Legislature(2001 - 2002)

02/01/2002 03:20 PM L&C

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
HB 290-COMPREHENSIVE  HEALTH INSURANCE ASS'N                                                                                  
Number 1966                                                                                                                     
CHAIR MURKOWSKI announced  that the next order  of business would                                                               
be the  continuation of HOUSE BILL  NO. 290, "An Act  relating to                                                               
membership in the Comprehensive Health Insurance Association."                                                                  
Number 1935                                                                                                                     
JOHN L.  GEORGE, Lobbyist for  American Council of  Life Insurers                                                               
(ACLI), and American Family Life  Assurance Company (AFLAC), said                                                               
that there  is a  proposed amendment  in the  committee's packet,                                                               
and  asked  that  the  committee  not  consider  it  today.    He                                                               
explained that  in further discussions  with his client  and with                                                               
the sponsor of the bill,  Representative Rokeberg, there has been                                                               
a  request for  some additional  information.   He  said that  he                                                               
would rather propose an  amendment that [Representative Rokeberg]                                                               
was in  agreement with and  asked the  committee to not  take any                                                               
action or even consider his current amendment.                                                                                  
MR. GEORGE  stated full  support of  the concept  of [HB  290] to                                                               
broaden  the  base of  people  that  subsidize the  Comprehensive                                                               
Health  Insurance  Association  [known  as  Alaska  Comprehensive                                                               
Health Insurance  Association (ACHIA)]  policies.  He  noted that                                                               
as it is  now, the small employer or the  single person buying an                                                               
individual  policy is  paying a  substantial  burden, while  many                                                               
people escape contributing.                                                                                                     
Number 1884                                                                                                                     
CHAIR MURKOWSKI said  that the House Labor  and Commerce Standing                                                               
Committee would  disregard Mr. George's proposed  amendment until                                                               
further notice.                                                                                                                 
REPRESENTATIVE ROKEBERG asked Mr. George  about "the scope of the                                                               
definition of  ... major  medical and what  can be  covered under                                                               
this bill."                                                                                                                     
MR. GEORGE  said the law as  it stands now says  that any insurer                                                               
that  sells  major medical  insurance  policies  is a  member  of                                                               
ACHIA,  and the  assessment is  based  not on  the major  medical                                                               
premium  but on  all health  insurance premiums  written by  that                                                               
company.   He stated that  AFLAC writes $14,106 of  major medical                                                               
premium[s];  it's Medicare-supplement  policies, not  even health                                                               
insurance policies as one would  think of a major medical policy.                                                               
He said  that the definition  includes Medicare  supplements, but                                                               
because [AFLAC] writes  over $5 million in  premiums in [Alaska],                                                               
its  assessment  this year  will  be  over  $30,000.   He  added,                                                               
"Because  they write  $14,000 worth  of major  medical, they  pay                                                               
$30,000 in assessment."                                                                                                         
Number 1820                                                                                                                     
MR. GEORGE said that interestingly  enough, AFLAC wrote Medicare-                                                               
supplement  policies  in  [Alaska]  until  "1997  or  1998,"  but                                                               
doesn't  anymore.     He   explained  that   "they're  guaranteed                                                               
renewable, so  they can't cancel  the policies and get  off; they                                                               
must  renew them.    And  as long  as  they  renew them,  they're                                                               
subject to  the assessment  of all their  premium."   Noting that                                                               
there may be  other approaches, he told the committee  that he is                                                               
going to  provide some  more information  to describe  what other                                                               
types  of  insurance  [AFLAC]  writes   that  fall  under  health                                                               
insurance but not major medical.                                                                                                
REPRESENTATIVE   ROKEBERG  said   that  Mr.   George's  testimony                                                               
clarified a  point that  he wants to  work on in  [HB 290]:   the                                                               
scope of how to get the premium expanded.                                                                                       
Number 1774                                                                                                                     
REPRESENTATIVE  HAYES said  that he  should claim  a conflict  at                                                               
this point.                                                                                                                     
CHAIR  MURKOWSKI said  that  it  is noted  for  the record,  with                                                               
Number 1749                                                                                                                     
GUY   BELL,  Director,   Division  of   Retirement  &   Benefits,                                                               
