Legislature(2007 - 2008)BELTZ 211

02/26/2008 01:30 PM LABOR & COMMERCE

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Heard & Held
Bills Previously Heard/Scheduled
Moved CSSB 149(L&C) Out of Committee
             SB 160-MANDATORY UNIVERSAL HEALTH CARE                                                                         
CHAIR ELLIS  announced SB 160  to be up for  consideration. [CSSB                                                               
160(HES), 25-LS0728\N, was before the committee.]                                                                               
SENATOR  FRENCH,  prime  sponsor   of  SB  160,  introduced  Andy                                                               
Moderow,  his staff  who  spent  a good  part  of  the last  year                                                               
working on this bill. He then  explained that at least 15 percent                                                               
of  his neighbors  do not  have health  insurance; 60  percent of                                                               
those have  full-time jobs that  do not provide  health insurance                                                               
as a benefit.  The upshot is that the costs  they incur when they                                                               
seek health  care, typically  through the  emergency room  or low                                                               
cost  clinics, get  passed  on to  the rest  who  do have  health                                                               
insurance.  Estimates are  that about  15 percent  of the  health                                                               
insurance premiums  people pay go to  care for those who  have no                                                               
insurance. Should  every Alaskan have a  health insurance policy,                                                               
one might  see as much  as a  $1000 annual reduction  in premium.                                                               
The  idea behind  SB  160 is  to provide  a  framework using  the                                                               
existing  landscape to  provide  affordable  health insurance  to                                                               
every Alaskan.                                                                                                                  
1:46:33 PM                                                                                                                    
SENATOR HOFFMAN joined the committee.                                                                                           
1:48:51 PM                                                                                                                    
SENATOR  FRENCH showed  a  slide from  a  Rand Corporation  study                                                               
indicating  that most  nations have  a fairly  tight relationship                                                               
between  gross domestic  product (GDP)  and health  care spending                                                               
until you come  to the U.S. which spends far  more on health care                                                               
-  and gets  the same,  if not  worse, results  when you  look at                                                               
infant  mortality and  life expectancy.  That  extreme amount  of                                                               
spending has  caught the eye  of many economists and  health care                                                               
A  slide  prepared  by  the  Institute  of  Social  and  Economic                                                               
Research showed a huge increase  in spending in health care, both                                                               
as  a total  and per  capita from  $1.6 billion  in 1991  to $5.3                                                               
billion in  2005. The idea of  this reform is to  get more people                                                               
covered by  insurance while trying to  decrease wasteful spending                                                               
in emergency rooms and other medical costs.                                                                                     
SENATOR  FRENCH  said one  of  the  problems  is that  it's  very                                                               
difficult for  small firms  or those who  work for  themselves to                                                               
provide  insurance for  employees.  Ninety-three  percent of  the                                                               
large firms  in Alaska offer  health insurance, while  88 percent                                                               
of the  medium sized firms  offer health insurance. But  when you                                                               
drop to  smaller firms,  it's very  difficult to  generate enough                                                               
income to provide insurance.                                                                                                    
1:50:36 PM                                                                                                                    
He said  the bill calls for  the creation of a  Health Care Board                                                               
that would  oversee a health  care fund, and  recommend essential                                                               
health care services  and certify private health  care plans that                                                               
would   rest  in   a  Alaska   Health  Care   Clearinghouse.  The                                                               
Clearinghouse  would not  be a  new  bureaucracy, it  would be  a                                                               
virtual  clearinghouse,  much  like  the  stock  exchange,  where                                                               
individual health care plans, having  been certified by the board                                                               
as  have  essential  health  care services  (as  defined  by  the                                                               
legislature),  are waiting  to be  purchased by  a person  with a                                                               
voucher  to purchase  it.  The  genius of  this  idea  is to  not                                                               
replace the  existing private insurance  landscape with  a single                                                               
insurance plan, but  to maintain the same  competition within the                                                               
clearinghouse that promotes lower  costs and better products that                                                               
works  so well  in  many other  aspects of  our  economic life  -                                                               
competing for the consumer voucher.                                                                                             
He said  essentially individuals who  earn less than  100 percent                                                               
of  the federal  poverty limit  would get  a free  voucher for  a                                                               
health  insurance  policy. Today  probably  95  percent of  those                                                               
people are on  Medicaid; the bill takes the other  5 percent into                                                               
account. The  vast bulk of the  folks that this bill  is meant to                                                               
help falls between 1 - 300  percent of the federal poverty level.                                                               
Other states that  are looking at these reforms tend  to use this                                                               
range of limits. The vast bulk  of Alaskans would be eligible for                                                               
a voucher in relationship to  their income; the lower the income,                                                               
the  bigger  the  voucher.  The higher  income  the  smaller  the                                                               
voucher, until you  get to 300 percent, in which  case you get no                                                               
voucher whatsoever.                                                                                                             
1:53:02 PM                                                                                                                    
