Legislature(1995 - 1996)
03/07/1996 02:05 PM Senate L&C
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* first hearing in first committee of referral
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= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
SB 253 INSURANCE FOR PROSTATE CANCER TESTING
CHAIRMAN KELLY brought up SB 253 as the next order of business
before the Senate Labor & Commerce Committee.
KRISTINE PELLET, Student Intern for Senator Duncan, prime sponsor
of SB 253, read the sponsor's statement, which contained
information on prostate cancer and how one is tested for the
disease. Currently, insurance companies are not required by Alaska
Law to cover prostate cancer tests; SB 253 would require coverage
for testing on annual physical examinations, when appropriate.
SENATOR DUNCAN said it was unfair for an individual to have to pay
for a simple test that could alter his life with serious medical
and personal ramifications. Four states already require insurance
companies to cover these tests. She urged support for insurance
coverage in Alaska of the PSA (prostate specific antigen) test, if
deemed necessary by a physician.
SENATOR DUNCAN offered an amendment for regarding discussions with
the American Cancer Society. They felt SB 253, as it stands, is
too broad.
CHAIRMAN KELLY asked if the American Cancer Society has data that
shows that African-Americans are at higher risk for prostate
cancer.
MS. PELLET responded that was correct.
CHAIRMAN KELLY thought "a family history of prostate cancer" is
pretty broad. He thinks "family history" should be clarified to be
"immediate family history". He asked if there are further
questions. Hearing none, he asked Ms. Pellet to remain in
attendance. The chairman called Mr. Evans to testify.
Number 175
GORDON EVANS, Lobbyist for the Health Insurance Association of
America, stated that HIAA opposes any mandated benefits; a mandated
offering would be a different thing. He stated that since he is a
male, he has nothing else to say.
CHAIRMAN KELLY asked what the difference is between mandated
benefits and mandated offerings.
MR. EVANS responded that mandated benefits are when an insurance
company must cover something. Mandated offering is when an
insurance company gives a person buying an insurance policy the
option of paying a little extra to have that coverage in the
policy.
SENATOR MILLER asked how SB 253 would affect premium charges.
MR. EVANS replied it would be considered in the underwriting
process. Any mandated benefit usually leads to some sort of an
increase in premiums. He noted that he is covered by state health
insurance through his wife, and they have always paid for PSA tests
for him. So he does not know why they say some companies aren't
covering it now.
CHAIRMAN KELLY asked if there is anyone who disagrees that the
state health insurance policy pays mandated benefits.
Number 207
CAROL EDWARDS, RN and nationally certified oncology nurse, stated
her husband was turned down for his PSA screening. She believes
that men deserve the same rights in PSA testing that women receive
in mammogram testing. Mandating insurance companies to pay for
mammogram screening is now common throughout the United States.
She believes that mandating payment by insurance companies for PSA
screening will follow. Prostate cancer is the most commonly
occurring cancer in men in the United States: 41% of all cancers in
men are prostate cancers. A lot of men die with prostate cancer,
and not of it. If a man lives to be 90 years old, he will probably
have prostate cancer, although it will probably not be the cause of
death.
Number 244
Ms. Edwards stated that the younger a man is, the more aggressive
prostate cancer will be, and the more likely that it will be the
cause of death. Early detection of prostate cancer is the best
chance for a cure. Ms. Edwards stated that unfortunately, she
mostly sees patients with cancer in more advanced stages. Ms.
Edwards stated that Aetna refused to pay for a PSA test for her
husband, even though his father died of prostate cancer. He has a
State of Alaska health insurance policy, and he carries the rider
for the annual physical. In a letter, Aetna stated they would not
pay for the PSA test, even though he was considered high risk,
because it was a questionable test. Ms. Edwards stated it is a
debatable test.
CHAIRMAN KELLY asked if that test that will be mandated by SB 253.
MS. EDWARDS responded it is.
CHAIRMAN KELLY asked if the state will, at this time, pay for
prostate examinations.
MS. EDWARDS replied they will pay for a digital rectal examination.
They will pay for a cardiac risk profile: her husband has no risk
of cardiac disease, but they will pay for that test. He does have
a risk of prostate cancer, but they will not pay for a PSA test.
They won't pay for this one particular test, which at Bartlett
Memorial Hospital costs between $60.00 - $70.00. She stated that
her family is personally willing to pay for that, because they are
capable of doing so. But it is the individual who is less
knowledgeable and would not know the value of the test who might
not be so likely to pay out of pocket. Ms. Edwards stated that in
the oncology world there is a phrase called "oncology family
syndrome". This phrase means that if there are three generations
of cancer in your family, and it does not have to be the same type
of cancer, then you are considered to be at high risk for having
cancer.
CHAIRMAN KELLY asked how family is defined.
