Legislature(2011 - 2012)HOUSE FINANCE 519
04/03/2012 01:30 PM House FINANCE
| Audio | Topic |
|---|---|
| Start | |
| HB310 | |
| HB330 | |
| HB296 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 276 | TELECONFERENCED | |
| + | HB 310 | TELECONFERENCED | |
| + | HB 296 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 330 | TELECONFERENCED | |
HOUSE BILL NO. 310
"An Act temporarily reinstating the child and adult
immunization program in the Department of Health and
Social Services; and providing for an effective date."
1:39:35 PM
Vice-chair Fairclough MOVED to ADOPT proposed committee
substitute for HB 310, Work Draft 27-LS1273\I (Mischel,
3/27/12).
Co-Chair Stoltze OBJECTED for purpose of discussion.
JOE MICHEL, STAFF, REPRESENTATIVE BILL STOLTZE, stated that
the changes were all located on page 3 of the work draft.
On page 3, line 5 "meningococcal" and "rotavirus" were
added. On page 3, line 8 "zoster" was added; "zoster" was
another name for shingles. Section 2, subsection g, part 2,
sub-parts A and B were added:
(2) subtract vaccines from inclusion in the program if
(A) the disease for which the vaccine is provided has
been declared eradicated in the United States by the
Centers for Disease Control and Prevention, United
States Department of Health and Human Services; or
(B) the commissioner finds that available high-grade
scientific evidence indicates that subtracting the
vaccine from inclusion in the program will result in
optimal efficacy and efficiency for the benefit of
residents.
Mr. Michel stated that line 19, subsection h was added:
(h) The procurement of vaccines that are provided
under the program is subject to the availability of
funding.
Co-Chair Stoltze WITHDREW his OBJECTION. There being NO
further OBJECTION, Work Draft 27-LS1273\I was ADOPTED.
REPRESENTATIVE BOB HERRON, SPONSOR, described SB 310. He
stated that HB 310 is a stop-gap measure to reinstate the
Alaska Immunization Program (AIP), which aimed to prevent
and control vaccine-preventable diseases in Alaska, to its
former level of coverage. Every year, Alaskans remember a
storied health emergency - our Iditarod commemorates the
1925 "Great Race of Mercy" serum run to Nome. Then, Nome
and several surrounding communities were in the throes of a
diphtheria epidemic, and dog teams with their fearless
mushers braved the elements to deliver a life-saving
antitoxin. Today, thanks to preventative vaccines, the
disease has been nearly eradicated in the United States.
Still, Alaska communities are highly vulnerable to
debilitating but entirely preventable health crises. For
decades, Federal funding ensured the AIP could make
preventative vaccines accessible to all Alaskans desiring
them. But that funding has seen a sharp downturn - from
$4.3 Million in FY10, to a mere $700 thousand in FY2013.
These reductions have cut the number of vaccines available
to children, and completely discontinued those available to
adults in our state. Preventative vaccines control diseases
such as whooping cough, lockjaw, pneumonia, meningitis,
polio, and others - silently saving lives every day.
Prevention, generally, is key - and by far the most cost-
effective way to address health issues. If we do not
prevent, we will have to treat, at far greater human and
financial cost. HB 310 and Senate Companion SB 144
temporarily substitute state funding for the decrease in
federal funding to AIP, through FY2015, while we seek a
more permanent solution. It provides a humane and business-
smart solution to the growing problem of unnecessary
disease wracking our communities.
1:44:33 PM
Co-Chair Thomas pointed to page 2, line 5, and wondered why
the word "may" was used. Representative Herron responded
that the bill gave the Department of Health and Social
Services (DHSS) the authority to decide which vaccines may
be added or subtracted to the program. He stated that DHSS
currently wanted to add meningococcal and rotavirus to the
list of "recommended vaccines."
Co-Chair Thomas reiterated his question about the term
"may" included in the bill.
Representative Gara added that the department should have
flexibility to determine the recommended vaccines, and felt
that perhaps the word, "shall", should be used instead.
Representative Herron deferred the question to the
Department of Health and Social Services (DHSS).
Representative Gara asked if the funding for Chlamydia and
Gonorrhea prevention would disappear if the bill was
passed. Representative Herron responded that HB 310 did not
have any effect on that funding.
