Legislature(1993 - 1994)
03/16/1994 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 introduced SB 270 (COMPREHENSIVE HEALTH CARE) and SB 284 (COMPREHENSIVE HEALTH INSURANCE ACT) as the final order r of business before the committee. He directed the committee to a discussion of public health regarding these bills. BRAD WHISTLER, Department of Health and Social Services, deferred the discussion of public health to Dr. Nakamura. DR. PETER NAKAMURA, Director of the Division of Public Health in the Department of Health and Social Services, deferred to Jay Livey to present the position of the department. He said that he could address public health and those elements critical to any health care reform. JAY LIVEY, Deputy Commissioner of the Department of Health and Social Services, noted that they had proposed an amendment in the House that had been adopted, which would be suggested for SB 270. He explained that the amendment has a public health focus in terms of developing a public health plan and providing public health information and guidance through the Commission. CHAIRMAN RIEGER asked if the establishment of a Public Health Advisory Committee was the only amendment from Healthy Alaska 2000 that the department would like in this legislation. JAY LIVEY said that they were not ready to propose legislation regarding Healthy Alaska 2000. At this point, the public health focus would be included in SB 270. DR. PETER NAKAMURA pointed out that the proposed amendment includes a public health improvement plan which would identify the essential functions necessary to ensure that public health is addressed. He explained that health care reform usually addresses cost containment, access, universal coverage, and tort reform; those issues relating to clinical services. He observed that population based public health services, such as safe water and food, never seem to be addressed. In order to develop a public health plan, those major population based public health services must be addressed; that would include the Healthy Alaska 2000 objectives. Number 524 SENATOR DUNCAN did not see any directives toward public health in the proposed amendment. JAY LIVEY noted that the amendment before the committee was not the version that the House passed. Mr. Livey stated that they supported the House version amendment being added to SB 270. DR. PETER NAKAMURA explained that the House version of the amendment is similar to Representative Sitton's bill. He clarified for Senator Duncan that the development of the health improvement plan is permissive, not required. SENATOR DUNCAN inquired of the rationale behind adopting permissive language. JAY LIVEY noted that the majority of the discussion was centered on available resources and what could be achieved without attaching the large fiscal note of the original public health bill. SENATOR DUNCAN informed the committee that the fiscal note of Representative Sitton's public health bill was approximately $300,000. He suggested that the permissive language indicates that they are not going to do public health because they are not going to have the money. He expressed surprise that Dr. Nakamura would agree with this language. Public health can already be addressed now, legislation is not necessary. He stated that the language should require public health be addressed. JAY LIVEY said that the public health issue was a matter of scope regarding what could be reasonably achieved given current resources. He noted that some additions to the original fiscal note were made in order to provide some resources to do public health work. He agreed with Senator Duncan, the scope is not as broad as that of Representative Sitton's bill. Getting a start on public health planning is reasonable even if a comprehensive plan cannot be achieved. SENATOR DUNCAN did not understand how a start could be made with this permissive language. He suggested that they develop a scope that could be achieved in the first year and use mandatory language. He expressed frustration with the Administration's view that nothing can be done; therefore, resources, which are not present anyway, should not be committed. JAY LIVEY offered to work with the committee on the scope and language regarding the public health issue. SENATOR DUNCAN discussed Dr. Nakamura's efforts towards public health. He stated that there was not a piece meal approach to public health or comprehensive health care reform. He suggested that the Administration say exactly what they are doing with these issues so that the legislature could continue its work. JAY LIVEY reiterated the added resources for public health. He expected that if the amendment passes they would work on a public health plan. TAPE 94-20, SIDE B Number 593 CHAIRMAN RIEGER stated that Healthy Alaska 2000 had more specific recommendations than occur in either SB 270 or SB 284. He indicated that he may choose some of those recommendations to bring before the committee for consideration. He welcomed other committee members to do the same. He regarded both bills as setting up an entity to further develop the public health improvement plan. This hearing was an opportunity to review specific legislative recommendations from Healthy Alaska 2000 which are not present in either bill. SENATOR DUNCAN disagreed with Chairman Rieger and pointed out that page 16 of SB 284 has recommendations that the public health improvement plan must include. He said that this section basically takes the language from Representative Sitton's bill. DR. PETER NAKAMURA explained that they are trying to avoid choosing specific activities without knowing the trade-off costs of those activities. He stated that choosing something at the cost of something else could result in a greater deficit situation. He indicated that knowing all the issues and the base core functions would create the ability to choose specific activities identified in Healthy Alaska 2000 and know their actual cost. Dr. Nakamura expressed concern that the issue of public health often gets lost in dialogue. He stated that the public health improvement plan can be done while the dialogue regarding cost containment, financing, insurance, deductibles, and comprehensive coverage issues continues. He did not want public health improvement to be lost in this debate. Number 552 SENATOR DUNCAN asked for the total of the fiscal note for Representative Sitton's bill. DR. PETER NAKAMURA estimated that it was about $358,000. JAY LIVEY believed the fiscal note was around $350,000. SENATOR DUNCAN was interested in how Representative Sitton's fiscal note matches that of SB 284.
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