SENATOR  FRENCH   explained  that   the  fund  would   also  have                                                               
"specified beneficiary  funds." Laile Fairbairn of  the Snow City                                                               
Café said  she would love to  be able to contribute  $100-$300 to                                                               
help employees buy health insurance,  but she couldn't afford the                                                               
full price. Companies  like hers that want to  offer to subsidize                                                               
employees'  health insurance  policies could  put money  into the                                                               
specified beneficiary fund  to help them buy  insurance. A person                                                               
would take  their voucher  to the  Health Care  Clearinghouse and                                                               
choose their fund.                                                                                                              
1:53:30 PM                                                                                                                    
CHAIR ELLIS asked  if this approach is  market-based and consumer                                                               
SENATOR  FRENCH  replied  yes;  market-based  means  you  haven't                                                               
remade the health insurance landscape to  go to a single payer. A                                                               
single  payer  operates  in  different   parts  of  the  country;                                                               
Medicare for instance  is a single payer for people  over 65, the                                                               
Veterans Administration  is another  example. But that  model has                                                               
never proved  to be successful  in any setting.  So, market-based                                                               
preserves   the   private   insurance  industry   competing   for                                                               
customers. The consumer driven portion  is just that - by letting                                                               
an individual  with a voucher  pick the insurance plan  that best                                                               
meets  his or  her needs,  the bill  maintains the  vital market-                                                               
place where consumers  meet a seller in a  free exchange, staying                                                               
in line with out capitalistic principles.                                                                                       
SENATOR STEVENS said Senator Ted  Stevens was talking about aging                                                               
of  Alaskans a  few days  ago in  addressing the  joint body  and                                                               
asked if Alaska is any worse than other states.                                                                                 
1:56:51 PM                                                                                                                    
SENATOR  FRENCH  replied  he  didn't  know.  He  thought  Senator                                                               
Stevens was  saying 90  percent of health  care costs  one incurs                                                               
are in  the last  18 months  of one's life,  but he  didn't think                                                               
that problem had a solution.                                                                                                    
CHAIR ELLIS  inserted that people  are fearful of  rationing care                                                               
when they get  to that age and that this  is troubling to medical                                                               
SENATOR  FRENCH   said  this  approach   was  first   enacted  in                                                               
Massachusetts  where they  were  "able to  meet  in the  middle."                                                               
Everyone could get  health insurance entity, and  the free market                                                               
was maintained.  Most models being  presented now work  along the                                                               
lines of this plan.                                                                                                             
CHAIR ELLIS said some folks  argue for the single payer approach,                                                               
which isn't  socialized medicine but rather  socialized insurance                                                               
through  a government  entity;  and there  are  good examples  of                                                               
that. He said  criticism exists of this approach  that the profit                                                               
motive  is  still involved  and  health  insurers will  still  be                                                               
making a profit.  He asked Senator French if he  had any thoughts                                                               
about controlling  costs being a  negative to the profit  side of                                                               
the picture.                                                                                                                    
SENATOR  FRENCH replied  that is  a legitimate  concern, but  the                                                               
central question is  if you have a health  insurance policy; this                                                               
is  a  pragmatic  approach  to  the problem.  The  flip  side  to                                                               
lowering costs  is better  infant care  and longer  and healthier                                                               
CHAIR ELLIS  asked if he just  faced up to the  political reality                                                               
that the  U.S. won't likely pass  a law to outlaw  private health                                                               
2:00:31 PM                                                                                                                    
SENATOR FRENCH  responded this is  a compromise between  the left                                                               
that  wants everybody  covered and  the right  that wants  a free                                                               
market approach.                                                                                                                
SB 160 sectional analysis                                                                                                     
2:01:08 PM                                                                                                                    
Section 1 is the findings section  of the bill. Article 2A is the                                                               
meat and potatoes  of the legislation and starts on  page 2, line                                                               
26 where it  establishes the health care program  laying out what                                                               
the  legislation  will  accomplish.  It ensures  that  all  state                                                               
residents can afford quality health  care coverage and that it be                                                               
meaningful. It  reduces unsustainable health care  cost increases                                                               
through encouraging  primary care  and prevention and  it centers                                                               
on  consumer  choice by  providing  a  framework for  competition                                                               
where  insurance  plans  must  compete   to  acquire  and  retain                                                               
Section 21.54.210 on page 3,  line 9, establishes the health care                                                               
board under the Department of  Health and Social Services (DHSS).                                                               
It will have 13 voting  members divided between those who operate                                                               
the  business  side and  those  who  provide the  care  delivery:                                                               
