Legislature(2013 - 2014)HOUSE FINANCE 519

04/14/2014 01:30 PM FINANCE

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CS FOR SENATE BILL NO. 169(FIN)                                                                                               
     "An Act  establishing in the  Department of  Health and                                                                    
     Social  Services a  statewide immunization  program and                                                                    
     the  State  Vaccine   Assessment  Council;  creating  a                                                                    
     vaccine   assessment  account;   requiring  a   vaccine                                                                    
     assessment from  assessable entities and  other program                                                                    
     participants  for   statewide  immunization  purchases;                                                                    
     repealing  the temporary  child and  adult immunization                                                                    
     program; and providing for an effective date."                                                                             
4:05:48 PM                                                                                                                    
SENATOR CATHY  GIESSEL, SPONSOR, addressed  the legislation.                                                                    
She spoke as  a proponent of the private  sector. She stated                                                                    
that  the bill  represented  a  public/private solution  for                                                                    
expensive and preventable health  issues seen in Alaska. She                                                                    
shared  that a  few years  earlier, federal  funds had  been                                                                    
provided for  a universal  vaccine program that  had existed                                                                    
for  40  years.  She  relayed that  a  former  Alaskan  U.S.                                                                    
Senator [Senator  Ted Stevens]  had made sure  health issues                                                                    
were  addressed  the  state. The  state  had  received  $4.3                                                                    
million annually until 2010 to  cover vaccines; however, the                                                                    
number  had  fallen  to   approximately  $700,000.  She  had                                                                    
sponsored  legislation two  years ago  using state  money to                                                                    
restore the funding. She explained  that the bill's activity                                                                    
was set  to last  three years. She  noted that  other states                                                                    
were  finding  a   public/private  partnership  solution  to                                                                    
funding universal  vaccines. The three-year  period provided                                                                    
the Department of Health and  Social Services (DHSS) time to                                                                    
formulate a solution.  She stated that the  current bill was                                                                    
the solution. The bill would  adopt a vaccine council (pages                                                                    
2 and  3 of the  legislation) and outlined that  the council                                                                    
would  be comprised  of State  of  Alaska insurers,  private                                                                    
providers,   a   tribal   entity,   and   other   healthcare                                                                    
participants.   Participation  in   the  program   would  be                                                                    
optional; it would provide insurers  with the option to pool                                                                    
funding with  the state to  purchase vaccines at  the lowest                                                                    
possible price. She noted that  the state had the ability to                                                                    
purchase vaccines  at the lowest  price through  the Centers                                                                    
for Disease Control as well as state buying pools.                                                                              
Senator Giessel  explained that the  bill she  had sponsored                                                                    
in the past only provided  a limited number of vaccines. She                                                                    
expounded  that uninsured  healthcare providers  had to  buy                                                                    
small quantities  of the vaccine  themselves because  of the                                                                    
short-term shelf life. She emphasized  that money was wasted                                                                    
when   vaccines  expired.   Many   clinics   had  opted   to                                                                    
discontinue providing  vaccines because  of the  expense and                                                                    
risk  of expiration.  The large  purchasing option  had been                                                                    
used  under Senator  Steven's funding  for  many years.  She                                                                    
detailed  that vaccines  were  stored in  a  depot and  were                                                                    
distributed to  healthcare providers across the  state based                                                                    
on the providers' request. She  noted that the providers had                                                                    
an  idea   how  many  vaccines  their   clinic  would  need;                                                                    
therefore, they  did not run  the risk of  vaccines expiring                                                                    
or being  incorrectly stored. The plan  would allow insurers                                                                    
to buy in  to the program; insurers would  be assessed based                                                                    
on the number  of insured individuals and  what the expected                                                                    
vaccine  need  would  be.  Insurers  would  likely  pay  the                                                                    
assessment  upfront   and  the  state  would   purchase  the                                                                    
vaccine.  She  explained  that  there  were  many  ways  the                                                                    
process could work,  which would be determined  in the first                                                                    
year after the  bill passage. She furthered  that DHSS would                                                                    
work with the  council to formulate the  plan going forward.                                                                    
