Legislature(2005 - 2006)CAPITOL 17

02/06/2006 03:15 PM LABOR & COMMERCE

Download Mp3. <- Right click and save file as

* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ Bills Previously Heard/Scheduled TELECONFERENCED
Moved CSHB 335(L&C) Out of Committee
<Bill Rescheduled from 02/03/06>
Moved CSHB 393(L&C) Out of Committee
<Bill Rescheduled from 02/03/06>
HB 393-INSURANCE FOR COLORECTAL CANCER SCREENING                                                                              
CHAIR ANDERSON announced  that the first order  of business would                                                               
be  HOUSE BILL  NO. 393,  "An Act  requiring that  certain health                                                               
care  insurance   plans  provide   coverage  for  the   costs  of                                                               
colorectal  cancer screening  examinations and  laboratory tests;                                                               
and providing for an effective date."                                                                                           
HEATH  HILYARD, Staff  to Representative  Anderson, Alaska  State                                                               
Legislature, Sponsor,  explained that this bill  will establish a                                                               
minimum standard requirement that  colorectal cancer screening be                                                               
provided in healthcare policies  in Alaska, particularly to those                                                               
individuals who are over 50 years of  age.  He added that this is                                                               
important  because  colorectal cancer,  if  caught  in the  early                                                               
stages, has a 90 percent  survival rate; however, if caught late,                                                               
the survival rate is around 10 percent.                                                                                         
3:31:28 PM                                                                                                                    
EMILY  NENON,  Alaska  Government  Relations  Director,  American                                                               
Cancer Society (ACS),  stated that she has  been researching this                                                               
legislation for  4 years.   She explained that  colorectal cancer                                                               
is  the second  leading  cause  of cancer  deaths  in the  United                                                               
States, adding  that Alaska has  an above average rate  for colon                                                               
cancer in  the general population.   She went on to  say that the                                                               
Alaska Native population has the  highest rate of colon cancer of                                                               
any population  group in the  country.  Ms. Nenon  also explained                                                               
that [via  a colonoscopy,  the doctor]  can remove  polyps before                                                               
they become  cancerous, adding  that this  is the  only screening                                                               
tool  available that  can  prevent  cancer.   She  stated that  a                                                               
colonoscopy  is  over 90  percent  effective  at detecting  colon                                                               
MS. NENON  informed the  committee that  currently 18  states and                                                               
the  District of  Columbia have  passed laws  that require  state                                                               
regulated plans to cover colon  cancer screening according to the                                                               
ACS  guidelines.    In  regards  to  plans  that  are  not  state                                                               
regulated, she  explained that in  the past couple of  years, ACS                                                               
has  increased  the number  of  Federal  plans that  cover  colon                                                               
cancer screening.   She also informed the  committee that current                                                               
state law  requires coverage for  breast, cervical,  and prostate                                                               
cancer, pointing  out that colon  cancer is the only  cancer with                                                               
recommended screening  that is  not listed.   She  commented that                                                               
[ACS]  would like  to give  people  the opportunity  to have  all                                                               
cancer screening  covered by insurance,  and adding  colon cancer                                                               
screening would complete the list.                                                                                              
3:36:02 PM                                                                                                                    
CHAIR  ANDERSON  inquired  about  the different  types  of  colon                                                               
cancer screening.                                                                                                               
3:36:24 PM                                                                                                                    
MS. NENON replied  that it is important for  doctors and patients                                                               
to make a decision about  which screening is most appropriate for                                                               
the patient.  She stated  that colonoscopy is the "gold standard"                                                               
because of its  ability to find and  remove pre-cancerous tissue,                                                               
adding that  it is not  appropriate for everyone.   She explained                                                               
that in addition  to the colonoscopy, the guidelines  in [HB 393]                                                               
include fecal  occult blood  test (FOBT),  double-contrast barium                                                               
enema, and flexible  sigmoidoscopy.  She went on to  say that the                                                               
colonoscopy only needs  to be repeated once every 10  years for a                                                               
person at average  risk - for example one colonoscopy  at age 50,                                                               
another at age  60.  Ms. Nenon added that  after age 65, Medicare                                                               
covers this procedure.                                                                                                          
MS. NENON,  in response  to a question,  confirmed that  the cost                                                               
for each procedure is different.   She explained that the ACS did                                                               
a  study  on this  issue,  looking  at  the  cost of  covering  a                                                               
