Controlling Medicaid Costs (Short Summary from House Finance Report)

Intro:
I'm going to do two or three posts on Friday's Finance Committee Hearing on Medicaid Costs.  This is "single greatest line item of state spending."  So,

• it is very complicated (but not impossible)
• it is important for Alaskans to understand
• the information provided at the hearing made things fairly easy to understand

This post is introductory, brief, and an looks at ways to control costs.   This is stuff most people hide from because it seems too difficult to grasp.  I challenge you to read this post carefully.  It's short.  It should give you some handles for starting to understand this issue.  The next post will offer my rough notes of the actual presentation so you can see the kinds of questions that legislators asked and the answers they got.  This post is extracted from that. 

What Happened Friday and Why?

The House Finance Committee commissioned, Janet Cooke, a former Health and Social Services employee, to evaluate the HHS' supplementary budget request for $88 million for Medicaid. (Supplementary budget means coming back mid year after seeing actual costs and adding to the original budget.)  They wanted to know:

1. What caused the increase from FY 2009 to FY 2010?  (Fiscal Year 2009.  Alaska State fiscal years begin July 1 the year before - for FY 2009 that would be July 1, 2008)
2. How much should the legislature add to the existing FY 2010 budget? (This year has already been budgeted so how much will the Department need to cover the costs? *
3. How much should the legislature spend for the next FY (2011)?

Two Terms

*Medicaid is an entitlement program.  This means if people meet the criteria for the program, they are eligible for services.  Thus the cost is not predictable.  If more people qualify (lose their jobs) or if those qualified get sick more, or if prices rise, the State is still obligated to pay and the costs will rise.

Also, the state shares these costs with the federal government.  FMAP stands for Federal Medicaid Authorized Percentage - the federal matching rate.  Alaskaʻs FMAP would have fallen to 50% (this year, I think) but the Economic Stimulus Bill (ARRA) [American Recovery and Reinvestment Act of 2009] increased the rate to 61.12%, meaning the federal government will pay 61.12% and the state 38.88%.  (Actually there are different formulas for different populations and programs.  So, for instance, Alaska Natives treated in an IHS facility get 100% federal reimbursement.)



Control of Costs:

Medicaid is an entitlement program.  If people are eligible, they are entitled.  So if the pool of eligible people increases, the costs go up.  That leaves limited options.  Here are some of the options I heard discussed at the hearing:

1.  Alaska Natives treated at IHS (Indian Health Service) facilities are covered 100% by Medicaid.  Therefore, the more Alaska Natives get care at IHS facilities, the less the state has to pay.  Thus there are several places where the state has some leverage:

• Helping set up IHS facilities in places where large numbers of Alaska Natives live but can't get to IHS care.  The issue of longterm care came up as one with the most potential, because now there are few or no such facilities in rural Alaska.
• Encourage Alaska Natives to use IHS facilities

As one legislator said, because of the IHS Alaska Natives get 100% paid by the federal government, and that leaves more money for non-Native Alaskan care.

2.  Prevent small problems from escalating into large problems

• Make more preventive care available.  (I believe it was Clarke who pointed out that Medicaid won't pay for this)
• Make primary care facilities (including quick access) available in communities so that people go to primary care doctors instead of emergency rooms. 
• Develop the economy, create jobs so that people move out of poverty and get health insurance

These ways that the State can affect Medicaid costs are just one issue that arose in the Friday hearing on Medicaid costs of the House Finance Committee.  I'll put up at least one other posts on this.  It is complicated, but Janet Clarke's report helps a great deal.

Getting a sense of Medicaid costs - a huge part of the Alaska State budget ($1.2 Billion) - is not that hard.  There will be repetition in the next posts, but I'm finding that the repetition is critical in my own understanding of this.