She  emphasized  that  the  council   was  not  a  board  or                                                                    
commission;  it would  operate under  DHSS at  no additional                                                                    
Senator  Giessel  continued  that   the  program  would  use                                                                    
volunteers and would  not have travel or  per diem expenses.                                                                    
She  pointed to  a  bubble chart  titled  "SB 169  Statewide                                                                    
Immunization Program"  in members'  packets (copy  on file).                                                                    
The legislation  had received letters  of support  from over                                                                    
30  healthcare   providers,  clinics,  and   senior  centers                                                                    
statewide.  She stressed  that  seniors  were interested  in                                                                    
various vaccines  including shingles,  pneumonia, influenza,                                                                    
diphtheria, tetanus, and pertussis.                                                                                             
Co-Chair  Stoltze remarked  that  the  interest was  evident                                                                    
based  on  the  number  of  health  fairs  and  immunization                                                                    
clinics held in senior centers.                                                                                                 
Senator  Giessel  agreed.  She   referred  to  a  letter  in                                                                    
members' packets  from a New Hampshire  pediatrician serving                                                                    
on  the state's  vaccine  association;  the association  had                                                                    
documented $45  million in savings  over the past  11 years.                                                                    
She noted that  nine other states had  similar programs. She                                                                    
reiterated  that  seniors  would  also have  access  to  the                                                                    
vaccines. She  noted that the bill  had undergone amendments                                                                    
in the House Health and Social Services Committee.                                                                              
JANE  CONWAY, STAFF,  SENATOR CATHY  GIESSEL,  spoke to  the                                                                    
changes  made  in  the  House  Health  and  Social  Services                                                                    
Committee  (bill  version  B). The  following  language  was                                                                    
added on page 2, line 3:                                                                                                        
     (1) establish a procedure to phase in the program over                                                                     
     a three-year period that provides for participation by                                                                     
     an assessable entity;                                                                                                      
Ms. Conway  pointed to  page 2, line  28 where  the language                                                                    
"or the chief  medical officer's designee" was  added to the                                                                    
council membership.  Page 2,  line 29  required that  one of                                                                    
the two  licensed healthcare providers on  the council would                                                                    
be a pediatrician. Page 3,  line 31 added the legislature as                                                                    
a recipient  of the council's annual  financial report. Page                                                                    
4,  lines 13  through  14 added  the  language "after  being                                                                    
phased  into the  program under  procedures approved  by the                                                                    
commissioner." Page  5, lines  4 and  5 added  the following                                                                    
     (e) An assessable entity may opt out of the program                                                                        
     during the three-year phase-in period under procedures                                                                     
     approved by the commissioner.                                                                                              
Ms.  Conway elaborated  that  the model  was  used to  allow                                                                    
providers to  choose whether  to opt  into the  program. She                                                                    
detailed  that a  timeframe would  be designated  similar to                                                                    
the  open  enrollment  system   used  for  state  healthcare                                                                    
4:15:05 PM                                                                                                                    
Ms. Conway continued to discuss  changes in the legislation.                                                                    
Page 5, lines 9 through 12 added the following provisions:                                                                      
     (b) An assessable entity may not deny a claim for                                                                          
     coverage by a health care provider of vaccines not                                                                         
     distributed under the program.                                                                                             
     (c) A health care provider may not bill a payor for or                                                                     
     resell a vaccine distributed under the program.                                                                            
She elaborated  that a provider  not in the program  may not                                                                    
deny a claim. She  explained that healthcare providers would                                                                    
be required  to ensure that  the program vaccines  were kept                                                                    
separately from others.                                                                                                         
Co-Chair  Stoltze asked  if the  mandate related  to vaccine                                                                    
coverage  was new.  Ms. Conway  replied that  it had  always                                                                    
been  the case  that state  vaccines could  not be  given to                                                                    
another person or resold.                                                                                                       
Co-Chair  Stoltze clarified  that he  was interested  in the                                                                    
coverage   mandate.  Senator   Giessel  replied   that  some                                                                    
