Legislature(2007 - 2008)BUTROVICH 205

01/30/2008 01:30 PM HEALTH, EDUCATION & SOCIAL SERVICES


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01:33:06 PM Start
01:33:48 PM SB160
02:47:34 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+= SB 160 MANDATORY UNIVERSAL HEALTH CARE TELECONFERENCED
Heard & Held
             SB 160-MANDATORY UNIVERSAL HEALTH CARE                                                                         
                                                                                                                                
CHAIR DAVIS announced SB 160 to be up for consideration.                                                                        
                                                                                                                                
1:33:48 PM                                                                                                                    
SENATOR  HOLLIS  FRENCH,  sponsor  of  SB  160,  said  this  bill                                                               
represents  the  culmination of  a  dream  of  finding a  way  to                                                               
provide affordable health  insurance to all citizens.  He went on                                                               
to say that a majority  of the 100,000 Alaskans without insurance                                                               
are  working  but  either  do  not  get  benefits  through  their                                                               
employer, or cannot  afford the benefits provided;  this bill was                                                               
designed to correct that. SB  160 represents a compromise between                                                               
two warring  factions in the  health insurance debates.  The left                                                               
gave up on the  idea of "single payer," and the  right gave up on                                                               
keeping folks  uninsured. This breakthrough occurred  when people                                                               
realized the  American values  of competition  and a  free market                                                               
could be preserved without sacrificing  health coverage for every                                                               
citizen.                                                                                                                        
                                                                                                                                
1:36:26 PM                                                                                                                    
SENATOR FRENCH said  the overall plan is to set  up a health care                                                               
board to  certify private  healthcare plans and  place them  in a                                                               
healthcare  clearinghouse, then  let  citizens purchase  coverage                                                               
from  the clearinghouse  using  a voucher,  the  amount of  which                                                               
would  be  determined  on  a   sliding  scale  based  on  income.                                                               
Competition between  private plans would maintain  a free market,                                                               
with the government involved only as a facilitator.                                                                             
                                                                                                                                
1:37:50 PM                                                                                                                    
He noted that there was a blank CS before the committee.                                                                        
                                                                                                                                
CHAIR  DAVIS said  it had  not  been adopted,  but the  committee                                                               
could address that at a  later time. She recognized that Senators                                                               
Wielechowski and  Ellis were  co-sponsors of  the bill,  and then                                                               
returned the floor to Senator French.                                                                                           
                                                                                                                                
1:38:43 PM                                                                                                                    
SENATOR FRENCH confirmed that he  was working from version V, and                                                               
provided an overview of the bill by section.                                                                                    
                                                                                                                                
Section  1 sets  out  the initial  findings:  primarily that  the                                                               
healthcare system  needs work, that  the goal  of the bill  is to                                                               
improve  and  protect  the  health  of  all  Alaskans,  that  all                                                               
Alaskans  should have  access to  essential healthcare,  and that                                                               
has  an  economic interest  in  insuring  equitable financing  of                                                               
essential  healthcare for  Alaskans  who do  not  have access  to                                                               
basic healthcare.                                                                                                               
                                                                                                                                
Section 2 lays out what  the legislation would accomplish and the                                                               
mechanics of implementation.                                                                                                    
                                                                                                                                
SB 160 would: ensure that  all state residents can afford quality                                                               
health  care coverage  appropriate to  their needs,  require that                                                               
healthcare  coverage be  "meaningful" as  discussed later  in the                                                               
bill,  reduce  unsustainable  healthcare cost  increases  through                                                               
encouraging  primary  care  and prevention,  center  on  consumer                                                               
choice by  providing a framework for  competition where insurance                                                               
plans must compete to acquire and retain customers.                                                                             
                                                                                                                                