If Thoreau Had a Blog - "will not any endeavor to cure the brain-rot"

A Juneau friend has lent me a book of poetry edited by Robert Bly.  I've never been particularly attracted to Bly, but there are a lot of poems by different poets in this book.  The Rag and Bone Shop of the Heart is subtitled "Poems for Men."  Except this piece by Thoreau is prose.

And I can't find, in the book, where this piece is from.  There's a copyright section at the end, but I guess this is old enough that the rights were public.  Fortunately, today, unlike 1992 when the book was published, I can easily find the source through Google.  It's little, but cumulative, issues like this, that I think have soured me on Bly.   In any case, Google tells me this is from the conclusion of Walden Pond.  So you can read what I left out, plus the rest of Waldon Pond at the link if you choose.

I fear chiefly lest my expression may not be extravagant enough, may not wander far enough beyond the narrow limits of my daily experience, so as to be adequate to the truth of which I have been convinced. Extra vagance! it depends on how you are yarded. . .

I desire to speak somewhere without bounds; like a man in a waking moment, to men in their waking moments; for I am convinced that I cannot exaggerate enough even to lay the foundation of a true expression. Who that has heard a strain of music feared then lest he should speak extravagantly any more forever?

Why level downward to our dullest perception always, and praise that as common sense? The commonest sense is the sense of men asleep, which they express by snoring. Sometimes we are inclined to class those who are once-and-a-half-witted with the half-witted, because we appreciate only a third part of their wit. Some would find fault with the morning red, if they ever got up early enough. "They pretend," as I hear, "that the verses of Kabir have four different senses; illusion, spirit, intellect, and the exoteric doctrine of the Vedas"; but in this part of the world it is considered a ground for complaint if a man's writings admit of more than one interpretation. While England endeavors to cure the potato-rot, will not any endeavor to cure the brain-rot, which prevails so much more widely and fatally?

Would this Thoreau's blog have any readers today?  How would he have written this today?  Would he think, perhaps that today we have taken his call for extravagance a bit too far?  Or not far enough?   I'm sure he would still be railing against the limits of common sense and brain-rot. 

From Boloji:  

Six hundred years ago Kabir was born in India in 1398 AD. He lived for 120 years and is said to have relinquished his body in 1518. This period is also said to be the beginning of Bhakti Movement in India.

A weaver by profession, Kabir ranks among the world's greatest poets. Back home in India, he is perhaps the most quoted author. The Holy Guru Granth Sahib contains over 500 verses by Kabir. The Sikh community in particular and others who follow the Holy Granth, hold Kabir in the same reverence as the other ten Gurus.

Kabir openly criticized all sects and gave a new direction to the Indian philosophy. This is due to his straight forward approach that has a universal appeal. It is for this reason that Kabir is held in high esteem all over the world. To call Kabir a universal Guru is not an over exaggeration. To me personally, the very name Kabir means Guru's Grace. 

And from Sacred-Texts:

The Vedas

There are four Vedas, the Rig Veda, Sama Veda, Yajur Veda and Atharva Veda. The Vedas are the primary texts of Hinduism. They also had a vast influence on Buddhism, Jainism, and Sikhism. Traditionally the text of the Vedas was coeval with the universe. Scholars have determined that the Rig Veda, the oldest of the four Vedas, was composed about 1500 B.C., and codified about 600 B.C. It is unknown when it was finally committed to writing, but this probably was at some point after 300 B.C.
The Vedas contain hymns, incantations, and rituals from ancient India. Along with the Book of the Dead, the Enuma Elish, the I Ching, and the Avesta, they are among the most ancient religious texts still in existence. Besides their spiritual value, they also give a unique view of everyday life in India four thousand years ago. The Vedas are also the most ancient extensive texts in an Indo-European language, and as such are invaluable in the study of comparative linguistics.

Did I Mention How Beautiful Juneau Is?

I got to sleep in and didnʻt get up til 9am. Then I worked on some posts and since the sun was shining again, went for a run.

It turned out that in the Channel it was foggy again.

