Legislature(2011 - 2012)CAPITOL 106

02/14/2012 03:00 PM HEALTH & SOCIAL SERVICES


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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
*+ HB 310 STATE IMMUNIZATION PROGRAM TELECONFERENCED
Heard & Held
+= HB 209 INSURANCE COVERAGE FOR TOBACCO CESSATION TELECONFERENCED
Heard & Held
               HB 310-STATE IMMUNIZATION PROGRAM                                                                            
                                                                                                                                
3:50:48 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER announced that the  final order of business would be                                                               
HOUSE BILL  NO. 310,  "An Act  temporarily reinstating  the child                                                               
and adult  immunization program in  the Department of  Health and                                                               
Social Services; and providing for an effective date."                                                                          
                                                                                                                                
3:51:04 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE HERRON,  introducing HB  310 as the  prime sponsor                                                               
of  the  bill, said  that  the  Alaska immunization  program  had                                                               
benefited from  federal grant money for  vaccines to underinsured                                                               
children and  adults who would  not, otherwise, have  had access.                                                               
He  pointed out  that  recent reductions  to  federal grants  had                                                               
resulted in  an 84 percent  loss of  funding.  He  reported that,                                                               
thanks to  the vaccines, many  common, life  threatening diseases                                                               
were now virtually  unheard of.  He confirmed  that, although the                                                               
Alaska  Health  Care  Commission  did  not  specifically  endorse                                                               
legislation,  its  report  encouraged  the  State  of  Alaska  to                                                               
"adequately support  a program  that improves  immunization rates                                                               
in order  to protect Alaskans from  serious, preventable diseases                                                               
and their complications."  He  opined that this legislation would                                                               
benefit all Alaskans.                                                                                                           
                                                                                                                                
3:53:57 PM                                                                                                                    
                                                                                                                                
CHAIR  KELLER  confirmed   that,  as  a  member   of  the  health                                                               
commission,  he had  "become painfully  aware of  the dangers  of                                                               
continually expanding  health care coverage, but  this particular                                                               
one is  probably a cost  savings measure.   I think  I'm probably                                                               
convinced."   He allowed that  immunizations costs had  been paid                                                               
for many  years, but that  $4.9 million  of federal money  was no                                                               
longer available for  immunizations.  He offered  his belief that                                                               
similar situations would be forthcoming  unless health care costs                                                               
were managed.                                                                                                                   
                                                                                                                                
3:56:10 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE MILLER  expressed his  concern with page  3, lines                                                               
3-7  of  the   proposed  bill,  and  asked  about   the  uses  of                                                               
"recommended" and  "approved."   He asked  for discussion  to the                                                               
exclusion of approval for two specific vaccines.                                                                                
                                                                                                                                
REPRESENTATIVE   HERRON   replied   that   testimony   would   be                                                               
forthcoming on  that section  of proposed HB  310.   He suggested                                                               
not precluding the commissioner  from making the determination of                                                               
approval for  the two specific vaccines,  meningococcal and human                                                               
papillomavirus  vaccines.    He  affirmed  that  testimony  would                                                               
discuss the advantages and disadvantages  for the State of Alaska                                                               
to make the determination for these vaccines.                                                                                   
                                                                                                                                
3:58:01 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER,  referring to the recommended  immunizations, asked                                                               
if the Department  of Health and Social  Services would determine                                                               
the provider.                                                                                                                   
                                                                                                                                
REPRESENTATIVE HERRON  agreed with a need  for further discussion                                                               
to this.                                                                                                                        
                                                                                                                                
3:59:12 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER opened public testimony.                                                                                           
                                                                                                                                
3:59:43 PM                                                                                                                    
                                                                                                                                
GEORGE BROWN,  MD, Glacier  Pediatrics, read  from a  letter from                                                               
Glacier Pediatrics [Included in members' packets]:                                                                              
                                                                                                                                
