Legislature(2013 - 2014)CAPITOL 106
04/15/2014 08:00 AM House STATE AFFAIRS
| Audio | Topic |
|---|---|
| Start | |
| SB206 | |
| HB356 | |
| SJR26 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | SB 206 | TELECONFERENCED | |
| + | HB 356 | TELECONFERENCED | |
| + | SJR 26 | TELECONFERENCED | |
| + | TELECONFERENCED |
HB 356-ADVISORY COMMITTEE ON WELLNESS
8:35:59 AM
CHAIR LYNN announced that the next order of business was HOUSE
BILL NO. 356, "An Act establishing the Advisory Committee on
Wellness; and relating to the administration of state group
health insurance policies."
8:36:06 AM
REPRESENTATIVE PAUL SEATON, Alaska State Legislature, as prime
sponsor, presented HB 356. He stated that HB 356 would require
the commissioner of the Department of Administration (DOA) to
implement procedures for decreasing the incidence of disease in
Alaska in order to hold the inflation of healthcare costs. He
said the proposed legislation focuses on the prevention of the
incidence of disease as opposed to the treatment of disease. It
would create an Advisory Committee on Wellness, which would be
charged with making recommendations to the commissioner.
Representative Seaton relayed that HB 356 would enforce a
paradigm shift for DOA, and it would require the agencies to
implement policies in Alaska to keep State of Alaska employees
and their independents healthy by preventing disease.
8:37:15 AM
REPRESENTATIVE SEATON offered a PowerPoint presentation, which
he explained would outline a possible plan that would come from
the [Advisory Committee on Wellness] to aid in lowering the
amount of money paid out by the State of Alaska for health care.
He referred to a graph at the beginning of the PowerPoint, which
shows the $3.8 billion unfunded liability in the Public
Employees Retirement System (PERS) and Teachers Retirement
System (TRS) directly related to the increase of health care
cost beyond what was originally estimated in 2002. The original
estimation was for a long-term escalation in health care costs
of 2 percent, but now the escalation is between 4 and 6 percent.
He showed the "Why are we here?" slide, which states that there
are approximately 17,000 members, including dependents, in the
active plan, and approximately 64,000 members in the retiree
plan, with a total cost to the state of approximately $600
million [spent in fiscal year 2013 (FY 13)]. He noted that $1.6
million was [Medicaid] related expenditure [in FY 13]. He said
these expenses are part of a contractual relationship.
REPRESENTATIVE SEATON directed attention to the "What Do
Alaska's Health-Care Dollars Buy?" slide, which shows that
[31.5] percent of those dollars go to hospital care and 28
percent to doctors and clinical services. He said finding ways
to avoid visits to hospitals, doctors' offices, and clinics by
means of disease prevention would address the crux of the
problem. Referring to information on the next slide, he relayed
that currently insurance focuses on constraints to the
healthcare providers, including limitations on coverage and
limitations on compensation to doctors. He said the Department
of Labor established rules to prevent accidents by setting
limitations on the length of a working day and requirements for
safe working conditions. Representative Seaton stated that the
Department of Health and Social Services (DHSS) focuses on
childhood vaccination, as well as voluntary lifestyle changes
and prescription drug safety. The Department of Environmental
Conservation (DEC) [and the Department of Natural Resources
(DNR)] address food safety requirements, such as paralytic
shellfish poisoning (PSP) testing, requirements for the
pasteurization of milk, and restaurant and food processor
inspections. The Department of Public Safety (DPS), he said,
enforces laws addressing illegal drugs and smoking in close
public places.
8:40:13 AM
REPRESENTATIVE SEATON turned to "The Question" slide, and he
indicated that the question to ask is how to avoid diseases
instead of just paying for sick care. He said the ensuing
slides show ideas for what can be done in "one little category"
and what the economic impact of that would be. The first slide
he highlighted shows a list of [health] issues of active care
members, and [x's] at the far right indicate which of the
conditions could be prevented by taking vitamin D supplements.
He said vitamin D deficiency is prevalent in Alaska. He showed
the next slide, which is the same chart for retirees. He said
66 percent of the total diseases in the active work force are
directly related to vitamin D status, while that number for
retirees is 61 percent.
