Legislature(1993 - 1994)
02/09/1994 01:40 PM Senate HES
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
CHAIRMAN RIEGER called the Senate Health, Education and Social Services (HESS) Committee to order at 1:40 p.m. He introduced SB 270 (COMPREHENSIVE HEALTH CARE) as the only order of business before the committee. Number 022 NANCY USERA, Commissioner of the Department of Administration, explained how SB 270 evolved. She emphasized that the main goal of SB 270 was providing access to affordable quality health care for all Alaskans. She stated that health care was assumed an inalienable right regarding SB 270. The model of the AUPC was chosen due to its depth, accountability and substantive attack on the issue. She asserted that SB 270 is not a comprehensive reform package, but rather a 10 percent advancement toward comprehensive reform. Ms. Usera discussed the three aspects of the Governor's Alaska Health Commission: (1) The Commission will perform insurance pooling, implement a universal health form, provide for court ordered non-binding arbitration for malpractice disputes and insurer- beneficiary disputes, provide rate approval for insurance premiums, and conduct public hearings. (2) The Commission will collect and review data on Alaska's health care needs and analyze the cost benefit. (3) The Commission will weigh the various proposals and make recommendations to the legislature and the Governor. Number 205 SENATOR DUNCAN did not believe that the Canadian plan had been submitted to the legislature or was even being considered. The plan being submitted by the work group is not a Canadian plan, but a uniquely Alaskan plan. NANCY USERA stated that she did not mean to imply that the Canadian plan had anything to do with any of the proposals submitted to the legislature. SENATOR SALO noted that the Commission would have six year staggered terms. She asked if the Commission would stay in existence if some sort of health care reform beyond this study was instituted. NANCY USERA emphasized that the Commission's tasks will make differences in the efficiency of the health care system. She asserted that the Commission will be helpful when addressing the ongoing issues of a comprehensive plan and its implementation. SENATOR SALO expressed concern about Alaska's public health services. She questioned if economical and common-sense approaches like those mentioned at the December conference would be considered in this plan. NANCY USERA agreed that Alaska's public health system is important in the overall health care system. SB 270 does not identify or mandate specific sectors or issues for review , but that she was amenable to including such. SENATOR DUNCAN was concerned with the three member paid commission. He stated that high paid positions usually become political appointments, who help the Governor get elected. He felt that the Permanent Fund Board of Trustees model was a more viable option because the members were not highly paid. Their dedication to the health care system would keep them in these positions. Senator Duncan also asked how you could get public involvement or other allied professionals on the three member Commission. He proposed broadening the Commission so as not to limit input or involvement. Number 309 NANCY USERA stated that a variety of models had been reviewed. Regarding the positions' pay scale, she informed the committee that these are director level positions. Ms. Usera noted that terms- certain and the legislature's confirmation of these positions should transcend gubernatorial administrations. Furthermore, her proposed Commission provides greater accountability due to their specific tasks in a full-time position. Ms. Usera explained that the three member Commission attempts to foster a more global view of the issues. Furthermore, the Commission provides a formal mechanism for the public to discuss the issues. She noted that the key responsibilities of the Commission are outreach and public hearings. Number 348 SENATOR DUNCAN stated that a volunteer board, such as the Permanent Fund Board of Trustees, does not necessarily lack commitment or dedication. He was concerned that the three member board would become a special interest group although Ms. Usera had stated she did not want or intend this. He suggested that the members of special interest groups could be prohibited from the commission, but he did not know how this could be done. NANCY USERA stated that a member is required to have a general background and understanding knowledge of health care systems. She described the individual as committed to the issue with a global understanding of how the system works outside of any special interest affiliation. SENATOR ELLIS referred to rate approval authority and the loophole in the law, when inquiring about the Governor's commitment to that part of SB 270. NANCY USERA said that the Governor believes this is a good package and he is open to suggestions and changes. She explained that she felt that the Governor wanted rate approval due to the public mechanism it creates for confidence building of insurance systems. She expressed the need to view the rate approval process as one component of the multifaceted system. Number 416 SENATOR DUNCAN reiterated that SB 270 is not a reform proposal only a 10 percent advancement of many issues. He asked if she would oppose more than a 10 percent advancement. NANCY USERA was not opposed to including other items to increase advancement of comprehensive reform. She viewed SB 270 as an incremental measure to begin the process. SENATOR DUNCAN said that SB 270 should add more specific duties and he gave suggestions. He viewed SB 270 as multiple points of decision making by the legislature and two to three years of study. He pointed out that SB 270 does not implement measures it only studies the various aspects. NANCY USERA explained that this Commission will be collecting and analyzing information, and offering recommendations. She emphasized that they need to have the benefit package first in order to determine the cost and implementation in Alaska. She asserted that the task is determining how the system will work. She felt that how the system should be applied in Alaska is uncertain. Therefore, if any comprehensive plan is to include universal coverage then a cost of the benefit package has to be done before knowing how it will work in Alaska. Number 502 SENATOR DUNCAN agreed that the benefit plan must come before the cost can be known. He cited that SB 270 does not suggest a final recommendation to the legislature. He