Representative Gara assumed the bill would cover public
health center immunizations. He asked for verification that
the bill would not provide immunizations for individuals
who could pay for them. Representative Herron replied in
the affirmative.
Co-Chair Stoltze wondered if the there was a subsidy for
vaccinations in medical facilities other than health
centers. Representative Herron responded in the
affirmative.
Representative Gara wondered if the vaccination would be
subsidized, if the patient was receiving the vaccination
from a private provider.
Representative Herron deferred the question to the medical
professional.
Representative Neuman declared that he had a problem with
mandatory immunizations from the government. He looked at
page 3, lines 4 and 5, which stated that the vaccines
included in the program:
(1) for a child under 19 years of age are all vaccines
required for school attendance under AS 14.30.125 and
meningococcal, rotavirus, influenza, and pneumococcal
vaccines
Representative Neuman wondered if the vaccinations were
required for people who choose to keep their children home-
schooled or in a correspondence program. Representative
Herron responded that the bill would not change any current
practice or process.
1:50:52 PM
LES MORSE, DEPUTY COMMISSIONER, DEPARTMENT OF EDUCATION AND
EARLY DEVELOPMENT, believed that Representative Herron was
correct, but he would need to follow up on the question
with more information at a later date.
Co-Chair Stoltze asked who would verify the issue. Mr.
Morse would make contact the department and would follow up
momentarily.
Representative Neuman remarked that his children were not
required to receive vaccinations, because they did not
attend school buildings.
Representative Neuman looked at page 3, line 9:
In addition to the vaccines listed in (f) of this
section, the commissioner may
(1) add vaccines for inclusion in the program based on
recommendations by 11 the federal advisory committee
on immunization practices and the availability of
funding
Representative Neuman remarked that although there were
specific vaccines listed, the commissioner could add any
immunizations, without statutory authority or approval from
the legislature. Representative Herron affirmed that
assumption.
Representative Neuman looked at page 3, line 4, "for a
child under 19 years of age." He believed that people in
the state of Alaska became adults at age 18. He wondered
why an "adult" would be required to have a vaccination.
Representative Herron deferred to the department, but
assumed that language was currently written in statute.
Co-Chair Stoltze remarked that it was probably not uncommon
for a 19-year-old to attend public high school.
Representative Neuman stressed that the statute did not
list the age of the vaccine recipient.
Representative Guttenberg looked at page 2, line 21. He
asked who was exempt from licensure under the provision.
Representative Herron deferred the answer to DHSS.
Representative Guttenberg wondered if the screening records
would be in compliance with Health Insurance Portability
and Accountability Act (HIPAA) laws. Representative Herron
responded in the affirmative.
Representative Wilson asked why specific language "for
vaccines" was added. Representative Herron deferred the
question to the DHSS. He assumed that diseases were common
enough that the department agreed there should be regular
vaccinations for specific diseases.
Representative Wilson looked at the attached fiscal note,
and pointed out that the explanation showed that the
federal funding had been cut to $700,000 in 2010. She noted
a possible discrepancy in total received federal funds.
Representative Herron replied that he had not seen the
finance fiscal note.
1:56:57 PM
WARD HURLBURT, DIRECTOR AND CHIEF MEDICAL OFFICER, DIVISION
OF PUBLIC HEALTH, DEPARTMENT OF HEALTH AND SOCIAL SERVICES
(via teleconference), explained that 50 percent of Alaskan
children benefit from the federally funded recommended
immunizations. He stated that an additional 25 percent of
Alaska's children were in families where adequate private
health insurance was available to cover most of the costs
of the recommended immunizations, so the bill would not
cover vaccines for any of those 75 percent of Alaska's
children. Therefore, 25 percent of Alaska's children were
not covered by private health insurance or federal vaccines
for children program. This 25 percent of children places
the other 75 percent at risk, because of the concept of
"herd immunity." If the immunity level for a preventable
contagious disease was not sufficiently high, all members
of the community were at a higher risk. He stated that
there was a low level of mumps immunization in California
in 2010, more than 2000 babies and young children developed
mumps. So, California needed to engage in a major
immunization program. Alaska had seen remarkable successes
related to vaccines that had become available during his
professional tenure.