REPRESENTATIVE SEATON directed attention to the next slide,
showing "Meta-analysis of breast cancer risk." He explained
that the graph is set up in quintiles. It shows that those with
higher risk for breast cancer are those with lower serum levels
of vitamin D. He said the average vitamin D level for the U.S.
population is 21 anagrams per milliliter (ng/ml), but the
average for Alaskans is generally much lower, because vitamin D
is made through exposure to sunshine on the skin, and during
Alaska winters, the angle of the sun is so low, that all of the
ultraviolet B is absorbed coming through the atmosphere. That
means that for seven months of the year in Alaska, a person can
be out in the sun and not make any vitamin D. He explained that
the graph shows that with a 50 percent reduction in breast
cancer [through use of vitamin D] by active and retired
employees and their dependents, the state could save $3 million
a year.
8:43:14 AM
REPRESENTATIVE SEATON directed attention to another meta-
analysis graph showing the relation of vitamin D and colorectal
cancer. He stated that breast cancer and colorectal cancer are
two big cost drivers in Alaska. The graph shows a projected
reduction in incidence with 34 ng/ml. He said currently the
state has no policy to encourage people to [take vitamin D
supplements] to lower the percentage who get colorectal cancer,
but doing so could save the state approximately $2 million
annually.
REPRESENTATIVE SEATON directed attention to another slide
showing results of a clinical trial related to type 2 diabetes.
He said the slide shows that the average U.S. population has 8.5
people per 1,000 annually who will be diagnosed with type 2
diabetes. During the clinical trial, 2,200 people got their
vitamin D levels up to 48 ng/ml, and the number of people per
1,000 diagnosed annually with type 2 diabetes dropped to [0.9].
He indicated that the cost to an individual to supplement
vitamin D is about $10 a year. Representative Seaton said this
kind of action could save the state approximately $4.3 million a
year.
8:45:42 AM
REPRESENTATIVE SEATON turned next to a slide showing results of
vitamin D supplementation on pre-term childbirth, which is a
focus of the March of Dimes. He explained that pre-term birth
not only has negative effects on health, but is also costly. He
related that the March of Dimes has been conducting a program in
South Carolina, wherein by raising the levels of vitamin D in
participants, the number of pre-term births was reduced to 7
percent - 2 percent below the national goal for the March of
Dimes for the year 2020. He said, "That's a 32 percent
reduction in the number of pre-term births, and for every 25
pre-terms births avoided, that saves about $1.3 million."
REPRESENTATIVE SEATON directed attention to a slide showing
results from a Canadian study on the effects of vitamin D
supplementation on the frequency of occurrence of upper
respiratory tract infections in children. He indicated that a
comparison was made between those children who were given 30
ng/ml and those that were given 20 ng/ml, and he said, "There's
a 70 percent reduction in upper respiratory tract infections,
[such] as tuberculosis, pneumonia, bronchitis, influenza, and
colds."
REPRESENTATIVE SEATON highlighted information on the next slide,
which showed the effect of vitamin D supplementation on
inflammatory gum disease. He said the study came out of India
in 2013. It shows that with a placebo, there was no change in
90 days; with 2,000 IU of vitamin D, people's vitamin D levels
were raised to about 50 ng/ml, and there was a reduction in
inflammation of more than 80 percent. He stated that gum
disease not only results in tooth loss, but when the body is not
able to fight inflammation, the result can be a hardening of the
arteries. He said that is why gum disease is also related to
heart disease.
8:48:00 AM
REPRESENTATIVE SEATON indicated that the proposed legislation
has one main purpose, outlined in Section 2, which read as
follows:
*Sec.2. AS 39.30.090(a) is amended by adding a new
paragraph to read:
(13) To the greatest extent legally and
reasonably practicable, the Department of
Administration shall work to hold the escalation of
health care costs to less than two percent annually by
administering policies of group health insurance
obtained under this subsection in a manner that is
likely to reduce the incidence of disease in the
state's population and that facilitates implementation
of the recommendations of the Advisory Committee on
Wellness established under AS 39.30.093.
REPRESENTATIVE SEATON said his goal in presenting HB 356 is to
illustrate an example of what the state could be doing. He said
he presumes the Committee on Wellness would look at this data
and determine whether the State of Alaska could hold down the
incidence of disease and save money. He said the State of
Alaska is self-insured; therefore, "every dollar that we save is
a savings to the State of Alaska." He continued as follows:
The bill that establishes this has a minimum of seven
members. The Department of Administration selects
those members. When they had a voluntary advisory
committee, which they do now, previously what they did
was they had over 90 people to apply to be on it.
This is a non-paid position. But people, members of
our employment workforce, do want to save health care,
do want to save the issues of health and the pain and
suffering that comes to families.
