Legislature(1995 - 1996)
04/30/1996 03:16 PM House L&C
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
CSSB 253(FIN) - INS.FOR PROSTATE & CERVICAL CANCER TESTS Number 230 CHAIRMAN KOTT announced the committee would hear CSSB 253(FIN), "An Act relating to insurance coverage for costs of prostate cancer or cervical cancer detection." Number 230 KRISTINE PELLET, Student Intern to Senator Jim Duncan, came forward to explain CSSB 253(FIN). She read her statement into the record: "Thank you for scheduling Senate Bill 253, `An Act relating to insurance coverage for costs of prostate cancer or cervical cancer detection.' Prostate cancer accounts for 36 percent of all male cancers and is the second leading cause of death in men, after lung cancer, as reported by the National Cancer Institute. Although often presumed to develop slowly, nearly two-thirds of new prostate cancer cases has spread beyond the prostate gland by the time of diagnosis. "In addition to coverage for screening of prostate cancer, Senate Bill 253 would require screening of cervical cancer screening. Cervical cancer accounts for about 16 percent of all cancers in women, is estimated that nearly half of the approximately 15,000 women who are diagnosed annually with the condition never underwent early screening procedures. "Senate Bill 253 makes health issues a priority. I recommend that the committee consider this Senate Finance Committee's version of Senate Bill 253. This version retains the mandatory aspect that I had originally intended with the bill. I would welcome your support in requiring that insurance companies cover the cost of prostate and cervical cancer testing." Number 356 REPRESENTATIVE ROKEBERG asked Ms. Pellet to point out the difference in wordage between the two bills. REPRESENTATIVE BEVERLY MASEK referred to the page 2, line 1 of the House Health, Education and Social Services (HESS) Committee's version of the bill it stated the bill says, "required to be offered". The Senate Finance Committee's version of the bill says, "required by this section". CHAIRMAN KOTT indicated there isn't a title change. He noted the committee is working on Version G. Number 467 REPRESENTATIVE GENE KUBINA moved to adopt CSSB 253(FIN), Version F. REPRESENTATIVE ROKEBERG objected. He said, "We did have a work session on this and related matters. I think there was a substantial amount of confusion, particularly after we received the testimony in this committee on Senate Bill, I believe, 193 which was Senator Salo's bill on child care extension of birthing periods under insurance and frankly, Mr. Chairman, I was a little disappointed because I think that this committee was somewhat misled, not intentionally of course, but by the testimony received from leg counsel when this issue was brought before us the last time on another bill, which is very similar - it's the very same type of language, and a distinction made between what was mandated in the insurance coverage and what could be offered. And this is this is a concern I have that is a distinction and I would caution the members of the committee that what I thought it was the intention as brought forward by legislative counsel at our last meeting on that bill is not the nature of the beast as we assumed. We thought that the ability of an insurer -- of an insured, that is the consumer, was best maintained or would be maintained by the original language and in this case the Finance language supported by the sponsor and that option really isn't there is my understanding. Lets see if I can think this through here. The problem and the real distinction becomes between the - a group plan and the individual plan. And right now if the sponsor's preferred version - it is my understanding that this would be mandated by all coverage and there would be no optional provision on the part of the consumer to take it or leave it, and correct me if I'm wrong here on that. Because a lot of the testimony on these bills we've had has been from the group side, for example, AETNA was (indisc.) and so forth. And my concern, frankly is for the people that are individually purchasing insurance, not group plans and that have all the economic power and abilities to come down. And the thinking being that this - any types of well treatments like this that are mandated under a policy will have the ultimate impact of increasing the amount of premium that the insured would have to pay. So I think the desire of the HESS Committee and so forth was to allow a matter of choice on the part of the insured and not to mandate the coverage and that was really the - kind of a philosophical issue and somebody correct me if I'm not telling this right. I'd just like to make sure the committee is getting the whole story. I'm not sure I'm doing a good enough job to explain it. I was thoroughly confused along with you the other day, Mr. Chairman. CHAIRMAN KOTT said as it was explained by leg counsel or the legal folks it was his understanding that what was being addressed was what was heard in a subsequent hearing, the work session. He said it is basically a policy call - one of requiring or one as requiring to offer. If it is required to be offered under the group plan, the employer is, in fact, going to make the choice for the employee. Chairman