SENATOR FRENCH  continued to Section 21.54.210,  which deals with                                                               
the creation of the Health Care  Board. The board would be set up                                                               
under the  Department of  Health and  Social Services  (DHSS) and                                                               
comprise  13  members:  2   representatives  from  the  insurance                                                               
industry,  1 representing  large business,  1 representing  small                                                               
business,   2   from  Alaska's   hospitals,   1   from  a   labor                                                               
organization,   2   licensed   Alaska  physicians,   2   consumer                                                               
advocates,  a registered  nurse, and  the Commissioner  of Health                                                               
and  Human  Services.  Each  member would  be  appointed  by  the                                                               
governor  for a  three year  term. Members  would be  entitled to                                                               
standard per diem  and transportation charges and  costs under AS                                                               
39.21.80.  The board  would  select  a chair  and  vice chair;  a                                                               
majority would  be considered a quorum  for transacting business.                                                               
The board  would have  six members  whose focus  would be  on the                                                               
business side  of health and six  who would focus on  the patient                                                               
side of health, with a commissioner serving as tie-breaker.                                                                     
                                                                                                                                
1:41:39 PM                                                                                                                    
Section 21.54.220  presents two  main elements  of the  bill: the                                                               
healthcare  clearing  house  and  the  healthcare  fund.  Senator                                                               
French said the function of the  fund would be described later in                                                               
the bill.  The board  would ensure  a variety  of plans  would be                                                               
made  available  through  the  clearinghouse,  help  educate  the                                                               
public  about different  plan options  and ensure  enrollment. He                                                               
added parenthetically  that he saw  an opportunity here  for some                                                               
synergy  with the  governor's plan  for  a web-based  information                                                               
system. The  board would also  establish enrollment  criteria and                                                               
provide for an  annual "open season" when  customers could change                                                               
their plan selections.  He felt the open season  was important to                                                               
prevent what he called "moral hazard",  or waiting to enroll in a                                                               
plan until it was needed.                                                                                                       
                                                                                                                                
The board would  hear complaints or objections  to decisions made                                                               
by the plan. Customers who objected  to a board decision would be                                                               
entitled to  a hearing.  The board would  also be  responsible to                                                               
implement the voucher system.                                                                                                   
                                                                                                                                
1:44:03 PM                                                                                                                    
He explained  that the idea  as set  out in Section  21.54.230 is                                                               
not to  create a  new bureaucracy;  it [the  clearinghouse] would                                                               
more  likely  be  a  web site  where  customers  with  healthcare                                                               
vouchers would make  their plan selections and  be connected with                                                               
quality insurance products.                                                                                                     
                                                                                                                                
Section 21.54.240 establishes the  voucher system and includes an                                                               
individual responsibility  clause requiring all Alaskans  to have                                                               
health   coverage  that   would   provide  essential   healthcare                                                               
services.  The   state  would  be  responsible   to  ensure  that                                                               
affordable healthcare  was made  available, but  it would  be the                                                               
responsibility of the  individual to go to  the clearinghouse and                                                               
get that coverage.                                                                                                              
                                                                                                                                
1:46:23 PM                                                                                                                    
SENATOR  FRENCH emphasized  that  there were  70,000 visits  last                                                               
year to  the Providence Hospital  emergency room and many  of the                                                               
those  treated were  not insured.  The individual  responsibility                                                               
clause is a necessary first step  to getting everyone in the pool                                                               
and keeping the costs down.                                                                                                     
                                                                                                                                
Sections  1 through  7 [AS  21.54.240] outline  who would  not be                                                               
subject  to  the  individual responsibility  requirement.  People                                                               
enrolled in Medicare or Medicaid,  people with existing insurance                                                               
coverage including  those covered  by the Indian  Health Service,                                                               
and those who  have been in the  state less than a  year would be                                                               
exempt from participation in the program.                                                                                       
                                                                                                                                
1:48:03 PM                                                                                                                    
Vouchers would be  issued to households and  individuals based on                                                               
the federal  government's federal  poverty level  (FPL) criteria.                                                               
In  Alaska, the  FPL for  2008 was  set at  $13,000 annual  gross                                                               
income  for  an individual  or  $26,500  for  a family  of  four.                                                               
Subsection (c) provides  that anyone falling below  the FPL would                                                               
get  free health  coverage. Those  people would  probably qualify                                                               
for  Medicaid,  but if  they  fell  through  a loophole  in  that                                                               
program, coverage would be paid  for by the state. Subsection (d)                                                               
provides  that  vouchers  would  be  issued  to  persons  earning                                                               
between  100 and  300 percent  of the  FPL. Subsection  (e) would                                                               
require individuals or  families earning over 300  percent of the                                                               
FPL to acquire their own  coverage. They would not receive needs-                                                               
based  vouchers, but  would be  eligible  to receive  one of  the                                                               
specified beneficiary vouchers described in 21.54.280.                                                                          
                                                                                                                                
