Legislature(2011 - 2012)BELTZ 105 (TSBldg)

04/14/2011 02:00 PM LABOR & COMMERCE


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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+= SB 74 INS. COVERAGE: AUTISM SPECTRUM DISORDER TELECONFERENCED
Moved SB 74 Out of Committee
+ SB 119 ATHLETIC TRAINER LICENSING TELECONFERENCED
Moved CSSB 119(L&C) Out of Committee
Bills Previously Heard/Scheduled
+= HB 164 INSURANCE: HEALTH CARE & OTHER TELECONFERENCED
Moved SCS CSHB 164(L&C) Out of Committee
+= HB 188 INTEREST RATES TELECONFERENCED
Moved HB 188 Out of Committee
         SB  74-INS. COVERAGE: AUTISM SPECTRUM DISORDER                                                                     
                                                                                                                                
2:26:41 PM                                                                                                                    
CHAIR EGAN announced SB 74 to  be up for consideration. He opened                                                               
public testimony.                                                                                                               
                                                                                                                                
2:26:58 PM                                                                                                                    
AMORY  LELAKE, staff  to Senator  Ellis, sponsor  of SB  74, said                                                               
this bill would help children  with autism get the treatment they                                                               
need while increasing  the number of autism  service providers in                                                               
Alaska and  lowering special education and  social service costs.                                                               
Autism  is a  devastating disorder  affecting at  least 1  in 110                                                               
American  children and  despite  being  treatable, most  children                                                               
diagnosed with autism spectrum disorders  (ASD) don't receive the                                                               
treatment they need.                                                                                                            
                                                                                                                                
SB  74  would  require  insurance  coverage  for  ASDs  including                                                               
evidence-based  medically  necessary  applied  behavior  analysis                                                               
(ABA) that have  shown to be an extremely  effective treatment of                                                               
these  disorders.  ABA  is  a  scientifically  driven,  validated                                                               
approach  to learning  and/or  change of  behavior  and has  been                                                               
widely accepted  as an effective treatment.  The American Academy                                                               
of  Pediatrics and  the  U.S. Surgeon  General  have both  issued                                                               
reports corroborating these findings.                                                                                           
                                                                                                                                
MS.  LELAKE  said  that   most  insurance  policies  specifically                                                               
exclude coverage for  treating autism even when  the services are                                                               
otherwise covered by  a health plan. In the  absence of coverage,                                                               
families are  often forced  to cover expenses  out of  pocket. In                                                               
the process,  many risk their  homes and the educations  of their                                                               
unaffected children.                                                                                                            
                                                                                                                                
According  to  the  Alaska  Department  of  Education  and  Early                                                               
Childhood Development,  in 1994, 37 children  enrolled in special                                                               
education were classified as having  autism. In 2006, that number                                                               
had grown to 477, an increase of 1200 percent.                                                                                  
                                                                                                                                
She said for  many parents school services are  a substitute from                                                               
private insurance  services. The goal of  the educational system,                                                               
of course,  is not  to provide  medical service.  Schools provide                                                               
speech therapy and other related  services to enable a child with                                                               
a disability to receive a  free appropriate public education. The                                                               
ability  of  schools  to educate  children  is  compromised  when                                                               
children  with  autism  don't receive  appropriate  care  through                                                               
private insurance.                                                                                                              
                                                                                                                                
MS.  LELAKE  said a  total  of  35  states  and the  District  of                                                               
Columbia have laws  related to autism and  insurance coverage. At                                                               
least  25   states  specifically  require  insurers   to  provide                                                               
coverage for the treatment of autism.                                                                                           
                                                                                                                                
According to  the Governor's Council on  Disabilities and Special                                                               
Education, insurance coverage of treatment  of ASDs will save the                                                               
state  $208,500 per  capita in  avoided  special education  costs                                                               
with a lifetime savings of $1.8 million per capita.                                                                             
                                                                                                                                
2:30:22 PM                                                                                                                    
According to  a Harvard economist's  study of the  societal costs                                                               
of  autism, every  new child  diagnosed with  autism that  is not                                                               
treated costs  an estimated $3.2  million over their  lifetime. A                                                               
majority  of   children  with  autism  who   receive  appropriate                                                               
intervention  and  treatment  experience marked  improvement;  47                                                               
percent  recover typical  function, 40  percent make  significant                                                               
improvement  and  the  remaining 13  percent  unfortunately  make                                                               
little progress.                                                                                                                
                                                                                                                                
