Legislature(2013 - 2014)CAPITOL 106

04/03/2014 03:00 PM HEALTH & SOCIAL SERVICES

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Heard & Held
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Heard & Held
        SB 169-IMMUNIZATION PROGRAM; VACCINE ASSESSMENTS                                                                    
3:10:12 PM                                                                                                                    
CHAIR HIGGINS  announced that the  first order of  business would                                                               
be 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."   [In  front of  the committee  was CSSB                                                               
169(FIN), labeled 28-LS1219\I.]                                                                                                 
REPRESENTATIVE  KELLER  moved  to adopt  the  proposed  committee                                                               
substitute    (CS)   for    CSSB   169,    labeled   28-LS1219\T,                                                               
Wallace/Mischel, 4/2/14,  as the working  draft.  There  being no                                                               
objection, it was so ordered.                                                                                                   
3:10:53 PM                                                                                                                    
The committee took an at-ease from 3:10 p.m. to 3:12 p.m.                                                                       
3:12:49 PM                                                                                                                    
TOM  STUDLER, Staff,  Representative Pete  Higgins, Alaska  State                                                               
Legislature, directed  attention to  the changes proposed  in the                                                               
working draft:   page 2, line  4, which established a  three year                                                               
phase in program, and provided  for voluntary participation; page                                                               
2,  lines 30  -  31,  which included  two  health care  providers                                                               
licensed in  the state, one of  whom must be a  pediatrician, for                                                               
the council;  page 4, lines 1  - 4, which added  a requirement to                                                               
submit  to  the  commissioner   and  the  legislature  an  annual                                                               
financial   report,  including   assessment  determinations   and                                                               
overall  costs of  the program,  for  an on-going  review of  the                                                               
program; page 4, line 13,  which added an incremental phase-in of                                                               
the  entities at  the  discretion of  the  commissioner; page  5,                                                               
lines 5 - 6,  which added an opt out of  the program clause under                                                               
procedures  approved by  the commissioner;  page 5,  lines 10-12,                                                               
which stated that  an assessable entity may not deny  a claim for                                                               
coverage  of vaccines  based on  the  decision of  a health  care                                                               
provider  to elect  not to  participate in  the program;  page 7,                                                               
line 7, which extended the sunset  date for repeal to allow three                                                               
years  of a  phase  in period  with an  additional  two years  of                                                               
operation to  determine the viability  of the program;  and [page                                                               
7],  line 15,  which  declared  that this  would  take effect  on                                                               
January  1,  2015.    He  explained  that  an  amendment  by  the                                                               
committee could  resolve an  inadvertent error  on [page  7] line                                                               
15, which included  Section 7 to take effect on  January 1, 2015.                                                               
He explained  that Section 6, page  7, line 8, repealed  the act,                                                               
removed  the  money, and  placed  it  in the  unobligated  funds;                                                               
however, waiting for  an effective date of January  1, 2015 meant                                                               
that  the department  could  not access  those  funds until  that                                                               
date, and would miss the flu season vaccines.                                                                                   
3:17:29 PM                                                                                                                    
REPRESENTATIVE SEATON referred  to page 2, line 4,  and asked if,                                                               
after three years to implement the  procedure for phase in to the                                                               
program, everyone was then included.                                                                                            
MR. STUDLER replied that this was correct.                                                                                      
CHAIR  HIGGINS explained  that  the three  year  phase in  period                                                               
would allow the  commissioner latitude to make  the program work.                                                               
He pointed to  the opt out language which allowed  any entity out                                                               
during the transitional  period.  He opined that  this three year                                                               
period allowed  plenty of  time for each  entity to  determine if                                                               
the program worked for them.                                                                                                    
MR. STUDLER  pointed out that this  was detailed on page  5, line                                                               
REPRESENTATIVE SEATON asked where it  stated that the program was                                                               
mandatory participation, or  voluntary participation, after three                                                               