insurance policies  had provided  coverage for  vaccines and                                                                    
had been  doing so  for some  time. The  provision prevented                                                                    
double assessment. She explained that  if an entity had paid                                                                    
for  the  vaccines  upfront  through  the  state  purchasing                                                                    
program, they would  not be billed by the  provider a second                                                                    
time for giving the vaccine.                                                                                                    
Ms. Conway moved  to page 7, lines 2 through  5; the section                                                                    
would repeal  statutes pertaining  to the  adult vaccination                                                                    
program on  January 1, 2021.  The provision  necessitated an                                                                    
act  by the  legislature  (prior to  2021)  to continue  the                                                                    
adult portion of the immunization  program set out under the                                                                    
legislation.  Page  7,  line  6  repealed  Chapter  24,  the                                                                    
current temporary  program; the funds would  be deposited to                                                                    
begin  the  vaccine  assessment account.  Page  7,  line  13                                                                    
changed the  bill's effective date  to January 1,  2015. She                                                                    
added  that  throughout  the   bill  the  term  "recommended                                                                    
vaccine"  had   been  changed   to  "included   vaccine"  in                                                                    
reference  to the  list of  vaccine  selections the  council                                                                    
would compile.                                                                                                                  
Representative  Munoz  asked  the  sponsor  to  address  any                                                                    
resistance  to  including  adults in  the  vaccine  program.                                                                    
Senator Giessel  answered that she  had been  surprised that                                                                    
the Pharmaceutical  Manufacturer's Association had  come out                                                                    
in  opposition  to the  bill.  She  pointed to  its  initial                                                                    
opposition  to  including  adults  in the  program  and  its                                                                    
subsequent  opposition  to the  bill  in  its entirety.  She                                                                    
deferred  the  question  to   the  association  for  further                                                                    
detail.  She  was  concerned  that   many  of  the  diseases                                                                    
affecting  children  such  as   pertussis  were  carried  by                                                                    
adults. She detailed that pertussis  manifested in adults as                                                                    
a  severe  cough, but  could  be  deadly for  children.  She                                                                    
pointed  to  multiple cases  in  Ohio  the prior  year  when                                                                    
newborns  had  died  after   contracting  the  illness  from                                                                    
adults.  She  stressed  the importance  of  making  vaccines                                                                    
available to adults in addition  to children. She added that                                                                    
seniors  were  supportive of  the  bill  and were  glad  the                                                                    
shingles vaccine  would be available  to them.  She believed                                                                    
including seniors in the program was critically important.                                                                      
Representative  Munoz wondered  what  the legislation  would                                                                    
take away.  She was  interested in the  cost benefit  of the                                                                    
program, its  impacts, and why  there was opposition  to the                                                                    
Senator  Giessel answered  that  currently  there were  many                                                                    
healthcare providers  who were  no longer  offering vaccines                                                                    
due to  the financial expense. She  elaborated that vaccines                                                                    
bought   in  small   quantities  for   small  clinics   were                                                                    
prohibitively expensive;  vaccines typically expired  in six                                                                    
months and  had to  be discarded  if they  were not  used in                                                                    
time. She  explained that  for over 30  years the  state had                                                                    
purchased a  large vaccine quantity  and had kept  the stock                                                                    
moving  to  prevent  expiration  issues.  Currently  various                                                                    
providers had some children who  qualified for the federally                                                                    
funded  Vaccines  for  Children  program;  approximately  50                                                                    
percent of  the state's  children qualified.  She elaborated                                                                    
that  the   program  vaccines  were  kept   separately  from                                                                    
vaccines  for  insured  children; vaccinations  for  insured                                                                    
children  could not  be  traded out  for  recipients of  the                                                                    
Vaccines  for  Children.  Many clinics  were  not  currently                                                                    
offering   vaccines  due   to  the   complex  administrative                                                                    
function and  potential loss in  revenue that  occurred when                                                                    
vaccines expired.                                                                                                               
Representative  Wilson referenced  a bubble  chart ["SB  169                                                                    
Statewide  Immunization Program"  pyramid chart].  She asked                                                                    