Early  intervention  and  treatment  work,  she  said.  Insurance                                                               
coverage of  ASDs can save  the state millions  and significantly                                                               
improve the lives of thousands of Alaskan children and families.                                                                
                                                                                                                                
MS.  LELAKE  said  that  many   families  are  unable  to  afford                                                               
treatment and  this limits the  number of providers  available in                                                               
Alaska.  According  to  the  Behavior  Analyst  Certifying  Board                                                               
(BACB) there are currently only  seven certified applied behavior                                                               
analysts  in  Alaska.  Although,  since  South  Carolina  adopted                                                               
similar  legislation three  years  ago, the  number of  certified                                                               
applied   behavior  analysts   has   increased  three-fold.   The                                                               
University of Alaska is working  to increase the ABA workforce in                                                               
Alaska   and   currently   17    people   are   working   towards                                                               
certification.                                                                                                                  
                                                                                                                                
Without  the   help  of  private  insurance   coverage,  families                                                               
affected by  autism may never  be able  to get their  heads above                                                               
water  and provide  their children  with the  medically necessary                                                               
evidence-based treatments  they need. It  is to the  advantage of                                                               
these Alaskan families and to  all of society that private health                                                               
insurance coverage provides these services.                                                                                     
                                                                                                                                
MS. LELAKE said  the supporters of this  legislation are: Senator                                                               
Ellis,  Representative   Peterson,  the  Governor's   Council  on                                                               
Disabilities, the  Mental Health Trust Authority,  the Stone Soup                                                               
Group,   the  Alaska   Primary  Care   Association,  the   Alaska                                                               
Association of Homes for Children,  the Key Coalition, the Alaska                                                               
Nurses Association and many others.                                                                                             
                                                                                                                                
2:32:33 PM                                                                                                                    
She walked  the committee  through the bill.  Section 1,  page 1,                                                               
line 1, through  page 3, line 21, amends as  AS 21.42 by creating                                                               
a new  section AS  21.42.397 relating  to insurance  coverage for                                                               
autism  spectrum  disorders.  Subsection  (a), page  1,  line  1,                                                               
through  page  2, line  12,  requires  insurance plans  to  cover                                                               
medically necessary treatment for  ASDs and exempts plans offered                                                               
by fraternal benefit societies.                                                                                                 
                                                                                                                                
Subsection  (b),  page  2,  lines   13-23,  further  defines  the                                                               
coverage that  must be  provided. Subsection  (c), page  2, lines                                                               
24-25,  establishes that  this section  does  not limit  coverage                                                               
already provided. Subsection (d),  page 2, lines 26-28, prohibits                                                               
an  insurance company  from denying  coverage to  someone because                                                               
they have an  ASD. Subsection (e), page 2, line  29, through page                                                               
3, line  21, defines "autism service  provider," "autism spectrum                                                               
disorders,"   "health   care   insurance  plan,"   "health   care                                                               
insurance," and "medically necessary."                                                                                          
                                                                                                                                
Section  2,   page  2,  lines   22-26,  establishes   that  these                                                               
provisions in section  1 only apply to  insurance policies issued                                                               
after January  1, 2012. Section  3, page 3, line  27, establishes                                                               
and immediate effective date.                                                                                                   
                                                                                                                                
2:34:18 PM                                                                                                                    
REPRESENTATIVE PETERSEN, sponsor  of HB 79, companion  bill to SB                                                               
74, said  they had worked very  hard on this bill  going on three                                                               
years  and he  supported  it.  He said  every  day  this bill  is                                                               
delayed there are  children who are losing  opportunities to have                                                               
a chance at a normal life.                                                                                                      
                                                                                                                                