CHAIR HIGGINS explained  that it was mandatory  under the earlier                                                               
version,  but that  the  proposed  CS allowed  "a  slow but  sure                                                               
process, a three year transitional  period for the entities."  He                                                               
declared that  the point was to  bring everyone on board,  and to                                                               
ensure that self-insured  third party payers could  come on board                                                               
immediately or at a slower rate if need be.                                                                                     
3:20:06 PM                                                                                                                    
REPRESENTATIVE  KELLER asked  how this  would affect  the vaccine                                                               
pricing, as the point was to get the purchase cost down.                                                                        
CHAIR HIGGINS  replied that he did  not know the answer,  as they                                                               
did  not know  who would  participate.   He  opined that  Premera                                                               
covered  the most  people in  the  state, and  would most  likely                                                               
cover 70 percent.                                                                                                               
3:21:06 PM                                                                                                                    
REPRESENTATIVE SEATON directed  attention to page 3,  line 5, the                                                               
director  of   the  division  of  insurance   or  the  director's                                                               
designee, and  page 2,  line 28,  the department's  chief medical                                                               
officer for public  health, and asked if there  was any intention                                                               
to allow a designee for the chief medical officer.                                                                              
CHAIR HIGGINS asked that the sponsor address this.                                                                              
3:22:31 PM                                                                                                                    
SENATOR CATHY  GIESSEL, Alaska State Legislature,  explained that                                                               
there was a not yet  proposed committee substitute (CS) which had                                                               
made that  change to include  chief medical officer  or designee.                                                               
She pointed out  that, as this was  a council and not  a board or                                                               
commission,   there  was   not  any   cost.     In  response   to                                                               
Representative  Keller  and  Chair  Higgins,  she  clarified  her                                                               
agreement  for  the  change  to add  "or  designee"  after  chief                                                               
medical officer.                                                                                                                
JANE  CONWAY,   Staff,  Senator   Cathy  Giessel,   Alaska  State                                                               
Legislature, pointed to page 2, line  28, for the addition of "or                                                               
designee" after chief medical officer.                                                                                          
3:24:32 PM                                                                                                                    
CHAIR HIGGINS opened public testimony.                                                                                          
3:25:02 PM                                                                                                                    
MARISSA WATKINS, Director of State  Policy, PhRMA, explained that                                                               
PhRMA represented  the leading bio-pharmaceutical  researchers in                                                               
the  country,   and  its  "members   are  committed   to  finding                                                               
tomorrow's  cures and  treatments for  some of  the most  serious                                                               
diseases."   She  stated  opposition  by PhRMA  for  SB 169,  and                                                               
offered  the  belief  that the  proposed  legislation  would  not                                                               
achieve  its goal  for ease  of vaccine  administration and  high                                                               
vaccination rates.  She stated  that the proposed bill would make                                                               
the vaccine market  more complex.  She noted  that the Affordable                                                               
Care   and   Patient   Protection    Act   "ensures   much   more                                                               
comprehensive,  first  dollar  coverage   for  vaccines  for  the                                                               
insured population."   She stated  that the  "complicated program                                                               
envisioned by  SB 169 is  unnecessary to raise  vaccination rates                                                               
and adds  administrative burden on  providers."  She  opined that                                                               
the  proposed  bill  could  jeopardize  the  competitive  vaccine                                                               
market.  She warned that the  use of Medicaid funding for vaccine                                                               
purchase for non-Medicaid recipients  could warrant review by the                                                               
federal  government  and  jeopardize   the  Medicaid  funding  to                                                               
Alaska.   She detailed  that PhRMA members  wanted to  ensure the                                                               
existence  for  all  possible  avenues   to  achieve  the  widest                                                               
vaccination rates in  every state.  She opined that  SB 169 would                                                               