labor, physicians, nurses and consumers.  The commissioner is the                                                               
13 member serving as a tie-breaker.                                                                                             
SENATOR FRENCH  said that Section 21.54.220  describes the powers                                                               
and duties  of the  board. Essentially it  oversees the  two main                                                               
elements  of the  bill -  the health  care clearinghouse  and the                                                               
health  care fund.  In particular  it ensures  that a  variety of                                                               
plans  are available  in the  clearinghouse and  that people  are                                                               
aware of them. It establishes  enrollment criteria and procedures                                                               
and provides for an annual  open season when customers can change                                                               
their plans.                                                                                                                    
2:04:35 PM                                                                                                                    
He  said  this annual  open  season  also keeps  the  competition                                                               
element of  the bill in  force because  insurers will have  to be                                                               
concerned about people jumping from  one company to another. That                                                               
concern about losing  customers helps them drive  prices down and                                                               
promotes greater  efficiency in  a private insurance  market. The                                                               
board will also  hear complaints or objections  to decisions made                                                               
by  the program  or  the  clearinghouse; it  also  has a  hearing                                                               
process for  appeals. Section  21.54.230 on page  5 is  about the                                                               
Alaska health care clearinghouse.                                                                                               
SENATOR  FRENCH said  Section 21.54.240  establishes the  voucher                                                               
system and  includes the  individual responsibility  clause. This                                                               
section  ensures  that all  Alaskans  can  afford quality  health                                                               
coverage. He explained that  the individual responsibility clause                                                               
puts  the responsibility  for  having an  insurance  plan on  the                                                               
individual,  and he  remarked that  in the  past many  plans have                                                               
called  for an  employer mandate.  This also  breaks the  problem                                                               
with individuals  who get  insurance through  their job  and then                                                               
lose it  when they  change jobs  by making  it portable  with the                                                               
individual; people  now change jobs  four or five times  in their                                                               
lifetimes. It  also means  that individuals have  to step  up and                                                               
take responsibility for  their own health care. The  flip side is                                                               
once every  individual buys  health insurance,  you can  tell the                                                               
industry it has to offer insurance  to people who ask for it. The                                                               
idea is  by grabbing the 20-30  year olds who do  not have health                                                               
insurance and  will not buy it  unless you nudge them  into doing                                                               
so, you can get the price down  for the rest of the consumers. He                                                               
said this  vast segment of  the Alaskan population  believes they                                                               
are  bullet-proof and  expects us  to take  care of  their health                                                               
care problems  when they  crash their snow  machine, fall  into a                                                               
crevasse or  their boat runs out  of gas in Cook  Inlet. We spend                                                               
all kinds of money to fix them up;  so it's only fair to ask them                                                               
to  contribute  something  every  month  to  a  health  insurance                                                               
2:08:17 PM                                                                                                                    
He said  the sliding scale  vouchers are  described on page  6 in                                                               
subsections (b)  - (e). Subsection  (c) provides that  people who                                                               
fall below  the federal poverty  level (FPL) will  receive health                                                               
insurance  at no  cost.  Subsection (d)  provides  vouchers on  a                                                               
sliding  scale to  individuals in  households  that earn  between                                                               
100-300 percent  of the  FPL. Subsection (e)  on page  7 requires                                                               
that all individuals  over 300 percent of the  FPL acquire health                                                               
coverage.  While they  won't be  able  to receive  a needs  based                                                               
voucher, they will be eligible  to receive "specified beneficiary                                                               
vouchers" discussed in a later section of the bill.                                                                             
SENATOR  FRENCH said  subsection (b)  on page  6 was  skipped and                                                               
that is  about how ACHIA,  the state's  high risk pool,  fits in.                                                               
Those rates are  typically 150 percent of what  normal people pay                                                               
for their  insurance. For  ACHIA, the FPL  limit is  increased to                                                               
450 percent to maintain the proportions  of going up the scale in                                                               
SENATOR  BUNDE went  to subsection  (f) and  asked if  an illegal                                                               
alien would qualify for this program.                                                                                           
SENATOR FRENCH replied no. But if you're a legal alien - yes.                                                                   
2:11:30 PM                                                                                                                    
He  said  that Section  21.54.250  on  page 7  defines  essential                                                               
health   care   services.   They  will   include   coverage   for                                                               
preventative  and  primary  care, emergency  services,  inpatient                                                               
services  and hospital  treatment,  ambulatory patient  services,                                                               
prescription drug  coverage and  mental health  services. Section                                                               
21.54.260  on   page  7  relates  to   employer  provided  health                                                               
coverage.  Here he  emphasized that  nothing  happens under  this                                                               
bill if a person already has insurance coverage.                                                                                
SENATOR  BUNDE said  including mental  health  services is  being                                                               