for verification  that the mandate  only applied  to private                                                                    
payors under the bill; it would  be up to the other entities                                                                    
to decide whether they wanted to participate.                                                                                   
4:23:00 PM                                                                                                                    
Senator  Giessel  replied  that  participation  for  private                                                                    
payors and small clinics would  be voluntary. She pointed to                                                                    
the "SB  169 Statewide  Immunization Program"  pyramid chart                                                                    
(copy   on  file).   She   recommended   hearing  from   the                                                                    
department's program manager Jill Lewis for details.                                                                            
Representative Wilson  asked whether Tricare,  Medicare, and                                                                    
Medicaid would be forced to  participate in the program. She                                                                    
thought  private payors  equated to  private insurance.  She                                                                    
wanted  to  ensure  that  the  program  included  more  than                                                                    
private insurance.                                                                                                              
Co-Chair Stoltze OPENED public testimony.                                                                                       
4:24:45 PM                                                                                                                    
JAMES  MATTEUCCI,  MERCK  SHARP  AND  DOHME,  PHARMACEUTICAL                                                                    
RESEARCH    AND   MANUFACTURERS    ASSOCIATION,   AND    THE                                                                    
BIOTECHNOLOGY    INDUSTRY    ORGANIZATION,   testified    in                                                                    
opposition to the bill. The  organizations were committed to                                                                    
growing the  vaccine market and ensuring  that vaccines were                                                                    
widely  distributed  and  used.   He  stated  that  vaccines                                                                    
provided  an  enormous  value  to  healthcare  in  terms  of                                                                    
quality of  a patient's  experience in lessening  the burden                                                                    
of  disease and  in  lowering overall  healthcare costs.  He                                                                    
stressed  that the  organizations were  not discrediting  or                                                                    
undermining  the  value  of  an  adult  vaccine  market.  He                                                                    
complimented  Senator  Giessel  for   taking  up  the  issue                                                                    
several years earlier when the  federal Vaccine for Children                                                                    
program    funding    was   significantly    reduced.    The                                                                    
organizations were  specifically opposed to the  creation of                                                                    
an  adult  vaccine  program  using an  assessment  on  to  a                                                                    
private plan.  The organizations believed that  the proposed                                                                    
program was  precedent setting;  other states  had attempted                                                                    
unsuccessfully to  implement a similar program.  He detailed                                                                    
that the states  using a format of an  adult vaccine program                                                                    
using   private   dollars    had   been   intermittent   and                                                                    
unsuccessful overall.                                                                                                           
Co-Chair Stoltze  interjected and  relayed that SB  64 would                                                                    
not be heard during that day.                                                                                                   
Mr. Matteucci focused on problems  the bill solved, problems                                                                    
it  created, and  problems it  ignored. He  stated that  the                                                                    
bill  did not  solve  a problem.  He  communicated that  the                                                                    
federal   Affordable  Care   Act   required  private   plans                                                                    
participating  in  the  market  to provide  a  full  vaccine                                                                    
benefit  for enrollees.  He explained  that SB  169 was  for                                                                    
private   plans   and   benefitting  people   with   private                                                                    
insurance. He stressed that the  benefit already existed and                                                                    
that  with  or without  the  bill  the patient's  experience                                                                    
would be unchanged.                                                                                                             
Mr.   Matteucci   looked   at  problems   created   by   the                                                                    
legislation. The organizations  believed the bill threatened                                                                    
the adult  market for vaccines.  The market was  growing and                                                                    
an  increasing number  of diseases  were being  successfully                                                                    
treated  by  more vaccines  from  companies  such as  Merck,                                                                    
GlaxoSmithKline, Pfizer, Novartis,  and other; the companies                                                                    
had dedicated enormous amounts of  research and resources to                                                                    
bringing  the vaccines  to  market  and commercializing.  He                                                                    
stated that  under the legislation  the state took  over the                                                                    
negotiating  authority  of  a  plan  such  as  Premera  with                                                                    
another private company (e.g. Merck)  for the benefit of the                                                                    
plan. He  explained that the  plan's premium  retained would                                                                    
