Legislature(2001 - 2002)

04/24/2002 01:12 PM JUD

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
SB 37 - PHYSICIAN NEGOTIATIONS WITH HEALTH INSURE                                                                             
                                                                                                                                
Number 2000                                                                                                                     
                                                                                                                                
CHAIR ROKEBERG  announced that the  next order of  business would                                                               
be  CS  FOR  SENATE  BILL   NO.  37(FIN),  "An  Act  relating  to                                                               
collective  negotiation  by   competing  physicians  with  health                                                               
benefit  plans,   to  health  benefit  plan   contracts,  to  the                                                               
application of  antitrust laws to agreements  involving providers                                                               
and groups of providers affected  by collective negotiations, and                                                               
to the effect of the  collective negotiation provisions on health                                                               
care providers."  [Before the  committee was HCS CSSB 37(L&C), as                                                               
amended on 4/10/02.]                                                                                                            
                                                                                                                                
Number 1970                                                                                                                     
                                                                                                                                
REPRESENTATIVE  COGHILL   moved  to  adopt  the   proposed  House                                                               
committee  substitute  (HCS)  for  SB  37,  version  22-LS0323\U,                                                               
Bannister, 4/18/02, as a work draft.                                                                                            
                                                                                                                                
Number 1968                                                                                                                     
                                                                                                                                
REPRESENTATIVE BERKOWITZ objected for the purpose of discussion.                                                                
                                                                                                                                
Number 1956                                                                                                                     
                                                                                                                                
HEATHER  M. NOBREGA,  Staff  to  Representative Norman  Rokeberg,                                                               
House  Judiciary Standing  Committee,  Alaska State  Legislature,                                                               
explained that Version U incorporates  the two amendments made at                                                               
the previous  hearing on SB  37.  One amendment  deleted multiple                                                               
employer welfare  arrangements (MEWAs), and the  other amendment,                                                               
which was  suggested by the  [Alaska] Nurses  Association (AaNA),                                                               
pertained to providers  that are not physicians.   She noted that                                                               
in  incorporating the  second amendment,  an error  was made  and                                                               
thus language which now reads  "not physicians" should be changed                                                               
to read "non-physicians.                                                                                                        
                                                                                                                                
REPRESENTATIVE BERKOWITZ  noted that the language  which needs to                                                               
be  changed is  located on  page 2,  lines 13  and 15.   He  then                                                               
indicated that he  no longer objected to the  adoption of Version                                                               
U as a work draft.                                                                                                              
                                                                                                                                
Number 1911                                                                                                                     
                                                                                                                                
CHAIR  ROKEBERG,   after  noting  that  there   were  no  further                                                               
objections, announced that Version U was before the committee.                                                                  
                                                                                                                                
Number 1890                                                                                                                     
                                                                                                                                
REPRESENTATIVE BERKOWITZ made  a motion to adopt  Amendment 1, on                                                               
page  2, lines  13 and  15,  delete "not  physicians" and  insert                                                               
"non-physicians".   There  being  no objection,  Amendment 1  was                                                               
adopted.   He  then  indicated  that he  had  more amendments  to                                                               
offer.                                                                                                                          
                                                                                                                                
CHAIR ROKEBERG called an at-ease from 2:17 p.m. to 2:18 p.m.                                                                    
                                                                                                                                
Number 1853                                                                                                                     
                                                                                                                                
REPRESENTATIVE BERKOWITZ  made a  motion to adopt  [Amendment 2],                                                               
which read [original punctuation provided]:                                                                                     
                                                                                                                                
     ADD NEW SECTION TO READ:                                                                                                   
                                                                                                                                
     "Sec.3.      AS    23.50.010,   23.50.020,   23.50.030,                                                                    
     23.50.040, 23.50.099; and  AS 45.50.572(k) are repealed                                                                    
     July 1, 2006.                                                                                                              
                                                                                                                                
Number 1847                                                                                                                     
                                                                                                                                
REPRESENTATIVE JAMES objected.                                                                                                  
                                                                                                                                
REPRESENTATIVE  BERKOWITZ  explained  that  [Amendment  2]  would                                                               
sunset the entire legislation, under  the theory that after it is                                                               
seen how well  the provisions of SB 37 work,  the legislature can                                                               
revisit the issue to determine whether  to extend the sunset.  He                                                               
added that  this concept falls  under the "less  legislation, the                                                               
better" theory.                                                                                                                 
                                                                                                                                
Number 1802                                                                                                                     
                                                                                                                                
SENATOR PETE KELLY, Alaska State  Legislature, sponsor, said that                                                               
he did not like Amendment 2.  He elaborated:                                                                                    
                                                                                                                                