do more harm than good.                                                                                                         
3:27:22 PM                                                                                                                    
CHAIR HIGGINS  asked if PhRMA  had also rejected the  other eight                                                               
states which currently had this program.                                                                                        
MS. WATKINS replied that PhRMA  companies had worked with some of                                                               
these  states  to  implement  the  programs  however,  PhRMA  now                                                               
opposed  the  creation  of  universal  purchase  programs.    She                                                               
suggested   that   there   were   better   solutions   for   more                                                               
3:28:17 PM                                                                                                                    
CHAIR  HIGGINS  asked  for clarification  that  PhRMA  previously                                                               
supported these  programs, however PhRMA now  believed that these                                                               
programs for adults or children should not be implemented.                                                                      
MS. WATKINS  expressed her agreement,  stating that  PhRMA member                                                               
companies  no longer  felt it  was in  the best  interest of  the                                                               
vaccine community for a universal purchase program.                                                                             
CHAIR  HIGGINS  relayed that  he  had  spoken with  other  states                                                               
having this  program, and "it seems  to be working very  well for                                                               
them."   He asked  why PhRMA  was opposed  to the  program, other                                                               
than its claim that the program was "directing market forces."                                                                  
3:29:44 PM                                                                                                                    
REPRESENTATIVE   TARR   asked   for   clarification   about   the                                                               
aforementioned statement regarding Medicaid dollars.                                                                            
MS.  WATKINS  explained  that  PhRMA believed  that  the  use  of                                                               
Medicaid   dollars   to   purchase  vaccines   for   non-Medicaid                                                               
recipients  could  warrant  review  by  the  federal  government,                                                               
thereby jeopardizing Medicaid funding to Alaska.                                                                                
CHAIR  HIGGINS  expressed  his agreement  that  Medicaid  funding                                                               
could not be used for private insurance.                                                                                        
3:30:47 PM                                                                                                                    
SHEELA  TALLMAN,  Premera  Blue  Cross  Blue  Shield  of  Alaska,                                                               
relayed  that Premera  Blue Cross  Blue Shield  had been  working                                                               
with  the   Division  of   Public  Health,   as  well   as  other                                                               
stakeholders, and were supportive of  the concept of the proposed                                                               
bill to maintain  the universal vaccine program.   She referenced                                                               
the letter of  support, [Included in members'  packets] which was                                                               
for a previous version of the  proposed bill.  She noted that the                                                               
Alaska Health  Care Commission had  included a  recommendation in                                                               
its  2011  report   to  ensure  that  the   vaccine  program  was                                                               
adequately  funded,   and  had  included  consequences   for  the                                                               
elimination of the vaccine program  in Alaska.  She reported that                                                               
Premera  had  not  had  a  chance  to  review  the  most  current                                                               
proposals.    She  expressed  concern   for  making  the  program                                                               
voluntary  for the  payers.    She pointed  out  that a  critical                                                               
component of the program was  that all payers participate and pay                                                               
for the  share of vaccines for  its membership.  If  all entities                                                               
did  not  participate,  the  costs   would  increase  for  Alaska                                                               
residents.   She stated  that vaccines  were more  cost effective                                                               
than treatment  of illness and  disease.  She offered  the belief                                                               
that  a  statewide  universal  vaccine   program  would  help  to                                                               
alleviate  any  issues for  access,  especially  with a  goal  of                                                               
improvement to the immunization rate.                                                                                           
MS. TALLMAN,  in response  to Chair  Higgins, explained  that her                                                               
understanding was  that the opt-in, opt-out  option for providers                                                               
was directed predominantly at the adult population.                                                                             
CHAIR  HIGGINS   replied  that  the  previous   version  had  not                                                               
designated for children or adults.                                                                                              
MS. TALLMAN offered  her belief that the opt-in was  not an issue                                                               