2:01:50 PM
Dr. Hurlburt suggested that the decisions regarding the
specific recommended vaccines should be made on the medical
and clinical level. He remarked that vaccines are
constantly changing and improving.
Co-Chair Stoltze acknowledged Rotary Clubs International
for their effort to eradicate polio.
Dr. Hurlburt agreed. He pointed out that the policy
requirements were specific for "school entry." He stressed
that there was no intent to change current policy. He
stated that military physicians or public health service
physicians were not required to have an Alaska license, but
were required to have a license from another state. He
remarked that the four new vaccines were recommended
because they are not required for school entry, but were
recommended by the American College of Emergency Physicians
(ACEP). The meningococcal vaccine was used to prevent
meningitis. The rotavirus vaccine was used to prevent
diarrhea, and that vaccine was not as cost effective at the
nationally, but Alaska had many cases of infantile
diarrhea. Influenza and pneumococcal vaccines were
recommended annual vaccines, and he remarked that babies
and older adults were particularly susceptible to
influenza. He addressed the fiscal note, and stated there
were two $700,000 figures. The federal government funding
had been reduced to $700,000, and the governor had
requested an additional $700,000.
2:06:13 PM
Representative Wilson wondered who determined the required
vaccinations for schools. Dr. Hurlburt responded that the
vaccines required for school entry were specific to the
risk and susceptibility of the specific diseases for the
particular ages of the children.
Representative Wilson asked whether the doctor believed
that children should receive the influenza vaccination
annually. Dr. Hurlburt responded in the affirmative.
Vice-chair Fairclough wondered if the commissioner of
Department of Health and Social Services was the person in
charge to determine vaccinations at schools. Dr. Hurlburt
responded in the affirmative.
Vice-chair Fairclough did not know why lines 3 through 8
needed to be in statute, as the commissioner currently had
the ability to make the decision.
2:09:58 PM
Dr. Hurlburt believed that the language had been included
to clarify the current practice. He understood that the
decision-making authority was with the DHSS commissioner.
Vice-chair Fairclough declared that she had a son who had
been adversely affected by an immunization. She did not
want to be put in the position of recommending a particular
immunization; she would leave that to the commissioner and
medical professionals to make the decision.
Representative Gara asked what the added $4.4 million
covered, that the governor's request of $700,000 did not.
Dr. Hurlburt responded that vaccinations were very
expensive. The total cost for a 2-year-old's vaccines, not
including administration, was $18,000. He furthered that
the shingles vaccine, that was currently recommended for
those 55-years-old and older, was very expensive. He stated
that the amount of the federal money and the governor's
budget totaled $1.4 million, and was very limited compared
to the actual cost of vaccinations. He stressed that it was
appropriate to examine vaccines from a cost-effectiveness
perspective. He felt that the money spent on vaccinations
was money spent to save human lives.
Representative Gara wondered how the department would
prevent "duplicate vaccines" that were available at city
health centers, schools, and community health clinics.
2:15:09 PM
Dr. Hurlburt believed that DHSS would procure the
immunizations in all of the mentioned examples. He
understood that there were some duplication issues, so he
felt that there needed to be only one procurement source.
He furthered that DHSS continued to look at different ways
to obtain funding. He understood that the three-year
initial authorization was intended for the department to
examine funding alternatives. The public health nursing
centers had been designated by the Anchorage Community
Health Center, so therefore uninsured children would be
qualified under the Federal Vaccines for Children Program.
Vice-chair Fairclough referred to a question related to the
overall subsidy of vaccines. She wondered if the subsidy of
vaccines was reflected in his previous statement about the
State providing vaccines at a lower cost to health clinics
and municipalities.
Dr. Hurlburt responded that vaccinations that were procured
under this legislation to providers were given to eligible
children at no cost for the vaccine. However, an
administrative fee may be charged.
2:19:28 PM
DAVID D'AMATO, GOVERNMENT AFFAIRS DIRECTOR, ALASKA PRIMARY
CARE ASSOCIATION (APCA) (via teleconference), spoke in
strong support of HB 310. He discussed that there had been
a profound shortage of vaccinations in recent years. Some
of the more capable locations had bought vaccinations to
provide; however, others had not. The APCA was "delighted"
the bill had been introduced.