2:35:44 PM                                                                                                                    
TONJA  UPDIKE, member,  Governor's  Council  on Disabilities  and                                                               
Special Education, said  she is also the mother of  an ASD child.                                                               
She very strongly supported SB 74.  She said it is frustrating to                                                               
not be  able to get  private insurance  for him. They  will cover                                                               
the  rest of  her family,  but  not her  ASD child.  When he  was                                                               
diagnosed he  was not quite  2 and now he's  8 years old  and has                                                               
come very far in so many  ways, a real testament to the treatment                                                               
he has received. She said she  knows that everybody wants to save                                                               
money, so  it's important to note  that if you spend  money early                                                               
on to  treat ASD, you're not  going to be spending  as much later                                                               
on  through the  child's  life. She  said  1,512 students  across                                                               
Alaska  are  now  diagnosed  with   autism;  many  more  will  be                                                               
diagnosed in the future.                                                                                                        
                                                                                                                                
2:38:01 PM                                                                                                                    
MILLIE   RYAN,   Executive   Director,  Governor's   Council   on                                                               
Disabilities  and  Special  Education,   said  that  the  Council                                                               
strongly  supports SB  74.  She  said their  letter  goes into  a                                                               
little more detail and offered to answer questions.                                                                             
                                                                                                                                
2:38:55 PM                                                                                                                    
LEN  SORREN, Legislative  Affairs Group,  BlueCross/BlueShield of                                                               
Alaska, said their several concerns  about SB 74 were outlined in                                                               
a  letter  submitted to  the  committee.  He said  "this  benefit                                                               
mandate"  will  increase costs  for  individual  and small  group                                                               
employer  plans across  the State  of  Alaska on  top of  federal                                                               
health care  reform requirements which were  implemented for most                                                               
plans  in  January. Individual  plans  at  that  time saw  a  2-4                                                               
percent increase.  Their estimates  indicate that the  mandate in                                                               
this bill could  add as much as  3 percent to the  cost of health                                                               
insurance premiums in Alaska.                                                                                                   
                                                                                                                                
He  shared  a cost  analysis  provided  to the  Washington  State                                                               
Legislature  on a  very  similar bill  that  was introduced  this                                                               
session.  Washington  State's   Office  of  Financial  Management                                                               
estimated that the  impact of the autism mandate  to state health                                                               
plans would be  $140 million over the two-year  budget growing to                                                               
over $200 million over subsequent years.                                                                                        
                                                                                                                                
He said  any state mandates  that go beyond the  essential health                                                               
benefits package that  will be designated under  federal law must                                                               
be paid for by the  state for all individuals receiving subsidies                                                               
through  the  exchanges.  The  federal  government  is  currently                                                               
working on  these benefits and he  believes it is prudent  to see                                                               
how their work is completed  to determine whether the state would                                                               
have substantial additional benefit costs.                                                                                      
                                                                                                                                
MR. SORREN said individual and  small group insurance markets are                                                               
already under  tremendous cost and  price pressures and  they are                                                               
concerned that SB 74 will simply add another cost burden.                                                                       
                                                                                                                                
2:41:34 PM                                                                                                                    
SENATOR MENARD  said he was citing  Washington State legislation,                                                               
but does exactly mirror SB 74?                                                                                                  
                                                                                                                                
MR.  SORREN replied  yes.  The  $140 million  was  a fiscal  note                                                               
attached to  the Washington bill  that relates to  the Washington                                                               
employee health plans (called Healthy  Options in Washington) and                                                               
Medicaid.                                                                                                                       
                                                                                                                                
SENATOR MENARD asked  if he agreed that by  doing nothing society                                                               
faces  $3.2 million  in costs  over the  lifetime of  an autistic                                                               
child.                                                                                                                          
                                                                                                                                
MS. SORREN  replied that he didn't  know. There are a  variety of                                                               
requirements  under  federal  law   that  requires  ASD  services                                                               
through public schools  across the United States.  They have some                                                               
concern  that this  becomes  a cost  transfer  from the  existing                                                               
federal  requirement to  the private  insurance market  in Alaska                                                               
that is already stressed.                                                                                                       
                                                                                                                                
SENATOR GIESSEL asked  if SB 74 places this mandate  on the State                                                               
of Alaska's insured population, that is to say, state employees.                                                                
                                                                                                                                
MR. SORREN replied that he didn't  know the answer, but he wanted                                                               
to  provide  them  with  the  State  of  Washington's  Office  of                                                               
Financial Management  estimate so they  have an idea of  the cost                                                               
of  the  mandate  without  specific reference  to  the  State  of                                                               
Alaska's health plan.                                                                                                           
                                                                                                                                