for the payer accessible entity side.                                                                                           
CHAIR HIGGINS asked for clarification  that it was now a concern,                                                               
although it  had not previously been  a concern.  He  stated that                                                               
it had not been changed in this version of the proposed bill.                                                                   
MS.  TALLMAN  expressed  her  understanding  that  this  was  now                                                               
voluntary for the payers.                                                                                                       
CHAIR HIGGINS said this was the same as previously.                                                                             
3:34:38 PM                                                                                                                    
MS.  TALLMAN  said  that  Premera  had  concerns  for  unintended                                                               
consequences from the  changes in the proposed bill,  as it could                                                               
undermine the entire program.   She suggested that there would be                                                               
few, if  any, vaccines  purchased by the  state, and  costs would                                                               
increase.   She  pointed  out that  Premera  participated in  the                                                               
universal  vaccine  programs in  other  states,  and was  key  in                                                               
development of the successful program  in Washington State, which                                                               
was very similar to the concept of proposed SB 169.                                                                             
CHAIR HIGGINS replied that SB  169 was different than the program                                                               
in  Washington  State,  as the  proposed  bill  included  adults,                                                               
similar only to Vermont.                                                                                                        
MS.  TALLMAN replied  that Premera  was aware  that the  proposed                                                               
bill included  adult vaccines.   She  suggested that  the program                                                               
begin with vaccine  for kids, and then implement  the vaccine for                                                               
CHAIR HIGGINS  asked that testimony  be limited to  the mechanics                                                               
of the proposed bill.                                                                                                           
3:37:23 PM                                                                                                                    
LAURA SARCONE, Nurse  Midwife, said that her  testimony was based                                                               
on the  essential nature of  vaccines for pregnant women,  as the                                                               
immune system was compromised during  pregnancy.  She spoke about                                                               
the risks and  dangers of flu for pregnant  women, including pre-                                                               
term  labor,  respiratory  failure,  and premature  birth.    She                                                               
reported that  Centers for Disease  Control and  Prevention (CDC)                                                               
had  recommended that  all pregnant  women be  vaccinated against                                                               
tetanus,  diphtheria, and  pertussis  in the  third trimester  of                                                               
pregnancy,  regardless of  prior  history  for this  vaccination.                                                               
She  declared   that  the  proposed  bill   would  allow  private                                                               
obstetric   and  family   practice  providers   to  provide   the                                                               
recommended vaccine  protection to pregnant patients.   She urged                                                               
support for the proposed bill.                                                                                                  
3:39:48 PM                                                                                                                    
CARRIE DOYLE,  MD, Alaska Clinical Nurse  Specialist Association,                                                               
said that  she was concerned  with the health of  adult patients,                                                               
especially  for those  patients administered  to hospitals.   She                                                               
reported  that immunized  patients  were less  likely to  require                                                               
hospitalization  from  illnesses  that were  preventable  through                                                               
vaccinations.   She declared  that the  cost and  availability of                                                               
immunizations was  of the utmost  concern.  She urged  support of                                                               
proposed SB 169.                                                                                                                
3:41:10 PM                                                                                                                    
JANETTA  SHOCKMAN,  President,  Alaska Nurses  Association,  said                                                               
that  she specialized  in  adult, critical  care  medicine.   She                                                               
spoke in support  of SB 169.  She declared  that illnesses can be                                                               
life threatening,  and life altering,  and that it  was necessary                                                               
for  the  vaccines to  be  easily  accessible and  affordable  to                                                               
protect  all  Alaskans.    She  stated  that  the  Alaska  Nurses                                                               
Association supported the proposed bill.                                                                                        
3:43:07 PM                                                                                                                    