be increased because  the state would be  negotiating on its                                                                    
behalf.  The  organizations   believed  that  the  precedent                                                                    
established  under  the  bill would  negatively  impact  the                                                                    
adult  vaccine  market  nationwide.  He  believed  that  the                                                                    
bill's  underlying funding  structure  was  in question.  He                                                                    
detailed that  the assessment  or tax  on private  plans was                                                                    
clear;  the plans  would participate  based on  market share                                                                    
and  utilization.  However,  the  bill also  relied  on  the                                                                    
participation  of Employee  Retirement  Income Security  Act                                                                    
(ERISA) third-party  plans, Medicaid,  and Medicare;  it was                                                                    
not possible  to proactively assess  monies for  these plans                                                                    
for  the purpose  of providing  care  at a  future time.  He                                                                    
stated that if  the past was prologue the  ERISA plans would                                                                    
not  participate; Tricare  in the  states of  Washington and                                                                    
Idaho had  elected not to  participate in  similar programs.                                                                    
In  Idaho the  state  had been  responsible  for picking  up                                                                    
unanticipated  costs of  approximately $600,000  annually to                                                                    
pay for  the backfill  of non-participating ERISA  plans. He                                                                    
discussed  that   Medicaid  was   a  federal   program  that                                                                    
reimbursed for  services delivered;  it was not  possible to                                                                    
proactively assess  Medicaid for a healthcare  service to be                                                                    
delivered in the future unless  it was petitioned for a plan                                                                    
amendment to the Medicaid plan.                                                                                                 
Mr. Matteucci  emphasized that  while universal  coverage of                                                                    
vaccines was  a goal  at Merck, universal  purchase programs                                                                    
had not  been demonstrated  to be a  silver bullet.  The CDC                                                                    
had done  a recent study showing  that three of the  top ten                                                                    
utilization states were  universal purchase states; however,                                                                    
there were  universal purchase states  in the bottom  ten as                                                                    
well.   He  agreed   that  promoting   vaccines,  conducting                                                                    
educational   outreach,   and  incentivizing   patients   or                                                                    
providers to  properly vaccinate  themselves was the  way to                                                                    
go; however,  universal purchase states as  a mechanism were                                                                    
not rate increasers.                                                                                                            
Mr. Matteucci addressed the problem  ignored by the bill. He                                                                    
stated that  the bill ignored the  uninsured population; the                                                                    
population needing  help the most.  The bill had  the intent                                                                    
to get to the uninsured  through the regulatory process, but                                                                    
the bill contained nothing that  benefited the uninsured. He                                                                    
noted  that  the  number  would dwindle  over  time  as  the                                                                    
Affordable Care Act was rolled  out, but the uninsured would                                                                    
either be too  wealthy for Medicaid or would  lack a private                                                                    
insurance through a  partner or other. He  detailed that the                                                                    
uninsured individuals  may lose  work if  they get  sick and                                                                    
miss  work;  the  economic  impact   to  families  could  be                                                                    
staggering.  He summarized  that the  bill did  not solve  a                                                                    
problem in the adult market;  the problem had been solved by                                                                    
the  Affordable   Care  Act.  He  stressed   that  the  bill                                                                    
significantly threatened the adult  private market in Alaska                                                                    
by positioning  the state  as a  negotiator for  one private                                                                    
entity  against  another  for the  benefit  of  one  private                                                                    
entity. He  stated that the patient  experience would remain                                                                    
unchanged  regardless of  the bill.  Finally, the  uninsured                                                                    
were   ignored  by   the   legislation.  The   organizations                                                                    
recommended the  removal of the  adult portion of  the bill.                                                                    
He pointed  to the vagary of  the phased in program  and the                                                                    
potentially  negative implications.  Merck was  committed to                                                                    
working with the  sponsor and department to  find a solution                                                                    
over  the   course  of  the  next   year  that  specifically                                                                    
identified and addressed the adult  uninsured portion of the                                                                    
population. The solution could be  an appropriation from the                                                                    
state or another mechanism.                                                                                                     