combination  of  FOBT  and   flexible  sigmoidoscopy,  which  are                                                               
commonly covered by  insurance, versus a colonoscopy.   The study                                                               
showed that if a person receives  a positive result from an FOBT,                                                               
they are  referred on  to receive a  flexible sigmoidoscopy  or a                                                               
colonoscopy.   At this point,  these are  considered "diagnostic"                                                               
tests.  Ms.  Nenon went on to  say that the FOBT has  a very high                                                               
false-positive rate, and  a person who receives  a false positive                                                               
and goes  on to receive  a colonoscopy then  has to pay  for both                                                               
tests.  Therefore,  it would be more cost effective  to start out                                                               
with the colonoscopy.                                                                                                           
CHAIR  ANDERSON asked  for clarification  regarding who  would be                                                               
covered by HB 393.                                                                                                              
3:41:21 PM                                                                                                                    
MS. NENON  responded that the retired  state employee [insurance]                                                               
plan  does not  cover colon  cancer screening,  adding that  each                                                               
state-regulated  insurance plan  varies  as to  what is  covered.                                                               
Self-insured plans  are not  regulated by the  state, and  ACS is                                                               
working with  these employers so that  they will be able  to make                                                               
the changes on their own.                                                                                                       
CHAIR  ANDERSON  offered  his belief  that  if  this  legislation                                                               
passes the population that will be affected will be small.                                                                      
REPRESENTATIVE LYNN  asked how often  a "high-risk"  person would                                                               
be required to get a colonoscopy.                                                                                               
MR. HILYARD referred to page 2, lines 24-26, which read in part:                                                                
     For individuals considered at high risk for colorectal                                                                     
       cancer, screening shall be provided at a frequency                                                                       
     determined necessary by a health care provider.                                                                            
REPRESENTATIVE LYNN  surmised then,  that whatever  frequency the                                                               
healthcare provider decided would then be covered.                                                                              
3:44:53 PM                                                                                                                    
REPRESENTATIVE LEDOUX,  referring to  page 1, lines  10-11, asked                                                               
why fraternal benefit societies are exempt.                                                                                     
MS.  NENON replied  that this  legislation was  drafted to  match                                                               
other cancer  screening statutes,  and so she  does not  know why                                                               
this  population is  exempt or  how  many plans  fall under  this                                                               
category.  She noted that  someone from the Division of Insurance                                                               
may be able to offer this information.                                                                                          
REPRESENTATIVE LEDOUX,  referring to page 2,  subsection f, asked                                                               
if  it  is  common  for  the insurance  provider  to  notify  the                                                               
enrollee of coverage.                                                                                                           
MS.  NENON replied  that this  type  of language  is being  added                                                               
around  the country,  and is  intended to  inform people  of what                                                               
their plan covers and what they are eligible for.                                                                               
3:47:09 PM                                                                                                                    
REPRESENTATIVE   ROKEBERG  stated   that  he   recently  received                                                               
information from  the Division  of Insurance  that there  are 118                                                               
thousand  individuals covered  under small  or large  group plans                                                               
who would  be affected  by this  legislation.   He noted  that 83                                                               
percent of  the people  in Alaska  would not  be covered  by this                                                               
3:50:51 PM                                                                                                                    
REPRESENTATIVE  CRAWFORD noted  that most  union trust  plans are                                                               
already covering [colon cancer screening].                                                                                      
CHAIR ANDERSON offered his belief  that the 83 percent figure may                                                               
be misleading,  adding that although  this bill does  not mandate                                                               
it, many independent insurance groups  are already covering these                                                               
REPRESENTATIVE  ROKEBERG  responded  that   this  law  impacts  a                                                               
limited number  of people, and has  no impact on groups  that may                                                               
cover [colon cancer screening].                                                                                                 
3:51:52 PM                                                                                                                    
REPRESENTATIVE  LEDOUX   asked  if  this  legislation   could  be                                                               
expanded to include [independent insurance groups].                                                                             
REPRESENTATIVE  ROKEBERG  replied   that  [independent  insurance                                                               
groups] are excluded by federal law.                                                                                            
