Legislature(2011 - 2012)BARNES 124
03/18/2011 03:15 PM House LABOR & COMMERCE
| Audio | Topic |
|---|---|
| Start | |
| HB155 | |
| HB139 | |
| HB11 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 139 | TELECONFERENCED | |
| *+ | HB 11 | TELECONFERENCED | |
| += | HB 122 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 155 | TELECONFERENCED | |
HB 11-COLONOSCOPY: PUB. EMPLOYEE RETIREES
4:43:31 PM
CHAIR OLSON announced that the final order of business would be
HOUSE BILL NO. 11, "An Act requiring that retiree health
insurance coverage offered by the state and by certain local
governments include coverage for colorectal screening, including
colonoscopies."
4:43:36 PM
REPRESENTATIVE LES GARA, Alaska State Legislature, stated that
in the State of Alaska, only one group of people is not covered.
All people covered by private insurance plans and state
employees are covered by law. Thus, the group that needs
coverage the most are the Retired Public Employees who are not
covered. Colon cancer is the third leading cause of cancer and
testing is most important for people over the age of 50.
Screening is important since the survival rate for early
detection is high, with an approximately 90 percent survival
rate for longer than five years. Without screening and early
detection the survival rate is 10 percent for over five years.
This bill would ask for coverage under the Retired Public
Employees plan consistent with the standards adopted by the
American Cancer Society. Typically, screening consists of a
colonoscopy but could be some other procedure depending on what
the doctor and patient agree is necessary. Additionally, the
Alaska Native population suffers from colon cancer at a two to
one rate over Caucasians. An alternative blood test is
especially dangerous to Alaska Natives, which makes the
colonoscopy more important. He referred to cost analysis on
colonoscopies. He expressed surprised by the fiscal note since
the studies show colonoscopies save money. The cost of
colonoscopy or other preventive care is offset by cost to treat
someone with colon cancer. He referred to a study in members'
packets by Buck Consultants, which shows a likely cost savings
by screening individuals over the age of 50 as opposed to not
providing screening and paying for cancer coverage. He referred
to the state's fiscal note which indicates a cost of $4 million
to provide a colonoscopy for everyone. He stated that the bill
is requesting colonoscopy coverage for those individuals who are
retired since the test is not necessary for someone who is 20 or
30 years old.
4:48:47 PM
WARD B. HURLBURT, M.D., MPH Director and Chief Medical Officer,
Division of Public Health, Department of Health and Social
Services (HSS), stated that he is a general surgeon who has
dealt with colorectal cancer for many decades.
REPRESENTATIVE GARA inquired as to whether he could speak to
costs for colonoscopies. He stated that the Department of
Administration (DOA) takes the position that it costs more to
provide the screening than treatment.
DR. HURLBURT stated that he has not performed an analysis on the
screening. He said he could not comment since the fiscal note
is prepared by another department. He related that he is
speaking of colorectal cancer screening in the same sense that
Centers for Disease Control (CDC). The CDC colorectal cancer
screening for individuals ages 50 to 75. The screening tests
include a fecal occult blood test, a flexible sigmoidoscopy
every five years, or a colonoscopy every ten years. The
colonoscopy is the most expensive test but those in the public
health circles subscribe to early intervention for colorectal
cancer since early detection and intervention can make a big
difference. He recommended preventive efforts to identify
lesions such as benign polyps and remove them or identify an
early cancer while it is still localized since it greatly
increases the odds of survival. He did not have a specific
analysis on the immediate costs, but over the long term when
considering costs of end of life care it would balance out. He
suggested it is reasonable to think in the short run that a
program would incur costs but the savings would come "further
down the road."
