Legislature(2005 - 2006)CAPITOL 106
02/14/2006 03:00 PM HEALTH, EDUCATION & SOCIAL SERVICES
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HB 393-INSURANCE FOR COLORECTAL CANCER SCREENING 3:50:53 PM CHAIR WILSON announced that the next order of business would be HOUSE BILL NO. 393, "An Act requiring that certain health care insurance plans provide coverage for the costs of colorectal cancer screening examinations and laboratory tests; and providing for an effective date." 3:51:13 PM REPRESENTATIVE ANDERSON, speaking as the prime sponsor, introduced HB 393 and paraphrased from his sponsor statement [original punctuation provided]: Colon cancer (technically known as colorectal cancer) is the second leading cause of cancer deaths in Alaska and across the nation. An estimated 57,000 Americans died from the colon cancer in 2005. Screening has the potential to drastically reduce this number. Consider these facts: When caught through routine screening at the localized stage, the 5-year survival rate from colon cancer is over 90%. If not caught until it has distant metastasis, when symptoms are likely to appear, the 5-year survival rate is only 10%. Colonoscopy is over 90% effective at detecting colon cancer and can remove pre-cancerous polyps, actually preventing cancer from ever developing. 3:54:50 PM REPRESENTATIVE ANDERSON moved to adopt proposed committee substitute (CS) for HB 393, Version 24-LS0780\Y, Bailey, 2/13/06. There being no objection, Version Y was before the committee. 3:55:36 PM HEATH HILYARD, Staff to Representative Anderson, Alaska State Legislature, explained the key changes between CSHB 393(L&C) and Version Y; directing the committee's attention to page 2, line 3. This change establishes the American Cancer Society standards as the guidelines for colorectal cancer screening, and removes the United States Preventative Services Task Force guidelines reference from the bill. In addition, he pointed out that the word "current" was removed [in this section] as a suggestion from the legal drafters, who opined that including the word "current" would require Alaska law to comport with an outside standard; an unconstitutional delegation of authority. 3:57:11 PM EMILY NENON, Director, Alaska Government Relations, American Cancer Society (ACS), echoed Representative Anderson's sponsor statement adding that with the colonoscopy screening method, precancerous polyps can be immediately removed, making this the only screening tool that can actually prevent cancer. She said that for the average risk patient, the ACS guidelines recommend this procedure every 10 years after the age of 50. She pointed out that this could limit an insurance plan from having to pay for more than two of these procedures, as Medicare coverage would apply after age 65. She highlighted that the cost savings of early diagnosis and prevention versus contracting cancer and undergoing cancer treatment, are significant. 4:01:27 PM MS. NENON pointed out that colon cancer occurs more frequently in Alaska than in the general U.S. population and is the second leading cause of cancer death. She said that the Alaska Native population represents an anomaly, with the single highest rates of colon cancer of any population group in America; double that of the U.S. white population. The ACS and the Alaska Native Tribal Health Consortium are researching this phenomenon; however, she reiterated that the screening tools and procedures are available to prevent this cancer. 4:02:47 PM REPRESENTATIVE GARDNER asked Ms. Nenon to estimate the number of Alaskan lives that might be saved if this bill passes and what the diagnosis frequency represents. MS. NENON said that colon cancer screening increases survival rates by 80 percent, and provided that 5-10 percent of the general population will develop colorectal cancer. 4:04:41 PM REPRESENTATIVE GATTO stated that the cost for screening is about $2,500.00, including the hospital fees, and that about 3 percent who come in for screening have polyps removed during the procedure. In comparison, he noted the high cost of cancer treatment. He also noted that, with these facts and figures before them, it is evident that this bill is a benefit to the population and the insurance companies. 4:07:38 PM REPRESENTATIVE ANDERSON, pointing out whom this bill will effect, stated that current State of Alaska employees are already covered for this screening, along with other self- insured employers such as Providence Medical Center, adding that this bill targets retirees. He also noted that there are three types of screening procedures, with various degrees of invasiveness. MR. HILYARD added that this screening is subject to policy plan provisions already in place with regard to co-pay and deductible requirements. 