 

Since I met that geologist while I was taking a picture 

like this, there will be no stopping me.

On the way back the creek was generating its own fog.

And when I got home, the crocus had opened.  I guess this is included in the rent.  The stigmaʻs bright orange reminded me that crocus stigmas are the source of saffron.  But it turns out not just any crocus.  From Local Harvest:

The expensive saffron spice that you buy in the store is the dried female portion (stigma) of the Saffron Crocus. Why not grow your own? Saffron is the world's most expensive spice. Fortunately the home gardener only needs a couple dozen Saffron Crocus to produce enough saffron for some occasional dishes throughout the year. The corms will multiply each year, and to prevent overcrowding, corms are divided every 4 to 5 years. Saffron is grown mostly as a culinary and medicinal herb, having been cultivated for at least 4,000 years. Historically saffron has also been used as a natural dye for hair and natural fabrics, and for use in perfumes. Medicinal: Traditional use for its spasmolytic and sedative effects. Ornamental: Saffron blooms in mid-fall, producing exquisite brightly colored, lilac-purple blooms, each with three vibrant red stigmas. Even if you never harvest Saffron Crocus for food use, it deserves its own special place in the flower garden.

 Unfortunately,  the site also says it grows in zones 6-9.  That would work in Juneau I suspect, but not in Anchorage.  

So then I went down to the capitol and sat in on the full Finance Committee hearing on the medicaid budget which was interesting, but they didnʻt talk about the mental health budget or Bring the Kids Home.  But Iʻd gotten a call from Rep. Jouleʻs staff to pick up the spread she they were working off of at the subcommittee meeting so Iʻll try to make the corrections this weekend. 

And when I was back home, K and P knocked on the window and invited me to walk back up Perseverance Trail.  P picked up a friend's dog - Apollo - and off we went.  Except an almost full moon was coming up as the sun was setting and I kept pulling out my camera.

From the street outside our gate.

Looking back as we walk up Basin Road past the houses.

Looking up ahead.  

 

Walking back.

Dan Sullivan House Judiciary Confirmation Hearing

Itʻs hard to be purely a reporter (in the literal sense) and not to add shading on the confirmation hearing for Dan Sullivan. In fact, simply presenting the cold facts would hardly convey the very warm reception Sullivan received. Committee Chair Jay Ramras did everything but blow kisses at the nominee and his in-laws (former Fairbanks Rep. Hugh ʻBudʻ Fate and former UA Regent Mary Jane Fate) who were in attendance.  He constantly called him "General" instead of "Attorney General."*  He looked at him like a kid staring at his new puppy. [If you question my interpretation, you can listen to the hearing yourself on Gavel to Gavel. NOTE: old hearings tend to disappear and this link is no longer good.]

And Sullivanʻs resume is very impressive - Harvard undergrad, George Washington law school, Marines, White House Fellow, Assistant Secretary of State ...

He presents his strong qualifications on this first video clip.




In his opening remarks Sullivan outlined four key areas of focus:

1. Protecting Alaskans first, in the criminal side, and he cited Gov. Parnellʻs sexual assault initiative and second in "the many other areas in the work that we do."
2. Support Economic Opportunity - which he acknowledged was not something you associate usually with an attorney-generalʻs office.  He specifically mentioned intervening in Endangered Species cases and Outer Continental Shelf cases, "anywhere the stateʻs economic interests are focused."
3. Protecting the Stateʻs fiscal integrity - collecting monies owed the state or fighting law suits against the state.  
4. Promoting good government and making sure our state operates within the parameters of the Constitution of the state.

Then he added "the challenges of improving the life in rural Alaska." (His mother-in-law is a Koyukon Athabascan who was born in Rampart.)