MS. EDWARDS thinks it goes back through generations. She knows
that mother, grandmother, and great-grandmother are considered to
be in those studies.
CHAIRMAN KELLY asked Ms. Edwards what word is used to describe
family relationship and degrees of family relationships.
MS. EDWARDS stated she would be willing to find that information
for the committee.
CHAIRMAN KELLY stated the committee would appreciate that. He
asked if there were any questions. Hearing none, he asked if
anyone knew the word used to define that whole phrase.
MS. EDWARDS asked if the chairman was thinking of "immediate
family".
CHAIRMAN KELLY responded that is not the word. He came across it
when he was working for the Nevada Legislature. He called Mr.
Chisholm to testify.
Number 299
BILL CHISHOLM stated he works in the claims field for the State of
Alaska, and is covered by Aetna for almost everything. He stated
he spends a great deal of time reviewing insurance provisions and
supports SB 253. Mr. Chisholm stated that in 1991 during his
annual physical, his physician recommended he take the exam. He
did, and Aetna paid for it. Aetna also paid for the PSA exam for
his 1992 physical. In 1993, Aetna would not pay for the test, and
they have not paid for it since then. When he called Aetna to
inquire why they did not pay for the test, he was told that the
test was not an acceptable diagnostic tool. He believes that a
test of this type is probably more accurate than the examination
which involves a physician facing a somewhat squirming subject and
trying to determine size and hardness or softness of a particular
part of the body. In looking at the 1994 denial, it states that,
"Services must be broadly accepted, professionally as effective,
appropriate and essential treatment of disease or injury. Based on
that, this is not covered." Mr. Chisholm pointed out that whether
it's a PSA screening or a digital rectal exam, they are both for
detection, not for treatment. He believes that men should be
entitled to have the best screening possible for a potential
disease of this type.
CHAIRMAN KELLY asked Dr. Palmer to testify.
Number 348
DR. PALMER, a Juneau physician, explained family genetics are such
that certain problems can skip generations in people who are
genetically interconnected (not family members by marriage). The
fact that a first degree relative (a parent or sibling) does not
have a specific disease does not dilute the fact that family
relationships where other members of the bloodline have had the
disease predisposes one to the disease. He believes the best
medical procedures are preventive, especially to help patients stop
smoking. Regarding the PSA, it will detect malignancy and is more
specific than mammography. The positive predictive value of
mammography is 20 percent, and around 35 to 50 percent with PSA.
SENATOR KELLY asked Janet Parker from the Division of Retirement
and Benefits why a zero fiscal note was submitted.
MS. PARKER replied the state's major medical plan only pays for the
PSA test if objective evidence exists throughout patient history
and after a digital rectal exam. The PSA test is not automatically
paid for as part of a routine physical exam. The state's plan does
not cover a routine physical exam unless employees select SBS
Option 1. The employee pays the premium for that option, and
although there will be an increase in the cost to the state, most
of the cost will be paid by the employee. The premium for Option
1 is expected to increase in future years.
SENATOR KELLY questioned whether Option 1 coverage includes a PSA
test. MS. PARKER answered it will if SB 253 passes, it does not
now.
SENATOR KELLY asked if employees who do not choose Option 1 are
entitled to a full physical exam every year. MS. PARKER stated
they are not, but a male employee would still be able to go in and
have a PSA test without a full physical exam.
SENATOR KELLY asked what the added cost to the state is. MS.
PARKER assumed most people will not have the test done. SENATOR
KELLY asked why she would make that assumption if the test was
free. MS. PARKER responded the current plan pays for a pap smear
test for a woman, but does not cover the office visit, therefore
the employee still has to pay some cost.
SENATOR KELLY commented he is surprised by the zero fiscal note.
PHILLIP GRAY, a Juneau resident, stated he was diagnosed with
prostate cancer in 1992, through a PSA test paid by Aetna. He is
not required to have a PSA blood test every three months which is
important to his treatment. He expressed his support for SB 253.
He discussed his treatment for prostate cancer since 1992. Aetna
has refused to pay for any of the treatment including blood tests,
x-rays, bone scans, a second opinion or prescribed medicines, even
though these things are covered in the manual. He noted Washington
State has recently passed a law requiring insurance payment to any
licensed practitioner. His last concern was that Juneau has no
cancer registry which could be computerized and analyzed to
pinpoint correlations.
SENATOR KELLY asked Ms. Parker if she could comment on Mr. Gray's
lack of coverage. MS. PARKER could not do so without looking at
the specifics of his case, but offered to review his file. She
noted that naturopathic services are generally not covered by
insurance companies.
SENATOR KELLY repeated his concern with the zero fiscal note, as it
is unlikely the state could mandate another medical test without
associated costs. He announced SB 253 would be held in committee
until next week.
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