1:50:25 PM                                                                                                                    
Subsection  (b)  provides  for  larger  vouchers  to  individuals                                                               
qualifying  for coverage  under the  Alaska Comprehensive  Health                                                               
Insurance  Association (ACHIA)  plan.  Because ACHIA's  high-risk                                                               
coverage  can be  extremely expensive,  the sliding  income scale                                                               
was adjusted to allow an income of  up to 450 percent of the FPL.                                                               
Subsection (f) specifies that only  legal Alaskan residents would                                                               
be eligible to receive vouchers.                                                                                                
                                                                                                                                
All plans sold  through the clearinghouse would  have to provide,                                                               
certain  minimum  benefits as  defined  in  Section 21.54.250  to                                                               
include: coverage  for preventative  and primary  care, emergency                                                               
services,   in-patient   hospital  charges,   prescription   drug                                                               
coverage, mental  health services.  Section 21.54.260  relates to                                                               
employer-provided health  coverage requirements.  Subsections (a)                                                               
and  (b)  in  that  section   make  clear  that  nothing  in  the                                                               
legislation  would change  employer-paid  insurance if  provided.                                                               
Subsections  (c) and  (d) ensure  that  all employers  contribute                                                               
something to  the public health by  imposing a tax levy  based on                                                               
size, on businesses without health insurance plans.                                                                             
                                                                                                                                
1:53:21 PM                                                                                                                    
SENATOR  FRENCH added  that  if  an employer  offered  to pay  33                                                               
percent of  its employees'  premium costs,  successfully enrolled                                                               
at least  25 percent  of its employees  in an  employer sponsored                                                               
plan, or established  a Section 125 cafeteria  plan, the employer                                                               
would be exempt from the levy.                                                                                                  
                                                                                                                                
Insurance   plans   offered   through   the   Alaska   Healthcare                                                               
Clearinghouse would have to  meet Section 21.54.270 requirements,                                                               
including  a mandate  in subsection  (b) that  an insurance  plan                                                               
offered through the  clearinghouse may not deny  enrollment to an                                                               
eligible individual.                                                                                                            
                                                                                                                                
1:55:00 PM                                                                                                                    
SENATOR FRENCH  emphasized that such  a mandate is  only possible                                                               
because  of the  individual responsibility  clause that  requires                                                               
everyone  to have  coverage. Subsection  (c) allows  companies to                                                               
offer  varied levels  of deductibles,  co  pays, coinsurance  and                                                               
out-of-pocket   maximums,   include  high-deductible   healthcare                                                               
plans,  and offer  different benefit  levels  for in-network  and                                                               
out-of-network   providers.   The  subsection   also   encourages                                                               
specialized plans for  young adults 18 to 30  that have different                                                               
terms  than normal  plans. The  idea was  to let  the marketplace                                                               
respond to the needs of the customers.                                                                                          
                                                                                                                                
Subsection (d)  would increase  the length of  time that  a child                                                               
must be covered under a clearinghouse  plan to 25 years of age or                                                               
until two  years after the  dependent no longer resides  with the                                                               
family.                                                                                                                         
                                                                                                                                
The  Alaska Health  Fund and  Specified Beneficiary  Vouchers are                                                               
explained  in  Section  21.54.280.   The  health  fund  would  be                                                               
established  as a  separate trust  fund  of the  state and  would                                                               
include appropriations  from the  state and  federal governments,                                                               
the  employer  levy,  healthcare  premiums,  and  other  sources.                                                               
Specified  Beneficiary  Vouchers   [Subsection  (b)]  would  give                                                               
employers the  ability to contribute to  employee health premiums                                                               
through a voucher.  If a person's income exceeded  300 percent of                                                               
FPL,  an  employer  that  could  not  afford  to  provide  health                                                               
insurance would  still be able to  help by providing some  of the                                                               
cost in the form of a  voucher in the employee's name. That would                                                               
work  especially   well  for  individuals  with   more  than  one                                                               
employer.                                                                                                                       
                                                                                                                                