3:52:47 PM                                                                                                                    
BRIAN  SWEENEY JR.,  M.D., informed  the committee  that he  is a                                                               
gastroenterologist, and  is board certified in  internal medicine                                                               
and  gastroenterology.   He stated  that 93  percent of  patients                                                               
that  are diagnosed  with stage  one cancer  survive five  years,                                                               
while only  8 percent  of those patients  who are  diagnosed with                                                               
stage four  cancer survive five  years.  He, too,  explained that                                                               
colonoscopy is the only type of  cancer screening that is able to                                                               
detect  cancer before  it starts,  adding that  FOBT has  a 20-40                                                               
percent rate of saving lives  and flexible sigmoidoscopy has a 60                                                               
percent rate.  In regard to  colonoscopy, he stated that there is                                                               
not  an  exact number,  but  computer  models  have shown  an  80                                                               
percent reduction in mortality.                                                                                                 
DR.   SWEENEY  informed   the  committee   that  40   percent  of                                                               
[individuals at  risk] receive colon  cancer screening,  which he                                                               
noted is up  from 20 percent in  the last five to ten  years.  He                                                               
opined that  the real danger is  that some individuals may  be at                                                               
higher risk and so the insurance  company may not want to cover a                                                               
"screening  procedure," which  may result  in a  decision not  to                                                               
have  the procedure  done.   He explained  that colonoscopy  done                                                               
once  every ten  years  is  more cost  effective  than any  other                                                               
screening test  that has been studied,  including mammography and                                                               
pap smears.                                                                                                                     
CHAIR  ANDERSON asked  if Dr.  Sweeney would  agree that  because                                                               
colon cancer screening has the  ability to catch cancer before it                                                               
begins, the legislation is valuable.                                                                                            
DR. SWEENEY replied that he  would agree, adding that on average,                                                               
colon  cancer is  diagnosed at  age 67,  at which  point Medicare                                                               
pays  for  the medical  treatment.    He expressed  concern  that                                                               
taxpayers pay for  this service.  He opined that  the cancer most                                                               
likely began  as a polyp when  the individual was in  his/her 50s                                                               
and could have been taken care  of [with screening].  With regard                                                               
to the  issue of saving money,  he opined that for  an individual                                                               
who has a  cancerous polyp and does not have  it removed, cost is                                                               
not the issue.                                                                                                                  
3:58:11 PM                                                                                                                    
DR.  SWEENEY,  in  response   to  questions  from  Representative                                                               
Rokeberg, explained  the procedure  for a  double-contrast barium                                                               
enema.  He stated that the  ACS guidelines are used in this bill.                                                               
He  went  on to  say  that  the ACS  lists  this  as a  potential                                                               
screening test,  while the  American College  of Gastroenterology                                                               
has  eliminated   it  from  their  colorectal   cancer  screening                                                               
guidelines.    He  expressed  his  agreement  with  removing  the                                                               
double-contrast  barium  enema  from  the  screening  guidelines,                                                               
adding that  there have not  been any studies showing  the test's                                                               
ability to screen  and save lives.  In addition,  if something is                                                               
found with this test, a colonoscopy is still needed.                                                                            
REPRESENTATIVE  ROKEBERG asked  if allowing  family practitioners                                                               
to  perform the  "less intrusive"  colon screening  procedures is                                                               
DR.  SWEENEY responded  that  FOBT has  a  3-10 percent  positive                                                               
rate, must  be done  every year,  and has  a high  false positive                                                               
rate.    He explained  that  studies  have  shown that  the  most                                                               
accurate  results come  from the  colonoscopy, not  from FOBT  or                                                               
flexible sigmoidoscopy.   He  stated that  if the  guidelines are                                                               
followed  exactly, the  patients  who receive  a positive  result                                                               
FOBT  and  flexible  sigmoidoscopy  will still  need  to  have  a                                                               
colonoscopy.  He  opined that getting a person to  do any kind of                                                               
testing is better than nothing.                                                                                                 
4:03:00 PM                                                                                                                    
REPRESENTATIVE  ROKEBERG asked  if he  would recommend  including                                                               
the basic tests that can be done by a general practitioner.                                                                     
DR. SWEENEY  responded that  he would include  it.   He explained                                                               