PATRICIA  SENNER, Professional  Practice Director,  Alaska Nurses                                                               
Association, spoke about  the need for a vaccine  program for the                                                               
uninsured in order to buy vaccines at a much lower rate.                                                                        
3:44:17 PM                                                                                                                    
MARIE DARLIN,  Commissioner, Alaska Commission on  Aging, pointed                                                               
to  the letter  from AARP  in support  of the  bill [Included  in                                                               
members'  packets].   She stated  that the  Alaska Commission  on                                                               
Aging was  in support  of vaccines  for all.   She  declared that                                                               
seniors needed to  have the option and the  ability for vaccines.                                                               
She  spoke of  the  concern for  shingles and  the  need for  its                                                               
vaccination.     She  explained  that   she  wanted  to   see  an                                                               
immunization  program to  cover both  adults and  children.   She                                                               
declared full support of the proposed bill.                                                                                     
3:47:36 PM                                                                                                                    
WARD HURLBURT,  MD, Chief  Medical Officer/Director,  Division of                                                               
Public Health,  Central Office, Department  of Health  and Social                                                               
Services, directed his response  to questions previously posed to                                                               
him.   He explained  that the patients,  the public,  the payers,                                                               
and  the providers  would all  benefit from  the vaccine  program                                                               
presented in SB 169.  He reported  that it would result in a more                                                               
efficient system  with less administrative  workload and  a lower                                                               
cost  for the  pharmaceutical  manufacturers.   He expressed  his                                                               
agreement  that  the  pharmaceutical   industry  was  a  critical                                                               
partner  for keeping  Americans healthy.   He  said that  vaccine                                                               
prices would  increase, and the assessments  would also increase.                                                               
He reported  that the  Idaho vaccine  program was  different than                                                               
the proposed program  in Alaska, as the Alaska  program would not                                                               
draw  from the  general fund.   He  relayed that  tribal entities                                                               
would  continue to  receive the  state distributed  vaccine under                                                               
the  Vaccines for  Children program.    He said  that the  tribal                                                               
program would have the option to opt  in to the program.  He said                                                               
that the proposed program was  designed to pay for people without                                                               
insurance, as  30-45 million Americans would  still be uninsured,                                                               
by choice or  by need, even with the Affordable  Care and Patient                                                               
Protection Act.   He  referred to  herd immunity  which protected                                                               
all of  society.  Directing  attention to the adult  programs, he                                                               
reported that  the Vermont  program, the  only state  program for                                                               
adults,  was working  very  well.   He  stated  that ERISA  plans                                                               
cannot  be mandated  for coverage  by the  state, although  other                                                               
states  had successfully  established that  an assessment  can be                                                               
imposed on the ERISA plans.   He reported that payers who elected                                                               
to buy  the vaccine  themselves were  reimbursed at  a comparable                                                               
rate,  often  less than  the  retail  purchase price;  hence,  an                                                               
incentive  to  participate.    He  explained  that  a  successful                                                               
program  would  have a  small  positive  economic impact  on  the                                                               
insurance companies,  about a 2  percent profit margin.   He said                                                               
there  was an  option to  purchase adult  vaccines through  multi                                                               
state purchasing  cooperatives.  He explained  that providers who                                                               
had purchased vaccines would have a  phase in period, in order to                                                               
allow for reimbursement  to those previous purchases.   He stated                                                               
that 75  percent of Medicaid  enrollees were women  and children,                                                               
and  were already  covered.   He clarified  that federal  dollars                                                               
would  not be  used inappropriately.   He  expressed concern  for                                                               
opt-out payers and  third party administrators, as  it would make                                                               
it  more difficult  to have  a successful  program without  their                                                               
3:55:19 PM                                                                                                                    
CHAIR  HIGGINS  said  that  many   providers  had  contacted  him                                                               