discussed  within the  industry  and this  bill  requires it.  He                                                               
asked if  someone's private insurance didn't  allow mental health                                                               
services, would that  mean they would now be  required to provide                                                               
SENATOR   FRENCH  answered   that  is   a  policy   decision  the                                                               
legislature will have to make.  "As proposed, the short answer is                                                               
2:13:27 PM                                                                                                                    
He  said Section  21.54.260 relates  to employer  provided health                                                               
coverage; subsections (a) and (b)  clarifies that nothing changes                                                               
for employer  based health coverage  for companies that  elect to                                                               
provide it. Subsections (c) and  (d) pertain to the employer levy                                                               
which  insures that  all employers  contribute  something to  the                                                               
health  of employees  around  the  state. The  levy  is only  put                                                               
against employers who don't offer  health coverage and the amount                                                               
depends on  the number of employees  they have. There is  no levy                                                               
for zero to 10 full-time employees.                                                                                             
2:15:40 PM                                                                                                                    
SENATOR BUNDE asked  how the levy would compare  to buying health                                                               
SENATOR  FRENCH replied  the levy  is  fairly low.  He said  that                                                               
business is  suspicious; the  National Federation  of Independent                                                               
Businesses is very  nervous, but when they realize  how it works,                                                               
they will see it as a big benefit.                                                                                              
He said Section  21.54.270 on page 8 relates to  the structure of                                                               
the  insurance plans  available  in the  clearinghouse. They  are                                                               
required to  provide coverage for essential  health care services                                                               
as described  in Section 21.54.250. Subsection  (b) mandates that                                                               
an  insurance company  not turn  down an  individual looking  for                                                               
coverage. He commented  that once you require everyone  to get in                                                               
the pool, the insurance industry has  to step up to the plate and                                                               
issue a policy.  "They are not going to turn  you down because of                                                               
this -  because you're a  hundred pounds overweight or  you smoke                                                               
or whatever  it is that they  try to use to  cull individuals out                                                               
of the herd."                                                                                                                   
2:18:26 PM                                                                                                                    
SENATOR FRENCH  said subsection (c)  makes clear that  the health                                                               
insurance plans  can have various levels  of deductibles, co-pays                                                               
and  out of  pocket maximums.  He said  that individuals  who are                                                               
between  18 and  30 can  have  a specially  crafted plan  because                                                               
there is  no sense in  them having insurance for  prostate exams,                                                               
for example.                                                                                                                    
Subsection  21.54.290  on page  9  covers  disputes and  appeals;                                                               
subsection 21.54.300  on page 10  requires the Health  Care Board                                                               
to provide an  annual report that includes statistics  on how the                                                               
health  reform  program  is  performing  and  an  evaluation  and                                                               
recommendations  on a  variety  of topics  including  the use  of                                                               
electronic health records.                                                                                                      
SENATOR FRENCH  said language  inserted by  the HES  Committee on                                                               
page 10, lines  23 - 26, requires the board  to look at expanding                                                               
Medicaid  every year  versus providing  vouchers and  providing a                                                               
cost  comparison -  because many  reformers  believe that  simply                                                               
expanding Medicaid is the way  to cover more individuals. Finally                                                               
Section  21.54.310 on  page 11  establishes some  regulations and                                                               
definitions and transitional provisions.                                                                                        
2:21:50 PM                                                                                                                    
LINDA  HALL,  Director,  Division  of  Insurance,  Department  of                                                               
Commerce, Community  & Economic Development (DCCED)  said she had                                                               
no position on  SB 160. She was interested in  the first slide on                                                               
the percent of gross national  product (GDP) spent on health care                                                               
and remarked that  she saw a similar slide at  a national meeting                                                               
that was  called "a  perfect storm" in  reference to  projects of                                                               
how much of our GDP will be  used in consuming health care and as                                                               
that increases  what happens to  the other things we  spend money                                                               
on. "At some point it does become a value judgment."                                                                            
She said this particular CS all  of a sudden puts this program in                                                               
Title  21  Insurance,   but  the  Division  of   Insurance  is  a                                                               
regulatory  agency; it  doesn't administer  programs and  she was                                                               
concerned about  that. She thought  there would be a  conflict in                                                               
her   regulatory  role   in  overseeing   the  health   insurance                                                               
companies,  adjudicating  claims,   and  similar  issues,  versus                                                               
overseeing  the health  care board  and administering  a program.                                                               
It's not insurmountable, but at  this point she couldn't identify                                                               
any  department  that  had  the  expertise  to  both  talk  about                                                               