4:10:21 PM MARIANNE BURKE stated strong support for HB 393, saying that this coverage should be mandated. She said that from a humanistic and financial point of view, "it is a no-brainer" to mandate insurance coverage for a procedure that can eliminate colon cancer. Having served as the director of the Division of Insurance for the State of Alaska, she said that she has upheld the belief that personal choice issues should not be covered by statute. However, she opined, that this issue goes beyond personal choice given the fiscal and life-saving impacts. REPRESENTATIVE ANDERSON asked whether Ms. Burke, as former director of the Division of Insurance, would concur with the zero fiscal note issued from the Division of Insurance. MS. BURKE said that she would concur, and further stated that there would be no impact on the state as the state's insurance coverage is not affected by this bill. 4:14:31 PM REED STOOPS, Lobbyist, Aetna and American Health Insurance Plans (AHIP), presented a proposal for an amendment to HB 393. He said that the amendment will serve to reflect the updates of screening standards by ACS and prevent the need to change state statute accordingly. He also proposed an amendment to allow health plan administrators to notify policyholders of this screening coverage in conjunction with other health care communications/mailings. He pointed out that this mandate will only apply to a small number of Alaskans who are not insured or whose coverage does not already encompass this procedure. In answer to a question, he clarified that the "legislature can't mandate coverages on any self-insured program or federally funded programs that don't come through the state." To a further question, he stated that it is hard to project who will take advantage of this screening coverage. 4:20:02 PM REPRESENTATIVE ANDERSON directed the committee's attention to the amendment to CSHB 393(L&C). 4:20:43 PM MR. HILYARD described the two versions of the same amendment, explaining that the concern was who would be responsible for notification of coverage to policyholders and the frequency of notification. He pointed out that the amendment inserts the word "annually," and the word "current" is omitted. 4:22:21 PM VICE CHAIR SEATON moved to adopt Amendment 1, which read [with handwritten changes]: Page 2, Lines 21-25 (f) Each [HEALTH CARE INSURER OR] health benefit plan shall notify each enrollee annually of the coverage for colorectal cancer screenings and provide the [CURRENT] American Cancer Society guidelines for colorectal cancer screenings. The notice shall be [DELIVERED BY MAIL UNLESS THE ENROLLEE AND HEALTH CARRIER HAVE AGREED ON ANOTHER METHOD OF NOTIFICATION] included in health benefit handbooks or be provided by written or electronic communication between health plan administrators and enrollees. There being no objection, Amendment 1 was adopted. REPRESENTATIVE CISSNA asked for clarity regarding how the state will be informing policyholders of this benefit. CHAIR WILSON explained that the state plan already covers employees for colorectal screening procedures and this bill will encompass state retirees as well. REPRESENTATIVE CISSNA said she was inquiring about the broadcast of information regarding colorectal screening procedures and the screening coverage. CHAIR WILSON said that Amendment 1 specifies that each enrollee will have to be notified annually of the coverage provided from colorectal cancer screenings and provide the ACS's guidelines for colorectal cancer screening. REPRESENTATIVE ANDERSON offered that Aetna and Blue Cross should not be mandated to provide monthly/annually notification to policyholders versus the electronic correspondence and [edited/issued policy pamphlet]. 4:26:58 PM REPRESENTATIVE CISSNA clarified that she wants to ensure that the ACS guidelines are contained in the current information provided to state employees. MR. HILYARD stated that this information is currently in the state insurance pamphlet. 4:27:47 PM CHAIR WILSON reiterated that in the long run this procedure will save human suffering and the insurance company's money. She relayed her personal experiences relating to colorectal screening and cancer. 4:30:16 PM REPRESENTATIVE SEATON moved to report CSHB 393, Version 24- LS0780\Y, Bailey, 2/13/06, as amended, out of committee with individual recommendations and the accompanying zero fiscal notes. REPRESENTATIVE GATTO objected to the effective date of the bill and asked how this date was established. MR. STOOPS explained how the employees, who sign up for insurance after this legislation passes, will receive the information in their handbook at that time. The bill allows for "other communication," which may be used by the employer during the interim of issuing the updated annual handbook. REPRESENTATIVE GATTO removed his objection. 4:32:29 PM CHAIR WILSON stated that there being no objection, CSHB 393(HES) was reported out of the House Health Education and Social Services Standing Committee.