While most of the committee members continued the effusive tone the Chair set, Rep. Herron, from Bethel, did question him closely about the stateʻs apparent challenging of federally recognized tribal sovereignty for Alaskaʻs Native peoples in the Kaltag case.  He seemed to sidestep the question whether the state is trying to take over tribal jurisdiction in custody cases by talking about areas of cooperation with Native organizations and by emphasizing concern about sovereignty over non-Natives. Hereʻs part of the Herron-Sullivan exchange:



Again, you can listen to the hearing on Gavel to Gavel.

One might get a little concerned when a Judiciary chair suggests to an Attorney General nominee that he try a little civil disobedience and become the Rosa Parks of Attorneys General and defy the feds in their interference in stateʻs rights through the Endangered Species Act and through Environmental Protection Act.  To the attorney-general nomineeʻs credit, he deflected that role and spoke of other strategies, such as getting other attorneys-general to see that Alaska was just one of the first and that it was in their own interest to support Alaska now, because this was ʻcoming soon to a theater near you.ʻ

Clearly, the Judiciary Chairʻs rapture over this nominee was not simply related to his resume.  Ideology, which included a strong anti-federal government stance on environmental issues (and to a lesser extent tribal sovereignty,) was clearly an important part of this based on the chairʻs explicit support of this stance.  One would hope there would be at least a symbolic acknowledgment that there are many Alaskans who do not share this perspective.   The sense portrayed was of black and white with no suggestion that while there may well be serious problems with the implementation of federal policies in Alaska, that there is some merit to the intent of the laws and regulations.  Only Herron raised a contrary idea on a central issue.

Again, though, the attorney-generalʻs experience in Washington DC - as White House Fellow, as an aide to Condeleezza Rice, and as an Assistant Secretary of State - showed when he said that we shouldnʻt view Washington as a monolith, that there are a number of different factions, and heʻs lobbying many beyond the first line agencies such as Interior.

The fact that Dan Sullivan has been in the job as Attorney-General for eight months now also reraises the question raised when Wayne Anthony Ross was rejected for Attorney-General.  While Ross is, as far as I know, the only Attorney-General not to be approved, it does raise questions about the Legislatureʻs Constitutional powers to approve cabinet appointments, if they start serving when appointed and - in this case - for eight months and counting, before they are approved. On the other hand, this is probably preferable to the long delays at the Federal level when the Senate delays confirmation hearings and nominees wait months, even years, to be confirmed.

And I wouldnʻt be surprised to see Mr. Sullivan running for Governor or Senator sometime.  How about a Republican primary with Mayor Dan Sullivan running against AG Dan Sullivan?

*See Virginia protocol , US State Dept. Protocol for the Modern Diplomat.

Legislator and Staffers Play the Alaskan Bar

I think that public folks deserve a little privacy and I have no intention of posting pictures of legislators drinking in bars.  But I think this is not in that category. I learned Wednesday that there would be a legislator and two staffers on stage. 

I do have to warn you the sound does not reflect how well all three of these singers performed.  In the bar, the sound was good and they all were more than respectable.   

I first found out about Paul Labolleʻs musical side when I stopped by Rep. Fosterʻs office and saw Paulʻs guitars.  

Like Taking a Drink From a Fire Hose

Iʻm sitting in the public lounge sort of overwhelmed with left over photos, videos, and notes from meetings and other things since Monday (and beyond.)  Someone yesterday mentioned the old quote about drinking from a fire hose to describe being in the legislature.  It may be worse, because with the fire hose, you know youʻre being hit.  Here, much of what is hitting you, may be invisible and you donʻt even know itʻs happening.  The previous post on the prayer was something I thought I could throw out there quickly while I catch my breath.

Things I havenʻt posted yet:

1.  Progress of HB 289 amending the ethics laws to incorporate the changes the AG wrote into regulations but with changes to clarify and limit somewhat. This was discussed Tuesday at State Affairs and today passed out of committee. There are two parts:

1. Paying the legal fees of executive branch employees charged but later exonerated on ethics charges.
2. Clarifying when spouses and other Governor and Lt. Gov. family members travel can be reimbursed by the state. (I use the word ʻclarifyʻ broadly.)
   
