Legislature(2007 - 2008)BELTZ 211

03/11/2008 01:30 PM LABOR & COMMERCE

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* first hearing in first committee of referral
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= bill was previously heard/scheduled
Heard & Held
Heard & Held
Bills Previously Heard/Scheduled
Including But Not Limited to:
Heard & Held
Moved SB 289 Out of Committee
Moved HJR 25 Out of Committee
             SB 160-MANDATORY UNIVERSAL HEALTH CARE                                                                         
2:34:14 PM                                                                                                                    
CHAIR  ELLIS announced  SB 160  to be  up for  consideration. The                                                               
committee had CSSB 160(L&C), 25-LS0728\T to consider.                                                                           
SENATOR FRENCH, sponsor of SB 160,  said he would comment on CSSB                                                               
160(L&C), 25-LS0728\T. He  said it makes six  changes, some small                                                               
and  some fairly  significant. The  first  change is  on page  3,                                                               
lines 15-17, that  broadens the view points  that are represented                                                               
on the Health Care Board.  Concerns were heard from insurers that                                                               
the  definition of  entities  that would  make  up the  insurance                                                               
representatives  on the  board was  too  narrow. So  now the  two                                                               
representatives are  one large scale  wholesaler and  small scale                                                               
retailer.  He  explained the  retailer  is  called an  "insurance                                                               
producer," an industry term that  refers to the customer oriented                                                               
on-the-ground insurance retailer.                                                                                               
2:36:20 PM                                                                                                                    
The second change is on page  5, lines 6-8, and clearly gives the                                                               
duty to the  board of making a plan that  can effectively protect                                                               
an individual from severe financial  hardship in times of medical                                                               
need  -  taking  into  account a  household's  income  and  other                                                               
relevant financial criteria. He said,  "It will make certain that                                                               
insurance  is  meaningful  for   each  Alaskan  since  a  $10,000                                                               
deductible health  care plan isn't  much use to a  household that                                                               
earns $15,000 a year."                                                                                                          
2:36:50 PM                                                                                                                    
SENATOR  FRENCH said  the  third  change came  in  response to  a                                                               
concern of Senator Stevens. It removes  a few words from what was                                                               
subsection  7 on  page  6.  It used  to  say  that Indian  Health                                                               
Service (IHS)  benefits had  to meet or  exceed the  benefits for                                                               
essential  health care  services as  defined in  the legislation.                                                               
That has been  removed to make it clear that  individuals who are                                                               
satisfied  with  the care  they  receive  through IHS  facilities                                                               
won't be subject  to the requirement to  have additional coverage                                                               
- even if  the IHS benefits don't line up  exactly with essential                                                               
health  care services.  To a  large extent,  this alleviates  the                                                               
fine  decisions the  board  would have  to make  as  to each  IHS                                                               
recipient and whether  the benefits they receive  met or exceeded                                                               
those adopted by the plan.                                                                                                      
He said he worked with  tribal representatives, and the important                                                               
facts to  keep in mind when  looking at the interplay  between SB                                                               
160 and  the IHS  system are  first, that  any third  party payer                                                               
will  be first  in line  if an  IHS beneficiary  with third-party                                                               
insurance walks into  a clinic anywhere if they  have third party                                                               
insurance. The  second thing  to remember is  that the  amount of                                                               
money dedicated  by the federal  government to  IHS beneficiaries                                                               
is fixed  every year; it is  distributed at the beginning  of the                                                               
year and  that's the end  of it. It  is not limitless.  They have                                                               
enough  money for  day-to-day clinic  visits and  check ups,  but                                                               
when it  comes to bone  marrow transplants or a  knee replacement                                                               
or heart surgery, they may  be "rationed out," because the amount                                                               
of money allocated  that year has been used up.  So in essence SB                                                               
160 helps add to the care of any IHS beneficiary in the state.                                                                  
SENATOR FRENCH  said IHS beneficiaries  receive on  average about                                                               
$2,000  per  individual  spread   across  the  entire  population                                                               
whereas someone outside the IHS  receives about $4,000 to $5,000.                                                               
SB  160 allows  any  IHS beneficiary  to join  the  plan if  they                                                               
choose or not depending on how  satisfied they are with their own                                                               
personal situation.  Senator French said,  "SB 160 will  not back                                                               
out a single  federal dollar that is currently  being received in                                                               
Alaska for  the benefit of  IHS beneficiaries." He said  this was                                                               