REPRESENTATIVE SEATON said HB 356 uses the model of the citizen
advisory committee used in relation to Alaska's Child in Need of
Aid (CINA); the department would have to answer within six
months if and how it would be implementing certain programs. He
said the proposed legislation would give "more of a push" and
"more authority" for the recommendations of the Advisory
Committee on Wellness to be heard. It is all within DOA, and
there are three positions. Members could participate in
meetings telephonically, so travel would not be required.
REPRESENTATIVE SEATON opined that attempting to move the state
forward in holding down the escalation of [health care] costs,
thereby removing some of the state's unfunded liability in the
retirement system is a good goal. He said some things that
could cut down on health care costs, such as losing 30 or 40
pounds, are difficult to do; however, other things that the
Advisory Committee on Wellness could consider are much easier to
accomplish.
[Vice Chair Keller handed the gavel back to Chair Lynn.]
8:51:42 AM
REPRESENTATIVE KELLER commended Representative Seaton's focus on
prevention and wellness. He explained that he had a problem
with the intent language, beginning on page 1, line 9, through
page 2, line 1. He said he would to like to delete [paragraphs]
(2), (3), and (4), which read as follows:
(2) the state has not adequately focused
state policy on avoiding disease and maintaining good
health in the state's population;
(3) the state relies on federal one-size-
fits-all human health policy recommendations, creating
federal overreach into the state's administration of
health policy;
(4) the state's human health policies have
not incorporated peer-reviewed scientific studies that
illustrate health-related differences between the
population of the state and the populations of other
states;
REPRESENTATIVE KELLER, regarding paragraph (2), said that may be
true, but opined that it would be better to say that the state
should focus more, because the state has focused on a state
policy on avoiding disease and maintaining good health.
Regarding [paragraph] (3), he suggested saying instead that the
state relies "in part" on federal policy recommendations. As
written, he said the language sounds like federal
recommendations are the only thing on which the state's policy
is based, which he said he does not believe is true. Regarding
[paragraph] (4), he said he would argue that the state certainly
has incorporated peer-reviewed studies, at least to some degree.
He said he knows this, because he has reviewed the studies and
has been involved in the process of making recommendations. He
stated that he does not think it would take away from the intent
of HB 356 to delete paragraphs (2), (3), and (4), in Section 1.
He said he supports the proposed legislation, but would like to
hear what the prime sponsor thinks about his recommendations for
changes.
8:56:09 AM
REPRESENTATIVE ISAACSON recommended instead to leave paragraphs
(2)-(4) in the proposed legislation, but to amend the language
to reflect that: state policy should focus on avoiding disease
and maintaining health, the state relies in part on federal
recommendations, and the state's human health policies should
always incorporate peer-reviewed studies. He emphasized his
support of peer reviewed studies that are made transparent to
the public and are opened for public comment. He clarified, "I
wouldn't take those out; I would just make them affirmative."
8:57:14 AM
REPRESENTATIVE KELLER responded that he had considered that and
would be open to it.
8:57:34 AM
REPRESENTATIVE SEATON said he fully agrees. He echoed
Representative Isaacson's suggestion by recommending "should"
replace "has not adequately", on line 9.
CHAIR LYNN suggested changing the language to "should focus
more".
REPRESENTATIVE SEATON suggested the language could read "should
focus state policy more on avoiding disease and maintaining good
health". He said he thinks the intent of paragraph (4) was
being misread, possibly because the language in paragraph (4)
begins on one page and ends on the next: "differences between
the population of the state and the populations of other
states". He said he did not intend for the language to mean
that "we" have not looked at peer-reviewed science. He
suggested switching the order of the words to emphasize that the
studies that have not been incorporated in the state's human
health policies are those comparing states.
8:59:10 AM
REPRESENTATIVE KELLER asked the prime sponsor what he thought of
Representative Isaacson's suggestion to strike "have not" and
replace it with "should".
REPRESENTATIVE SEATON said that would be fine.
8:59:29 AM
REPRESENTATIVE KELLER said he would like the words "in part" to
follow "relies", on page 1, line 11, because one-size-fits-all
recommendations from the federal government are not the only
thing on which the state relies.
