Alaska's Legislature recently passed Senate Bill 105, legislation that if signed into law will make it more difficult for children from low-income families to qualify for Denali Kid Care. This program originally was developed to reduce the number of uninsured Alaskans, and has been quite effective at extending health coverage to poor children whose families couldn't otherwise afford insurance. In addition, by leveraging a favorable federal match, each state dollar spent on the program brings in about three additional dollars from Washington, D.C., to purchase local medical services.
If SB 105 becomes law, more than 1,300 Alaskans from low-income families will no longer be "poor enough" to qualify for the program and will lose their coverage. A similar number would likely lose coverage over the next five years. The cuts will affect children mostly, but because the legislation also deals with Medicaid qualifications, some low-income pregnant women also would lose coverage. Studies clearly show children with chronic diseases as well as pregnant women have substantially poorer health outcomes when they are uninsured. Thus, it's virtually certain the health of many Alaskans will be adversely affected by the cuts.
Recent analysis of U.S. Census Bureau data found 169,000 Alaskans lacked health insurance for at least some portion of the last two-year period. The problem, of course, isn't unique to Alaska. Nationwide, 75 million Americans lacked health insurance over the two years, representing almost one-third of non-Medicare eligible Americans. More than half were without coverage for a full year, and one-fourth lacked coverage for the entire 24 months. Twenty-five percent of the uninsured are under 18, translating to roughly 42,000 Alaska children.
The number of patients without insurance had been relatively steady during the 1990s, due in part to the expansion of programs such as Denali Kid Care. Unfortunately, recent economic downturns have swelled the uninsureds' ranks. In 200l alone, 1.4 million more Americans lost their insurance as workers were laid off, employers found they could no longer afford to offer benefits, or premium co-pays made insurance too costly for many employees.
Since health insurance is traditionally provided through work, it is often assumed that the uninsured are unemployed. In fact, fully three-fourths of the uninsured are workers or dependents in working families. Likewise, it is sometimes assumed that these patients get adequate care in emergency rooms. In fact uninsured persons with chronic illnesses are known to lack routine care and are almost twice as likely as the insured to require emergency hospitalizations. Studies show that parents of uninsured children are seven times as likely to delay or go without filling prescriptions than parents of insured.
Not only will the health of children be negatively impacted if SB 105 is enacted, but total health care costs incurred by Alaskans will almost certainly increase. This is because most of these patients will still require care that will have to be provided for free by physicians and hospitals. In turn these providers will shift costs to their paying patients. Through this cost-shifting, insured Alaskans will end up covering close to 100 percent of the uninsureds' costs, whereas the state is currently purchasing the care for closer to 27 cents on the dollar. In other words, while the Legislature may save $7 million over the next five years, Alaskans paying insurance premiums, along with providers like Bartlett and Providence Hospitals, will pick up most of the tab, plus much of the $20 million that has been provided through federal funds until now.
The Alaska State Medical Association represents physicians statewide and is primarily concerned with the health of Alaskans. We support the administration's original budgetary proposal calling for continued full funding of Denali Kid Care and urge the governor to veto Senate Bill 105. This veto would allow Alaska to continue receiving the millions in federal funds that will flow into the state to cover costs of services that are going to be provided anyway. More importantly, a veto would ensure high quality health care and improved health status for some of our most vulnerable neighbors.
Dr. Alex Malter is a Juneau internist and president-elect of the Alaska State Medical Association.
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