4:52:42 PM
BRIAN SWEENEY, SR., Physician, Alaska Correctol Council, stated
that he is a member of the American College of Gastroenterology*
Alaska Correctol Council He is speaking today on behalf of his
son who is a member of the Alaska Correctol Council. He has
provided Representative Gara with the American College of
Gastroenterology guidelines. The guidelines cover all insurers
except the retired State of Alaska (SOA) employees. A number of
studies have shown the long term cost effectiveness of
colonoscopy cancer screening. One of the dilemmas is that
people 65 years and older become Medicare patients so any
specific entity making reimbursement payments may not see short
term cost effectiveness since the cost benefits accrue later on,
he said. Recent studies have shown a 30 percent decline in
colon cancer rates which has been attributed to the aggressive
screening procedures that began about eight years ago. He
reported that gastroenterologists nationwide have been taking a
more aggressive approach to screening. Patients identified as
high risk with cancerous polyps have had a 90 percent decline in
new cancer. The American Cancer Society has developed its
guidelines and the legislature has adopted their guidelines for
almost everyone in Alaska. He pointed out that patients often
know what they should do to maintain good health but if they
experience a financial hardship or the procedures are not
covered by insurance it makes it difficult. He has seen retired
state employees deny themselves their colonoscopy tests due to
lack of insurance coverage. He strongly supports coverage for
retired SOA employees so they may have parity with other
Alaskans. He urged members to pass HB 11.
4:56:16 PM
MOLLY MCCAMMON stated that in 1997 she was 45 years old and a
SOA employee diagnosed with Stage 1 colorectal cancer following
a colonoscopy paid for by her state insurance coverage. She
knew her grandfather had died of colon cancer at 45 years old
but a grandfather is a second degree relative so she was not too
concerned. However, her doctor recommended a colonoscopy. Her
symptoms were very minor and she felt confident she would have
ignored them if state insurance had not covered the procedure.
Fortunately, she was scoped and her tumor was discovered early
enough to be surgically removed so she was able to avoid
radiation and chemotherapy. She is now 59 and a SOA retiree and
screening colonoscopies are not covered under the SOA retiree's
health insurance. She said, "This seems totally absurd to me.
My body continues to want to make cancer as evidenced by
numerous precancerous polyps removed over the last 13 years. If
left in place these polyps would have developed into cancerous
tumors that would have required extensive treatment at a
substantial cost yet this is considered routine screening." She
reported that the American Cancer Society recommends routine
screening for colorectal cancer starting at age 50 unless a
person's family history indicates otherwise. She stated that
the ACS recommends that preventing colorectal cancer should be a
major reason for getting tested and the best way to test is the
colonoscopy. She pointed out that this cancer is so treatable
if caught early but the procedure is expensive enough that the
tendency is to postpone or avoid the test until a tumor is too
large to ignore or the cancer has spread. She concluded that
due to screening and improved treatment the U.S. has one million
survivors of colorectal cancer including her. She urged members
to support HB 11.
4:58:41 PM
EMILY NEENAN, Alaska Government Relations Director, American
Cancer Society Cancer Action Network, stated she has worked on
for six years. In 2006, the state law passed that required a
full range of colorectal cancer screening for all state-
regulated insurance plans many other plans followed suit for
colonoscopy screening including Providence Health Systems. The
active state employees already had this coverage. Some union
plans did not have coverage but have since added coverage. The
SOA retirees are the only group not covered for the 50-64 year
age group since Medicare has had coverage for some time for
those 65 years of age or older.
5:01:13 PM
The committee took an at-ease from 5:01 p.m. to 5:02 p.m.
5:02:25 PM
MS. NEENAN related that as of January 1, 2011, Medicare covers
screening, including colonoscopies at 100 percent with no
copayment. Screening can prevent cancer from ever developing,
which is unique to colorectal cancer. She expressed concern
with the 2007 Buck Consultants analysis including that the
consultant used the terms "screening" and "diagnostic"
interchangeably which indicates some confusion.
5:04:12 PM
REPRESENTATIVE SADDLER referred to information in members'
packets from Buck Consultants and to the relative tests
including fecal occult blood test, flexible sigmoidoscopy,
barium enema, and colonoscopy. He inquired as to whether it
fair to assume that it is a straight cost which is a less
effective strategy. He further inquired as to whether there is
a hierarchy for the screening tests.