1:58:37 PM                                                                                                                    
SENATOR FRENCH stated  that a weakness of  earlier reform efforts                                                               
was  that  they forced  employers  to  offer employee  insurance,                                                               
which  was  too  great  a   financial  burden  and  the  business                                                               
community pushed back against that.  In the modern economy people                                                               
change jobs frequently  or work multiple jobs  that come together                                                               
to provide a  living, but often don't offer  insurance. This plan                                                               
would provide portable insurance  policies that people could take                                                               
with them as they change jobs.                                                                                                  
                                                                                                                                
Section 21.54.290  grants individuals the  right to a  hearing if                                                               
denied health  coverage by a certified  plan, if a plan  fails to                                                               
deliver essential healthcare services,  or if they were aggrieved                                                               
by a decision of the board.                                                                                                     
                                                                                                                                
1:59:36 PM                                                                                                                    
Section  21.54.300 requires  a  comprehensive annual  performance                                                               
report by the board. The board  would also give an evaluation and                                                               
recommendation on  a number of  health reform topics such  as the                                                               
use  of  electronic  health   records,  State  Children's  Health                                                               
Insurance  Program  (SCHIP),  the effect  of  mandated  benefits,                                                               
prescription drug bargaining and more.                                                                                          
                                                                                                                                
SENATOR  FRENCH  said section  21.54.210  requires  the board  to                                                               
establish  regulations under  the Administrative  Procedures Act.                                                               
The  remaining   parts  of  the  bill   include  definitions  and                                                               
transitional provisions.                                                                                                        
                                                                                                                                
2:00:38 PM                                                                                                                    
He offered to take questions.                                                                                                   
                                                                                                                                
SENATOR DYSON said  he was impressed with the scope  and depth of                                                               
the bill.  He asked what  would happen if  a person chose  not to                                                               
enroll.                                                                                                                         
                                                                                                                                
SENATOR  FRENCH  reiterated  that the  individual  responsibility                                                               
clause  requires it.  In Massachusetts  a person  would lose  the                                                               
ability to take  a standard deduction on his or  her state income                                                               
tax return.  Alaska would not  have that mechanism  available, so                                                               
one of  the policy decisions that  needs to be addressed  is some                                                               
form  of soft  enforcement  of the  individual  mandate. It  will                                                               
never  be a  crime  not to  have health  insurance  and he  would                                                               
prefer not to  tie it to the permanent fund,  he would rather tie                                                               
it  to an  individual's ability  to qualify  for other  financial                                                               
benefits such as in-state tuition at University of Alaska.                                                                      
                                                                                                                                
2:03:18 PM                                                                                                                    
SENATOR  DYSON  said that  government  has  created a  suboptimal                                                               
situation that forces hospitals to  take anyone who walks into an                                                               
emergency  room without  any assurance  of  cost recovery,  which                                                               
results  in  spreading  the  costs  to  everyone.  This  proposal                                                               
appears to correct  that. However, he wants to  discuss the civil                                                               
liberties  aspect   of  coercing   citizens  to   participate  in                                                               
something for their  own good, but tramples on the  right of free                                                               
citizens in order to accomplish the greater good.                                                                               
                                                                                                                                
2:04:52 PM                                                                                                                    
SENATOR  FRENCH said  the immediate  comparison is  probably most                                                               
apt  to education.  Every citizen  deserves some  basic level  of                                                               
education  in  order  to  fulfill  his or  her  potential  for  a                                                               
meaningful life. He opined that  the same applies to health care.                                                               
Human bodies  break down and at  some point in life  every person                                                               
will  need medical  care. For  that  care to  be meaningful,  one                                                               
needs  an insurance  policy. Some  people exempt  themselves from                                                               
public  education  by  taking  steps   to  prove  that  they  are                                                               
homeschooling  or providing  that  education in  some other  way.                                                               
There  are  also  mechanisms  for  exempting  oneself  from  this                                                               
requirement, like posting a bond  for example. He maintained that                                                               
it is not  fair for a person  to expect everyone else  to pick up                                                               
the bill when something happens.                                                                                                
                                                                                                                                
