Legislature(2001 - 2002)
04/24/2002 01:12 PM JUD
* first hearing in first committee of referral
= bill was previously heard/scheduled
= 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 AS 23.50.010, 23.50.020, 23.50.030, 23.50.040, 23.50.099; and AS 45.50.572(k) are repealed July 1, 2006.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.