Legislature(1995 - 1996)
02/15/1996 01:34 PM Senate L&C
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* first hearing in first committee of referral
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= bill was previously heard/scheduled
SL&C 2/15/96
SB 193 MANDATORY INSURANCE FOR COSTS OF BIRTH
CHAIRMAN KELLY called the Senate Labor and Commerce Committee
meeting to order at 1:34 p.m. and announced SB 193 to be up for
consideration.
SENATOR SALO, sponsor of SB 193, said she introduced it because a
Kenai constituent called her after the birth of her third child and
said her insurance company would only allow her to stay in the
hospital 24 hours following the birth.
SENATOR SALO said she found that this is an increasing problem
across the United States, although it's just emerging in Alaska.
She followed the guidelines for the American Academy of Obstetrics
and Gynecology and the AMA who recommend that 48 hours is a much
more appropriate amount of time to be allowed.
The trend down south has been to reduce hospital time because of
HMO's. She wanted to alter the statutes relative to health
insurance rather than health care by saying 48 hours for a normal
vaginal birth or 96 hours in the case of a cesarian. She
emphasized this is not mandating a longer hospital stay, but is
rather saying that amount of coverage would be available should the
health care provider and the patient deem it is necessary.
SENATOR SALO said in Alaska, unlike in some other states, she did
not want to mandate follow-up care and home visits, given the wide
variety of health care within the State.
One of the reasons health care providers have been interested in
this legislation is because in Alaska we have many women who fly to
a central area, like Bethel or Nome, to have child and they many be
ready for discharge from a hospital, but they may not be ready to
travel immediately. Another reason for more time being allowed is
even with a normal vaginal birth, there is great variance in how
much time is needed afterwards. For the newborn more time is even
more important in some cases, PKU tests for example, which aren't
effective unless the blood is drawn 24 hours after birth.
BRIAN GILBERT, Administrator, Wrangell General Hospital, commented
that we have reached a point in health care, where we're allowing
insurance companies to make decisions for the physician and
patient. He said they have a lot of people coming into Wrangell to
have babies and the first day is usually the most expensive day.
They usually keep the mother and the baby in the hospital another
24 hour period, usually just a room and board charge, and then just
"eat the bill" if people can't pay.
GORDON EVANS, Health Insurance Association of America, said they
oppose mandatory coverage for maternity stays because they believe
that patients and their physicians and not the government can best
determine when a mother and her newborn are ready to leave the
hospital safely. The Legislature should not be making medical
decisions or embodying such decisions in law. State and federal
regulations already exist to assure quality health care. State
mandated benefits always drive up costs and ultimately limit access
to quality care.
MR. EVANS said that health plans right now do not discharge mothers
and newborns until they are medically ready to leave. He suggested
that this bill could be amended to provided that the doctor has the
ability to discharge a patient earlier if that is proper and the
patient concurs.
Number 173
SENATOR SALO responded that was the content of the proposed
amendment and is also the content of the bill. The insurance part
of the bill simply says that the care has to be offered to the
person, not that it has to be used. This bill does not require
mandatory coverage and the proposed amendment clarifies that.
Number 209
SENATOR SALO said part of the problem stems from the fact that
hospitals have different discharge policies. Some hospitals
discharge at noon, for instance, and the baby was born at 4:00 a.m.
If it's a strict 24 hour rule, you get only eight hours before you
have to leave the hospital.
MR. EVANS responded that some people think the hospitals are
driving this legislation because of the number of beds they have to
fill.
CAROL CLAUSSON, registered nurse and member of the Alaska Nurses
Association, supported SB 193. There are problems associated with
early discharge of mothers after the birth of their child. These
include mothers not being able to get infants to breast feed
properly and therefore shifting to formula, mothers not
understanding the teaching that is given to them in the hospital
because it occurs too soon after the birth of the child, and
infants are developing problems like jaundice, weight loss, and
infection which are not identified quickly because they have been
discharged.
Even nurses have difficulty in getting newborns to nurse properly.
Having a baby is a major change and young families in Alaska
frequently lack extended family to help with this change. They
feel patients should have the option of a 48 hour hospital stay
and/or home visits by a maternal child nurse or lactation nurse.
PAT SENNER, mother of three children, added that when you have a
two year old at home, it's very helpful to have the extra day to
recuperate and have that time alone with the new infant before you
have to go home and assume your duties there.
Number 250
VELETA MURPHY, Infant Learning Specialist, supported SB 193 saying
they have a lot of new mothers who are being sent away after 24
hours and they have not had time for bonding and to learn feeding
skill. She said if they don't have time with the parent or child
they can not identify skills they need that they can provide for
them. She knew of babies who would have been much healthier if
they had another 24 hours in the hospital so someone could notice
their problem.
Number 280
DON KOCH, Division of Insurance, said they support this
legislation. He had two technical suggestions. On page 1, lines 12
- 13 where there is a reference to the federal statute (ARISA)
which includes self insured plans, but his Division has no
jurisdiction over those. He wanted it clear that this deals with
insured plans.
SENATOR SALO replied that she understood the Division's inability
to control self-insured plans, but she has the same concern for
mothers who are employed under one of those plans and she
understands that a lot of people in Alaska are. She asked what
legal problems we face with the inclusion. MR. KOCH explained that
Chapter 42 deals with insurance contracts and since a self insurer
doesn't technically have an insurance contract this will be a piece
of language that sits out there intending to do a purpose which it
doesn't do. If they create the perception that this is reaching
self insured plans when it really doesn't, that tends to mislead
people into thinking that some protection is there when it isn't.
MR. KOCH's second concern was on page 2, lines 4 and 5 dealing with
nursing home administrators. If the intent is to reach entitlement
plans, this statute, since it deals with insurance contracts,
doesn't accomplish that. If it's dealing with an insured plan,
subsection 1 already takes care of that.
SENATOR SALO said that her preference would be to leave it alone,
because she didn't hear there was some catastrophic problem caused
by it being there.
She said the first amendment inserts a new subsection, "except as
otherwise required to provide coverage specified under A of this
section." This section does not affect a payment arrangement
entered into between the hospital or physician and an insurer.
There is no intent to interfere with the way hospitals and
insurance companies deal with each other in terms of business. It
is common practice with some insurance companies to have a flat
rate they use as reimbursement for a pregnancy. That rate is
subject to negotiation between the hospital and the insurer.
SENATOR SALO moved to adopt amendment 1. There were no objections
and it was so ordered.
SENATOR SALO said amendment 2 simply makes it crystal clear the
bill is not mandating an hospital stay.
SENATOR SALO moved to adopt amendment 2. There were no objections
and it was so ordered.
Number 367
SENATOR SALO moved to pass SB 193 (am) from Committee with
individual recommendations. There were no objections and it was so
ordered. #
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