Kott said his opinion under the group policy plan is he would much rather see the employee have the say so in having it required. He said he can understand Representative Rokeberg's concern with the individual policy. Chairman Kott suggested the committee hear from someone who represents the industry. Number 800 REPRESENTATIVE KUBINA explained he has a little bit of first hand knowledge of this and that is why he feels so strongly that it be a required thing in the policies. He said with his and his wife's insurance through the school district, it was not in the policy. He asked Chairman Kott if this is the appropriate time to debate the bill. CHAIRMAN KOTT suggested he withdraw his motion for the purpose of taking testimony. REPRESENTATIVE KUBINA withdrew his motion. Number 849 GENE DAW, Volunteer, representing American Association of Retired People and the Veterans of Foreign Wars, came before the committee to address SB 253. He said the organizations he represents thinks the bill is good for all Alaskans. Mr. Daw indicated this is the fifth time he has testified on the bill. He referred to prostate cancer and indicated he has had the screening test three times. His doctor told him that this test is one of the quickest ways for detecting prostate cancer. This type of cancer spreads very fast so the sooner you catch it, the better chance you have of stopping it. Once it spreads, it is hard to do anything about it. Mr. Daw said insurance people gave testimony at some of the other hearings on the measure where they said that this test is an experimental test. It is not an experimental test, it is a well established test and most doctors use it. It should be provided for by insurance companies to encourage people to have this test. He explained if the screen tests aren't paid for by an insurance company, it would be easy for someone to say, "Well, maybe I'll have it next year or the year after." Mr. Daw noted he is a disabled veteran and he is lucky the Veterans Administration pays for his medical expenses. He stated that the prostate and the cervical cancer tests are good. Prostate cancer is the second largest killer of men in America. He urged passage of CSSB 253(FIN). Number 1138 SENATOR JIM DUNCAN urged the committee to pass CSSB 253(FIN) out of committee. He added he believes it is very important to include the word "provide" in the legislation instead of "offer." If you say "offer," it does nothing more than what is the present status quo because they can currently offer. Senator Duncan said several years ago, there was similar legislation passed relating to mammograms and it has been very successful and is a very good preventive health care step, not only for breast cancer but for prostate and cervical cancer. REPRESENTATIVE ROKEBERG recalled reading an article which indicated that the PSA test had about a 30 or 35 percent efficacy. There was also another article which pointed out that there was a new test coming. He referred to subsection (e) on page 2 which said, "In this section, `prostate cancer screening tests' includes a prostate antigen blood test or another test that is equivalent or better in cancer detection," and questioned if this would include another test. SENATOR DUNCAN indicated that if there is another test that comes along that has better and more accurate findings and results than the PSA test, then it should be provided. He said the PSA test may not always be accurate, but the medical providers he has talked to indicated that the test is very helpful and is one they recommend be done. REPRESENTATIVE ROKEBERG said he believes there is some controversy about "experimental nature" of this. So if there is a new better version, he would presume unless it has significantly higher positive rates, it could be categorized as experimental also. Number 1274 SENATOR DUNCAN said he isn't sure that providers nor would he say that PSA is experimental. It has been used. He said he would say that the accuracy rate is not 100 percent, but it is a good test for early detection of prostate cancer and it has been very successful. Surely, it is better to have the test than not to have it. Even if there is a misleading result, it is better to have it than not to have it. REPRESENTATIVE ROKEBERG said there was testimony in other hearings where some insurers call it experimental. SENATOR DUNCAN referred to subsection (e) and said it was written with providers and others involved. Clearly, he believes that indicates that prostate antigen blood tests or another test if one is developed that is equivalent or better would be included. If a better test comes along he doesn't say that it should not be provided. REPRESENTATIVE ROKEBERG said, "However this bill comes out, I'm gunna be supporting I want you to know." SENATOR DUNCAN said he hopes that he will support it with the word "provide," because if it is supported with "may offer," nothing changes. What they'll do is give a laundry list of coverages that people may select, there will be a long list and you'll have to read through and select it and most people won't do that. Number 1394 BILL CHISHAM, State Employee, came before the committee to testify in support of the bill. He said he has a background in insurance law. He said he is in favor of the specific