Department  of  Administration,  said   that  the  Department  of                                                               
Administration  supports  expanding  those who  can  be  assessed                                                               
under  the ACHIA  program because  of the  need for  an equitable                                                               
approach to this  issue.  In regard to the  legislation, Mr. Bell                                                               
said that [HB  290] identifies the State of Alaska  as one of the                                                               
groups.   He said  from [the Division  of Retirement  & Benefits]                                                               
perspective,  that means  two groups.   The  first is  the Select                                                               
Benefits group  of about  5,000 state  employees covered  under a                                                               
plan that [the  division] administers.  The second  group is over                                                               
23,000 state and political subdivision  retirees under the public                                                               
employees' and  teachers' retirement  systems.  He  said, "That's                                                               
who we think would be affected  by that reference to the State of                                                               
Alaska."  He  added that there are certain groups  that would not                                                               
be included and  he thought that Bob Lohr made  reference to them                                                               
in his testimony  at an earlier hearing.  He  mentioned that [the                                                               
Division  of Retirement  &  Benefits] based  its  fiscal note  on                                                               
numbers  from the  Division of  Insurance,  assuming that  Select                                                               
Benefits and retirees would be assessed.                                                                                        
MR. BELL said:                                                                                                                  
     Because the employer contribution  to ... insurance and                                                                    
     Select Benefits  is capped, either in  statute for non-                                                                    
     covered   people  or   through  collective   bargaining                                                                    
     agreements   otherwise,  we've   indicated  that   this                                                                    
     increase  would  be  assessed against  state  employees                                                                    
     based on the  current law.  And that's  why we've shown                                                                    
     an  asterisk  on  fiscal  impact,  because  really  the                                                                    
     premium increase  would go to  employees as  opposed to                                                                    
     the employer under the current law.                                                                                        
Number 1653                                                                                                                     
REPRESENTATIVE  ROKEBERG interjected  and  said, "That's  because                                                               
the $500 figure is in statute right now."                                                                                       
MR. BELL said that the amount  of the employer contribution is in                                                               
statute.  He said:                                                                                                              
     The  retirement  funds  are actuarially  funded,  which                                                                    
     means  we  pre-fund  obligations  associated  with  the                                                                    
     retirement  system.    So  the   actual  costs  to  the                                                                    
     retirement funds in  the ... year will  be greater than                                                                    
     the amount of the  assessment against the retiree plans                                                                    
     because   we're  collecting   in  advance   for  active                                                                    
     employees  as well  as paying  for  the assessment  for                                                                    
     retirees.  So there's effectively  a double hit when it                                                                    
     comes to the retirement  funds because of our actuarial                                                                    
     funding approach.   Now in  a conversation I  had today                                                                    
     with Representative  Rokeberg, I must  acknowledge that                                                                    
     this is  a savings  the retirement funds  received some                                                                    
     years  ago when  we went  from being  fully insured  to                                                                    
     being  self-insured, so  at one  point, of  course, the                                                                    
     retirement funds were paying  their share of this cost,                                                                    
     up to  ... 1997, when  both the retiree and  the active                                                                    
     plans became self-insured.                                                                                                 
Number 1582                                                                                                                     
REPRESENTATIVE ROKEBERG  referred back  to his  conversation with                                                               
Mr. Bell.  He said one  could make the case that particularly the                                                               
retirees had already  actuarially made the payments  up until the                                                               
point  that they  ceased making  payments when  the state  became                                                               
self-insured.  He said there was  only a small period of time and                                                               
the figure  of some $1  million is pretty substantial  given that                                                               
the whole assessment  now is perhaps $3.5 million.   He commented                                                               
that it is almost double-paying in  the future and that one could                                                               
make the  case that  he/she wouldn't  really need  to do  that if                                                               
[the division] gave credit for the previous pre-payments.                                                                       
Number 1534                                                                                                                     
MR.  BELL said  that in  a theoretical  sense that  is true.   He                                                               
said, "Based on  what the Division of Insurance has  told us, the                                                               