the most complex change even though  it was just the reduction of                                                               
a few words.                                                                                                                    
The fourth  change was  on page  6, lines 11-14,  that has  to do                                                               
with concerns  on behalf  of the  Christian Science  Religion who                                                               
eschew  modern  medical  practices.  So SB  160  has  allowed  an                                                               
exemption for those  individuals. If they can  demonstrate to the                                                               
board that  their deeply held  religious beliefs are  contrary to                                                               
this program, they don't have  to participate. Exemptions will be                                                               
rigorously granted.                                                                                                             
SENATOR FRENCH  said the next  change is how "employees"  and the                                                               
"employer levy"  are defined. There  was concern  that "employee"                                                               
was  defined  too  broadly.  Imagine  a  business  that  employed                                                               
nothing  but military  spouses  or spouses  of  state or  federal                                                               
employees - all covered by  health insurance. There is absolutely                                                               
no need to apply an  employer levy against that employer, because                                                               
not a single one of  those individuals needs health insurance. So                                                               
an  "employee"  is   defined  as  someone  who   is  required  to                                                               
participate in the  Alaska Health Care Plan on page  8, lines 11-                                                               
20 and that means they don't have coverage anywhere else.                                                                       
2:42:06 PM                                                                                                                    
He  said  the  second  change  is with  counting  the  number  of                                                               
employees, because  you get  into problems  of defining  how many                                                               
hours a  week that  is. So,  they went  with the  payroll number,                                                               
which is  roughly equal  to what one  would imagine  10 full-time                                                               
employee equivalents  is - the  $500,000 figure. He  explained if                                                               
your  total  payroll  of  employees   that  don't  have  coverage                                                               
anywhere else  is $500,000 or  less, no levy whatsoever.  If it's                                                               
between  $500,000 and  $1,000,000 it's  1 percent;  if it's  over                                                               
$1,000,000 it's  2 percent.  This is  more business  friendly and                                                               
easier to understand.                                                                                                           
Finally,  he said  language  on  page 12,  line  18, changes  the                                                               
effective dates  to comport with  concerns Legislative  Legal had                                                               
regarding adoption of regulations.                                                                                              
2:43:48 PM                                                                                                                    
MARY  RAYMOND,  representing  herself   from  Homer,  said  after                                                               
listening  to task  forces and  various bills  to get  affordable                                                               
insurance  for the  last  20  years this  is  very exciting.  Her                                                               
concern that it was promoted as compulsory had been addressed.                                                                  
2:45:09 PM                                                                                                                    
PATRICK  DALTON,  Delta  Junction, representing  himself,  agreed                                                               
with  the public  oversight provision.  He also  suggested having                                                               
two alternative health  professionals on the Health  Care Board -                                                               
naturopath or  herbologist. However, he asserted  the legislature                                                               
has no constitutional authority to  require a citizen to contract                                                               
into any health care plan whatsoever.                                                                                           
Second, Mr. Dalton  said, an element of  hypocrisy exists because                                                               
SB 160 requires  everyone to have a health care  card and then it                                                               
turns  around and  denies coverage  to any  Alaskan who  does not                                                               
have one. He said the "preamble"  of the bill clearly states that                                                               
all  Alaskans  are  eligible  for  this  and  he  suggested  just                                                               
expanding health care coverage to  any Alaskan who can prove they                                                               
are a citizen or a resident.  That way compliance doesn't have to                                                               
be forced.  Furthermore, he asked  what criminal  penalties there                                                               
are for  not partaking in  the system.  Finally, he said  if they                                                               
have  to require  health care  coverage, even  though he  doesn't                                                               
think they  have the  right to  do that,  he suggested  having an                                                               
opt-out system.  He also asked  how someone can  demonstrate they                                                               
have  a firmly  held  religious belief  that  being a  subjective                                                               
CHAIR ELLIS thanked everyone for  sharing their thoughts and said                                                               
he would  hold SB 160  for further  work. There being  no further                                                               
business to come  before the committee, he  adjourned the meeting                                                               
at 2:49:27 PM.                                                                                                                

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