ROSALYN SINGLETON, PEDIATRICIAN, ALASKA NATIVE TRIBAL
HEALTH CONSORTIUM (via teleconference), testified in
support of HB 210. She remembered treating a very high
number of infants with meningitis, who had either died or
developed severe brain damage as a result of the
meningitis. Alaska had a very high rate of the disease, but
since 1990 the rate of the disease had decreased by 95
percent. In the year prior to the licensure of the
vaccination, four people had been lost including two
teenagers. She discussed hospitalization of individuals
with measles, was very concerned about the growing number
of communities that were under vaccinated. She urged the
passage of the bill.
Co-Chair Stoltze remembered a family member that had dealt
with a measles outbreak.
2:25:03 PM
DENISE DANIELLO, EXECUTIVE DIRECTOR, ALASKA COMMISSION ON
AGING, spoke in support of HB 310. The commission felt that
the legislation was important for Alaskans of all ages. The
vaccinations would help to keep people healthy. As people
age, their immune systems deplete and the immunizations
would help keep people healthy. Also thanked committee for
adding the shingles vaccine.
MARIE DARLIN, AMERICAN ASSOCIATION OF RETIRED PERSONS-
ALASKA, testified in support of HB 310. She stressed that
vaccinations of older citizens was an effective health
procedure. She also mentioned grandparents raising
grandchildren, and felt that this legislation was very
important for them and the state.
2:30:21 PM
Co-Chair Stoltze CLOSED public testimony.
Representative Edgmon stated that Dr. Hurlburt had worked
with one of his relatives.
Vice-chair Fairclough remarked that the fiscal note stated
that the State would replace federal funds, so she wondered
if there were new listings in the area of illness that had
been added or if were they all covered under the previous
federal program. Dr. Hurlburt asked to hear the question
again.
Vice-chair Fairclough restated her question. Dr. Hurlburt
stated that the only added immunization was for HPV.
Representative Costello spoke in support of the
legislation. She discussed receiving immunizations in the
family health clinic. She asked whether there was a
provision included that would allow people with insurance
to visit the public health clinic.
Dr. Hurlburt responded that if an individual had insurance
that covered the immunizations the bill would not provide
funding for those individuals. He added that no one would
be denied care at a public health center.
2:38:07 PM
Representative Neuman pointed to a vaccination exemption
form that listed administrative codes. He wondered if
refusal to vaccinate based on a philosophical standpoint
would be considered an exemption based on religion. Dr.
Hurlburt stated that some parents have vaccination
hesitancy. He stressed that the vaccine hesitancy rate in
Alaska was 9 percent, which was the highest of any state.
He remarked that Alaska was number 42 in the country for
immunizations, and stressed that there was work to continue
efforts in thorough vaccinations.
Representative Neuman wondered why there were immunizations
required as listed on page 3, lines 4 through 9. Dr.
Hurlburt answered that the items had been listed to clarify
that there would not be a change. He stressed that the list
included vaccinations required for school entries and
federal recommendations. He furthered that the recommended
vaccinations for adults were based on the perceived level
of importance.
Representative Doogan referenced the repeal language on
page 4. He wondered why the program would be discontinued
in 2015.
2:45:44 PM
Co-Chair Stoltze assumed that the sunset date was standard
for this kind of legislation.
Representative Herron looked to page 2, line 1, and stated
that the act is considered temporary. He furthered that
time was needed to determine what is best for Alaskans. The
next legislature and administration would be given the
chance to determine the next step.
Representative Gara asked about the "shall" language. He
pointed to page 2, line 5. He wondered whether there was
objection to change "may" to "shall." Dr. Hurlburt replied
that he was not an attorney. As a reasonable person, he
believed the change would allow for flexibility.
WILDA LAUGHLIN, LEGISLATIVE LIAISON, OFFICE OF THE
COMMISSIONER, DEPARTMENT OF HEALTH AND SOCIAL SERVICES,
asked for a restatement of the question.
Representative Gara repeated his question.
Ms. Laughlin deferred the question to the Department of
Law.
Representative Gara stated that he would discuss the issue
with the Department of Law after the meeting, and also
speak to the issue on the House floor, if the bill reported
out of committee.