share ...  of what the premium  share would be of  the total, and                                                               
that annual  assessment would be  $1 million against  the retiree                                                               
plans."  He  noted that [the Division of  Retirement & Benefits']                                                               
fiscal note indicates  that the annual cost to  employers who pay                                                               
rates  to  the  retirement  funds would  be  about  $2.2  million                                                               
because  [the  division has]  to  collect  not  only for  the  $1                                                               
million in premium  it will pay in  year one, but it  also has to                                                               
pre-fund  future payments  for  currently active  employees.   He                                                               
said  that   is  because  "when   I  retire,   theoretically  the                                                               
retirement fund  has collected  from ... my  employer and  me 100                                                               
percent of my expected retirement benefit."                                                                                     
Number 1480                                                                                                                     
REPRESENTATIVE ROKEBERG  asked if,  by statutory  definition, the                                                               
legislature could require  that credit be given  for the previous                                                               
deposits when making  the computation.  He asked, "How  do we get                                                               
credit for those deposits?"                                                                                                     
MR. BELL said, "Every employer is  like a separate bucket, and we                                                               
take all of  the employer contributions to  the retirement system                                                               
for, let's  say, the State  of Alaska and  put that in  a bucket.                                                               
And that  bucket is to be  used to fund all  future obligations."                                                               
He  stated that  this  doesn't segregate  the pension  obligation                                                               
from the other  obligations; it is the asset.   The asset is then                                                               
measured  against  the  expected  liability,  and  if  there's  a                                                               
difference, that employer  is charged a higher rate  to cover the                                                               
difference.   He  said, "Effectively,  I think  what happened  is                                                               
that our  medical costs  modestly dropped when  we went  to self-                                                               
insurance and  so the liability associated  with medical dropped,                                                               
but  at the  same time  employer  rates came  down, maybe  partly                                                               
because  of this,  but also  because of  ... other  issues."   He                                                               
concluded by saying  that there are a lot of  things that go into                                                               
determining assets and liabilities.                                                                                             
REPRESENTATIVE ROKEBERG  suggested perhaps  it is  "commingled in                                                               
the pot."                                                                                                                       
MR. BELL said that it can't really be segregated.                                                                               
Number 1385                                                                                                                     
REPRESENTATIVE ROKEBERG said  that it seems to him  that there is                                                               
an  equity  issue  in  terms  of not  getting  credit  for  those                                                               
payments  that are  already made  actuarially.   He said  that he                                                               
doesn't want  to create  too big  a burden, or  too big  a fiscal                                                               
note, no matter where the costs fall.   He asked, "Is there a way                                                               
we can  bring equity  to this  equation and  get some  credit for                                                               
those deposits?"                                                                                                                
Number 1330                                                                                                                     
MR. BELL  said that  the short  answer to  that question  is that                                                               
adding an obligation to the  retiree medical plan increases cost.                                                               
He  explained that  there is  no other  place it  can come  from,                                                               
because for  99 percent of  retirees, their retirement  funds pay                                                               
100  percent of  the premium.   He  commented that  although this                                                               
looks like  a large  number in  terms of the  total asset  of the                                                               
retirement funds,  it's not a  substantial amount.  He  said that                                                               
[the Division of  Retirement & Benefits] has, as  of June [2001],                                                               
$12 to $13 billion in the retirement funds.                                                                                     
MR.  BELL added  that as  the number  of individuals  affected by                                                               
this is expanded, the cost to  the retirement system will go down                                                               
Number 1266                                                                                                                     
REPRESENTATIVE  ROKEBERG said,  "If  we are  able  to expand  the                                                               
amount of  coverage, ...  those costs  would go  down."   He said                                                               
that looks like  a very high cost  in the scope of  what [HB 290]                                                               
is trying to attain.   He said this makes [HB 290]  look bad.  He                                                               
explained that  "they have  to actuarially  put this  money aside                                                               
now for down the road, but they  already did it in the past."  He                                                               
asked, "So  where is  that money?"   He  stated that  although he                                                               
understands  that [the  division] has  to charge  now for  it, he                                                               