2:06:10 PM                                                                                                                    
SENATOR   THOMAS  appreciated   that   the   bill  would   create                                                               
competition  in  the insurance  industry,  but  wondered how  the                                                               
payment schedule  would be  structured. He  asked if  the [Health                                                               
and  Human  Services]  commission   would  be  charged  with  the                                                               
responsibility  to  review  what  was  paid  and  determine  what                                                               
reasonable and  customary charges were. He  feared that providers                                                               
might increase rates knowing that everyone had coverage.                                                                        
                                                                                                                                
SENATOR FRENCH  answered that  the same  market forces  that keep                                                               
payment schedules  from getting  out of  line now  would continue                                                               
under this program. He pointed  out that doctors don't triple the                                                               
price  of a  procedure  when  they treat  a  patient  who has  an                                                               
insurance policy.  He would actually  expect costs to  come down,                                                               
because 15  percent of  health insurance  premiums now  cover the                                                               
uninsured.                                                                                                                      
                                                                                                                                
2:08:37 PM                                                                                                                    
SENATOR THOMAS  asked if  there would be  any limitation  on what                                                               
facilities might be used.                                                                                                       
                                                                                                                                
SENATOR  FRENCH said  the plan  would allow  for a  difference in                                                               
payment  for  in  and out-of-network  providers,  but  would  not                                                               
restrict where an individual could go for medical care.                                                                         
                                                                                                                                
2:09:43 PM                                                                                                                    
SENATOR THOMAS asked  about the 450 percent of  FPL for Specified                                                               
Beneficiary Vouchers.                                                                                                           
                                                                                                                                
SENATOR  FRENCH clarified  that the  upper limit  for a  standard                                                               
voucher  for a  family  of four  would be  300  percent. The  450                                                               
percent voucher would apply only  those individuals who would now                                                               
be enrolled  in the ACHIA high  risk pool. The idea  is that we'd                                                               
have to offer a better voucher  to avoid pricing those people out                                                               
of the system.                                                                                                                  
                                                                                                                                
SENATOR  THOMAS asked  if  drug and  alcohol  treatment would  be                                                               
considered mental health disorders.                                                                                             
                                                                                                                                
SENATOR FRENCH agreed that they would.                                                                                          
                                                                                                                                
2:11:14 PM                                                                                                                    
SENATOR ELTON asked how the  definition of an employer applied to                                                               
franchises.   For   example,   he  wondered   whether   Macdonald                                                               
Corporation would  be considered  the employer, or  the franchise                                                               
holder for a particular restaurant.                                                                                             
                                                                                                                                
SENATOR FRENCH  answered that it  would be the entity  that signs                                                               
the paycheck.                                                                                                                   
                                                                                                                                
SENATOR  ELTON noted  that the  fiscal  note said  20 percent  of                                                               
uninsured  have Indian  Health  care and  wondered  why they  are                                                               
included.                                                                                                                       
                                                                                                                                
2:12:30 PM                                                                                                                    
SENATOR  FRENCH answered  that  the fiscal  note  referred to  an                                                               
earlier  version of  the bill  and those  people would  be exempt                                                               
under the current version.                                                                                                      
                                                                                                                                
SENATOR  DYSON asked  how this  bill  would encourage  healthcare                                                               
savings accounts.                                                                                                               
                                                                                                                                
2:13:46 PM                                                                                                                    
SENATOR  FRENCH  said  the  current  draft of  the  bill  had  no                                                               
provision  for  them and  encouraged  Senator  Dyson to  bring  a                                                               
provision that would incorporate  healthcare savings accounts. He                                                               
suggested  those  accounts  could,   if  meaningful  and  set  up                                                               
correctly, serve as healthcare policies.                                                                                        
                                                                                                                                
2:14:38 PM                                                                                                                    
SENATOR DYSON  took exception to Senator  French's statement that                                                               
a person who  does not have insurance really  doesn't have access                                                               
to care.  He asserted that  people who  can afford it  have taken                                                               
responsibility for their health and  paid their own bills for 300                                                               
or  400  years quite  successfully.  He  didn't see  anything  to                                                               
prevent people  from doing so  now and further stated  that those                                                               
who can pay their own bills are charged more.                                                                                   
                                                                                                                                
SENATOR FRENCH said it seemed  fairly clear that, while there may                                                               
be a  very small number of  people in the United  States who have                                                               
enough money  to pay the going  rate for healthcare, that  is not                                                               
the case  for the majority  of Americans.  He felt that  he could                                                               
show clearly that those who do  not have insurance do not get the                                                               
same quality of medical care as  those who do. They don't get all                                                               
of the medical  tests or follow-up care and they  don't enjoy the                                                               
lifespan of people who do have insurance.                                                                                       
                                                                                                                                