     Please support  HB 310.   It is critical  that children                                                                    
     and  families  in  our great  state  receive  and  have                                                                    
     access to vaccinations, not only  to ensure the overall                                                                    
     health of our  youngest members but also  to lessen the                                                                    
     possibility  of  dangerous   infections  ravishing  our                                                                    
     state.   As a  state that is  working on  improving our                                                                    
     vaccine rates  (we have been  in the lowest  10 percent                                                                    
     for the past  several years), it can only  happen if we                                                                    
     continue  to have  vaccines available  for  all of  our                                                                    
     citizens.  As pediatric  health care providers, we know                                                                    
     that if  the Alaska  vaccine program decreases  or ends                                                                    
     its'  subsidy,  the  people who  will  suffer  are  the                                                                    
     working  underinsured.   We urge  you to  support House                                                                    
     Bill 310.                                                                                                                  
                                                                                                                                
4:01:32 PM                                                                                                                    
                                                                                                                                
DR. BROWN agreed that it was  necessary to have concern for cost,                                                               
but  he  emphasized that  providing  vaccines  saved money.    He                                                               
stated  that in  the past  decade it  had been  shown that  every                                                               
dollar spent for  measles, mumps, and rubella  vaccines had saved                                                               
$16.  He referred to a  recent whooping cough outbreak in Juneau,                                                               
and  pointed  out  that  these  bacterial  infections,  including                                                               
diphtheria  and  tetanus, required  boosters.    He allowed  that                                                               
without the  vaccines, this outbreak  would have been  far worse.                                                               
At that  time, the vaccine  cost $3 or  less per person,  and the                                                               
average   cost   of   treatment    was   several   thousand   per                                                               
hospitalization.  He  emphasized that this bill would  save a lot                                                               
of money, and "some major catastrophes."                                                                                        
                                                                                                                                
4:04:40 PM                                                                                                                    
                                                                                                                                
DR. BROWN,  in response to  Representative Miller, said  that the                                                               
Tdap vaccine was for tetanus, diphtheria, and pertussis.                                                                        
                                                                                                                                
4:05:41 PM                                                                                                                    
                                                                                                                                
ROSALYN  SINGLETON, MD,  Alaska Native  Tribal Health  Consortium                                                               
(ANTHC) Immunization Program,  shared some background information                                                               
on the  use of vaccines  in Alaska.   She declared  that vaccines                                                               
were  critical  to  the  health  of  Alaskans.    Speaking  about                                                               
Hepatitis A,  she reported  that before  vaccines there  had been                                                               
massive  epidemics  every  seven  to ten  years  which  had  cost                                                               
hundreds  of thousands  of  dollars in  health  response.   Since                                                               
effective   Hepatitis  A   vaccines  were   developed  in   1995,                                                               
infections had dramatically  declined, and Alaska now  had one of                                                               
the  lowest rates  in the  U.S.,  with the  resultant savings  of                                                               
public  health dollars.   She  reported that  in the  1960s, five                                                               
percent of the infants in  Southwest Alaska, one to eleven months                                                               
of age, died,  with half of these deaths secondary  to measles or                                                               
pertussis.   Since 1997, Alaska  has been free of  outbreaks from                                                               
measles because of  vaccines.  She reminded that,  because of the                                                               
staged  federal  funding  decreases  in 2011,  Alaska  no  longer                                                               
provided adult  vaccines; and,  in 2012,  Alaska would  no longer                                                               
provide vaccines to children who  were not eligible for federally                                                               
funded vaccinations.  She pointed  out that proposed HB 310 would                                                               
reinstate these vaccines until there  was a longer term solution.                                                               
She  stated   that  many  small  medical   practices  would  stop                                                               
providing  vaccines, and  that many  parents were  deferring them                                                               
until  the vaccine  was  necessary for  school  attendance.   She                                                               
opined that  a decrease  in coverage could  lead to  an increased                                                               
risk  of outbreaks,  and it  would also  leave Alaska  without an                                                               
adequate vaccine supply to respond to outbreaks.                                                                                
                                                                                                                                