administration of  programs and  look at insurance  coverages and                                                               
costs. However, she said the discussion needs to happen.                                                                        
She  said the  Department of  Health and  Social Services  (DHSS)                                                               
received a federal grant to study  the uninsured. She was part of                                                               
a team that  held regional forums talking to  the uninsured about                                                               
what they  were looking for.  The people who participated  in the                                                               
forums wanted  to pay, but  they couldn't  pay a lot;  the number                                                               
she heard regularly was $100/month.                                                                                             
2:27:20 PM                                                                                                                    
She said  health care  costs in Alaska  are 30-plus  percent more                                                               
than in other  states even in Washington. So it's  clear that the                                                               
cost of  health has to be  realized; it's the major  cross driver                                                               
in workers' compensation premiums. She  said for two years Alaska                                                               
was number one in the  highest workers' compensation rates in the                                                               
country, and she  guessed that we are still in  the top five even                                                               
with two years of rate decreases.                                                                                               
MS.  HALL emphasized  that last  week she  approved an  almost 32                                                               
percent increase  in the premium for  individual health insurance                                                               
policies written by the state's  primary carrier. It was based on                                                               
increases in  two things: cost  of health care (which  is keeping                                                               
track with  inflation) and, even  more, increased  utilization of                                                               
going to the  doctor. She said the division's  actuary works with                                                               
these  filings. Two  years ago  the legislature  passed standards                                                               
for health insurance rates; rates  can't be excessive, inadequate                                                               
or unfairly  discriminatory. She emphasized that  they don't want                                                               
inadequate  rates because  they want  the insurance  company that                                                               
sold the policy to be able  to pay the claim. Anyhow, her actuary                                                               
tried everything  that she  could find to  reduce this  rate, but                                                               
couldn't. So she approved it.                                                                                                   
2:31:23 PM                                                                                                                    
MS. HALL said she is still  stunned by that and suggested that we                                                               
begin to look in smaller steps  at what other states are doing to                                                               
change in  conjunction with  the goals  of this  bill. She  had a                                                               
list of  10 things she  saw in other  states that we  could start                                                               
with to  look at the cost  of health care. She  said the National                                                               
Association  of Insurance  Commissioners (NAIC)  spends a  lot of                                                               
time  on  health insurance  issues.  She  spends  a lot  of  time                                                               
listening to  them and  to what states  are doing  "because every                                                               
state is suffering from this."                                                                                                  
2:32:37 PM                                                                                                                    
One success  she has  seen is in  Utah where  insurance providers                                                               
send  these bills  to a  clearinghouse, and  it pays  probably 90                                                               
percent of the claims without a problem.                                                                                        
She said  much of the  cost of health care  is not in  the actual                                                               
health  care; it's  in  the  paperwork that  is  involved in  the                                                               
health care  system. Utah's  system is run  by a  private entity,                                                               
but it  is supported  by state agencies.  She stated  that Alaska                                                               
has  a  really  good  record for  telemedicine  and  she  thought                                                               
electronic medical records could be expanded.                                                                                   
MS. HALL said  she could work with  the individual responsibility                                                               
the  bill sponsor  talked about  - to  talk about  evidence-based                                                               
medicine and optimizing care  suggesting alternative treatment or                                                               
generic  drugs, consumer  education  and questioning  treatments.                                                               
Alaska  could  expand  its  efforts   in  those  areas  to  avoid                                                               
emergency  room  visits and  to  encourage  looking over  a  bill                                                               
received from  a doctor. She  once had an insurance  company that                                                               
paid  you half  of what  you  saved if  you found  errors in  the                                                               
doctor bill.                                                                                                                    
She  said  they don't  put  enough  emphasis on  employer  health                                                               
insurer  wellness   programs  -  for  things   like  preventative                                                               
measures,  health assessments  and health  club memberships.  She                                                               
has  asked for  increased  funding to  investigate and  prosecute                                                               
health care  fraud and they need  to talk about what  fraud costs                                                               
all of us.                                                                                                                      
MS. HALL  concluded that access  to health care and  finding ways                                                               
to pay  for it is  a complex issue for  all Alaskans. She  had no                                                               
position on this bill, but she urged  them to find a way to adopt                                                               
some  initiatives that  could immediately  make inroads  into the                                                               
cost of health care as they study these programs.                                                                               
2:36:26 PM                                                                                                                    
CHAIR  ELLIS asked  if she  wanted cost  containment requirements                                                               
added to the bill.                                                                                                              