     Because  of  the  voluntary nature  of  this,  and  the                                                                    
     timeframe it  would take  to promulgate  regulations, I                                                                    
     don't think ... we'll  ever get to where Representative                                                                    
     Berkowitz wished to get with  this:  finding out to see                                                                    
     ... if  it works  or not.   The fact  is, ...  when you                                                                    
     have  [that]  the  attorney   general  can  kill  these                                                                    
     negotiations at  any time, the insurance  companies can                                                                    
     kill  the  negotiations at  any  time,  or the  doctors                                                                    
     themselves can  do it  at any  time, [then]  anyone who                                                                    
     wants to  can just hold out  for a few years,  the bill                                                                    
     sunsets, and then  we never get to it.   And because of                                                                    
     the voluntary  nature, I don't think  it represents any                                                                    
     kind of threat to begin with.                                                                                              
                                                                                                                                
Number 1753                                                                                                                     
                                                                                                                                
A roll call  vote was taken.  Representative  Berkowitz voted for                                                               
Amendment  2.     Representatives  James,  Coghill,   Meyer,  and                                                               
Rokeberg voted  against it.   Therefore, Amendment 2 failed  by a                                                               
vote of 1-4.                                                                                                                    
                                                                                                                                
Number 1743                                                                                                                     
                                                                                                                                
REPRESENTATIVE  BERKOWITZ made  a  motion to  adopt Amendment  3,                                                               
which read [original punctuation provided]:                                                                                     
                                                                                                                                
     PAGE 5, LINE 9                                                                                                             
                                                                                                                                
     "and completing  the period for comment  and review for                                                                    
     interested parties  required by  this subsection.   The                                                                    
     review  of the  contract by  the attorney  general must                                                                    
     allow  adequate   time  for   comment  and   review  by                                                                    
     interested parties  and must  include a  review whether                                                                    
     the contract would harm consumers  or providers who are                                                                    
     not physicians"                                                                                                            
                                                                                                                                
Number 1740                                                                                                                     
                                                                                                                                
REPRESENTATIVE JAMES objected.                                                                                                  
                                                                                                                                
REPRESENTATIVE BERKOWITZ explained that  Amendment 3 would ensure                                                               
better public  process by  providing for  a comment  [and review]                                                               
period for interested parties.                                                                                                  
                                                                                                                                
SENATOR KELLY said he objects to Amendment 3.  He elaborated:                                                                   
                                                                                                                                
     It's  private  negotiation between  private  companies.                                                                    
     There are  things that  we do even  at the  state level                                                                    
     where all  the information is  not laid out  for public                                                                    
     access.                                                                                                                    
                                                                                                                                
CHAIR ROKEBERG asked for clarification.                                                                                         
                                                                                                                                
REPRESENTATIVE BERKOWITZ,  in defense  of Amendment 3,  said that                                                               
it would  ensure that  the attorney  general doesn't  take action                                                               
before the comment period has elapsed.                                                                                          
                                                                                                                                
CHAIR ROKEBERG  remarked that Amendment 3  is vague, specifically                                                               
the words, "allow an adequate time for comment".                                                                                
                                                                                                                                
SENATOR  KELLY  noted   that  the  amount  of   time  needed  for                                                               
negotiations  between  companies  is quite  different  than  what                                                               
would be needed for the promulgation of regulations.                                                                            
                                                                                                                                
CHAIR ROKEBERG said he tended  to favor Amendment 3, but remarked                                                               
that it is poorly drafted.                                                                                                      
                                                                                                                                
REPRESENTATIVE  BERKOWITZ  said  he  would  accept  a  clarifying                                                               
amendment to Amendment 3.                                                                                                       
                                                                                                                                
CHAIR ROKEBERG declined to offer such.                                                                                          
                                                                                                                                
Number 1679                                                                                                                     
                                                                                                                                
A  roll  call vote  was  taken.   Representatives  Berkowitz  and                                                               
Rokeberg voted for Amendment 3.   Representatives James, Coghill,                                                               
and Meyer voted  against it.  Therefore, Amendment 3  failed by a                                                               
vote of 2-3.                                                                                                                    
                                                                                                                                
Number 1660                                                                                                                     
                                                                                                                                
REPRESENTATIVE  BERKOWITZ made  a  motion to  adopt Amendment  4,                                                               
which read [original punctuation provided]:                                                                                     
                                                                                                                                
     Page 6, Line 20 add new subsection:                                                                                        
                                                                                                                                
    "individual   physician   members    covered   in   the                                                                     
    collective    negotiations    shall   accept    without                                                                     
     qualification Medicare patients."                                                                                          
                                                                                                                                