4:35:14 PM                                                                                                                    
Representative  Guttenberg asked  for verification  that Mr.                                                                    
Matteucci's primary objection  was to the idea  of the state                                                                    
exerting its buying  power by pooling its  needs. He thanked                                                                    
Senator Giessel for bringing the  bill forward. He had asked                                                                    
the commissioner in the past  about what the state was doing                                                                    
to increase its  bargaining power by enlarging  the pools of                                                                    
healthcare  industry   components.  He  observed   that  the                                                                    
pharmaceutical  manufacturers  always  had  the  ability  to                                                                    
choose not  to sell  a drug  at a  certain price.  He stated                                                                    
that a  larger pool would  drive the cost down,  which would                                                                    
be a direct benefit to the state and programs.                                                                                  
Mr. Matteucci replied  that his argument was  not related to                                                                    
pooling. He elaborated that pooling  took place on a variety                                                                    
of  levels;   the  state  currently   pooled  pharmaceutical                                                                    
benefits  under Medicaid  with  other  states. He  contended                                                                    
that the action  under the bill was different;  the bill was                                                                    
for people in the private  marketplace who receive a private                                                                    
benefit from  a private  plan. He detailed  that it  was not                                                                    
the traditional  concept of a  state pooling  its resources;                                                                    
it was  the exercise  of the  state interceding  between two                                                                    
private  entities  negotiating  price   and  volume  in  the                                                                    
private marketplace  for the benefit  of one of  the private                                                                    
Representative  Guttenberg  believed  the  purpose  was  the                                                                    
same, but  that the organizations objected  to the structure                                                                    
of  the  proposal. He  addressed  testimony  that a  patient                                                                    
would not see any cost differences  as a result of the bill.                                                                    
He opined  that part of  the problem  was that there  was no                                                                    
transparency on the cost of  vaccines when they were covered                                                                    
by insurance.  He remarked that  people would be  unhappy to                                                                    
learn about  price differentials between  various healthcare                                                                    
facilities. He discussed that the  bill was in line with the                                                                    
state's goal  to get a  handle on healthcare costs.  Part of                                                                    
the solution  was to make  healthcare recipients  more aware                                                                    
of the  costs of  services. He believed  plan administrators                                                                    
also saw the issue as a problem.                                                                                                
Mr.  Matteucci answered  that transparency  was a  key issue                                                                    
included  in the  Affordable Care  Act  and in  a number  of                                                                    
bills  nationwide.  He  asserted  that the  bill  would  not                                                                    
necessarily make  any costs transparent to  patients; it was                                                                    
simply  negotiating on  behalf of  a particular  health plan                                                                    
against another  commercial enterprise.  The balance  of the                                                                    
discount would  likely be  retained in  the premium  for the                                                                    
health  plan; there  was  no mechanism  that  passed on  the                                                                    
savings  to patients.  The bill  benefitted the  plan itself                                                                    
because  a greater  portion of  the premium  value would  be                                                                    
retained given the state's negotiated vendor discount.                                                                          
Representative  Munoz  asked   whether  providers  currently                                                                    
purchased   vaccines   directly  from   the   pharmaceutical                                                                    
associations. She wondered whether  under the bill the state                                                                    
would   purchase  the   vaccines  and   would  act   as  the                                                                    
Mr.  Matteucci answered  that he  was not  an expert  on the                                                                    
distribution   channels.   He  explained   that   individual                                                                    
providers  had several  sources  of  vaccines for  Medicare,                                                                    
Medicaid, Tricare, and private  plans; the providers reached                                                                    
individual agreements with private  plans. He addressed cost                                                                    
and  relayed   that  the  companies  he   worked  for  would                                                                    
negotiate  agreements  with each  plan  in  each state;  the                                                                    
agreements  would  be different  because  it  was a  private                                                                    
marketplace.  Cost was  based on  sales volume  and expected                                                                    
return on  investment. He added  that in the  private market                                                                    
it was  unusual to have the  state step in and  negotiate on                                                                    
behalf  of a  plan  alongside his  companies. The  companies                                                                    