2:44:24 PM                                                                                                                    
SENATOR  DAVIS  said  Washington  has a  bigger  population  than                                                               
Alaska and  she asked what  his estimate was for  implementing SB                                                               
74 in Alaska.                                                                                                                   
                                                                                                                                
MR. SORREN replied  he didn't have those figures  for Alaska, but                                                               
he did have  an actuarial estimate that the mandate  in this bill                                                               
could add  as much as 3  percent to the cost  of health insurance                                                               
premiums across  the individual  and small  group markets  in the                                                               
State of Alaska.                                                                                                                
                                                                                                                                
SENATOR DAVIS responded that even  at 3 percent, it wouldn't come                                                               
anywhere near the Washington State figures he provided.                                                                         
                                                                                                                                
MR. SORREN responded, "It may or  it may not." He didn't know the                                                               
number of covered  persons involved in Alaska that  the 3 percent                                                               
would need to  be multiplied by. But by anyone's  estimation, a 3                                                               
percent increase in response to a single mandate is substantial.                                                                
                                                                                                                                
SENATOR DAVIS asked  when would be the right time  to take action                                                               
if not now.                                                                                                                     
                                                                                                                                
MR. SORREN answered  that it would be prudent for  Alaska to wait                                                               
until  the essential  benefits package  under the  federal health                                                               
care reform bill is made  clear from Washington, D.C. Then Alaska                                                               
could make  an informed judgment whether  this additional benefit                                                               
would be the state's cost  for all subsidized folks going through                                                               
the exchange or a benefit under  federal law and therefore not at                                                               
the state's expense.                                                                                                            
                                                                                                                                
The other  possible avenue to think  through as a way  for making                                                               
this  available  is giving  individual  employers  the option  of                                                               
covering  this in  the event  they chose  to bear  the additional                                                               
cost.                                                                                                                           
                                                                                                                                
2:47:21 PM                                                                                                                    
LORRI  UNUMB, counsel,  National Office  of Autism  Speaks, South                                                               
Carolina, said  she is also  the parent  of a child  with autism,                                                               
and said  she supported  SB 74.  She provided  a power  point and                                                               
asked  them to  go to  slide 17,  the hard  cost data  for autism                                                               
insurance.                                                                                                                      
                                                                                                                                
She  explained that  in 2007  South  Carolina passed  legislation                                                               
very  similar  to what  they  are  considering. So,  rather  than                                                               
looking at any  estimates from states that  are still considering                                                               
legislation, she suggested  they look at the hard  cost data. The                                                               
entire  cost to  the state  for providing  coverage to  the state                                                               
employee health  plan during 2010  was $2 million,  a per-member,                                                               
per-month  increase  of  44  cents.   So,  yes,  this  does  cost                                                               
something, but  there has been no  state that has documented  a 3                                                               
percent cost increase  or even 2 or 1 percent  cost increase. The                                                               
states that now have data  on this coverage have documented costs                                                               
increases of  around .1  percent or  .2 percent.  Translated into                                                               
dollars in  South Carolina that came  out to 44 cents  per member                                                               
per month. She didn't know of  anyone who would not be willing to                                                               
an extra  pay 44  cents a month  so that all  of the  children in                                                               
Alaska could get the treatment their doctors prescribe.                                                                         
                                                                                                                                
She asked them  to be mindful that these families  are not asking                                                               
for  a  handout; these  are  families  who are  working,  they've                                                               
bought insurance and are paying  their premiums every month. They                                                               
want their end of the  bargain; they have insured against medical                                                               
disaster.  It  has now  befallen  their  children and  they  want                                                               
coverage for the recommended treatments.                                                                                        
                                                                                                                                
MS. UNUMB  said state  employees are not  included in  the Alaska                                                               
bill, so the $100 million cost  impact is not transferable to the                                                               
state even if  it were a close to accurate  figure. She also said                                                               
that  25 other  states have  already passed  similar legislation.                                                               
Two  states have  already passed  it  this year  and waiting  for                                                               
federal  health care  reform  is not  a good  reason  to wait  on                                                               
moving  this  legislation forward.  They  do  not know  what  the                                                               
essential benefits package under  federal health care reform will                                                               
include,  but  they have  lots  of  reasons  to believe  it  will                                                               
include ABA therapy for children with autism.                                                                                   
                                                                                                                                