4:10:44 PM                                                                                                                    
                                                                                                                                
DR.   SINGLETON   explained    that   meningococcal   and   human                                                               
papillomavirus  vaccines were  not  included in  proposed HB  310                                                               
because of cost.   She said they were important  vaccines, but as                                                               
they were costly, they were left out of the proposed bill.                                                                      
                                                                                                                                
4:11:20 PM                                                                                                                    
                                                                                                                                
CHAIR  KELLER  directed  attention  to  the  fiscal  note,  which                                                               
confirmed the cost benefit ratio for these vaccines.                                                                            
                                                                                                                                
4:12:00 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  DICK  asked  if  Hepatitis A  existed  in  Alaska                                                               
before contact with Europeans.                                                                                                  
                                                                                                                                
4:12:31 PM                                                                                                                    
                                                                                                                                
DR.  SINGLETON replied  that  testing for  Hepatitis  A had  only                                                               
begun about  30 years  ago, but that  "people have  had hepatitis                                                               
and  yellow  jaundice for  many  years."    She spoke  about  the                                                               
successes  for  eliminating  chronic  Hepatitis  B,  with  Alaska                                                               
Natives  now having  the lowest  rate  for any  racial or  ethnic                                                               
group in the U.S.                                                                                                               
                                                                                                                                
4:14:54 PM                                                                                                                    
                                                                                                                                
RANDI   SWEET,  Director,   Community  Action,   United  Way   of                                                               
Anchorage,  expressed  support  for  proposed  HB  310,  and  its                                                               
stopgap  funding  for  the Alaska  immunization  program  through                                                               
2015.  She  lauded the framing and analysis for  development of a                                                               
long  term funding  resolution so  that  vulnerable children  and                                                               
adults would receive needed vaccines.   She stated that access to                                                               
vaccines was necessary for quality  health care.  She remarked on                                                               
the economic attraction  of a healthy Alaska to  businesses.  She                                                               
pointed  to  the  Alaska  Constitution,  which  stated  that  the                                                               
legislature shall  "provide for  the promotion and  protection of                                                               
public  health."     She  stated  that   through  this  temporary                                                               
solution, the  legislature would  "promote prevention  of illness                                                               
and  protect  the  public health  of  Alaskans  from  unnecessary                                                               
exposure to  and spreading of  disease and associated  illness or                                                               
death."                                                                                                                         
                                                                                                                                
4:16:14 PM                                                                                                                    
                                                                                                                                
MARY SULLIVAN, Alaska Primary  Care Association (APCA), confirmed                                                               
that  APCA  represented  the  143  community  health  centers  in                                                               
Alaska.   She reported that  these mostly small clinics  would be                                                               
severely impacted with this loss  of funding.  She announced that                                                               
some  clinics had  already overspent  their immunization  budget,                                                               
with  an  expectation  of  zero compliance  and  an  increase  to                                                               
serious  public health  risk from  measles,  mumps, rubella,  and                                                               
pertussis.   She reported  that many of  the APCA  providers were                                                               
less  concerned  with  the language  about  meningococcal.    She                                                               
suggested  that  a  better  funding  stream  could  include  more                                                               
expensive serums, as some providers  had suggested that increased                                                               
funding could free  up money in immunization  budgets to purchase                                                               
the more expensive vaccines.                                                                                                    
                                                                                                                                
4:20:12 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  MILLETT asked  if shingles  was recognized  as an                                                               
adult vaccination.                                                                                                              
                                                                                                                                
MS.  SULLIVAN offered  her belief  that shingles  was covered  by                                                               
Medicare.                                                                                                                       
                                                                                                                                