MS. HALL replied  that things like that should  be adopted before                                                               
looking at spending as much as  this bill would require. A health                                                               
care board could look into those things and other states have.                                                                  
CHAIR  ELLIS asked  how many  states have  rate review  authority                                                               
inherent in their division of insurance regulation.                                                                             
MS. HALL replied she didn't know.                                                                                               
CHAIR  ELLIS  said  most  states  have  stronger  authority  than                                                               
MS.  HALL  commented  that  Washington's  Division  of  Insurance                                                               
doesn't  do rate  review, but  its legislature  has introduced  a                                                               
bill today to fix that.                                                                                                         
CHAIR ELLIS asked if she was requesting rate review authority.                                                                  
MS.  HALL  answered not  at  this  time,  but it's  important  to                                                               
understand what the division does and doesn't do.                                                                               
CHAIR   ELLIS   asked  if   she   requested   funding  for   more                                                               
investigative resources to get to  the fraud she thinks exists in                                                               
the system.                                                                                                                     
MS. HALL answered  yes. She added that she is  seeing a number of                                                               
bills  with  insurance  coverage   mandates.  It's  important  to                                                               
recognize she  regulates the  private insurance  marketplace that                                                               
sells  to  individuals  and  small groups  and  that  those  laws                                                               
require guaranteed  offer of coverage for  groups of 2 to  50. So                                                               
they are  discussing things the  division already does.  But, she                                                               
said,  Alaska  has a  large  population  of individuals  who  are                                                               
covered under self  insurance plans that are  governed by federal                                                               
CHAIR  ELLIS said  she is  giving  them the  impression that  she                                                               
didn't want this  authority, and he asked what  she thought about                                                               
making it a  Department of Health and Social  Services issue also                                                               
and sharing the responsibility with them.                                                                                       
2:41:28 PM                                                                                                                    
MS. HALL wanted to ponder that.                                                                                                 
2:41:42 PM                                                                                                                    
SENATOR BUNDE said  this bill is modeled  after the Massachusetts                                                               
experience and he has heard various critiques of that.                                                                          
MS. HALL  replied that she  is not  familiar with that  plan, but                                                               
has heard  mixed reviews. However,  she pointed  out it is  a new                                                               
SENATOR BUNDE said some plans  are Volkswagen models, but Senator                                                               
French's is  a Cadillac plan.   He  asked where she  thought this                                                               
plan fell.                                                                                                                      
2:45:05 PM                                                                                                                    
MS. HALL answered this is  the parameters of a program. Different                                                               
plans are  structured around the  country. For  instance, Montana                                                               
has a bare-bones program that  is geared at preventative care and                                                               
going in early, and it costs  less than $200/month. It depends on                                                               
the goal and  what their philosophy is about health  care and she                                                               
said they  need to talk about  preventative care and end  of life                                                               
issues, which gets  into moral decisions and  value judgments. It                                                               
gets down  to what is  most important  with health care,  and she                                                               
thinks  preventative measures,  disease  management programs  and                                                               
health education are extremely important.                                                                                       
2:46:36 PM                                                                                                                    
SENATOR  BUNDE asked  if the  proposed assessment  would actually                                                               
provide the coverage being mandated.                                                                                            
MS. HALL answered that she hadn't analyzed that.                                                                                
2:47:31 PM                                                                                                                    
SENATOR  STEVENS asked  how this  would mesh  with the  extensive                                                               
Native health care system in Alaska.                                                                                            
2:48:26 PM                                                                                                                    
SENATOR FRENCH went to page 6,  lines 4-7, where the bill exempts                                                               
those  who receive  Indian health  services. The  idea is  to not                                                               
disrupt that system. Many Native  Alaskans already have access to                                                               
health care,  but they  don't have health  insurance. If  you get                                                               
sick in  Seattle, you can't go  to a hospital say  "I'm an Alaska                                                               
Native; take  care of me."  They do  have access in  Anchorage to                                                               
the Alaska  Native Medical  Center, for  instance. This  bill, in                                                               
essence,  says that's  pretty  good. We're  going  to leave  that                                                               
alone because it  seems like its working, but it's  not a perfect                                                               
SENATOR HOFFMAN remarked  he can go to the  Indian Health Service                                                               
Hospital in Seattle, too.                                                                                                       
SENATOR STEVENS was worried that  Native Alaskans might feel left                                                               
SENATOR FRENCH said  he is trying to fill the  gap to make access                                                               
to health care more like  health insurance, but to recognize that                                                               