2:51:46 PM                                                                                                                    
SENATOR MENARD said for the record  that she read that autism has                                                               
had  a 600  percent  increase over  the last  20  years. Is  that                                                               
nation-wide?                                                                                                                    
                                                                                                                                
MS. UNUMB replied yes.                                                                                                          
                                                                                                                                
SENATOR MENARD asked Ms. Lelake what the increase is in Alaska.                                                                 
                                                                                                                                
MS. LELAKE replied that she  didn't know the percentage, but they                                                               
do know according  to the Governor's Council  on Disabilities and                                                               
Special Education  there are about  1500 children in  Alaska with                                                               
autism.  Between 1994  and 2006  the school  district saw  a 1200                                                               
percent increase.                                                                                                               
                                                                                                                                
SENATOR MENARD  said she  knows the MatSu  Borough has  over 2500                                                               
students  (6.5  percent)  with special  disabilities;  it  is  an                                                               
increasing cost  that has to  be looked at. She  wanted realistic                                                               
numbers because of Alaska's small population.                                                                                   
                                                                                                                                
2:53:36 PM                                                                                                                    
MARC LAMBRIGHT,  principal and  consulting actuary,  Oliver Wyman                                                               
Actuarial  Consulting, said  he  prepared a  very detailed  cross                                                               
analysis of the cost for  various insurance markets in Alaska. He                                                               
said  he completed  similar analyses  in  approximately 20  other                                                               
states;  and  the  analysis  has   been  made  available  to  the                                                               
committee.                                                                                                                      
                                                                                                                                
Brief highlights of  the report are that page  8 provides several                                                               
examples of  some very low  initial and ongoing costs  for states                                                               
that  have mandated  autism coverage.  Pages 9-15  of the  report                                                               
provide  very  extensive detail  regarding  the  drivers of  cost                                                               
estimates   including  treated   prevalency  to   diagnosis,  ABA                                                               
utilization and  unit costs. His  cost estimates are  outlined on                                                               
page 17;  they indicate an  anticipated cost per member  of about                                                               
$20 per year or about $1.50  per month. That would translate into                                                               
about .04  to .05 percent of  the average premiums in  Alaska and                                                               
an increase of .3 to .7 percent in premiums.                                                                                    
                                                                                                                                
He said there has been no  indication anywhere cost data has been                                                               
collected that costs have been  anywhere near the 3 percent level                                                               
and  typically  they  are  less   than  one-half  of  1  percent.                                                               
Secondly,  he said  there have  been a  lot of  other independent                                                               
actuarial  analyses completed  and  typically  the cost  estimate                                                               
outlined in them is one-half of 1 percent of premium.                                                                           
                                                                                                                                
2:56:29 PM                                                                                                                    
KARA   THRASHER  LIVINGSTON,   representing  herself,   said  she                                                               
supported SB  74. She  said she has  two children  who experience                                                               
autism  and received  early  intervention  and special  education                                                               
from the  school district. But  it would  have been nice  to have                                                               
the choice of having their  therapy covered by insurance as well.                                                               
Having worked  in long term  care, she can understand  how having                                                               
enhanced  early intervention  available through  therapy such  as                                                               
ABA  would result  in lower  costs over  a child's  lifespan. She                                                               
thought Alaskans would be willing to pay the added cost.                                                                        
                                                                                                                                
2:58:17 PM                                                                                                                    
DEBBIE THOMPSON,  Executive Director, Alaska  Nurses Association,                                                               
said  they  support  SB  74.  It   is  the  right  thing  to  do.                                                               
They must look at what the costs  are now as opposed to what they                                                               
would be  later in an  autistic child's life. The  treatment will                                                               
impact the  lives of not only  the child with autism,  but all of                                                               
their family members and those that are around them.                                                                            
                                                                                                                                
2:59:13 PM                                                                                                                    
LINDA  ROBERTSON, business  partner, Step-In  Autism Services  of                                                               
Alaska,  Fairbanks, supported  SB 74.  They are  finding families                                                               
that  are very  desperate  for services  and  they can't  provide                                                               
them, because  these families are  not able to  provide insurance                                                               
payments  and   are  not  eligible   for  Medicaid   or  Tri-Care                                                               
Insurance. The reason they provide  ABA applied behavior analysis                                                               
is because  it is  the most effective  treatment they  have found                                                               
for kids  with autism. She  said she  had worked in  Alaska since                                                               
1981 and has spent 35 years  as a special educator and found that                                                               
children with autism are the  most difficult to reach and applied                                                               
behavior  analysis allows  them to  do that.  The right  services                                                               
provide incredible differences.                                                                                                 
                                                                                                                                