stated that SB 270 is not a plan of action, but rather a study of alternative systems for Alaska. He pointed out that a lot of those studies have already been done by the legislative task force and providers. NANCY USERA supported more study. She did not think an overwhelming consensus of the answer for Alaska had been reached. SENATOR DUNCAN explained that a public consensus would never be reached due to the many different recommendations of delivery systems brought before the public by the Commission in SB 270. He suggested identifying the system that would work and build public support. CHAIRMAN RIEGER emphasized that the debate on the delivery system should be as important as the debate on the benefit package. He suggested that the legislature is not the best forum to develop a benefit package. He expressed that he did not believe there was a consensus whether there should even be a mandate on health care and if so how extensive. That itself would merit having many alternatives presented to the public. Chairman Rieger expressed his reluctance to mandate power delegated away from the legislature and the Governor. The legislature should review a mandate. He said that health promotion should be reviewed and incorporated into anything moving out this committee. He did believe there would be controversy if a price control mechanism was implemented to increase the efficiency of the health care industry. TAPE 94-7, SIDE B Number 581 SENATOR ELLIS stated that there was no giving away of legislative authority, it is more a matter of time lines and decisiveness to bring back one decision to the legislature. He asked if the time lines of SB 270 assume that the Congress will not act on health care reform this year. NANCY USERA said that SB 270 assumes that comprehensive federal reform will not happen this year and that the National Governor's Association will prevail; the other mandatory component of any federal plan will be state option. SB 270 is not hanging on those assumptions, it can only enhance and facilitate any other comprehensive reform measures at the state or federal level. SENATOR ELLIS explained that he believed federal health care reform would be phased in over time under any of the plans passed. There will be a date by which states must submit their plan that meets the national goals of the federal government. Senator Ellis pointed out that Nancy Usera used the words access and coverage interchangeably regarding universal access and universal coverage. He inquired about the Governor's position, whether his goal would be universal access or universal coverage. NANCY USERA emphasized that SB 270 assumes that there will be a universal benefit plan with a specific benefit package. SB 270 does what it can now. SENATOR ELLIS stated that choosing the goal either of universal access or universal coverage is very crucial for the starting point. NANCY USERA noted that this approach does not foreclose either option. SENATOR ELLIS asked if the Cooper Plan, which guarantees universal access, was approved would the Governor go along with the federal government. NANCY USERA could not respond for the Governor. She felt that the 10 percent advancement was a firm first step allowing adjustment for the best interests of Alaskans. Number 477 CHAIRMAN RIEGER agreed with Senator Ellis that there is a significant difference between universal access and universal coverage. He said that universal access pools do not seem to work as well as universal coverage. He asked how narrowly they should mandate the constraints of what the Commission should take as givens when developing the alternatives within those givens. SENATOR DUNCAN stated concern with analyzing and studying programs that do not ultimately result in universal coverage when President Clinton specifically said he would veto any program that does not have universal coverage. He thought that SB 270 was too broad. NANCY USERA pointed out that if SB 270 passes and the Commission is in place and functioning this summer and President Clinton gets his universal plan in place, then that is what the Commission will study. SENATOR DUNCAN asked if the intent of SB 270 is to study President Clinton's plan and how to implement it in Alaska. He said that they should study an Alaskan plan so that the federal plan does not have to be implemented in Alaska. NANCY USERA explained that if the mechanism that SB 270 provides is already in place to design the benefit plan, Alaska is in a better position to implement the plan. SENATOR SALO expressed frustration with the Commission's focus on study rather than on implementation. She said that a lot is already known about what the problem is and the solution; is there a need to study more. She asked if the studying was to advance or slow the solution. NANCY USERA indicated that she is open to other options for further advancement. She stressed that she had not seen all the data specific to Alaska and until then it is guessing. She said that thus far the Department of Health and Social Services does not know specifically where the costs are and what the system in Alaska would look like. Number 390 SENATOR SHARP asked if a determination had been made as to what level of universal coverage Alaska is going to have. He proposed various options regarding the level of universal coverage. He asked what level the state is going to mandate. SENATOR DUNCAN clarified the need to have public health as a portion of this legislation as well as long-term care. He felt that everyone should have the same comprehensive preventive health care plan available to them; if some people want more, they can negotiate and purchase more. The Commission is responsible for developing a preventative health care plan as determined by federal guidelines and the needs of Alaska. SENATOR SHARP pointed out that those who are paying for health plans with long-term contributions through wages do not want to give up their premium to bring everyone to the same level, a lower level than they are now. He said that these people want some premium left to buy the optional coverage. SENATOR DUNCAN put this issue into perspective by pointing out that the issue is not what you pay today but rather what you will pay in the future. He suggested that one would pay less in the future under a reform system. Number 342 CHAIRMAN RIEGER proposed that Monday or Wednesday Senator Duncan's bill will be before the committee. After the sponsor statements have been heard, public testimony will be taken.
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