recommended  that the  state pursue  a separate  program for                                                                    
uninsured adults  that would not be  captured under Medicaid                                                                    
or  the Affordable  Care  Act.  He would  follow  up on  how                                                                    
vaccines were obtained.                                                                                                         
4:42:29 PM                                                                                                                    
Vice-Chair   Neuman  asked   for  Mr.   Matteucci's  contact                                                                    
information. Co-Chair  Stoltze replied that  the information                                                                    
would be provided.                                                                                                              
JANA   SHOCKMAN,  PRESIDENT,   ALASKA  NURSES   ASSOCIATION,                                                                    
ANCHORAGE  (via teleconference),  spoke  in  support of  the                                                                    
legislation.   She  spoke   to  the   bill's  inclusion   of                                                                    
immunizations  for  adults.  She  relayed  that  every  year                                                                    
adults ended up in hospital  critical care units as a result                                                                    
of  illnesses  such as  flu  and  pneumonia; both  would  be                                                                    
covered under  the bill's vaccination program.  The majority                                                                    
of the patients were  young and previously healthy; however,                                                                    
they had  not received  vaccinations. She stressed  that the                                                                    
illnesses  could be  life threatening  and  could have  life                                                                    
altering  consequences.  She  emphasized the  importance  of                                                                    
making the  vaccinations easily  accessible at  a reasonable                                                                    
cost  to providers.  She  stated that  the  bill provided  a                                                                    
means  for   the  state  to   protect  its   residents  with                                                                    
affordable vaccines.  She urged the committee's  support for                                                                    
the legislation.                                                                                                                
4:45:11 PM                                                                                                                    
PATRICIA SENNER,  ALASKA NURSES ASSOCIATION,  ANCHORAGE (via                                                                    
teleconference),  spoke in  favor  of  the legislation.  She                                                                    
discussed the  vaccine supply  chain. She  communicated that                                                                    
Alaska  had many  small providers  which meant  that it  was                                                                    
necessary  to  pool together  to  purchase  vaccines at  the                                                                    
cheapest  rate possible.  She  had run  a  small clinic  and                                                                    
pointed  to the  considerable difference  in vaccine  prices                                                                    
between the clinic and the  hospital. As a private provider,                                                                    
she  paid  upfront  for vaccines  and  was  reimbursed  once                                                                    
vaccines were  given. She stressed  that it put  an enormous                                                                    
burden  on private  providers, particularly  family practice                                                                    
doctors and  pediatricians. She addressed the  importance of                                                                    
providing vaccines  to young adults. She  explained that the                                                                    
flu was  likely to be  much more severe for  pregnant women.                                                                    
She  spoke  to  the  goal of  vaccinating  young  women  and                                                                    
families  to  prevent  the  spread   of  whooping  cough  to                                                                    
infants. She relayed  that it made a  difference to patients                                                                    
how the vaccines  were made available. She  detailed that if                                                                    
a private provider could not  pay to bring the vaccines into                                                                    
their  clinic, they  could not  provide their  patients with                                                                    
vaccines  on   normal  visits;  requiring  patients   to  go                                                                    
elsewhere for  vaccines increased the probability  that they                                                                    
would not  follow through. She  urged the committee  to pass                                                                    
the bill.                                                                                                                       
4:48:18 PM                                                                                                                    
WILLIAM  STREUR,  COMMISSIONER,  DEPARTMENT  OF  HEALTH  AND                                                                    
SOCIAL  SERVICES, spoke  in support  of the  legislation. He                                                                    
stated that  the bill would help  the state in the  long run                                                                    
and would help  to reduce costs. He noted that  the bill was                                                                    
not  a  magic  bullet,  but  it  would  improve  access  and                                                                    
quality.   He  understood   that  challenges   would  exist,                                                                    
including how to  work the adult population  in. He believed                                                                    
the  three-year phase-in  would  provide  an opportunity  to                                                                    
address  any kinks  such  as  determining funding  partners,                                                                    
covered population,  and covered  vaccines. He  believed the                                                                    
bill   presented  an   opportunity  to   address  increasing                                                                    
healthcare  costs  and to  look  at  the state's  vulnerable                                                                    