SENATOR DYSON said that if they  have the money and don't get the                                                               
care, it is their choice and not government's job to fix.                                                                       
                                                                                                                                
2:16:33 PM                                                                                                                    
CHAIR DAVIS said that healthcare  savings accounts were discussed                                                               
by the Healthcare Strategies Planning  Council, which was looking                                                               
for ways to encourage their use,  and she felt they might be part                                                               
of the answer for people who can  afford them. She went on to say                                                               
that  they could  not expect  everyone to  be covered  under this                                                               
plan, although that is the goal,  and thought it would be helpful                                                               
if  Senator  French  would  bring  back  some  numbers  from  the                                                               
Massachusetts plan  on how  many are covered,  how many  are not,                                                               
and  what Massachusetts  is  doing  to ensure  that  they do  get                                                               
insurance.                                                                                                                      
                                                                                                                                
2:17:43 PM                                                                                                                    
CHAIR  DAVIS said  there are  other states,  including California                                                               
and  Vermont, which  have similar  plans she  would like  to hear                                                               
about.  She   stated  that  they   would  do  the   fiscal  notes                                                               
separately.                                                                                                                     
                                                                                                                                
SENATOR FRENCH  said he  had completed the  overview and  that he                                                               
would  provide  the  committee  with   a  recent  report  on  the                                                               
Massachusetts program key indicators.                                                                                           
                                                                                                                                
CHAIR  DAVIS  said   she  would  also  like   to  see  additional                                                               
information on  how this would  integrate existing plans  such as                                                               
Medicaid, Medicare and Denali Kid Care.                                                                                         
                                                                                                                                
2:20:03 PM                                                                                                                    
CHAIR DAVIS  said it would  not be possible  to hear from  all of                                                               
the witnesses who  had signed up to testify on  the bill, but she                                                               
would  continue  public testimony  the  next  time the  bill  was                                                               
scheduled.                                                                                                                      
                                                                                                                                
BEVERLY  SMITH,  Christian   Science  Committee  on  Publication,                                                               
Anchorage  AK,  said  her  role   was  to  ensure  that  proposed                                                               
legislation  preserves   the  choice   for  Alaskans   to  pursue                                                               
spiritual  means   for  the  prevention  and   cure  of  disease,                                                               
including Christian  Science treatment and care.  She also wanted                                                               
to ensure that the committee  had accurate information concerning                                                               
spiritual healing  as practiced in Christian  Science, so that...                                                               
"this  cost-effective, reliable  and effective  form of  care"...                                                               
would not be  overlooked or restricted in  the state's healthcare                                                               
reform efforts.  She said  that to meet  the healthcare  needs of                                                               
all Alaskan  residents, this legislation should  include coverage                                                               
for  spiritual  care  similar  to the  coverage  offered  by  the                                                               
federal  government and  some other  state  plans. She  described                                                               
Christian Science  as a religious, non-medical  form of treatment                                                               
available to  anyone, not just  members of the  Christian Science                                                               
church  and  explained that  it  involves  reliance on  spiritual                                                               
means  through  prayer  to  heal   illness,  injuries  and  other                                                               
conditions.                                                                                                                     
                                                                                                                                
She  stated  that  she  would  not take  a  position  on  whether                                                               
healthcare   should   be   mandated,   but   pointed   out   that                                                               
Massachusetts  and some  other states  were considering  allowing                                                               
people  to  opt  out  on  the  basis  of  religious  belief.  She                                                               
emphasized however, that any reform  discussion should include an                                                               
acknowledgement of spiritual care  and that costs associated with                                                               
it should be included in  healthcare reform. She requested that a                                                               
specific reference be included in  SB 160 under section 21.54.250                                                               
to spiritual care services as  a category of essential healthcare                                                               
services.                                                                                                                       
                                                                                                                                
2:24:14 PM                                                                                                                    
MS.  SMITH  referred  to  the "Request  for  Amendment"  she  had                                                               
provided to the committee members and  said she would be happy to                                                               
work  with them  on language  to ensure  that insurance  coverage                                                               
would be provided for those Alaskans choosing spiritual care.                                                                   
                                                                                                                                