requesting a choice for the  opt-out option, as their concern was                                                               
for  directing market  forces toward  competitors.   He explained                                                               
that  it was  up  to the  insurance  companies how  to  pay.   He                                                               
declared that insurance companies were  very good at figuring the                                                               
rates.   He stated that  there was  concern by the  providers for                                                               
the unknown cost of the assessment.                                                                                             
3:58:46 PM                                                                                                                    
DR.  HURLBURT pointed  out that  the assessment  would be  on the                                                               
payers, with an assurance that there  was not double payment.  He                                                               
said that the  only possibility that providers  pay an assessment                                                               
would be an optional participation  by some unique providers.  He                                                               
said  that  a disadvantage  for  non-participation  would be  the                                                               
increased administrative  requirements for double  record keeping                                                               
and double  storage facilities.   He  noted that  providers would                                                               
only  have  an  assessment  if  they were  both  a  payer  and  a                                                               
provider,  such   as  Veterans   Administration  or   the  tribal                                                               
CHAIR HIGGINS directed attention to  page 4 of the original bill,                                                               
which  described the  annual  assessment reporting  requirements.                                                               
He  said that  the  aforementioned  "other program  participants"                                                               
created "a little bit of a grey area."                                                                                          
4:01:15 PM                                                                                                                    
REPRESENTATIVE SEATON  directed attention  to Version T,  page 4,                                                               
line 18, and asked if there  was any reason for "or other program                                                               
participant" if there were assessable entities.                                                                                 
DR. HURLBURT offered his understanding  that the private practice                                                               
doctors would  not be  assessed.  He  offered that  Indian Health                                                               
Service  received  vaccines  at   no  cost  for  Native  American                                                               
children and  Medicaid enrollees,  although the  facilities often                                                               
also functioned  as a  community hospital for  other payers.   He                                                               
said that this gave the  tribal program the option to participate                                                               
in order  to lower  their vaccine costs  to the  public, although                                                               
participation could not be mandated.                                                                                            
CHAIR HIGGINS directed attention to  page 4, line 31, [Version I]                                                               
and said  that a health care  provider or group of  providers may                                                               
opt into the program, if approved by the commissioner.                                                                          
CHAIR HIGGINS,  in response  to Representative  Seaton, clarified                                                               
that although he  had referenced Version C, this  was also stated                                                               
in Version T, page  5, line 7.  He stated  that any concerns were                                                               
corrected with the option to opt-in or opt-out.                                                                                 
DR. HURLBURT  referenced earlier testimony for  pregnant mothers,                                                               
stating  that this  allowed the  opportunity to  opt in,  without                                                               
becoming an assessable entity.                                                                                                  
4:04:48 PM                                                                                                                    
REPRESENTATIVE SEATON directed attention  to page 4, lines 16-19,                                                               
and asked  if the definition  for program participant  was better                                                               
clarified if included in the assessment portion.                                                                                
DR. HURLBURT  noted that  he did not  have expertise  for writing                                                               
legislation,   although  the   intent  of   the  suggestion   for                                                               
clarification was consistent.                                                                                                   
REPRESENTATIVE  SEATON  clarified  that the  assessable  entities                                                               
were  being  assessed, and  not  the  providers; therefore,  both                                                               
should not be included in the  same sentence.  He asked that this                                                               
be considered for clarification.                                                                                                
CHAIR HIGGINS explained  that this language had  been included in                                                               
Version  T,  page   4,  lines  13  -  15,  and   it  allowed  the                                                               
commissioner to approve who were the program participants.                                                                      