words, "will provide," and nothing that gives them an opportunity to make it optional. Mr. Chisham said in 1992 and 1993, his physician recommended this test on his annual physical. So he had it and AETNA paid for it. The following year he had the test and AETNA said they wouldn't pay for it. He called and questioned why and they said, "Well, we apparently made a mistake in paying for last year." Mr. Chisham said since then, he has been paying for it. It runs between $70 and $75. He said he personally feels it is a good test to take as a backup, particularly to the other tests, and to some extent somewhat more comfortable to take. Mr. Chisham continued to explain the process of the test and said he will continue to have the test whether AETNA will pay for it or not. He urged that the legislation move forward. He noted he prefers the original version, but if that isn't possible, he would prefer a version that does make this specifically required by the insurance carrier. REPRESENTATIVE ROKEBERG asked if the proper way to do the test is to have both the digital and the PSA test together because of the higher level of accuracy. MR. CHISHAM said he can't speak as a doctor, but as an individual if there was a choice of one or the other, he would pick the PSA test first. If possible, he would prefer to have both. Number 1614 REPRESENTATIVE ELTON noted it is his understanding that if the test is flawed, it gives false positives, not false negatives. Having a PSA test originally doesn't preclude the backup test if you get a false negative. Number 1614 MR. DAW said he would like to note that his doctor has told him the PSA screening test is 95 percent positive and if there is any type of infection or prostate cancer, 95 percent of the time they'll detect it. He explained he would rather have the PSA test. REPRESENTATIVE ROKEBERG said, for the record, that he saw a Larry King show with Michael Milken (Sp.?) who was underwriting a major genetic study of prostate cancer and Mr. Milken, General Swartzkoph, Lynn Donson and Jack Kemp were also on the show. They all had false negative PSA tests and without the digital and follow up, they would have not been diagnosed timely. CHAIRMAN KOTT asked if there was anybody else wishing to testify. there being none, he close the public hearing. Number 1715 REPRESENTATIVE KUBINA moved that the committee adopt CSSB 253(FIN), Version F. REPRESENTATIVE ROKEBERG objected. REPRESENTATIVE KUBINA informed the committee that his wife, through their school district insurance policy, would not cover this. At one time when his wife went to get a check up, the insurance company wouldn't cover the test under their insurance so they decided to pay for it themselves. Some cervical cancer was discovered. Representative Kubina said the district has now negotiated for the cervical test so that if a doctor required it, they would pay for it. He noted that was something they had to negotiate outside of the policy. Our dental health insurance is all preventive, but the health insurance isn't preventive at all. Representative Kubina said he has been told that this isn't a big cost factor to insurance companies - yes, the cost will get passed on, but there are major insurance companies that are not objecting to this. Number 1818 REPRESENTATIVE PORTER said you could come up with a good reason for adding a whole bunch of tests to the bill. The point is when a insurance company offers coverage, they cost it out with specific testing and coverage in mind and that's what they're covering. If new tests come along or the individual policy holder did not opt for a certain kind of coverage, that isn't provided. Representative Porter said philosophically, he is opposed to mandating these kinds of things. The section in (e) that has been added to take care of developing expertise in these kinds of areas might have an effect of not being negligible cost even to the group policies. As it stands, it has an effect on individual policies, but not knowing what it is that this better detection test involves or how much it's going to cost, we could be setting up a scenario that could run into a whole lot of money. He said he would support the G version of the bill. Number 1915 CHAIRMAN KOTT said he has had some discussion with some of the major insurance carriers in the state and they are comfortable with Version F, which is the Senate Finance Committee's version. The small amount of money that these tests costs is clearly a minor amount compared to not discovering the cancer at a later stage which would then entail some exorbitant costs that will have to be paid for by the insurance company. He said he thinks they are willing to prevent or to detect early on any types of cancer which would reduce some of the expenses from their behalf. Chairman Kott said he will support the Senate version of the bill. He noted he is philosophically opposed to mandating coverage in most cases and that's basically what the insurance company said, but in this particular case they were willing to make some concession. He said he believes they're looking out for their long-term interest. Number 1987 REPRESENTATIVE ELTON said indicated that substituting Version G for Version F essentially does nothing. He said he would encourage the committee