4:21:07 PM                                                                                                                    
                                                                                                                                
CARL  ROSE,  Executive  Director, Association  of  Alaska  School                                                               
Boards (AASB), submitted a letter in support of proposed HB 310.                                                                
                                                                                                                                
Chair Keller read the letter from Mr. Rose:                                                                                     
                                                                                                                                
     AASB supports  HB 310/SB 144.   AASB believes  that the                                                                    
     health,  welfare,  safety  and  education  of  Alaska's                                                                    
     children and youth are our  highest priority.  As such,                                                                    
     AASB supports  the establishment  of a child  and adult                                                                    
     immunization program  in the  Department of  Health and                                                                    
     Social Services.   Thank you  for reading  my statement                                                                    
     of  support to  the  House Health  and Social  Services                                                                    
     Standing Committee.                                                                                                        
                                                                                                                                
4:22:11 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER declared that he would leave public testimony open.                                                                
                                                                                                                                
4:22:50 PM                                                                                                                    
                                                                                                                                
WARD HURLBURT, M.D., Chief  Medical Officer/Director, Division of                                                               
Public Health,  Central Office, Department  of Health  and Social                                                               
Services,  mentioned that  Hepatitis  B had  resulted  in a  huge                                                               
number of  liver cancer cases,  but that vaccines had  reduced it                                                               
to an  uncommon cancer.   He pointed out that  measles, pneumonia                                                               
and encephalitis no  longer threatened the lives of  infants.  He                                                               
reported  that the  Centers for  Disease  Control and  Prevention                                                               
(CDC)  offered statistics  for  immunizations  which showed  that                                                               
every  $1 spent  would save  $16  in overall  direct health  care                                                               
costs and time lost from work.   He stated that although vaccines                                                               
were  not 100  percent  effective, they  provided herd  immunity,                                                               
which meant that  the whole population was protected  if about 80                                                               
percent of  the population  were vaccinated.   He noted  that the                                                               
American  Committee  on  Immunization Practices  (ACIP)  and  the                                                               
American   Academy  of   Pediatrics  (AAP)   both  made   regular                                                               
recommendations about new  vaccines.  He noted  that most states,                                                               
including   Alaska,   mandated   certain  vaccines   for   school                                                               
attendance,  although these  were fewer  than on  the recommended                                                               
list.     He   explained   that   therapeutic  and   preventative                                                               
interventions were  often determined  by a quality  adjusted life                                                               
year  (QALY),   which  involved  input  from   statisticians  and                                                               
clinicians, and  required a philosophical decision.   He referred                                                               
to the proposed bill, which  would provide vaccinations to the 25                                                               
percent of kids in Alaska who  were under insured.  He noted that                                                               
currently almost half  the kids in Alaska  received vaccines paid                                                               
by  the  federal  government  under  the  Vaccines  for  Children                                                               
program, but  there were still  25 percent  of the kids  who were                                                               
not  covered.    He  addressed   the  ACIP  list  of  recommended                                                               
vaccines, which  was used to  determine the Alaska  vaccine list.                                                               
He shared  that the QALY value  had to be less  than $25,000 each                                                               
year  for a  vaccine  to  be included.    He  reported that,  for                                                               
adults, this list included the  flu and pneumococcal vaccines, as                                                               
these were  especially effective for  herd immunity.   He offered                                                               
his belief that  the intent of proposed HB 310  was to leave some                                                               
flexibility for  vaccine choice to  the Department of  Health and                                                               
Social Services.                                                                                                                
                                                                                                                                
4:32:51 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  HERRON   surmised  that  Dr.  Hurlburt   had  put                                                               
parameters  on the  use of  higher  priced vaccines  in order  to                                                               
offer more of the other vaccines to more people.                                                                                
                                                                                                                                
DR.  HURLBURT  endorsed  this  to   be  the  reasonable,  prudent                                                               
decision when resources were limited.                                                                                           
                                                                                                                                
