Legislature(1995 - 1996)
05/02/1996 08:05 AM House STA
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
SB 253 - INS. FOR PROSTATE & CERVICAL CANCER TESTS CHAIR JAMES brought SB 253 before the committee and called on Senator Duncan to present the bill. Number 0032 SENATOR JIM DUNCAN, sponsor of SB 253, said it basically required that insurance policies cover both Prostate Specific Antigen (PSA) tests and cervical cancer detection. According to the National Cancer Institute, prostate cancer accounts for 36 percent of all male cancers and is the second leading cause of cancer death in men. Senator Duncan said an estimated 40,000 men in the United States would die from prostate cancer this year. SENATOR DUNCAN explained that although prostate cancer was often presumed to develop slowly, nearly two-thirds of new cases had spread beyond the prostate gland by the time of diagnosis. SENATOR DUNCAN said SB 253 was amended in the Senate Finance Committee to require coverage of screening for cervical cancer, which accounts for 16 percent of all cancers in women. "It is estimated that nearly half of the approximately 15,700 women who are diagnosed annually with the condition never underwent early screening procedures which could have led to highly successful treatment," he stated. Number 0154 SENATOR DUNCAN believed SB 253 made preventive health care a priority. He noted that committee packets contained letters of support from providers who worked in the field; information from the National Cancer Institute, including their recommendation of a PSA test for men over age 50 or in a high-risk group; and a recommendation for cervical cancer screening. SENATOR DUNCAN acknowledged there was debate over whether the tests were always accurate. "In fact, the providers indicate ... there are times that they may have a false reading," he stated. "But it's better to have that false reading and further examination than to not detect cancer early at all." Number 0259 SENATOR DUNCAN pointed out there was a zero fiscal note and said, "There's not expected to be ... any premium increase as a result of coverage of these two tests. The one thing that the fiscal notes do not show, however, is the long-term savings. It's clear that when you have a preventive health care measure in place, when you require preventive health care tests and you have early detection of a disease, that the cost savings in the long term are great. They're hard to quantify, so ... they're not on a fiscal note. But if you have early detection and catch a disease early, the costs are much less than if you let the disease get well-underway and then have to do some major surgery or major treatment, which is very expensive." Number 0315 SENATOR DUNCAN expressed that even more important than overall cost savings was the savings of life. "Early detection, of course, means that many people can be cured, and, therefore, many lives saved," he stated. "So, I think it's a very important piece of legislation." SENATOR DUNCAN urged committee members to pass out CSSB 253(FIN), the version passed out of the Senate and the House Labor and Commerce Committee. "That's the bill that very clearly says that the insurance policy shall provide for a PSA test and shall provide for a cervical cancer screening," he explained. "It's important, I think, to have that provision there, to make it clear that those insurance policies will provide those preventive tests and not just offer them. If we're to just ... ask insurance companies to offer them, we're really doing nothing, because right now, insurance companies can offer [them]." Number 0410 SENATOR DUNCAN related that four years earlier, legislation had passed in Alaska requiring that mammograms be covered by insurance companies. "And that's being done," he said. "There was no appreciable increase, or any increase that we could detect, in health care premiums because of that requirement. ... But undoubtedly, and again, that's difficult to quantify, there has been a lot of costs saved because of early detection, and a lot of lives saved. So, I think it's very important to look at these two tests in the same regard." SENATOR DUNCAN noted there were related articles in the committee packets, including one from the Juneau Empire. There was also a quote from a lobbyist for a major insurance company in Alaska, indicating the company believed covering preventive health care was the right thing to do, because in the long run, it saved money and lives. Number 0517 EUGENE DAU, Capital City Task Force, American Association of Retired Persons (AARP) and Member, Veterans of Foreign Wars (VFW), believed SB 253 was extremely important. Most men do not talk about prostate cancer, even with their doctors, he stated, despite the high death rate. Early screening was needed because prostate cancer, when not caught in the early stages, spread fast. His own doctor claimed the PSA test was 95 percent accurate. His doctor had told him the test could reveal other problems with the prostate, unrelated to cancer, as well. MR. DAU said the PSA test was simple and not painful. "I think by passing this bill, it would make people more aware of these two tests, and especially the prostate cancer part," he said. "I think if the bill passed in the original version, the Senate version where insurance companies pay for these tests, it would encourage people to take the test." He believed the bill would benefit all Alaskans. Number 0827 CHAIR JAMES noted someone was present from the Division of Retirement and Benefits to answer