4:07:23 PM                                                                                                                    
REPRESENTATIVE KELLER shared  that this was tied to  page 2, line                                                               
3,  in which  "the commissioner  shall establish  a procedure  to                                                               
phase in the  program over a three-year period."   He stated that                                                               
the discretion of the commissioner had increased.                                                                               
REPRESENTATIVE  SEATON  clarified  that   page  2  referenced  an                                                               
assessable entity and not a program participant.                                                                                
CHAIR HIGGINS  read page  4, line 13,  "an assessable  entity and                                                               
other  program  participant."    In  response  to  Representative                                                               
Seaton,  he   offered  his  understanding  that   "other  program                                                               
participant" could  constitute other than  a provider, such  as a                                                               
third  party insurer;  hence, the  decision  to leave  it in  the                                                               
proposed bill.                                                                                                                  
REPRESENTATIVE SEATON suggested  a review of this,  so that there                                                               
would not be any confusion in the proposed bill.                                                                                
REPRESENTATIVE KELLER expressed his  agreement for the confusion,                                                               
and  he pointed  out  that  some entities  were  in  both of  the                                                               
categories, insurers and providers.                                                                                             
CHAIR  HIGGINS offered  his belief  that this  had been  resolved                                                               
when providers were allowed to opt out.                                                                                         
4:10:14 PM                                                                                                                    
REPRESENTATIVE  SEATON asked  for  clarification  of the  opt-out                                                               
provision on page  5, line 5, whereby an  assessable entity could                                                               
opt-out at  any time,  and he  asked if  the providers  should be                                                               
added to  this provision.   He stated that  there would not  be a                                                               
large  enough assessment  pool if  the  assessable entities,  the                                                               
insurance  companies, could  opt out.   He  pointed out  that the                                                               
sunset clause was only four years.                                                                                              
CHAIR  HIGGINS  asked  whether   insurance  companies  should  be                                                               
mandated  for their  participation in  the State  of Alaska.   He                                                               
declared that  the Affordable Care  and Protection  Act mandated,                                                               
and  "one  of the  things  that  offends  me  the most"  was  the                                                               
mandate.   He  offered his  understanding that  "this thing  [the                                                               
proposed program]  is the best  thing since buttered toast."   He                                                               
declared that  all insurance companies  wanted to opt-in  to this                                                               
program, and  therefore, there  should not be  any problems.   He                                                               
noted that the  insurance companies had three years  to make this                                                               
determination.    He  declared  that   "I  have  a  real  problem                                                               
mandating  insurance companies,  forcing them  to do  a program."                                                               
He offered his belief that a mandate was not "the American way."                                                                
REPRESENTATIVE SEATON  suggested that the flexibility  to opt-out                                                               
at  any  time  could  affect   the  purchase  for  quantities  of                                                               
CHAIR HIGGINS,  directing attention  to page  5, line  5, replied                                                               
that the opt-out  only extended for the first three  years of the                                                               
phase in period.                                                                                                                
REPRESENTATIVE SEATON  pointed out  that, as  vaccines had  to be                                                               
ordered ahead, it  would be beneficial to have  an opt-out window                                                               
equivalent to the order period for vaccines.                                                                                    
CHAIR HIGGINS replied that was the idea of the three years.                                                                     
REPRESENTATIVE SEATON asked about  a window for commitment during                                                               
each year to allow for the order of vaccines.                                                                                   
CHAIR  HIGGINS expressed  his understanding  and  agreed to  give                                                               
this idea more consideration.                                                                                                   
4:14:48 PM                                                                                                                    
DR. HURLBURT said  that he had concerns with the  opt-out for the                                                               
assessable  entities, the  payers.   He  expressed his  agreement                                                               
that the insurance companies should not  be told what to do, even                                                               