doesn't think it is fair to double up on [retirees] now.                                                                        
Number 1210                                                                                                                     
MR.  BELL said  that  he needs  to research  whether  or not  the                                                               
retirement funds  did in fact  pay a  premium in the  past toward                                                               
REPRESENTATIVE ROKEBERG said that  was his understanding in their                                                               
conversation earlier.                                                                                                           
REPRESENTATIVE CRAWFORD  said, "Just  for my edification  ... and                                                               
clarification, I  was under the  impression what [Mr.]  Lohr said                                                               
the other  day was that this  would expand the ACHIA  premiums to                                                               
the  ERISA [Employee  Retirement and  Income Security  Act] plans                                                               
that had stop-loss  insurance, that it would really  cast a broad                                                               
net and  would be very cheap  for each individual."   He asked if                                                               
he is correct in this assumption.                                                                                               
REPRESENTATIVE  ROKEBERG  said   that  he  thinks  Representative                                                               
Crawford's assumption is  correct.  He also stated  that he wants                                                               
to  clarify that  point  with  Mr. Lohr  later.    He stated  his                                                               
concern over  the high fiscal  note if,  in fact, money  has been                                                               
paid in  previously.  He  offered that  this is because  it's all                                                               
done on an actuarial basis, not a current-cost basis.                                                                           
Number 1106                                                                                                                     
CHAIR  MURKOWSKI  commented  that  perhaps  the  committee  would                                                               
receive some additional research on this topic.                                                                                 
MR. BELL said  when actuaries do evaluations, they  don't look at                                                               
the obligations item by item, but at the total - the aggregate.                                                                 
RESPECTIVE ROKEBERG  said it shouldn't  be looked at again  if it                                                               
wasn't taken into account before.                                                                                               
MR. BELL pointed out that something is being added.                                                                             
Number 1048                                                                                                                     
BOB  LOHR,   Director,  Division  of  Insurance,   Department  of                                                               
Community and Economic  Development, said, "It was  really just a                                                               
non-substantive  procedural comment  that  if it  turns out  that                                                               
they  have  been  actuarially pre-funded,  possibly  transitional                                                               
language  and temporary  professional acts  would be  one way  to                                                               
handle that,  but I'm  sure Representative  Rokeberg is  aware of                                                               
that."   He said  that [the  Division of  Insurance's] conceptual                                                               
support for HB 290 is based  on the notion that by broadening the                                                               
applicability  of the  assessment,  it would  in  fact bring  the                                                               
rates down for all payers into the ACHIA fund.                                                                                  
REPRESENTATIVE ROKEBERG asked  Mr. Lohr, "Is it  your belief that                                                               
we can go to those organizations that have stop-loss now?"                                                                      
MR.  LOHR said  that is  correct and  "we do  believe you  can go                                                               
there."  He  referred to a letter from  Signe Anderson, Assistant                                                               
Attorney General, Fair Business  Practices Section, Department of                                                               
Law, who responded to the  question relating to the applicability                                                               
of ERISA and possible pre-emption.  He said:                                                                                    
     We do  believe that  stop-loss policies  are reachable,                                                                    
     and  in fact  other states  have successfully  included                                                                    
     them  in  the  assessment  base  through  a  comparable                                                                    
     program in  those states.   And  to my  knowledge there                                                                    
     has  not  been   a  legal  challenge  -   let  alone  a                                                                    
     successful  legal  challenge  -   against  that  it  is                                                                    
     somehow violative of ERISA, or preempted by ERISA.                                                                         
MR. LOHR offered  that it's important in the rate  design of this                                                               
assessment  to  ensure  that stop-loss  coverage  doesn't  become                                                               
unaffordable or  do anything to  drive it out  of the state.   He                                                               
said, "It  is an important  insurance feature, and  you certainly                                                               
would not  want to assess  it unduly  in some fashion  that might                                                               
jeopardize the availability of the  coverage."  He commented that                                                               
he thought it could be handled  rather carefully in the design of                                                               
the actual assessment figures themselves.                                                                                       
Number 0895                                                                                                                     
REPRESENTATIVE ROKEBERG  asked Mr. Lohr  if he could  request his                                                               
council  to look  into that,  or  to provide  a letter  regarding                                                               