questions. She asked if anyone else wished to testify. Chair James referred to Senator Duncan's suggestion that the committee accept the Senate Finance Committee version of the bill, and asked: "When it says `shall provide coverage', how does that make people do it? Because just having the coverage there does not necessarily get people in to take the test." She asked if Senator Duncan was expecting insurance companies to do something beyond paying for the tests when requested. Number 0893 SENATOR DUNCAN replied he did not expect insurance companies to force people to go to the doctor for tests. "But it would be a covered item on your insurance policy, on every insurance policy that's sold in this state, if you meet the qualifications or the requirements that are under this legislation: age 50 or older if you're a man, or if you're in a high-risk category, or age 18 and older if you're a woman," he stated. Senator Duncan believed that knowing it was covered, and knowing the seriousness of the illnesses, people would request the tests, allowing early detection. Number 0947 CHAIR JAMES commented that under some dental plans, people who did not get their teeth checked regularly did not receive the same kind of coverage as those who did. "And that was what I was wondering, if that was what you're expecting this to do," she said. SENATOR DUNCAN replied that was not the intent. Number 0962 REPRESENTATIVE CAREN ROBINSON suggested the outcome would be more education, with people realizing it was important to take the tests. She believed it was similar to what took place when the legislature did the same thing with mammograms. "I think it started the education, out in both the public and the media, and people started doing what they should be doing," she stated. CHAIR JAMES noted that Representatives Green and Ogan had joined the meeting. Number 0994 REPRESENTATIVE BRIAN PORTER indicated he would vote against the bill, as he philosophically did not believe in this form of providing medicine. "I think preventative medicine is so beneficial that its efficacy should be apparent to even insurance companies," he stated. However, he believed requiring it would raise costs for individuals maintaining insurance. He said he would support the other version, which required that it be offered. CHAIR JAMES agreed, saying it was for an even more imbedded philosophical reason. She suggested this moved further into social engineering, where people did not have to make choices. She preferred that people be responsible for their own lives. She suggested coverage would make no difference for those who seldom went to the doctor, because the deductible would not be met. However, she thought it should be offered. "I understand the interest of it," she said. "I'm not totally convinced that there will not be an increase over the long term ... because I'm not convinced that because we make them provide the coverage, that the actual thing is going to be happening that much more." Number 1148 REPRESENTATIVE SCOTT OGAN apologized for his late arrival and asked for clarification about projected costs. SENATOR DUNCAN referred to the fiscal notes and said he believed a PSA test was about $75, not a major cost but one that was prohibitive to many individuals. There was no appreciable projection of increase in premiums, if any, he said. He emphasized that long-term savings, due to early detection, were not included in the fiscal note because that could not be quantified. "So, the fiscal note shows zero," he said. "I believe in the long term, it's a cost savings." Number 1235 CHAIR JAMES emphasized that she supported preventive measures, not only in medicine. However, she also strongly supported the concept of people taking responsibility for their lives. She noted that PSA screenings were $30 at the health fair, an amount that she did not believe would prohibit people from taking the test if they wanted preventive medicine for themselves. Chair James agreed the bill would probably not have a big cost impact and would probably save some lives. "But the biggest objection I have to it is that it takes away individual responsibility and puts the responsibility somewhere else," she said. Number 1287 REPRESENTATIVE JOE GREEN apologized for being late and explained he and Representative Ogan had been in another meeting. He asked if these tests would be part of a general physical. He said some health policies covered physicals, whereas others did not, unless they were associated with diagnosis of an ailment. SENATOR DUNCAN explained that under SB 253, every insurance policy sold in the state would cover a PSA test for men who meet the criteria in the legislation. Men would qualify at age 50, because that was the age at which prostate cancer became a problem. If they were in a high-risk group, they would qualify at age 40. Women over the age of 18 would qualify. This was true whether the insurance covered a physical exam or not. Number 1383 REPRESENTATIVE GREEN questioned when a person would take this test. SENATOR DUNCAN indicated people should get physicals and suggested men should be screened for prostate cancer when they reached age 50. He pointed out an article in the packet about a local man, in a high-risk category, who got a serious case of prostate cancer in his 40s. He apologized for not providing a further article in the packet and said, "The insurance industry, you don't see them here at the table today opposing this. Some insurance companies might say it increased costs. But the major insurers recognized