4:34:45 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE MILLER asked if there  were any other vaccinations                                                               
more specific to Alaska which should be recommended.                                                                            
                                                                                                                                
4:35:25 PM                                                                                                                    
                                                                                                                                
DR. HURLBURT replied  "basically, our diseases are  what are seen                                                               
elsewhere."   He noted that  the some,  such as hepatitis  A, had                                                               
already  been addressed  in  Alaska with  dramatic  success.   He                                                               
allowed  that regional  outbreaks  did occur,  such  as a  recent                                                               
outbreak of pertussis in California.                                                                                            
                                                                                                                                
4:37:16 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  MILLER, directing  attention to  the fiscal  note                                                               
which mentioned rotavirus,  asked why it was not  included in the                                                               
proposed bill.                                                                                                                  
                                                                                                                                
REPRESENTATIVE HERRON replied that he did not know.                                                                             
                                                                                                                                
DR.  HURLBURT, in  response to  Representative Miller,  said that                                                               
there were  not unlimited  dollars for the  program, so  the cost                                                               
benefit  ratio was  utilized in  the  decision.   He opined  that                                                               
rotavirus was  a more common  problem, and that he  would suggest                                                               
it be added first if more money became available.                                                                               
                                                                                                                                
4:39:00 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE MILLETT, reflecting on  the 50 percent success for                                                               
shingles vaccine, asked about the  success rate for the rotavirus                                                               
vaccine.                                                                                                                        
                                                                                                                                
DR. HURLBURT said that he would find out.                                                                                       
                                                                                                                                
4:39:34 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  MILLETT asked  about the  increase to  the fiscal                                                               
note if these two vaccines were included.                                                                                       
                                                                                                                                
DR. HURLBURT,  in response  to Representative  Millett, explained                                                               
that the  equation used for determining  vaccines had established                                                               
the additional  cost to include  rotavirus would be  $409,000 and                                                               
to include the shingles vaccine would cost $980,000 each year.                                                                  
                                                                                                                                
4:41:23 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE MILLETT asked if  there were specific problems for                                                               
shingles in Alaska.                                                                                                             
                                                                                                                                
DR. HURLBURT  replied that there was  nothing out of the  norm in                                                               
Alaska.                                                                                                                         
                                                                                                                                
4:41:48 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER agreed with the  necessity that "following the money                                                               
to try  to figure these  things out  [was] a worthwhile  thing to                                                               
do."   He reviewed that  proposed HB  310 offered coverage  to 25                                                               
percent of  Alaska children, and  he asked to clarify  what other                                                               
payment  coverage,  along  with private  insurance,  covered  the                                                               
remaining 75 percent.                                                                                                           
                                                                                                                                
DR.  HURLBURT declared  that the  federal  Vaccines for  Children                                                               
program  immunized anyone  with  Medicaid and  all Alaska  Native                                                               
children.   He stated  the immunization  rates for  Alaska Native                                                               
children to be "admirable."   He pointed out that immunization to                                                               
the rest of the state's children only ranked 42nd in the U.S.                                                                   
                                                                                                                                
CHAIR KELLER asked for more information about the providers.                                                                    
                                                                                                                                
DR. HURLBURT  explained that the  vaccine would  be significantly                                                               
less expensive  if the State  of Alaska procured the  vaccine for                                                               
all  the  providers,  and  maintained  a  single  stock  of  each                                                               
vaccine.    He described  that  currently  each provider  had  to                                                               
maintain separate  refrigerators and  supplies for  the privately                                                               
insured patients  and for  the Medicaid patients.   He  said that                                                               
pediatricians,    family   medicine    physicians,   and    nurse                                                               
practitioners  provided vaccines.   He  noted that  the federally                                                               
qualified  health clinics  and public  health  nurses could  give                                                               
vaccines to uninsured kids.   He emphasized that it was necessary                                                               
to find  a way to  procure vaccines from  one source to  make the                                                               
cost of the  process reasonable for private  practices, to ensure                                                               
they also participate.                                                                                                          
                                                                                                                                