a vast  majority of those costs  are already being absorbed  by a                                                               
different system. There is no sense in recreating the wheel.                                                                    
SENATOR HOFFMAN suggested addressing  that issue by allowing them                                                               
to be covered as a co-insurer.                                                                                                  
2:51:17 PM                                                                                                                    
LYNN  HARTZ, Legislative  Committee,  Alaska Nurses  Association,                                                               
said  that this  association  represents the  Forensic Nurses  of                                                               
Alaska,  Certified Nurse  Anesthetists, Certified  Nurse Midwives                                                               
and the  Alaska Nurse Practitioner  Association and  it supported                                                               
SB  160. She  elaborated that  they favor  innovative legislation                                                               
that  makes  health  insurance   affordable  for  businesses  and                                                               
individuals and this bill meets those goals.                                                                                    
2:53:03 PM                                                                                                                    
GARVAN  BUCARIA, former  federal  employee representing  himself,                                                               
was very  concerned about "mandatory" universal  health care. The                                                               
increases in his  costs over the last year  are greatly affecting                                                               
his retirement  money. He was  very concerned that  this proposal                                                               
didn't  eliminate the  emergency  medical  service treatment  for                                                               
uninsured  residents and  that  it  has no  upper  limit for  the                                                               
health care  fund. He was  also concerned that health  care costs                                                               
are trending  upward. For  example, he had  a CAT-scan  that cost                                                               
$5,000, but  an ultrasound would  have revealed the problem  at a                                                               
far  lower cost.  He also  mentioned that  dental costs  vary for                                                               
services like  teeth cleaning,  and he  thought this  meant there                                                               
are some  possible savings.  He would like  to see  an advertised                                                               
cost  per treatment  for  the various  medical  services so  that                                                               
clients  could level  questions  at the  health professional.  He                                                               
felt  very strongly  that education  in preventative  maintenance                                                               
should have high priority; he did  not see the need for mandatory                                                               
health programs  when we are  not effectively providing  for this                                                               
CHAIR  ELLIS remarked  that separate  legislation is  before them                                                               
this  year about  publication of  relative medical  costs in  the                                                               
state of Alaska so people can shop around.                                                                                      
2:58:52 PM                                                                                                                    
BEVERLY  SMITH, Christian  Science Committee  on Publication  for                                                               
Alaska, said she reviews legislation  to ensure that it preserves                                                               
the  choice  of  Alaskans  to  pursue  spiritual  means  for  the                                                               
prevention  and  cure  of disease,  including  Christian  Science                                                               
treatment  and  care,  which  is  cost  effective,  reliable  and                                                               
effective.  She commended  this bill  that ensures  that everyone                                                               
can  purchase  an affordable  health  plan  that they  select  to                                                               
fulfill  their  medical  needs,  but she  wanted  it  to  include                                                               
coverage for  spiritual care similar  to the coverage  offered by                                                               
the  federal government  and other  state plans.  In Alaska,  she                                                               
said, state  employees and retirees have  insurance coverage that                                                               
includes payment to Christian Science practitioners.                                                                            
MS.  SMITH  explained  that  Christian  Science  is  one  of  the                                                               
religious  non-medical forms  of treatment  that is  available to                                                               
anyone, not just  members of the church. It  involves reliance on                                                               
spiritual  means through  prayer  to heal  illness, injuries  and                                                               
other conditions.  It has  systematically been  practiced quietly                                                               
and effectively in many Alaskan  families for over 100 years. She                                                               
has experience many physical healings through Christian Science.                                                                
She said  she was not here  to take a position  on whether health                                                               
insurance  should  be  mandated; however  any  reform  discussion                                                               
should  include  an  acknowledgment  that  spiritual  care  is  a                                                               
significant part  of people's approach to  maintaining health and                                                               
that costs associated  with such care are  deserving of inclusion                                                               
in health care  reform, so that those relying  on spiritual means                                                               
for  healing  may  have  access  to  their  preferred  method  of                                                               
She  requested that  essential health  care services  as used  in                                                               
Section  21.54.250  on page  7  be  interpreted to  include  non-                                                               
medical  health   care  services   for  individuals   relying  on                                                               
spiritual means for healing. She  provided the committee with the                                                               
text of her proposed amendment.                                                                                                 
CHAIR ELLIS asked  if the state covers  Christian Science healing                                                               
expenses now.                                                                                                                   
MS. SMITH replied yes.                                                                                                          
SENATOR ELLIS asked if the  federal government pays for Christian                                                               
Science healing.                                                                                                                
MS. SMITH  replied that both  Medicare and the  military benefits                                                               
do cover it.                                                                                                                    