MR.  LOHR said,  "We  can  certainly ask  her  to supplement  the                                                               
opinion."   He stated that  all of the available  literature that                                                               
[the  Division of  Retirement &  Benefits] has  reviewed suggests                                                               
that  this is  a  viable  method of  assessing  premiums for  the                                                               
competence  of health  insurance programs,  and that  practice is                                                               
active and growing in several states.                                                                                           
Number 0855                                                                                                                     
REPRESENTATIVE ROKEBERG stated that  he is leaning towards trying                                                               
to  expand the  definition  of "those  that  offer major  medical                                                               
coverage."  He referred to  the situation that Mr. George brought                                                               
up with AFLAC.                                                                                                                  
MR.   LOHR  said   that  he   would   be  happy   to  work   with                                                               
[Representative  Rokeberg] on  that.   He offered  that generally                                                               
the broader  the base, the better  the managing of the  impact on                                                               
the  private  insurance  market  and   on  all  payers  into  the                                                               
assessment would be.                                                                                                            
REPRESENTATIVE ROKEBERG  said that  he has  spoken with  Mr. Bell                                                               
about "bringing the University of  Alaska in, and the other union                                                               
trusts that weren't already covered."   He commented that several                                                               
of them already  are [included] because they  are underwritten or                                                               
they have stop-loss coverage and are already paying into ACHIA.                                                                 
Number 0709                                                                                                                     
JACK  McRAE, Blue  Cross  Blue Shield  of  Alaska, testified  via                                                               
teleconference   and  said,   "We're  very   supportive  of   the                                                               
legislation  that will  broaden this  pool."   He explained  that                                                               
[Blue  Cross  Blue  Shield  of  Alaska's]  costs  in  Alaska  run                                                               
approximately $1 million  a year into the pool.   He said that in                                                               
2002 it looks as if [Blue  Cross Blue Shield of Alaska's] payment                                                               
into the pool will just about double  to a $2 million figure.  He                                                               
offered  that "with  other  (indisc.)  going self-insured,  there                                                               
seems to  be an  inequity of  that burden being  put on  just the                                                               
members  of our  commercial market  place up  there."   Mr. McRae                                                               
said that  Blue Cross  Blue Shield  would like  to work  with the                                                               
committee in  any way possible  to work through  some legislation                                                               
in this area.                                                                                                                   
MR.  McRAE  addressed  the  issue  of  stop-loss  and  said,  "In                                                               
Washington State they did tax  stop-loss last session, I believe,                                                               
or it  could be the session  before, at a different  formula than                                                               
the commercial carriers.  But  there hasn't been any problem down                                                               
here, to  the best of  my knowledge, with the  stop-loss carriers                                                               
being part of the pool."                                                                                                        
Number 0645                                                                                                                     
REPRESENTATIVE ROKEBERG asked, "Were they  taxed as part of their                                                               
guaranteed program, or for other purposes?"                                                                                     
MR. McRAE said  that he would have to check  the legislation, but                                                               
he believes that the rate at  which they were taxed was one-tenth                                                               
of what the commercial carriers were taxed at.                                                                                  
REPRESENTATIVE  ROKEBERG asked  Mr.  McRae if  he'd  said that  a                                                               
different rate was added.                                                                                                       
Number 0616                                                                                                                     
MR. McRAE  said that they  are paying at  a lower rate  than what                                                               
the commercial carriers  are paying into the pool.   He mentioned                                                               
that the  logic behind this was  to make sure that  the burden is                                                               
such  that stop-loss  carriers  aren't chased  out  of the  state                                                               
because it is a fragile marketplace.                                                                                            
REPRESENTATIVE ROKEBERG asked Mr. McRae  if he could also look at                                                               
the  issue of  assessment by  premium versus  covered lives.   He                                                               
said that he would be looking at  that issue also.  He also asked                                                               
what percentage of  the market Blue Cross Blue  Shield has, since                                                               
it makes up about $2 million of the premium.                                                                                    
MR.  McRAE said  that with  85,000 lives  covered in  Alaska, not                                                               
including  a federal  program, Blue  Cross Blue  Shield has  just                                                               
about 50  percent of the  marketplace, although it goes  back and                                                               