otherwise. Blue Cross and Aetna have both indicated that they are not opposing this. In fact, one of the lobbyists clearly said that they support preventive measures such as Pap tests and prostate tests, and that they believe preventive health care is the right direction." He suggested that the insurance company recognized that in the long-run, preventive health care probably reduced their costs. Number 1515 REPRESENTATIVE GREEN said he understood the blood test was effective and considerably cheaper than the old-fashioned test. SENATOR DUNCAN said when he had the blood test, he thought it was around $75. REPRESENTATIVE GREEN indicated although he thought it was a good idea, he was a little concerned it was getting into social engineering. "If I elect to be dumb enough not to get those tests, then that's my prerogative," he said. Number 1592 REPRESENTATIVE ROBINSON said once a woman was in a high-risk category and supposed to get a certain number of mammograms, they could become very costly. "And they didn't used to be paid for," she said. "As a matter of fact, once you're in the high-risk, quite often they want you to get it every six months. And all this is saying, just like when you get a throat culture and you send it into your insurance company and it comes back and they have agreed to pay for it, it's just saying this is a coverage that's going to be paid for." Representative Robinson indicated she knew of many women who were required by their doctors to get mammograms, and yet it had not been paid for. "And this is just bringing, in my opinion, equity into the other areas that are serious cancers, and primarily for men," she concluded. REPRESENTATIVE GREEN commented that somebody had to pay for it and this seemed more a socialist approach than a free-enterprise approach. Number 1664 CHAIR JAMES stated, "I do believe with ... preventive medicine, that there will be a savings over the long haul. And ... I don't believe that we ought to be here legislating that the insurance companies cover these. I think the insurance companies, looking for long-term savings, ought to be doing this on their own." Number 1691 SENATOR DUNCAN replied, "I didn't want to mislead you to believe that Aetna, and other insurance companies, always cover PSA tests. They don't. There are many times when men have had a PSA test and they have denied payment on it. Even though they believe it's the right thing to do, ... they are not covering it unless we tell them to cover it. And, therefore, it's discouraging people from getting those tests." SENATOR DUNCAN explained the bill got started after a local man in a high-risk category was turned down by Aetna for a PSA test. He said that was one example, of many, where insurance companies did not cover tests they were not required to cover. Senator Duncan disagreed that it smacked of socialism, as someone was paying for the premiums. Nor did he believe premiums would rise. "But I think the bottom line, most important consideration here, is ... the cost savings over the long term, the fact that you will detect cancer early, you'll avoid many major surgical procedures and long- term cancer treatment, and you're going to save lives," he stated. Number 1813 CHAIR JAMES commented, "It is not fair for someone who didn't have a preventive test taken to say they didn't do it because nobody was going to pay for it." REPRESENTATIVE OGAN said although he concurred in philosophy with his Republican colleagues, his father had died of prostate cancer at 52 years of age and he himself was high-risk. "I think I'm going to have to come down on the side of supporting this," he said. Representative Ogan doubted that many people even knew the blood tests were available. While he agreed about personal responsibility, he supported moving the bill from committee and felt it was worthy of a floor debate. Number 1888 REPRESENTATIVE GREEN said his concern stemmed from a recent diagnosis that he was a borderline diabetic. He asked: "What is to prevent me from introducing a bill next year that says that all diabetics get the test kit....?" He asserted a number of tests could be added into health insurance. Representative Green acknowledged that perhaps socialism was the wrong term. However, he felt all were being forced to take care of the high-risk groups. CHAIR JAMES cited an example from her childhood and reiterated her beliefs in preventive medicine and individual responsibility. Number 2109 REPRESENTATIVE ED WILLIS said, "[On] this one, I've got to come down on the side that prevention can save lives and it can save money." He indicated that a physical exam, which had identified a problem early on, had saved his life on two occasions. CHAIR JAMES agreed and said the only issue is who pays. Number 2170 REPRESENTATIVE ROBINSON made a motion that CSSB 253(FIN), version F, move from committee with attached zero fiscal notes and individual recommendations. CHAIR JAMES noted the motion and asked if there was an objection. There being no objection, SB 253 moved from committee. Number 2250 CHAIR JAMES informed committee members of plans to put SB 280 into subcommittee for the summer, with public hearings. She asked anyone who wanted to be part of that to let her know. REPRESENTATIVE GREEN asked if Chair James would be notifying members. CHAIR JAMES agreed she would and said they would try to have hearings on it this summer. REPRESENTATIVE GREEN asked if hearings would be on teleconference. CHAIR JAMES indicated they would try to do so.
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