She suggested including language  saying "non-medical health care                                                               
services for  individuals relying  solely on spiritual  means for                                                               
healing in accordance  with the practices or tenants  of a church                                                               
or  religious denomination  that  teaches  reliance on  spiritual                                                               
means through prayer for healing."                                                                                              
3:05:46 PM                                                                                                                    
PATRICIA  BOILY, representing  herself,  Homer,  had some  issues                                                               
with SB  160. Her impression  is that the insurance  industry has                                                               
had quite a hand in developing much of the criteria in this bill                                                                
CHAIR ELLIS remarked "Well, not really."                                                                                        
MS. BOILY said she works in  the health care industry and has had                                                               
to plead financial bankruptcy because  of health care. One of her                                                               
concerns was  the eligibility  to get  these services  in Section                                                               
21.54.240  that   excludes  people  who  already   have  coverage                                                               
regardless of how  expensive it may be, and it  doesn't matter if                                                               
the  coverage  is  different.  It also  excludes  anyone  who  is                                                               
already covered  by ACHIA,  which is a  category she  falls into,                                                               
although  reluctantly. She  explained that  she had  group health                                                               
for 12  years, but  it terminated  on 10/31  through no  fault of                                                               
hers or  her employer's  and neither she  nor her  employer could                                                               
find affordable  health insurance  to replace it.  In the  end he                                                               
offered to subsidize individual plans,  which was fine for people                                                               
who were under 50 without past medical histories.                                                                               
While at  58 years old,  she doesn't consider  herself unhealthy,                                                               
but she was  denied coverage. She further stated  that 25 percent                                                               
of  women over  50 are  denied  health care  insurance. Her  only                                                               
option  to appeal  the  denial  was to  send  her entire  medical                                                               
record  to them,  which to  her  was an  intolerable invasion  of                                                               
privacy.  She  settled   for  the  ACHIA  plan   with  the  $5000                                                               
deductible. So, if  she gets sick or injured this  year enough to                                                               
actually use it, it will start  out by costing her $16000. If she                                                               
stays well  enough that she  doesn't make her deductible  it will                                                               
still cost her almost $10000 - plus up the $5000 deductible.                                                                    
MS. BOILY said she has worked  for the same employer for 20 years                                                               
and finding  herself in  this predicament  is unsettling,  to say                                                               
the very least.  But to go without any insurance  at all puts her                                                               
family and her future at incredible risk.                                                                                       
She said that small businesses  in Alaska are having a particular                                                               
hard  time   in  today's   market.  They   are  not   allowed  to                                                               
discriminate  against their  employees based  on age  or sex  and                                                               
they are  required to  abide by  the Americans  with Disabilities                                                               
Act. Yet  when they purchase  insurance for their  employees, the                                                               
quotes they get back are based  entirely on the ages, the sex and                                                               
the past medical histories of their employees. She said:                                                                        
     This is wrong and Alaska needs  to step up to the plate                                                                    
     and  stop  the  insurance   industry  from  making  its                                                                    
     profits  off  the  relatively  healthy,  while  leaving                                                                    
     those  with  maturity   and  experience  scrambling  to                                                                    
     protect  their  homes,  their life  savings  and  their                                                                    
     financial security.  Alaska needs  to address  the dual                                                                    
     standards   that   force   businesses   to   be   equal                                                                    
     opportunity employers  yet denies  them the  ability to                                                                    
     offer their employees affordable health care coverage.                                                                     
3:09:17 PM                                                                                                                    
She said  SB 160 "needs  more tweaking." All  Alaskans regardless                                                               
of what  coverage they have  currently should have the  option to                                                               
improve their situation. She suggested  the insurance industry is                                                               
practicing  discrimination  while  charging too  much  for  their                                                               
MS.  BOILY took  issue with  some of  Ms. Hall's  statements that                                                               
health care premiums are high because  of the high cost of health                                                               
care. But  this is  an industry  that pays  its CEOs  millions of                                                               
dollars in salaries, stock options and other benefits.                                                                          
3:12:29 PM                                                                                                                    
ANDY MODEROW, staff  to Senator French, said  the website Senator                                                               
French created  over the  summer to  share information  about the                                                               
bill  is   at  www.healthyalaskans.com.   In  addition   to  bill                                                               
documents, it has an interactive  calculator for comparing health                                                               
care costs in different states.                                                                                                 
CHAIR ELLIS  said he  would hold  SB 160  for a  further hearing.                                                               
There being no further business  to come before the committee, he                                                               
adjourned the meeting at 3:15:01 PM.                                                                                          

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