2:25:16 PM                                                                                                                    
CHAIR DAVIS commented that anyone  can use spiritual care whether                                                               
or not it  is included in this bill, and  cautioned that it would                                                               
not  be  possible  to  include a  reference  to  every  religious                                                               
organization  that  offered  healing services.  She  assured  Ms.                                                               
Smith however, that she wanted to  ensure that her needs were met                                                               
and would discuss it with her  further when the committee took up                                                               
amendments.                                                                                                                     
                                                                                                                                
SENATOR DYSON said  he also comes from a  tradition that includes                                                               
spiritual  healing,  but  respectfully  questioned  what  charges                                                               
would be involved in the services Ms. Smith was referring to.                                                                   
                                                                                                                                
MS. SMITH  answered that  Christian Science  practitioners devote                                                               
their full  time to healing prayer  and charge a small  amount to                                                               
support themselves  and their families. Christian  Science nurses                                                               
also  charge  to  provide  physical  care  for  those  undergoing                                                               
spiritual treatment.                                                                                                            
                                                                                                                                
2:27:33 PM                                                                                                                    
JAMES  SHILL, CEO,  North Star  Behavioral Health,  Anchorage AK,                                                               
said  he supported  SB 160.  North  Star employs  500 people  who                                                               
provide  hospitalization and  residential care  for children  and                                                               
adolescents,  with over  1100 admissions  to their  hospitals and                                                               
treatment  centers annually.  They  are  the primary  psychiatric                                                               
provider  for youth  experiencing  serious  mental health  issues                                                               
that  make them  a danger  to  themselves or  others. A  hospital                                                               
cannot turn people  away for treatment, nor do they  want to, but                                                               
physicians have high liability  insurance payments, student loans                                                               
and other  expenses that  make it difficult  for them  to provide                                                               
pro  bono  care or  negotiate  for  payment from  people  without                                                               
health  insurance. That  makes  it difficult  for  a hospital  to                                                               
recruit physicians, who  know they could work  for an out-patient                                                               
facility  that has  no requirement  to take  patients who  cannot                                                               
pay. He said he supports  the bill because it takes affordability                                                               
of insurance into account.                                                                                                      
                                                                                                                                
2:31:04 PM                                                                                                                    
SENATOR ELTON  asked how  many people  have insurance  plans that                                                               
cover mental health services.                                                                                                   
                                                                                                                                
MR. SHILL responded  that Denali Kid Care helped a  great deal to                                                               
cover most  of the  low-income children.  The bigger  problem was                                                               
families  that  make too  much  for  Medicaid but  cannot  afford                                                               
insurance, or who have insurance  that doesn't provide for mental                                                               
health services. He said the  largest payor in their hospitals is                                                               
traditionally Medicaid,  although Tri-Care was increasing  due to                                                               
the  war and  currently accounted  for 20  to 30  percent of  the                                                               
patients.                                                                                                                       
                                                                                                                                
2:32:35 PM                                                                                                                    
BONNIE  NELSON, representing  herself from  Chugiak, AK,  thanked                                                               
Chair Davis for  bringing up what is being  done about healthcare                                                               
in  other states.  She  felt the  information  should be  debated                                                               
before  the legislature  and aired  on gavel  to gavel  like AGIA                                                               
was, instead of being dealt with by a council or committee.                                                                     
                                                                                                                                
She  was not  convinced that  the  Mitt Romney  approach was  the                                                               
answer,  because  Massachusetts  has many  supplemental  programs                                                               
that Alaska does  not, that allow the program to  work there. For                                                               
example, Alaska does  not have a way for the  disabled or elderly                                                               
to  stay on  Medicaid and  still save  some money  when they  can                                                               
work, as  they are able to  do in Massachusetts. She  thought the                                                               
bill  should  deal  with  Medicare   and  Medicaid  problems  and                                                               
suggested that the legislature look  at California and Colorado's                                                               
"One Care for All" programs.                                                                                                    
                                                                                                                                