4:45:44 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER asked  if there was any danger to  a central vaccine                                                               
supply.                                                                                                                         
                                                                                                                                
4:46:36 PM                                                                                                                    
                                                                                                                                
DR. HURLBURT  replied that central  procurement for  vaccines was                                                               
through  CDC.   He  stated  that the  Division  of Public  Health                                                               
maintained  the  handling  chain  for  vaccines.    He  described                                                               
parental  hesitancy, when  parents were  reluctant to  have their                                                               
children immunized,  as even  a two-year  old required  15 shots.                                                               
He  reported that  Alaska had  the  highest rate,  9 percent,  of                                                               
parental hesitancy in the U.S.   He stressed a need for education                                                               
about vaccines  and the  recommended schedule for  shots.   As an                                                               
example,  he  pointed  to  the  debunked  British  physician  and                                                               
researcher  who had  published a  purported  study that  measles,                                                               
mumps and  rubella vaccines lead  to autism.  He  emphasized that                                                               
this  had been  proven to  be a  deliberate falsification  of the                                                               
data, and the researcher had  since lost his physician's license.                                                               
He repeated the need for education for patients and parents.                                                                    
                                                                                                                                
4:49:47 PM                                                                                                                    
                                                                                                                                
CHAIR  KELLER shared  that  one community  health  center in  his                                                               
constituency had  reported never having  treated a child  who was                                                               
up to date on immunizations.                                                                                                    
                                                                                                                                
[HB 310 was held over.]                                                                                                         
                                                                                                                                

Document Name Date/Time Subjects
02 Sponsor Statement HB 209.docx HHSS 2/14/2012 3:00:00 PM
HB 209
HB209.pdf HHSS 2/14/2012 3:00:00 PM
HB 209
HB209-DCCED-INS-12-28-11fiscasl note.pdf HHSS 2/14/2012 3:00:00 PM
HB 209
04 Supporting Data Summary HB 209.docx HHSS 2/14/2012 3:00:00 PM
HB 209
05 AK Tobacco Facts 2009 Update.pdf HHSS 2/14/2012 3:00:00 PM
06 Tobacco in the Great Land HB 209.pdf HHSS 2/14/2012 3:00:00 PM
HB 209
07 HB209 American Cancer Society Cancer Action Network.pdf HHSS 2/14/2012 3:00:00 PM
HB 209
01 - HB 310 27-LS1273.A.pdf HHSS 2/14/2012 3:00:00 PM
HB 310
02 - HB 310 sponsor statement 27-LS1273.pdf HHSS 2/14/2012 3:00:00 PM
HB 310
2.5HB310-DHSS-EPI-2-10-12.pdf HHSS 2/14/2012 3:00:00 PM
HB 310
03 - SB 144 Leg Legal Sectional Analysis (HB310 MODIFICATION HAS BEEN REQUESTED).pdf HHSS 2/14/2012 3:00:00 PM
HB 310
SB 144
04 - DHSSdph Epidemiology Bulletin 2010.10.06.pdf HHSS 2/14/2012 3:00:00 PM
4.5 - DHSSdph Epidemiology Bulletin 2010.10.19.pdf HHSS 2/14/2012 3:00:00 PM
05 - Alaska Health Care Commission 2011 Report exerpt.pdf HHSS 2/14/2012 3:00:00 PM
06 - HB 310 support letter Dr. Rosalyn Singleton.pdf HHSS 2/14/2012 3:00:00 PM
HB 310
07 - HB 310 support letter PremeraBCBS.pdf HHSS 2/14/2012 3:00:00 PM
HB 310
08 - HB 310 support letter Dr. Mary Ann Jacob.pdf HHSS 2/14/2012 3:00:00 PM
HB 310
Amendment HB 209.pdf HHSS 2/14/2012 3:00:00 PM
HB 209