Statements on Introduced Bills and Joint Resolutions S294

STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

By Ms. MURKOWSKI:

S. 294. A bill to eliminate the sunset for the determination of the Federal medical assistance percentage for Alaska under the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000; to the Committee on Finance.

Ms. MURKOWSKI. Mr. President, I speak today on behalf of Alaska's most vulnerable individuals, our children, the disabled, and the elderly poor. Since its enactment in 1965, the Medicaid program has helped States provide low-income and disabled individuals with access to vital health care services. In 1997, Congress allowed States to take on certain health-related responsibilities for children. The Denali Kid Care program, a Medicaid expansion, has been very successful in providing health services for Alaskan children. Unfortunately, under current law many Alaskans who rely on this program could lose some or all of their Medicaid coverage. This is because Alaska's Federal Medical Assistance percentage, FMAP, adjustment, a correction to the Medicaid formula due to the high cost of health care in Alaska, will expire within the next 2 fiscal years. An FMAP correction is necessary for Alaska because this "one-size-fits-all" formula does not account for variations in cost-of-living, and does not consider Alaska's higher federally mandated poverty level.

First of all, the FMAP formula was developed in 1946, 13 years before Alaska was admitted to the Union. This archaic formula is used to calculate the Federal share of Medicaid costs for each State. The calculations are based on the per capita income of individual States relative to the national per capita income. In this way, States with higher per capita incomes end up paying a higher percentage of their Medicaid costs. This formula appears to work well for States near the national norms for most economic indicators. It most certainly does not work in the State of Alaska, however, where these economic indicators appear more frequently as statistical exceptions and outlyers.

The problem is fairly simple: it just costs more to do business in Alaska, and this includes health care. A national per capita income threshold is not a fair indicator unless it takes into account the cost of living in that area. The cost-of-living adjustment for Federal employees in Alaska suggests that it costs 25 percent more to live in Alaska than in the lower 48, and Federal employee salaries are adjusted accordingly. A dollar simply does not buy the same thing in Alaska that it does in the lower 48.

This is especially true for health care costs. Estimates suggest that, on average, it costs up to 71 percent more to deliver health care services in Alaska. American Hospital Association data shows that Alaska has the highest average expense per hospital admission of any State in the Nation. But let's talk real numbers again. If you were to be admitted to a hospital in Oregon, on average the cost would be $6,649.00; in Alaska the same average hospital stay costs almost double, $10,859.00. There are also higher costs associated with limited road access and necessary air ambulance service for rural and isolated communities, but the Medicaid FMAP formula does not consider any of these additional costs.

In addition to the higher cost of services in Alaska, the Federal Government sets the poverty level 20 percent higher in Alaska than in any of the lower 48 States. This means 1 out of every 5 Alaskans is eligible for Medicaid. The problem is that this is essentially an unfunded Federal mandate because the FMAP formula, again, does not change to reflect this additional requirement. The higher demand for services that results from the higher poverty level dilutes our resources. The Medicaid FMAP formula was developed before Alaska became a State and does NOT provide the funds to cover all of those who are eligible.

However, in 1997 and again in 2000, Congress recognized that the Medicaid FMAP formula was unfair for Alaska and enacted an adjustment to the formula. Due in part to this more equitable funding and a careful re-allocation of resources, Alaska now: has the lowest age-adjusted death rate for breast cancer in the Nation; has one of the lowest infant mortality rates in the Nation; and has one of the lowest percentages of low birth weight babies in the Nation.

These are encouraging statistics, but more can and must be done to improve access to quality health care. All disabled and low-income Americans, including Alaskans, have been assured access to quality medical care. Alaska has proven it can deliver this quality care, but only with the necessary adjustment to the FMAP formula that recognizes the reality of Alaska's needs.

This issue is timely because the Congress has the opportunity to allow the State of Alaska to plan for the future. Planning is the essence of good management, and when it comes to health care, we must allow States to plan for future needs. In short, the Federal Government must remember its commitment to Alaskans, and allow my State a benefit that all other states have, assurance that money for vital Medicaid services will not just dry up and disappear.

Alaskans do not seek charity, we seek equity. The Congress has supported this request twice before, and I ask for an additional extension to honor Federal commitments to my state. The legislation that I am introducing today will permanently adjust the Medicaid formula for Alaska. I sincerely hope that my colleagues will support this vital legislation that will preserve my State's ability to provide health insurance to the most vulnerable Alaskans.