that although he feels colonoscopy  is "the best" screening test,                                                               
no  randomized  studies have  been  done  to show  how  effective                                                               
colonoscopy is.                                                                                                                 
CHAIR ANDERSON  commented that it  is important to know  that all                                                               
of the tests are critical.                                                                                                      
4:04:21 PM                                                                                                                    
DR. SWEENEY  replied that  there have  been computer  models that                                                               
suggest that  if a person were  to do both the  FOBT and flexible                                                               
sigmoidoscopy,  more  lives  may  be  saved  than  by  doing  the                                                               
4:05:25 PM                                                                                                                    
REPRESENTATIVE  ROKEBERG  noted  that  the  legislation  provides                                                               
coverage for  those over 50 years  of age, or less  than 50 years                                                               
of age with a high risk of colon  cancer.  He asked what would be                                                               
required for someone to be considered "high risk."                                                                              
DR.  SWEENEY  replied  that  having  two  first-degree  relatives                                                               
(mother/father)  who  die of  colorectal  cancer  makes a  person                                                               
"high risk".   He expressed his  feeling that there is  no excuse                                                               
for  not screening  "high  risk" patients,  adding  that in  this                                                               
case,  a  colonoscopy would  be  the  most appropriate,  since  a                                                               
person with a family history would  be likely to get colon cancer                                                               
higher up in the  colon.  He stated that a person  who has one or                                                               
two  first-degree  relatives  with   colon  cancer  should  begin                                                               
screening  at age  40.   He  went  on to  say  that the  American                                                               
College of Gastroenterology did a  study that showed that African                                                               
Americans should begin  screening for colon cancer at  the age of                                                               
4:08:40 PM                                                                                                                    
REPRESENTATIVE  ROKEBERG  noted  that   the  "patients'  bill  of                                                               
rights"  is  intended to  help  patients,  adding that  they  can                                                               
appeal a dispute about coverage.                                                                                                
DR. SWEENEY stated that although  it sometimes takes extra effort                                                               
from the  patient, he  has yet  to see  any situations  where the                                                               
insurance company refuses to pay for the procedure.                                                                             
REPRESENTATIVE LEDOUX, referring  to page 3, line  9, inquired as                                                               
to the meaning of, "other predisposing factors."                                                                                
DR.  SWEENEY explained  that this  would include  persons with  a                                                               
genetic defect  which makes  them more  likely to  develop polyps                                                               
and colon  cancer.  He  added that  he feels that  these patients                                                               
are  "surveillance" patients,  rather than  "screening" patients.                                                               
He went  on to say  that high-risk  patients, such as  those with                                                               
Crohn's  Disease,  are  more   likely  to  receive  colonoscopies                                                               
CHAIR  ANDERSON highlighted  that  "ethnicity"  would fall  under                                                               
[other predisposing factors].                                                                                                   
4:11:22 PM                                                                                                                    
CLAUDIA  CHRISTENSEN,  Alaska  Native  Tribal  Health  Consortium                                                               
(ANTHC), informed  the committee  that she  has been  involved in                                                               
colorectal cancer screening  for the past six years.   She stated                                                               
that  in addition  to having  a high  rate of  colorectal cancer,                                                               
Alaska Natives  also have  low screening  rates in  comparison to                                                               
other ethnic  groups, due to  the majority of them  being located                                                               
in Alaska's  remote and  rural areas.   Ms.  Christensen informed                                                               
the  committee that  the ANTHC  and  the Southcentral  Foundation                                                               
began a screening  program in Anchorage, and  explained that they                                                               
offer  colonoscopy and  flexible sigmoidoscopy.   She  noted that                                                               
they now  have a 50 percent  screening rate, which is  "well over                                                               
the  national average."   She  went on  to say  that rural  areas                                                               
still have low screening rates,  adding that the ANTHC is working                                                               
on recognizing patients with a  family history in order that they                                                               
begin screening.  Ms. Christensen  stated that the ANTHC does not                                                               
have  gastroenterologists, but  does  have  general surgeons  who                                                               
make  field  visits to  rural  areas  in  an effort  to  increase                                                               
screening rates.                                                                                                                
4:13:47 PM                                                                                                                    