8:59:53 AM
REPRESENTATIVE KELLER moved to adopt Conceptual Amendment 1, as
follows:
Page 1, line 9, between "the state" and "state":
Delete "has not adequately focused"
Insert "should focus"
Page 1, line 9, between "policy" and "on":
Insert "more"
Page 1, line 11, between "relies" and "on":
Insert "in part"
Page 1, line 13, between "policies" and
"incorporated":
Delete "have not"
Insert "should"
9:01:38 AM
The committee took a brief at-ease at 9:02 a.m.
9:02:25 AM
REPRESENTATIVE KELLER [moved to adopt an amendment to Conceptual
Amendment 1], so that the language on page 1, line 9, would read
as follows: "the state policy should focus more on avoiding
disease and". [There being no objection, the amendment to
Conceptual Amendment 1 was treated as adopted.]
9:03:06 AM
CHAIR LYNN announced that there being no objection, Conceptual
Amendment 1, [as amended], was adopted.
9:03:22 AM
REPRESENTATIVE ISAACSON imparted that he had begun a regimen of
taking vitamin D, and has seen improvement in a former pre-
diabetes diagnosis; he expressed his hope that the use of
vitamin would further improve his test results. He said, "This
is not a vitamin D commission, this is a wellness commission."
He acknowledged that the prime sponsor had shown one way to
improve the health of Alaskans through the use of vitamin D;
many more methods exist, including exercising, cutting out
certain substances, and moderating smoking and drinking. He
asked Representative Seaton if his intent was to instigate an
Advisory Committee on Wellness, in order to bring the national
discussion on wellness to the administration.
9:04:20 AM
REPRESENTATIVE SEATON confirmed that was his intent exactly. He
clarified that the proposed legislation would not take over the
Health Care Commission, which is a broad, statewide entity that
considers the entire population of the state. The committee
proposed under HB 356 would focus on individuals with whom the
State of Alaska has a contractual relationship as a provider of
health insurance. He said the result could be not only a cost
savings to the state, but also a relief from pain and suffering
by many. He reiterated that the vitamin D aspect was one of
many the Advisory Committee on Wellness might consider.
9:06:19 AM
REPRESENTATIVE KELLER said a positive approach is a good one,
and he does not know anyone who is against vitamin D or
wellness.
9:06:48 AM
REPRESENTATIVE KELLER moved to report HB 356, as amended, out of
committee with individual recommendations and the accompanying
fiscal notes. There being no objection, CSHB 356(STA) was
reported out of the House State Affairs Standing Committee.
| Document Name | Date/Time | Subjects |
|---|---|---|
| 01 SJR 26 Resolution.pdf |
HSTA 4/15/2014 8:00:00 AM |
SJR 26 |
| 02 SJR 26 - Sponsor Statement.pdf |
HSTA 4/15/2014 8:00:00 AM |
SJR 26 |
| 03 SJR 26 - Supporting Document.pdf |
HSTA 4/15/2014 8:00:00 AM |
SJR 26 |
| 04 SJR 26 - Fiscal Note.pdf |
HSTA 4/15/2014 8:00:00 AM |
SJR 26 |
| 01 HB0356A.pdf |
HSTA 4/15/2014 8:00:00 AM |
HB 356 |
| 02 HB356 sponsor statement.pdf |
HSTA 4/15/2014 8:00:00 AM |
HB 356 |
| 03 HB356 Background Materials.pdf |
HSTA 4/15/2014 8:00:00 AM |
HB 356 |
| 04 HB356 Mayo Clinic vitamin D for health a global perspective.pdf |
HSTA 4/15/2014 8:00:00 AM |
HB 356 |
| 05 HB356 Cost Savings per year with vitamin D.pdf |
HSTA 4/15/2014 8:00:00 AM |
HB 356 |
| 06 HB356 Support KPBSD.pdf |
HSTA 4/15/2014 8:00:00 AM |
HB 356 |
| 07 HB356-DOA-DRB-03-14-14.pdf |
HSTA 4/15/2014 8:00:00 AM |
HB 356 |
| 01 SB 206 STA CS Version C.pdf |
HSTA 4/15/2014 8:00:00 AM |
SB 206 |
| 02 SB 206 Sponsor Statement.pdf |
HSTA 4/15/2014 8:00:00 AM |
SB 206 |
| 03 CS SB 206 Sectional.pdf |
HSTA 4/15/2014 8:00:00 AM |
SB 206 |
| 04 CS SB 206 explanation of amendments.pdf |
HSTA 4/15/2014 8:00:00 AM |
SB 206 |
| 05 Fiscal Note CSSB206.pdf |
HSTA 4/15/2014 8:00:00 AM |
SB 206 |