gradually the Institute's research and funding base broadened. Today, federal government contracts provide about 55% of the Institute’s operating funds, foundations another 34%, and state and local governments and private individuals the rest. Some of the Institute’s more than 100 private sponsors and funders include the Atlantic Philanthropies, the Annie E. Casey Foundation, the Ford Foundation, the Robert Wood Johnson Foundation, the Henry J. Kaiser Family Foundation, the Charles Stewart Mott Foundation, and the Rockefeller Foundation.

At any given time, 200 or more projects are underway at the Institute. New work includes studies on retirement and aging in America, who pays income taxes, state implementation of the Affordable Care Act, working families and their children, immigrant children in US schools, the cost-effectiveness of crime prevention, and the personal and national challenges of long-term unemployment. The Institute also studies the family, economic, and societal issues faced by prisoners released from prison. Overseas, UI has had projects in 20 countries, providing technical assistance in decentralization, local governance, and service delivery. Many Urban Institute policy centers are recognized as the leading policy institutes in their fields.

Urban Institute's staff of approximately 350 works in several research centers and program areas.

Scratching our heads

The heads of DHSS and Administration continue their joint presentation on the cost of health care and the need for providers to take an active role in slowing the growth. The core of the presentation is fairly similar to the one they presented last year at the ASHNHA Winter meeting.  The compelling presentation resulted in several follow up presentations at local hospital boards.
But there is one factoid cited by Commissioner Hultberg that we haven’t heard before.  Hultberg mentioned that according to a Rand study, each health care job created causes the loss of 0.85 jobs in other sectors of the economy.  We are digging into that information to check on the analysis.

Rumblings of budget cuts

For several weeks there have been discussions about further operating budget cuts. Mostly they are coming from the House Finance process.  Despite the fact that operating budgets are coming in with the lowest increases in recent memory—there is discussion of requesting an additional 5%-7% in reductions.  While that sounds fairly small, the savings would be difficult to achieve in a twelve month fiscal year period and would possibly trigger layoffs, grant and benefit reductions.   The House Finance committee has until the end of February to determine what cuts if any they will propose and mid-March until those budgets are passed to the Senate.

Senator Lisa Murkowski introduces Alaska Wellness Package

After speaking to the National Rural Health Association Conference, Senator Lisa Murkowski announced that she is sponsoring four new pieces of health care legislation aimed at improving Alaskans’ – and Americans’ – quality of life.  These bills will deal with:
  • Improving access to quality care for Medicare recipients;
  • Having better diagnosis and care for people with Fetal Alcohol Spectrum Disorders (FASD);
  • Conducting a land transfer for land near the Alaska Native Medical Center to ANTHC so that a new facility could be constructed to handle the growing number of patients being seen at the current facility.
  • Extending the Frontier Extended Stay Clinic (FESC) Demonstration for the four clinics in Alaska (Prince of Wales, Haines, Glenallen, and Unalaska).  This program is due to expire at the end of March and this legislation extends the program for three more years.
Click here to read the full article from Senator Murkowski.

Rep. Wes Keller sponsors legislation requiring a consultation requirement for the prescription of opiates under certain circumstances

Representative Wes Keller (R-Wasilla) introduced HB 53 to address the issue of opiate prescription drugs by establishing a process for patient and medical professionals to work with a pain relief specialist on the actual drug needed for treatment.  Rep. Keller stated that opiate drugs also have another more sinister reputation, illegal resale. Rep. Keller believes that this legislation will be an important step in identifying and helping reduce dependency on addictive drugs and provides a potential decrease in availability keeping those drugs off the illegal distribution system.

Under the terms of the legislation a health care provider “who prescribes 120 milligrams morphine equivalent or more a day of an opiate to a patient shall consult with a pain management specialist if the patient is still taking 120 milligrams of morphine equivalent or more a day of an opiate after four weeks.”  There are exclusions to this including patients who are receiving end-of-life care, under surgical care, following a tapering schedule, who is on a nonescalating dose of an opiate, or if the provider is a pain management specialist.

House Bill 53 is in the House Health and Social Services Committee.  You can read the entire legislation by clicking here and selecting the CS HB 53 Ver C.pdf link.

Legislative Hearings February 11 – 15:

  • Monday, February 11th  @ 8:30am – House Health & Social Services Finance Subcommittee – Legislative Budget & Audit - Single Audit, capital projects as they relate to the operating budget, and intent language
  • Monday, February 11th @ 1:30pm – Senate Health and Social Services Committee – Senate Bill 39, Statutory Refs to Mental Retardation
  • Tuesday, February 1212h @ 3:00pm – House Health and Social Services Committee – House Bill 16, Adult Public Assistance Eligibility
  • Wednesday, February 13th @ 8:30am - House Health & Social Services Finance Subcommittee – Senior & Disabilities Services
  • Thursday, February 14th @ 9:00am – Senate Finance Committee – Health and Social Services Capital Budget Overview
  • Thursday, February 14th @ 1:45pm – Senate Finance Subcommittee – Mental Health Trust
  • Thursday, February 14th @ 3:00pm – House Health and Social Services Committee – House Bill 44, Advance Health Care Directives Registry.
  • Friday, February 15th @ 8:30am - House Health & Social Services Finance Subcommittee – Public Assistance

It’s not too late to join us in Juneau for the Legislative Meeting

We are putting the final touches on the agenda for the ASHNHA Winter meeting February 18-19 in Juneau.  The agenda is packed with updates from the Capitol including:
  • Dinnerwith Senator Kevin Meyer, Co-Chair of Senate Finance
  • Commissioner of DHSS, William Streur          
  • Department of Administration Commissioner Becky Hultberg
  • A deep dive into recent reports issued on the Medicaid expansion in Alaska
  • A review of selected issues in the state’s Medicaid program by Director of Health Care Services, Margaret Brodie
  • An update on Background Checks by Director Brodie and Jane Urbanovsky
  • Analysis and review of State Active and Retiree claim trends by Commissioner Becky Hultberg and her staff
  • A first review of the financing plan for Alaska’s Health Information Exchange
All this is interspersed with visits to Legislators and an Executive Committee meeting with Governor Parnell and a House HSS overview.

If you haven’t made your plans to come, there is still time. We have a few hotel rooms left at the Baranof.  If you are interested in attending, contact Geoff Bullock in the Juneau office at 586-1790 or

Mentors for Quality Program

On January 24th, the Mentors for Quality Program convened for the first time in Fairbanks, Alaska. A partnership between Fairbanks Memorial Hospital, Central Peninsula Hospital, and ASHNHA; the newly developed program brings together experienced Quality Improvement leaders and pairs them with those new to the field. The first cohort is comprised of seven candidates from seven small hospitals and seven mentors from FMH and Central Peninsula. During 2013, each candidate will work on a rigorous quality improvement project at their respective hospitals. The mentor will provide guidance, knowledge and experience as each project moves forward. Near the end of 2013, the participants will have the opportunity to present posters showcasing their efforts at a state-wide conference. As the Mentors for Quality Program develops, its success will be evaluated and if it meets its intended goals, a second cohort will be formed to continue developing the QI infrastructure in our state.

Direct Incentive & Loan Repayment deadline is March 18

SHARP - Alaska’s health care student loan repayment program, is once again accepting applications from health practitioners seeking school loan reimbursement. Deadline is March 18, 2013.

Qualified applicants can receive repayment benefits of up to $47,000/year and now direct incentives are also available. To learn more click here

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