REPRESENTATIVE ROKEBERG  asked what  type of health  insurance is                                                               
available for Alaska Natives.                                                                                                   
MS.  CHRISTENSEN replied  that  the Indian  Health Service  (IHS)                                                               
covers colorectal  screening for  Alaska Natives living  in areas                                                               
where  the  screening is  offered,  adding  that not  all  Alaska                                                               
Natives use the IHS.                                                                                                            
REPRESENTATIVE ROKEBERG  opined that  some Alaska Natives  have a                                                               
health insurance  company as  their primary  carrier but  use the                                                               
IHS  as a  backup.   With  regard  to the  issue  of "stop  loss"                                                               
insurance, he said  that some individuals may be  covered under a                                                               
high deductible.                                                                                                                
DR.  SWEENEY,  in  response   to  questions  from  Representative                                                               
Rokeberg,  stated that  billable  charges for  a colonoscopy  are                                                               
around $2,500,  including operating  room costs.   He  added that                                                               
Medicare  reimbursement  is  around  $700.    He  explained  that                                                               
facility fees  range from $1,500-$2,000,  while the  doctor's fee                                                               
is  about [$750-$1,000],  noting that  if a  polyp is  found, the                                                               
cost rises.                                                                                                                     
4:16:43 PM                                                                                                                    
STEPHEN  WARREN  informed  the committee  that  his  brother  was                                                               
recently diagnosed  with symptomatic colorectal cancer  and has a                                                               
10  percent chance  of survival.   He  stated that  his brother's                                                               
insurance did  not cover the  screening and, urged  the committee                                                               
to pass HB 393.                                                                                                                 
MR.  WARREN,   in  response  to  questions   from  Representative                                                               
Rokeberg, said  that he  is not aware  of what  insurance company                                                               
was used, adding that his brother works for the state.                                                                          
4:18:30 PM                                                                                                                    
RICK  URION  informed  the committee  that  although  he  usually                                                               
speaks on  behalf of the  Division of Occupational  Licensing, he                                                               
would  be speaking  today as  a "cancer  patient."   He said  "It                                                               
makes a whole  lot of sense to me, given  my personal experience,                                                               
that you would  spend a few bucks  up front, to save  ... the big                                                               
costs ... later  on if you have full-blown cancer."   He informed                                                               
the committee  that he  had received  a colonoscopy  during which                                                               
polyps  were  removed.    Less  than one  year  later,  a  second                                                               
colonoscopy was  performed, this time finding  full-blown cancer.                                                               
He  said "I'm  before you  today  as, I  hope to  say, a  'cancer                                                               
survivor'  because  of  early  detection,  and  I  think  it's  a                                                               
wonderful  thing  that  you  would   include  this  in  insurance                                                               
policies, and I think it's a good deal."                                                                                        
4:20:13 PM                                                                                                                    
REED  STOOPS,   Lobbyist  for   the  American   Health  Insurance                                                               
Association (AHIA),  explained that  there have  been 12  or more                                                               
mandated  coverages adopted  by the  legislature.   Individually,                                                               
the  cost implications  are "marginal",  but  when combined,  the                                                               
cost is more  significant.  He stated that this  policy trade off                                                               
provides better coverage,  but raises the cost  for [small groups                                                               
and  individuals].   Mr. Stoops  noted that  the AHIA  recommends                                                               
mandated  offerings as  an  alternative  to [mandated]  coverage,                                                               
thus giving  the individual  the option to  buy coverage  but not                                                               
requiring it.   Referring to  a handout in committee  packets, he                                                               
recommended  that the  committee  adopt  language from  Tennessee                                                               
law, which references current  American Cancer Society guidelines                                                               
and  United States  Preventive  Services  Task Force  guidelines,                                                               
explaining that this would keep the  law up to date with the most                                                               
recent research.                                                                                                                
CHAIR ANDERSON  moved that  the committee  adopt Amendment  1, as                                                               
     Page 2, lines 5-14;                                                                                                        
          Delete all material                                                                                                   
     "coverage  for   colorectal  cancer   examinations  and                                                                    
     laboratory tests  specified in current  American Cancer                                                                    