   The audio for the Tuesday session is here.  It includes at the beginning discussion of authorizing bonds for housing loans for veterans.  They are state bonds, but using a federal program that only five states took advantage of.
   
   
   
   
   

[Rep. Gruenberg and staffer presenting amendments 

to HB 289 to State Affairs Committee]

2.  Discussion of the Fish and Game Budget at the House Finance Fish and Game Subcommittee meeting, Monday I think.  I hadnʻt been to one of their meetings before and the decorum was a little looser than most meetings Iʻve been to.  Commissioner Denby Lloyd and two of his staff took pointed questions from the panel. My sense was that some of the Representatives were frustrated about how the department allocates resources around the state.  I really have no context to say a whole lot more other than people I asked afterwards said, "There are less fish to allocate and everyone is frustrated."  Thatʻs pretty simplistic, but I donʻt have time to gain expertise on every issue and all the personalities.  You can listen to this one here. 

3.  The Supreme Court Chief Justice met with legislators yesterday at lunch to bridge communication issues.  Justice Carpeneti spoke about the meaning of ʻlegislative intentʻ and how judges determine it.  He also asked the committee whether his belief that sometimes legislators, on the losing side of a debate, make speeches on the floor about the intent in hopes of influencing future court decisions even though their position was not the prevailing intent.  The legislators there agreed.  This audio is worth listening to.  This was the first meeting as I understand it where the Supreme Court and the Legislature are trying to work on cross-branch communications.  This was sponsored by the House Education Committee.

Hō mai ka ʻike

From the House Journal, we learn that yesterday's session was opened with a Hawaiian prayer.  

The invocation was offered by the Chaplain, Pastor Judy Shook of Aldersgate United Methodist Church. Representative P. Wilson moved and asked unanimous consent that the invocation be spread on the journal. There being no objection, it was so ordered. I was in ministry for 6 years in Hawaii prior to moving to Juneau. This prayer is a Hawaiian chant written by Kumu Keala Ching:

[For the fanatically curious, the printed journal had the whole prayer in Hawaiian, but the online version only had the first and last lines of Hawaiian. I tried to find the way to write the letters with the ¯ (I learned this is called a macron) over them. I found the ¯ but couldn't figure out how to put the letter under it and after ten minutes of searching online, decided to just take a picture of the printed text. But then I wanted to type the title in Hawaiian so I looked again. By going into Apple system preferences, then to language and text, then go down the list and choose Hawaiian. If you have the language symbol - the flag - on your top bar - the one with the File, Edit, View, etc. - click on it and change to the Hawaiian flag. Then, if you want the macron above the letter, hit option+letter. I decided to just leave the photo of the poem instead of retyping.]

Rep. Joule Explains Budget Cuts to Bring the Kids Home Program

Yesterday I discussed concerns that the Bring the Kids Home program as proposed by the Governor would see major cuts. This morning I sat in on that hearing and blogged it live, or at least as much as I could keep up with. After that I got Mental Health Trust Director Jeff Jesse's response to the cuts, because his agency had committed funds on the assumption that the State would have a significant match. He said they'd have to cut back their funding. And here is Finance Subcommittee on Health and Social Services Chair Rep. Regie Joule's explanation of how they chose to make the cuts.

Mental Health Trust Head Jessee on Cuts to Gov's Budget

I spoke to Mental Health Trust Authority Chief Executive Officer* Jeff Jessee after the House Finance Sub Committee on Health and Social Services approved "99.6% of the Governor's budget" but not a key program of interest to the Trust - The Bring the Kids Home program that is funding community mental health programs so that kids that are now institutionalized outside of Alaska can be brought home and get treatment here.  Jessee said that not only does this have obvious benefits to the families and kids, it also will save the state considerable money.