MS. NEENAN responded that differences exist in the effectiveness
of the screening tests and the decision needs to be made patient
and the doctor dependent on the patient's comfort. She reported
that the colonoscopy is the most sensitive test since it screens
entire colon and can remove precancerous polyps. She recalled
earlier testimony that fecal occult blood testing poses some
problems in the Alaska Native population due to a high incidence
of a stomach lining infection that causes low grade bleeding and
should not be used in that population. She offered to provide
new facts and figures on colorectal cancer to members from the
Alaska Cancer Society.
5:06:45 PM
REPRESENTATIVE GARA stated that retired public employees are
only covered if the retiree shows symptoms. This is problematic
since the whole point of screening is to identify issues prior
to symptoms developing. Currently, retirees are eligible for
colonoscopies if they exhibit symptoms of cancer such as
bleeding. The colonoscopy will remove the polyp before any
bleeding exists. Once bleeding occurs it may be too late for
the patient to survive.
5:07:38 PM
REPRESENTATIVE SADDLER inquired as to whether other tests are
covered.
REPRESENTATIVE GARA answered that the tests are only covered
when symptoms are present.
CHAIR OLSON offered to provide additional information.
5:07:48 PM
RICHARD BENAVIDES stated that he has been a legislative aide for
Senator Bettye Davis. He is in Anchorage receiving cancer
treatment for Stage 4 colorectal cancer that metastasized to his
liver. His doctor recommended a colonoscopy in 2008 during a
routine physical, which he credits for saving his life. The
colonoscopy was covered under his state health plan so he had it
done. He did not experience any symptoms. He passed all the
tests. He was stunned to learn he had any cancer let alone
anything as serious as a stage four colorectal cancer. He was
told that the average survival rate for his cancer is two years.
Since diagnosis he has had two radiation treatments, two major
surgeries, five months of chemotherapy, and is now on oral
chemotherapy. The point is that without this coverage he would
not have known and he would not have had the test done since he
felt great. He stated that this bill would offer retirees the
same coverage that he attributed to saving his life. He offered
his belief that this bill would save thousands of dollars by
identifying colorectal cancer before it becomes more serious and
by preventing it before it is cancerous. He thought any
reduction in colon cancer is a good thing. He thought the bill
is a great idea. He urged members to pass HB 11.
5:11:06 PM
CHAIR OLSON related he has known Mr. Benavides for some time and
urged him to "keep up the battle."
5:11:22 PM
BOB DOLL, President, Retired Public Employees of Alaska (RPEA),
stated that the Retired Public Employees of Alaska (RPEA)
consists of 2,200 individuals who have retired from
municipalities and the SOA. He urged members to support HB 11.
Each year this issue emerges at the top of the RPEA's agenda.
Retirees are aware of the benefit for active employees but are
acutely aware of problem of not having it for retirees. It is
implied in the coverage for active employees that efficacy is
indicated and saves lives. It is a good thing to do. Its
absence has implications that dive it to the top of the list.
He offered his belief that this is a benefit that would not be
abused. No one would undergo the procedure except to maintain
good health. He referred to a letter of November 2007 from Buck
Consultants. He related that their letter states in four
instances that colonoscopy screening benefits is likely to
produce a positive return on investment. He referred to pages
1, 3, and 4 as references. He acknowledged that likely does not
mean certainty, but it does suggest a trial may be in order. He
observed that for us to bemoan the existence of an unfunded
liability and yet resist the adoption of a likely cost savings
procedure on at least a trial basis is inexplicable. It
suggests a bargaining position rather than address good health
care. He urged members to support HB 11.
5:14:50 PM
MARIE DARLIN, Coordinator, AARP Capital City Task Force,
referred to a letter from AARP in members packets. The AARP
fully supports HB 11. This bill could save money and save lives
for state employees and retirees.
[HB 11 was held over.]