     Society   guidelines   or  United   States   Preventive                                                                    
     Services  Task Force  guidelines for  colorectal cancer                                                                    
     screening of asymptomatic individuals."                                                                                    
[Following  was a  brief discussion  regarding other  language in                                                               
the handout.]                                                                                                                   
REPRESENTATIVE LYNN  objected for  discussion purposes  and asked                                                               
if this  language would cover  the guidelines that  are currently                                                               
written out in the bill.                                                                                                        
CHAIR ANDERSON offered his understanding  that it would and would                                                               
also allow for any future changes.                                                                                              
REPRESENTATIVE  ROKEBERG  asked Chair  Anderson  if  he would  be                                                               
amenable  to amending  Amendment 1  by  adding the  words "as  an                                                               
optional benefit."                                                                                                              
CHAIR  ANDERSON  said  he  would  not  be  amenable  to  such  an                                                               
amendment to Amendment 1.                                                                                                       
CHAIR  ANDERSON  asked if  there  was  any further  objection  to                                                               
Amendment 1.  There being none, Amendment 1 was adopted.                                                                        
4:28:31 PM                                                                                                                    
MR.  STOOPS,   in  response  to  questions   from  Representative                                                               
Rokeberg, stated  that Aetna, Inc., is  a member of the  AHIA and                                                               
traditionally  covers colorectal  screening, including  the State                                                               
of Alaska plan.  He stated  that Aetna, Inc., and Blue Cross Blue                                                               
Shield have a  combined market share of 80-85 percent.   He noted                                                               
that the  agencies who represent  the small-group  and individual                                                               
market in Alaska will be affected the most by the legislation.                                                                  
REPRESENTATIVE  LEDOUX   asked  if  there  was   any  information                                                               
regarding the change in individual policy  cost if HB 393 were to                                                               
MR. STOOPS replied that he  would attempt to get cost information                                                               
before the next committee hearing.                                                                                              
4:31:15 PM                                                                                                                    
JEFFREY   TROUTT,  Deputy   Director,   Division  of   Insurance,                                                               
Department  of   Commerce,  Community,  &   Economic  Development                                                               
(DCCED), in  response to questions from  Representative Rokeberg,                                                               
informed the  committee that the  department does not  support or                                                               
actively oppose  mandates.  He  explained that HB 393  would cost                                                               
money, but was unable to give an exact amount.                                                                                  
REPRESENTATIVE ROKEBERG  asked if there is  an average deductible                                                               
for "stop  loss" [insurance] carriers, and  requested information                                                               
on how Blue Cross Blue Shield will be affected.                                                                                 
MR. TROUTT  replied that he is  not aware of whether  there is an                                                               
average or deductible.                                                                                                          
CHAIR  ANDERSON  requested  that  this  information  be  supplied                                                               
before the bill is heard in the next committee of referral.                                                                     
4:33:32 PM                                                                                                                    
REPRESENTATIVE LYNN  moved to report  HB 393, as amended,  out of                                                               
committee  with individual  recommendations and  the accompanying                                                               
fiscal notes.                                                                                                                   
REPRESENTATIVE ROKEBERG objected, and  urged committee members to                                                               
consider the ramifications,  pointing out that a  majority of the                                                               
people in  Alaska are covered  by independent insurance  plans or                                                               
"stop loss"  plans and  therefore would not  be affected  by this                                                               
legislation.   He commented  that 20 percent  of Alaskans  and 50                                                               
percent  of the  children in  Alaska are  on Medicaid,  and asked                                                               
members to  consider the direction  of healthcare in  Alaska, and                                                               
urged them to "be very careful."                                                                                                
REPRESENTATIVE ROKEBERG then withdrew his objection.                                                                            
CHAIR ANDERSON  commented that he  would be interested  in seeing                                                               
the  statistics regarding  the  aforementioned  states that  have                                                               
similar laws, and whether insurance  carriers will say they won't                                                               
provide  services  in  Alaska  because  of  mandatory  colorectal                                                               
CHAIR  ANDERSON asked  whether there  was any  further objection.                                                               
There being none, CSHB 393(L&C) was reported from the committee.                                                                

Document Name Date/Time Subjects