if participation was  in their best interest.   He explained that                                                               
the  proposed bill  was for  assessments  to insurance  companies                                                               
that were  required, or had  decided, to cover the  vaccines, and                                                               
the  assessment was  only for  the vaccine  doses they  required.                                                               
This proposed  bill saved the  insurance companies money,  and it                                                               
also  generated the  funding to  pay for  vaccines for  uninsured                                                               
individuals, which benefited everyone.                                                                                          
4:16:07 PM                                                                                                                    
REPRESENTATIVE KELLER asked for  clarification that the insurance                                                               
companies were  obligated to  supply the  vaccines, and  that, in                                                               
reality, they did not have the choice.                                                                                          
DR. HURLBURT  expressed his  agreement, and  "to date,  it's been                                                               
their option,  their enlightened option, because  they save money                                                               
if they can  prevent somebody my age from  getting pneumonia with                                                               
the pneumococcal  vaccine."  He  pointed out that  the Affordable                                                               
Care and Patient Protection Act also mandated this coverage.                                                                    
CHAIR HIGGINS  said that  the insurance company  only had  to pay                                                               
when the provider billed them for the services.                                                                                 
DR.  HURLBURT  explained  that  the   two  methods  to  levy  the                                                               
assessment were  based on either  vaccine doses given  or covered                                                               
lives.  He relayed that  Premera had expressed its preference for                                                               
the vaccine  dosage basis.   He opined that  this may not  be the                                                               
most favorable pricing approach.   He said that the covered lives                                                               
liability could  be adjusted according  to the numbers  of people                                                               
who refused the vaccine.                                                                                                        
4:19:38 PM                                                                                                                    
REPRESENTATIVE TARR asked  if there was an option  for two years,                                                               
instead of the current three years.                                                                                             
DR. HURLBURT  replied that,  as the  first year  was transitional                                                               
under the  proposed bill,  it was necessary  to give  the program                                                               
enough years to  see if it was successful.   He reported that the                                                               
New  Hampshire  program  was  in   its  eleventh  year,  and  its                                                               
immunization rate for  two year olds had increased  by 20 percent                                                               
and was now the second best in the United States.                                                                               
4:21:37 PM                                                                                                                    
REPRESENTATIVE  SEATON, directing  attention to  page 7,  line 7,                                                               
asked if those  dates should be June  30 to repeal and  July 1 to                                                               
take effect,  in order to correspond  to the fiscal year,  or was                                                               
that not the most optimal when ordering an assessment.                                                                          
DR. HURLBURT offered his belief  that the fiscal year basis would                                                               
make more sense.   He pointed out that currently  there was still                                                               
funding and a supply of vaccine for the startup.                                                                                
4:23:10 PM                                                                                                                    
CHAIR  HIGGINS closed  public  testimony, and  said  that SB  169                                                               
would be held over.                                                                                                             

Document Name Date/Time Subjects
SB 162 - Sponsor Statement.pdf HHSS 4/3/2014 3:00:00 PM
SB 162
SB 162 Ver A.PDF HHSS 4/3/2014 3:00:00 PM
SB 162
SB 162 - Fiscal Note.PDF HHSS 4/3/2014 3:00:00 PM
SB 162
SB 162 - Lentfer support.PDF HHSS 4/3/2014 3:00:00 PM
SB 162
SB 162 - FDA announcement.PDF HHSS 4/3/2014 3:00:00 PM
SB 162
SB 162 - Dobson support.PDF HHSS 4/3/2014 3:00:00 PM
SB 162
SB 162 - Blower support.PDF HHSS 4/3/2014 3:00:00 PM
SB 162
SB 162 - AK Optometric Association.PDF HHSS 4/3/2014 3:00:00 PM
SB 162
SB 162 AKhydrocodoneHouseHessltrsb162-1.pdf HHSS 4/3/2014 3:00:00 PM
SB 162
SB 162 2013 Annual Drug Report.pdf HHSS 4/3/2014 3:00:00 PM
SB 162
SB 169 CS for HSS vsn H.pdf HHSS 4/3/2014 3:00:00 PM
SB 169
SB 169 Sectional CS vsn H.pdf HHSS 4/3/2014 3:00:00 PM
SB 169
SB 169 Support Dorius.pdf HHSS 4/3/2014 3:00:00 PM
SB 169
SB 169 Support Juneau Empire.pdf HHSS 4/3/2014 3:00:00 PM
SB 169
SB 169 Support Lily Lou.pdf HHSS 4/3/2014 3:00:00 PM
SB 169
CS SB 169 Version T.pdf HHSS 4/3/2014 3:00:00 PM
HHSS 4/8/2014 3:00:00 PM
SB 169
SB 169 responses HHSS.pdf HHSS 4/3/2014 3:00:00 PM
SB 169
SB 169 Support Ilona Farr.pdf HHSS 4/3/2014 3:00:00 PM
SB 169
SB 169_Premera.pdf HHSS 4/3/2014 3:00:00 PM
SB 169
SB 169 Support AARP.pdf HHSS 4/3/2014 3:00:00 PM
SB 169
HCS for CSSB 169 ver T Explanation of Changes.pdf HHSS 4/3/2014 3:00:00 PM
HHSS 4/8/2014 3:00:00 PM
SB 169
HCS for CSSB 169 ver T Section Analysis.pdf HHSS 4/3/2014 3:00:00 PM
HHSS 4/8/2014 3:00:00 PM
SB 169