Representative Neuman asked whether anyone in Alaska could
visit a clinic and ask to receive the vaccinations
2:49:53 PM
Ms. Laughlin deferred the question to Dr. Hurlburt.
Dr. Hurlburt responded that the bill's intent was for
services for Alaskan residents. He believed the issue may
not be clear and that visitors could potentially get the
vaccinations.
Representative Neuman asked how the program would work.
Dr. Hurlburt responded that the vaccinations were
distributed to the providers at no cost to the recipient
and by the agreement the provider could not charge a
vaccination fee; however an administration fee could be
charged.
Ms. Laughlin noted that the department was working on
getting an answer from DOL.
Mr. Morse addressed an earlier question, and he discussed
medical and religious waivers. He stated that every student
that was enrolled in the public and private school systems
was required to be immunized, therefore, the requirement
also applied to correspondent students. He addressed a
question related to school age. He explained that school
age was defined as age 6 through 19.
Representative Wilson asked whether children receiving
homeschooling would be exempt. Mr. Morse read from the
bill, "before entry into a state public school district or
a non-public school offering pre-elementary through grade
12." He stressed that the requirement spoke of entry into a
school.
Co-Chair Stoltze asked whether it was entry into a school
building or the system. Mr. Morse clarified that it was a
school system and not a "brick and mortar" building. He
felt that if a child was privately home-schooled, that
would not apply to a "school system."
2:55:30 PM
Vice-chair Fairclough directed attention to the Department
of Health and Social Services fiscal impact note. She
detailed that FY 13 through FY 15 included $4.496 million
per year, with $700,000 added from the governor's current
budget request.
Representative Doogan discussed the fiscal note. He
wondered whether the money in the governor's budget was
subtracted or added to the $4.5 million. Co-Chair Stoltze
interjected that it was $5.1 million.
JILL LEWIS, DEPUTY DIRECTOR, DIVISION OF PUBLIC HEALTH,
DEPARTMENT OF HEALTH AND SOCIAL SERVICES, asked for a
repeat of the question.
Representative Doogan wondered whether the money in the
governor's budget was subtracted or added to the $4.5
million. Ms. Lewis replied that the total amount was $5.8
million. The current budget included $700,000 of federal
funds and the governor's budget included $700,000 - both
were subtracted from the amount which equaled $4.5 million.
Representative Doogan surmised that the actual fiscal note
would include amounts that were actually above $$4.5
million. Ms. Lewis replied that there was an assumption
that the federal funds would continue to be provided, along
with the governor's request.
Representative Doogan believed it was a big assumption.
Vice-chair Fairclough stressed that the governor's request
for the $700,000 was part of the base, so it currently
existed in the operating budget that had passed the House.
Ms. Lewis affirmed Vice-chair Fairclough's statement.
Vice-chair Fairclough asked if the fiscal note added $4.456
million in FY 13 through FY 15 to the $700,000 from the
federal government, the additional $630,000 of general
funds, plus the $70,000 of federal match funds, for a grand
total of $770,000 of federal receipts and $630,000 of
general fund receipts.
Representative Wilson asked
Ms. Lewis replied that the bill provided flexibility to add
or subtract vaccines to fit the available funding
3:01:53 PM
Representative Wilson asked if there would be flexibility
in the required list of vaccinations. Ms. Lewis responded
that under the conditions listed in the bill, the
flexibility was provided.
Ms. Laughlin informed the committee that Commissioner
Streur preferred the "may" language, but he was concerned
that if there was a lack of funding there would be a
problem.
Representative Herron stated that the language on page 3,
line 19 was very important for the legislation.
Representative Neuman asked whether the fiscal note
included money for advertising the immunizations.
Ms. Lewis responded in the negative.
Representative Doogan commented that the total fiscal note
was $5.9 million. He wanted to make sure that the committee
understood that there was a $6 million total.
Co-Chair Stoltze believed the comment was a relevant part
of the fiscal discussion.
Vice-chair Fairclough MOVED to report CSHB 310(FIN) out of
committee with individual recommendations and the
accompanying fiscal note. There being NO OBJECTION, it was
so ordered.
CSHB 310(FIN) was REPORTED out of committee with a "do
pass" recommendation and with one new fiscal impact note
from Department of Health and Social Services.
3:05:24 PM
AT EASE
3:17:59 PM
RECONVENED