*I've got Jessee's position mislabeled and his name mispelled in the video and I'll get that fixed when I get more time.

I'll put up a video comment from Finance Subcommittee Chair Joule as soon as I can.

Finance Subcommittee on Health Social Services Live

NOTE:  THESE ARE MY VERY ROUGH AS THE MEETING WAS GOING NOTES.  I'll try to clean them up a bit.  Basically, Chair Joule said that 99.6% of the Gov's proposed budget was approved.  I'll try to highlight the parts that were not.  I'm also working to put up an interview I did with Mental Health Trust Executive Director  Jeff Jesse which I'll get up as soon as I can.

I went to the wrong room this morning.  But fortunately the Education committee started on time and now I'm up at the House Finance Committee room and this meeting hasn't begun yet at 8:15am.

(H)HEALTH & SOCIAL SERVICES		FINANCE SUBCOMMITTEE *
Feb 24 Wednesday 8:00 AM		HOUSE FINANCE 519
+		Final Closeout	TELECONFERENCED

Opening at 8:15 by Rep. Joule.
Joule: Anyone do Facebook? Invited to Mike's Place - Island Pub - met with First Alaska Fellows. Then see pony tail waving at me. Here was Willie Hensley sporting a pony tail as long as mine. Where Facebook comes in, be careful, we both had our pictures taken with hair out to sides and within seconds, it hit Facebook.

Ask Virginia to go through the packets. Then we'll entertain the Gov's amendments, then we'll discuss, and move it out. I think we can do this in short order.

Virginia: Technical changes but numbers didn't.

1. Fully funded medicaid - health, line 4, line 56, line 89, Gov. Amendments ??
Alcohol and Sub Abuse program - line 2 of spreadsheet. Therapeutic Case management, Clitheroe, Palmer Therapeutic Court, Substance abuse for pregnant women. one more I missed

[Numbers refer to lines on the budget spreadsheet]

Stimulus Funding
OCS line 51
Health Care Service 63 69
Public Assistance 77 81
Public Health 86

Gov Amend 1, 5, 7

Formula Programs
76 Enrollment growth
78 Burial costs
79 Sr. Ben enrollment

All 39 Emtar [MHTAAR] requests Fully funded
Beh Health Office of Child Service
Public Health
Div of S???

[MHTAAR = Mental Health Trust Authority Authorized Receipts]

Also Tobacco Prevention fully funded

Accepted all interagency transactions

Bring the Kids Home - fully funded 13 of MHTAAR requests and 2 of the

Reductions of Tribal, ok on transfer , but not postion

Did not accept money for new grants, but there is 2.3 million in base

Reduced increment by 50% ???

Foster Parent Training - reduced by 50%

Fully funded
Probation line 73 ???
Public health nursing grantees 82
Med examiner office line 87
Traumatic Brain injury and Senior Dis 91?
Rev. Collection cleanup

Did not make final decision on school based admin claims

Nor increments to tech services components - need to be made at full Finance commitee level - complicated and have leg technicalities. pass these on up to Full finance commitee

Did not fund new programs

12 Phd Internship program

20 Forensic ?? Team

Look at spreadsheet row 332 Funding multiplier determines if funded it has a 1, if it has a 0= not funded .5= 50%

[I'm going to post this and then keep going.]

Rep. Cissna: Are we cutting Bring the Kids Home in the Community area?
Virginia: Only cutting increments.
Joule: We continue funding, just not accepting the full amount. 99.6% of the increments  in this budget have been approved.
Cissna: I know this was a hard budget to take on and deal with. But we continue to not look at outcomes right next to our goals are. I have no idea what my complaint is. So that next year we have a much better understanding of what is at risk.

Joule: We aren't going to have much of a choice not to do that. House Subcommittee is just the first step before going to Finance committee. I truly appreciate your comments. If we are going to do this in a meaningful way, we'll have to look at more than just increments.