to move Version F. REPRESENTATIVE ROKEBERG said Representative Elton indicated that Version G would have no value at all. He said it seems to him that by mandating the offer of coverage, it institutes a line item on a menu - it's a menu type selection, whereas today he isn't aware that a consumer coming in to buy an individual policy would be offered this coverage at all. Therefore, Version G would mandate that they be offered coverage. Number 2092 SENATOR DUNCAN said he concurs with Representative Elton. He said he believes if the committee adopts the House HESS Committee version, you really are doing nothing because insurance companies can now offer a coverage for PSA or can offer coverage for a pap smear. So really the committee would be doing nothing but saying, "You must offer it." That doesn't mean that it will be provided or that anyone will select it. The problem would be that most people when they get their insurance probably aren't going to spend a lot of time going through the long laundry list of options available to then and, therefore, in many cases wouldn't select it. Senator Duncan said if you are going to use the words "must offer," you really are not solving or addressing the problem. He said when it was mandated that mammograms be covered, there wasn't a great jump in health care premiums. So there wouldn't be a great jump in health care premiums because of this. Unfortunately, the fiscal notes can't reflect what the true savings are. We don't know, but we do know that preventive health care saves money. To spend $75 on a PSA test may save many months in the hospital later on because you have cancer and many other expensive procedures. Number 2187 REPRESENTATIVE KUBINA said in his school district the people covered doesn't receive a list. The school district actually determines what coverage they are going to accept. He said he thinks why the insurance companies would be supportive of this is because they probably understand the benefit of it. When employers come to negotiate the package that they're going to get, they want the cheapest one they can get, so it could fall off the list. If it is required the insurance company can't say, "Well, it's off the list." REPRESENTATIVE ELTON suggesting defining the wording "to offer." To use the wording "to offer" doesn't mean it will come up on the menu. REPRESENTATIVE ROKEBERG explained it says "shall offer." REPRESENTATIVE ELTON said that doesn't mean it has to be on a menu list. It just means that if they're asked, they have to offer it. He said he doesn't believe that "to offer" means that it is going to be one of the lists of options. He said he thinks that it means if somebody asks for it, they're going to have to offer it. REPRESENTATIVE ROKEBERG said it doesn't say that to him. From his perspective, everybody seems to be talking about the group plans, fiscal notes, etc. He said he happens to represent small business people in this state and nobody talks about the person who goes in for an individual policy and those are the people he is concerned about. They will directly pay that policy increase. He said he is all for this particular bill and the concept of it, but he wants to be able to make sure it is a matter of choice for those people who do make those choices when they go as consumers to buy that policy. Representative Rokeberg said his understanding of the cervical cancer/pap smear test, because it is an annual test, it is recommended by all gynecologists to be done yearly from an early age in the 20s for all female patients, where the PSA tests are for men over 50. Number 2337 CHAIRMAN KOTT noted when he was in the military, his wife had annual physicals in the doctor's offices on military instillation. She could have rejected it, but as part of the physical they require her to have a pap smear. Obviously, there is a reason behind that. They are trying to look at it from a long-term perspective, if they catch it early, you pay it now or pay later. Chairman Kott said he understands Representative Rokeberg's concern over the small group type employers, but from the insurance perspective they could offer it and you could reject it. REPRESENTATIVE ROKEBERG said he would point out that after mammograms were mandated, some insurers did provide that as required by statute but they put caps and limits on the coverage. REPRESENTATIVE ELTON said if you have an individual policy and it is mandated, you're saving costs down the road too. Maybe it has a negative effect on the premium over time. He said he can't prove that will happen, but he certainly thinks that there is a cost savings down the road. TAPE 96-42, SIDE B Number 001 CHAIRMAN KOTT called for a roll call vote. Representatives Masek, Kubina, Elton and Kott voted in favor of the adoption CSSB 253(FIN), Version F. Representatives Porter and Rokeberg voted against the adoption CSSB 253(FIN), Version F. So CSSB 253(FIN), Version F was adopted. Number 020 REPRESENTATIVE ELTON made a motion to pass CSSB 253(FIN), Version F, out of committee with individual recommendations and the accompanying fiscal notes. CHAIRMAN KOTT asked if there was an objection. Hearing none, CSSB 253(FIN) moved out of the House Labor and Commerce Committee.
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