population that had no other coverage.                                                                                          
Vice-Chair Neuman  asked how the legislation  would not cost                                                                    
the state  money. He had been  told that the bill  would not                                                                    
result in costs  to the state; he wondered  if that factored                                                                    
in  savings  in  medical  costs that  would  occur  if  more                                                                    
individuals received vaccinations.                                                                                              
Commissioner Streur  replied that part of  the savings would                                                                    
be  related to  downstream healthcare  cost reductions.  The                                                                    
initial savings would be in the  cost of the vaccine and the                                                                    
state's ability to pool resources to purchase vaccines.                                                                         
Vice-Chair  Neuman pointed  to the  $28 million  fiscal note                                                                    
and wondered how the bill cost nothing.                                                                                         
Commissioner Streur replied that  the bill was an assessment                                                                    
to  insurance  carriers  (e.g. Medicare,  Medicaid,  Premera                                                                    
Blue Cross,  and other). The  goal was  to bring on  as many                                                                    
people as  possible at a  lower vaccine cost, to  provide an                                                                    
incentive to  reduce provider costs  within the  system, and                                                                    
ideally to return the investment to the purchaser.                                                                              
Vice-Chair Neuman  asked if  the assessment  was a  fee that                                                                    
would be charged to  insurance carriers. Commissioner Streur                                                                    
replied in the affirmative.                                                                                                     
Vice-Chair Neuman  noted that  there was  currently $700,000                                                                    
in  general  funds  in  the  department's  base  budget.  He                                                                    
wondered  what  would  happen  if  the  legislative  finance                                                                    
subcommittee chose to reduce the department's budget.                                                                           
Commissioner  Streur  answered  that  was  experienced  with                                                                    
budget reductions.                                                                                                              
4:52:12 PM                                                                                                                    
Co-Chair Stoltze CLOSED public testimony.                                                                                       
CSSB 169(FIN)  was HEARD and  HELD in committee  for further                                                                    

Document Name Date/Time Subjects
1.1 CSSB 108(JUD) Sponsor Statement.pdf HFIN 4/14/2014 1:30:00 PM
SB 108
3.1 CSSB 108(JUD) Section Analysis.pdf HFIN 4/14/2014 1:30:00 PM
SB 108
5 CSSB 108(JUD) Summary of Changes.pdf HFIN 4/14/2014 1:30:00 PM
SB 108
6 SB108 Legal Memo 2 26 14.pdf HFIN 4/14/2014 1:30:00 PM
SB 108
6.2 SB108 Rule 37.pdf HFIN 4/14/2014 1:30:00 PM
SB 108
7 SB108 Support Letters - Dr. Don Brink, Chugiak, AK.PDF HFIN 4/14/2014 1:30:00 PM
SB 108
12 SB108 OVR Written Testimony.pdf HFIN 4/14/2014 1:30:00 PM
SB 108
7.1 SB108 Support - Dr. Donna Klecka, Eagle River, AK.pdf HFIN 4/14/2014 1:30:00 PM
SB 108
7.2 Support of SB108 - James Noble, Kenai, AK.pdf HFIN 4/14/2014 1:30:00 PM
SB 108
6.1 CSSB 108(JUD) Collateral Consequences & Reentry in Alaska.pdf HFIN 4/14/2014 1:30:00 PM
SB 108
7.3 Support of SB108 - Carmen Gutierrez.pdf HFIN 4/14/2014 1:30:00 PM
SB 108
House Finance OVR Opposition to SB 108.pdf HFIN 4/14/2014 1:30:00 PM
SB178 DOR Letter - Rodell.pdf HFIN 4/14/2014 1:30:00 PM
SB 178
SB 178 Letters of Support.pdf HFIN 4/14/2014 1:30:00 PM
SB 178
CSSB 178 Sponsor Statement.pdf HFIN 4/14/2014 1:30:00 PM
SB 178
SB 127 Sponsor Statement.pdf HFIN 4/14/2014 1:30:00 PM
SB 127
SB 127 Explanation of Changes.pdf HFIN 4/14/2014 1:30:00 PM
SB 127
SB 127 Support Documents - AK Statute 28.10.421 Registration Fee Rates.pdf HFIN 4/14/2014 1:30:00 PM
SB 127
SB 127 Letters of Support.pdf HFIN 4/14/2014 1:30:00 PM
SB 127
SB 127 Support Documents - AK Statute 16.05.380 & .390 ADF&G.pdf HFIN 4/14/2014 1:30:00 PM
SB 127
SB 127 Support Documents - DMV Non DL Transactions FY 2013.pdf HFIN 4/14/2014 1:30:00 PM
SB 127
SB 127 Support Documents - DMV Revenue Sources.pdf HFIN 4/14/2014 1:30:00 PM
SB 127
SB 127 Support Documents - AK Statute 28.10.431(e) Re Municipal Tax Collection.pdf HFIN 4/14/2014 1:30:00 PM
SB 127
SB 127 Support Documents - Alaska Tags & Titles Transaction Count and Revenue 04-13.pdf HFIN 4/14/2014 1:30:00 PM
SB 127
SB169PayerPyramid_7Mar2014.pdf HFIN 4/14/2014 1:30:00 PM
SB 169
SB169 WhoPaysFor VaccineInAK.pdf HFIN 4/14/2014 1:30:00 PM
SB 169
AdultFluPneumoniaImmunizations2012.pdf HFIN 4/14/2014 1:30:00 PM
SB 169
StateSupplyVaccinesDistributedByProviderType2013.pdf HFIN 4/14/2014 1:30:00 PM
SB 169
Questions from Higgins March 26.pdf HFIN 4/14/2014 1:30:00 PM
SB 169
SB169 Vaccines In AK short vsn (2).pdf HFIN 4/14/2014 1:30:00 PM
SB 169
SB 169 Additional Questions Rep. Higgins.pdf HFIN 4/14/2014 1:30:00 PM
SB 169
SB169FlowChart_7Mar2014.pdf HFIN 4/14/2014 1:30:00 PM
SB 169
SB 169 FAQs vsn I.pdf HFIN 4/14/2014 1:30:00 PM
SB 169
SB 169 Support all.batch 1.pdf HFIN 4/14/2014 1:30:00 PM
SB 169
SB169 Vaccines In AK short vsn (2).pptx HFIN 4/14/2014 1:30:00 PM
SB 169
SB 169 Support batch 2.pdf HFIN 4/14/2014 1:30:00 PM
SB 169
SB 169 Sponsor Stmt FIN.pdf HFIN 4/14/2014 1:30:00 PM
SB 169
SB 169 Response to BIO concerns.pdf HFIN 4/14/2014 1:30:00 PM
SB 169
SB 169 Opposition.pdf HFIN 4/14/2014 1:30:00 PM
SB 169
SB 169 Opposition Pharma.pdf HFIN 4/14/2014 1:30:00 PM
SB 169
SB 169 Historic vaccine photo.pdf HFIN 4/14/2014 1:30:00 PM
SB 169
SB129 Supporting Documents-Letter AK Chamber.pdf HFIN 4/14/2014 1:30:00 PM
SB 129
SB129 Sectional Analysis.pdf HFIN 4/14/2014 1:30:00 PM
SB 129
SB129 Supporting Documents-DCCED BCREA Audit 2013.pdf HFIN 4/14/2014 1:30:00 PM
SB 129
SB129 Supporting Documents-Summary of Changes.pdf HFIN 4/14/2014 1:30:00 PM
SB 129
SB129 Sponsor Statement.pdf HFIN 4/14/2014 1:30:00 PM
SB 129
SB 64 (HJUD) Presentation.pdf HFIN 4/14/2014 1:30:00 PM
SB 64
SB 127 Testimony Opposition.pdf HFIN 4/14/2014 1:30:00 PM
SB 127
HB 287 New Fiscal Note CS FIN DOR.pdf HFIN 4/14/2014 1:30:00 PM
HB 287
HB 287 New Fiscal Note CS FIN DNR.pdf HFIN 4/14/2014 1:30:00 PM
HB 287
test Geddes Letter on SB 108.docx HFIN 4/14/2014 1:30:00 PM
SB 108
HB 316 Amendment #2 Thompson.pdf HFIN 4/14/2014 1:30:00 PM
HB 316
Replacement Amendment #1 Gara.pdf HFIN 4/14/2014 1:30:00 PM
HB 316
SB 56 APD Suggested Sentencing.pdf HFIN 4/14/2014 1:30:00 PM
SB 56
SB 108 adm-40a Courts.pdf HFIN 4/14/2014 1:30:00 PM
SB 108
AK Chamber SB 127 Stoltze April 17, 2014.pdf HFIN 4/14/2014 1:30:00 PM
SB 127