Five Amendments: By myself- behavioral health -

Amendment #1.  Peer Navigators $200K - this is one of those programs, not intimate with all these, but did see this one. I've had people who have been touched by this program after insurance has run out. People took the time, because of their own life experience, they were the people who had some of these issues. On the road to recovery and education, got into this line of work and they offer hope in a way others can't. Just reminded me how fragile we might all be. How close to the edge maybe some of us are. And after today's budget I may be calling...no that's a joke. I believe this has MHTAAR of $175K, not something new.

  Foster Care Special needs - request for $50K, on reassignment of homes try to keep in normalcy with schools, so this is bussing to old school. One time funding to see how it works. Will revisit.

 $300K General Fund Mental Health - Beh Health for detox. $518K ask. They have 9 emergency beds and 8 were being used for detox. Not a sexy act, it's reality. Will help community address those issues. Will take the pressure of the hospital and takes them to facility where they can get the treatment they need.

Keller: I want to commend you on the second one. Good use. Thank you.

Amendment is adopted.

Amendment #2: Rep. Dahlstrom and Joule - One time request Dept HSS primary eye care and vision in rural AK communities that don't have access. Lions Int. AK Optometrists, and ?? they are offering matching funds. They came up with pared down numbers, nothing extra they are asking. Children will be able to see so they can learn.

Joule: Comments? Adopted.

Amendment 3A:
Keller: Decrement in calendar abortions performed in AK 6.2% increase 1000+ received abortions or services $600K none qualifie under Hyde Amendment, confirms not money psent based on Federal rqts. Should I read it?

Joule: No. I will maintain objections

Dahl. yes. Keller yes Miller yes Heron no Cissnoa no Holmes no Joule no.

4=3 fails

Amendment 3B: Keller: Increment to Com Health centers to cover differential on per person bases on grant for senior services. Increase 23% so $51K reps ....
Cissna: I would like to support this incremental increase, because we have had huge problem with this population.
Adopted

Amendment #4: Cissna. I would like to recommend we have addition here for Sateria ??? House operating in AK now - wonderful outcomes since July 2009. nationally has record of non-institutional - get people out of institutions into community and succeeding in their lives. one of the steps we need to make. They are also geting mental???
Dahlstrom: One time request?
Cissna: Yes. Just started last year and doing a number of different community and working with Alaska Public Housing Finance.
Dahlstrom: p. 2 says supported by AK Mental Health Turst. Will this cover the extra? Have they applied for other grants?
Cissna: Yes. This is for this year. Annually they need $250K for increased capacity and um. I don't know enough to say that faithfully.
Joule: I will maintain object

Keller no Millet no heron no Cissna yes Holmes yes Joule no Dahlstrom no

5-2 no

Amendment #5.
Rep. Holmes: We've heard on childhood obesity. 27% of High Svhool students. Half showing signs onf increased risk of blood pressure and cholesterol. This will do continuation funding for ongoing programs in six diff communities, so Statewide, with goals even more so.
Heron: We visited this last year at same kind of meeting. Failed in subcommittee and put back in Full Committee. Did something change?
Joule: Yes, Fed funding went away. Last year found $475K of fed money, That money is going away but the probelm isn't.
Cissna: Probably in terms of all the issues, one of the most severe is what is happening to our children. Obesity rate increasing, but to get programs that are in place used, we have to give them some funding. The obesity rise puts the kids in harms way for things like diabetes. It's right there ahead of them. Future increases in costs for the state with our youth having future diabetes. We need to think of future costs. Remove objection.
Amendment adopted.

I move to move the budget out of the committee.

Dahlstrom:

Keller: I think it's a mistake to pass out a budget... without the amendment to exclude funding for abortion.

Joule: yes Dahlstrom yes Keller no Millet yes Cissna yes Herron yes Holmes yes
6-1 adopted

Joule: As you know Gov. has initiative on sexual assault, will be addressed at full Finance committee meeting.