forth between 50 and 51 percent.                                                                                                
REPRESENTATIVE ROKEBERG asked Mr.  Wiggins if Aetna's 3.6 percent                                                               
of   the  marketplace   in   Alaska   includes  its   third-party                                                               
MIKE   WIGGINS,  Vice   President,   National  Accounts,   Aetna,                                                               
testified via teleconference.  He  said, "The majority of Aetna's                                                               
business here  is self-funded  groups, not just  the state.   And                                                               
I'm saying  [Mr. McRae] and I  are wrestling back and  forth, but                                                               
with the loss  of GGU [General Government Unit]  last year, we're                                                               
probably about 20,000  less than he is."  He  added that Aetna is                                                               
definitely a significant  player in the marketplace  and covers a                                                               
lot of  the significant employers  that have home offices  in the                                                               
Lower 48, for example, some of the oil companies.                                                                               
Number 0440                                                                                                                     
REPRESENTATIVE  ROKEBERG asked,  "How about  the non-ERISA?   How                                                               
many do you have there?"                                                                                                        
MR.  WIGGINS  said, "Well,  I  think  the state's  non-ERISA,  so                                                               
that's  the only  one  I know.    Most all  of  our other  funded                                                               
groups, as far as I know, are all ERISA-exempt."                                                                                
REPRESENTATIVE ROKEBERG said that the state is ERISA-exempt.                                                                    
MR.  WIGGINS said  that it's  always a  question, and  he doesn't                                                               
have an opinion  on that.  He commented on  the fragile stop-loss                                                               
market, and said:                                                                                                               
     I agree with that; it's  a fragile market up in Alaska,                                                                    
     and  maybe  it's  just  an education  on  the  type  of                                                                    
     coverage we're  talking about, but a  stop-loss carrier                                                                    
     doesn't  get a  large premium.   He  may be  carrying a                                                                    
     specific  stop-loss at  a level,  let's say,  $250,000,                                                                    
     and  his premium  may be  10 bucks,  and so  he's doing                                                                    
     assessment  on   a  per-covered-life  [basis].     That                                                                    
     doesn't make  a whole  lot of sense  if that's  the way                                                                    
     you're going to do the apportionment.                                                                                      
REPRESENTATIVE ROKEBERG  said, "It would  be better as  a premium                                                               
tax, then, rather than a covered (indisc.)."                                                                                    
Number 0361                                                                                                                     
MR. WIGGINS  said, "Yes, I  totally agree  with you, that  it's a                                                               
premium tax,  but right now  it's written on a  per-head [basis],                                                               
and  as  it's  written  here,  we'll  have  some  difficulty  and                                                               
definitely could hurt the marketplace for stop-loss carriers."                                                                  
REPRESENTATIVE ROKEBERG asked,  "Where are we now?   We're on the                                                               
premium, I thought, right?"                                                                                                     
Number 0290                                                                                                                     
CHAIR MURKOWSKI said that the sponsor  has asked to hold [HB 290]                                                               
over as  he continues  to work  through the process  on it.   She                                                               
added  that  there  has  been  some  good  information  that  the                                                               
committee has benefited from.                                                                                                   
REPRESENTATIVE  ROKEBERG said  that it  isn't his  intention, but                                                               
there  are "a  few  complex issues  and ...  could  be some  very                                                               
political   and  technical   applications,  which   there  really                                                               
shouldn't be.   That's  not my  intention."  He  said that  he is                                                               
really  pleased that  the  administration  has indicated  general                                                               
conceptual support for  [HB 290] because "that shows  that we can                                                               
make this  a bipartisan thing and  this is not intended  to hurt,                                                               
like, the  union trust."  He  mentioned that [HB 290]  is to make                                                               
sure  everybody  equitably is  paying  into  this very  important                                                               
program that  needs to  continue and which  is growing,  and that                                                               
insurance needs to  be available for everybody in the  state.  He                                                               
said that there  is testimony that Blue Cross is  paying half the                                                               
premium at $2  million a year.  He summarized  by saying that "we                                                               
need to  expand that base  of contribution into the  program, and                                                               
to make sure it's a viable program for the future."                                                                             
Number 0159                                                                                                                     
CHAIR MURKOWSKI thanked Representative  Rokeberg for bringing the                                                               
bill forward.  [HB 290 was held over.]                                                                                          

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