Number 1605                                                                                                                     
                                                                                                                                
REPRESENTATIVE JAMES objected.                                                                                                  
                                                                                                                                
REPRESENTATIVE  BERKOWITZ recalled  from previous  testimony that                                                               
physicians  wanted to  ensure that  patients  were protected  and                                                               
that  everyone receive  adequate  health care.    He stated  that                                                               
Amendment   4  "would   just  enshrine,   in  legislation,   that                                                               
sentiment,"  adding   that  [Amendment  4]  would   also  have  a                                                               
favorable impact on the state's fiscal situation.                                                                               
                                                                                                                                
SENATOR KELLY said,  "This seems quite a bit out  of the scope of                                                               
the bill; I  don't think this is  the time or the  place to begin                                                               
requiring physicians to take on patients here."                                                                                 
                                                                                                                                
CHAIR ROKEBERG  queried, "But aren't we  granting them additional                                                               
rights  to bargain?"    He remarked,  "I  guess this  amendment's                                                               
requesting them to give something back."                                                                                        
                                                                                                                                
REPRESENTATIVE JAMES said she objects  to Amendment 4 because she                                                               
does not  wish to restrict physicians'  choices regarding whether                                                               
or not  to serve Medicare  patients.  She  remarked, nonetheless,                                                               
that Medicare is the worst possible insurance people could have.                                                                
                                                                                                                                
CHAIR ROKEBERG  mentioned that the  "phantom insurance  tax" just                                                               
perpetuates "that."  "What we need  to do is destroy Medicare and                                                               
rebuild it from its ashes," he added.                                                                                           
                                                                                                                                
REPRESENTATIVE BERKOWITZ  said that  the danger of  not [adopting                                                               
Amendment 4] is that "these  groups" would be allowed to "cherry-                                                               
pick"  patients, which  would  leave the  other  physicians in  a                                                               
given community  in a worse  position.   He remarked that  such a                                                               
situation would be unfair from  a bargaining perspective and from                                                               
an economic perspective, and would  lead to degraded health care.                                                               
"People  want to  come to  the  legislature for  a benefit,  then                                                               
they've got  to do something  to help the  state out of  the bind                                                               
that we're in," he added.                                                                                                       
                                                                                                                                
REPRESENTATIVE  JAMES opined  that  something should  be done  to                                                               
ensure that Medicare is not always the first payor.                                                                             
                                                                                                                                
CHAIR ROKEBERG  said, "I certainly  agree that we need  to reform                                                               
Medicare."                                                                                                                      
                                                                                                                                
Number 1493                                                                                                                     
                                                                                                                                
SENATOR  DONNY OLSON,  Alaska State  Legislature, said  he agrees                                                               
that "there  are battles we  can get  into and battles  we should                                                               
not get  into, but reforming Medicare  is not one of  the battles                                                               
that we have the resources to go and do at this point."                                                                         
                                                                                                                                
Number 1450                                                                                                                     
                                                                                                                                
A  roll  call vote  was  taken.   Representatives  Berkowitz  and                                                               
Kookesh voted  for Amendment 4.   Representatives James, Coghill,                                                               
Meyer, and  Rokeberg voted  against it.   Therefore,  Amendment 4                                                               
failed by a vote of 2-4.                                                                                                        
                                                                                                                                
SENATOR OLSON  remarked that he  has taken  an interest in  SB 37                                                               
because it could  affect him and the private practice  that he is                                                               
involved with in Nome.                                                                                                          
                                                                                                                                
CHAIR ROKEBERG closed public testimony on SB 37.                                                                                
                                                                                                                                
Number 1398                                                                                                                     
                                                                                                                                
REPRESENTATIVE  JAMES   moved  to   report  the   proposed  House                                                               
committee  substitute  (HCS)  for  SB  37,  version  22-LS0323\U,                                                               
Bannister, 4/18/02, as amended,  out of committee with individual                                                               
recommendations and the accompanying fiscal notes.                                                                              
                                                                                                                                
Number 1383                                                                                                                     
                                                                                                                                
REPRESENTATIVE BERKOWITZ objected.                                                                                              
                                                                                                                                
Number 1367                                                                                                                     
                                                                                                                                
A  roll call  vote was  taken.   Representatives Coghill,  Meyer,                                                               
James, and Rokeberg voted to report HCS for SB 37, version 22-                                                                  
LS0323\U,  Bannister,   4/18/02,  as  amended,   from  committee.                                                               
Representatives   Berkowitz  and   Kookesh   voted  against   it.                                                               
Therefore,  HCS  CSSB  37(JUD)  was reported  out  of  the  House                                                               
Judiciary Standing Committee by a vote of 4-2.                                                                                  

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