Ms. Nelson  added that  Massachusetts does not  have a  high risk                                                               
pool  like  ACHIA. She  suggested  that  insurance companies  use                                                               
"community  rating"  to  spread  the cost  and  that  people  pay                                                               
premiums based on their income  rather than their disability. She                                                               
also supported  a supplemental program  to assist people  who are                                                               
turned away from Medicare or Medicaid.                                                                                          
                                                                                                                                
2:36:31 PM                                                                                                                    
DARYL WAYNE  NELSON, Chugiak AK,  thanked the committee  and said                                                               
this is an important topic to  him. He has cerebral palsy but had                                                               
not  been on  Medicaid for  over a  year because  he spent  eight                                                               
years  working to  save  money  and putting  the  money in  other                                                               
people's names  to hide  it so  he could  get his  long-term care                                                               
services.  He  asserted  that  he  would not  break  the  law  or                                                               
encourage  others do  so  but  felt that  people,  no matter  how                                                               
disabled, should  be allowed to  be productive citizens  and have                                                               
the right to  save some money. He said it  is "immoral and wrong"                                                               
that the  Medicaid IM  program allows participants  to get  up to                                                               
$5000 per  month but requires them  to spend down to  the federal                                                               
poverty  level (FPL)  of $2000  to maintain  eligibility. Seniors                                                               
who develop disabilities late in  life have to give up everything                                                               
they worked for or sign it  over to their children when they have                                                               
to  go  into a  nursing  facility  or  home  care. He  also  felt                                                               
strongly that Medicaid and Medicare  should allow greater freedom                                                               
in  the  choice  of  providers  and  types  of  medical  services                                                               
covered.                                                                                                                        
                                                                                                                                
2:40:49 PM                                                                                                                    
MR. NELSON  said he was  born in Alaska  but might have  to leave                                                               
the state in order to get the  care he needs. He was pleased that                                                               
the legislature has finally started  talking about the issue in a                                                               
meaningful way  and hopes it  will result in a  healthcare system                                                               
that includes everyone.                                                                                                         
                                                                                                                                
2:43:01 PM                                                                                                                    
CHAIR DAVIS said she appreciated  Mr. Nelson's comments, although                                                               
he strayed quite  a bit from discussion of the  bill, and that it                                                               
would go  on record  that he  was pleased there  is a  bill under                                                               
discussion to deal  with some of Alaska's  healthcare issues. She                                                               
assured him  that it would come  before the public again  and she                                                               
would welcome suggestions on how to make it a better bill.                                                                      
                                                                                                                                
SENATOR THOMAS  moved to adopt the  proposed committee substitute                                                               
to SB  160, labeled  25-LS0728, Version V,  as the  working draft                                                               
for  the committee  with attached  fiscal notes.  There being  no                                                               
objection, the motion carried.                                                                                                  
                                                                                                                                
2:44:59 PM                                                                                                                    
SENATOR FRENCH closed  by saying that his staff  had put together                                                               
a detailed bill packet that should  answer a lot of the questions                                                               
that came  up during  the meeting.  He offered  to work  with the                                                               
committee to put the bill into  a form that would please them and                                                               
stressed that, while this isn't the  final answer, it is a way to                                                               
begin the  conversation and move  toward their goal to  lower the                                                               
number of uninsured  and provide better healthcare  and access to                                                               
everyone in the state.                                                                                                          
                                                                                                                                
CHAIR DAVIS said she also  appreciated Senator French's staff for                                                               
the  hard work  they  put  into the  bill  packet.  She said  the                                                               
administration still had  to "weigh in" on the bill  and, if they                                                               
didn't  come on  their  own she  would invite  them  to the  next                                                               
meeting.                                                                                                                        
                                                                                                                                
SENATOR  DYSON  asked  for  a  rough idea  of  when  Chair  Davis                                                               
expected to finish work on SB 160.                                                                                              
                                                                                                                                
CHAIR  DAVIS responded  that  she couldn't  say  when they  would                                                               
finish, but  she planned to  bring it back  up in two  weeks. She                                                               
admonished  the committee  to get  their ideas  to her  office so                                                               
they could work on them before  the next meeting. She held SB 160                                                               
in committee.                                                                                                                   
                                                                                                                                
There being no further business to come before the committee,                                                                   
CHAIR DAVIS adjourned the meeting at 2:47:34 PM.                                                                              

Document Name Date/Time Subjects