MS.  ROBERTSON said  the  intensive  ABA is  not  offered in  the                                                               
school system, although many families  get it privately. She said                                                               
they are very eager to bring  this service to as many families in                                                               
Alaska  as  possible  who  have children  with  autism  or  other                                                               
disabilities.                                                                                                                   
                                                                                                                                
3:01:39 PM                                                                                                                    
EMILY ICE,  business partner, Step-In Autism  Services of Alaska,                                                               
Fairbanks, offered her support for SB 74, as well.                                                                              
                                                                                                                                
SENATOR GIESSEL  said one paper  provided by Ms.  Hall summarized                                                               
those who are  affected by SB 74. It says  self-insured plans are                                                               
not currently subject to mandates.  That means that TERS and PERS                                                               
beneficiaries would not be required to provide this coverage.                                                                   
                                                                                                                                
LINDA  HALL,  Director,  Division  of  Insurance,  Department  of                                                               
Commerce,  Community and  Economic Development  (DCCED), answered                                                               
that is accurate.                                                                                                               
                                                                                                                                
SENATOR GIESSEL said  that shows to be 34 percent  of the state's                                                               
population.  And  15  percent  of the  plans  that  are  directly                                                               
affected by SB 74 are those that are bought privately.                                                                          
                                                                                                                                
MS. HALL agreed.                                                                                                                
                                                                                                                                
SENATOR  GIESSEL  asked if  that  includes  small businesses  and                                                               
employers that provide insurance.                                                                                               
                                                                                                                                
MS. HALL  replied yes;  it applies to  the individual  market and                                                               
predominantly  the small  group market.  Most but  not all  large                                                               
employers do  their health benefits  through a  self-insured plan                                                               
which is regulated the federal Department of Labor.                                                                             
                                                                                                                                
SENATOR GIESSEL  asked if Medicaid  in Alaska  currently provides                                                               
some treatment for ASD.                                                                                                         
                                                                                                                                
MS. HALL replied that she didn't know what Medicaid covers.                                                                     
                                                                                                                                
SENATOR GIESSEL asked if SB 74 would affect Medicaid.                                                                           
                                                                                                                                
MS. HALL replied no.                                                                                                            
                                                                                                                                
SENATOR  GIESSEL asked  if  she said  the  Indian Health  Service                                                               
already covers autism.                                                                                                          
                                                                                                                                
MS.  HALL replied  that she  would  not have  commented on  those                                                               
types  of  programs,  because  she  didn't  have  any  particular                                                               
knowledge of them.                                                                                                              
                                                                                                                                
SENATOR GIESSEL  said she was trying  to figure out who  is going                                                               
to be affected by SB 74 and it  looks like on her chart that it's                                                               
going to be 15 percent of the Alaska population. Is that true?                                                                  
                                                                                                                                
MS. HALL  replied that is true;  when you add a  mandate to Title                                                               
21, the  insurance code,  it only  impacts the  private regulated                                                               
insurance market  unless the bill contains  other provisions that                                                               
broaden the mandate.                                                                                                            
                                                                                                                                
SENATOR  GIESSEL asked  what she  thought about  the added  costs                                                               
being applied to only 15 percent of the state's population.                                                                     
                                                                                                                                
MS. HALL  replied that  she didn't have  that estimate.  She said                                                               
her  division does  a rate  review of  just one  company and  she                                                               
wouldn't  have any  way  to  estimate the  cost  of a  particular                                                               
mandate going forward.                                                                                                          
                                                                                                                                
SENATOR  GIESSEL asked  how many  insurance  mandates Alaska  has                                                               
now.                                                                                                                            
                                                                                                                                
MS. HALL replied 15 benefit mandates.                                                                                           
                                                                                                                                
SENATOR  GIESSEL asked  how much  that adds  to the  cost of  the                                                               
premium.                                                                                                                        
                                                                                                                                
MS. HALL answered that don't  have that information although they                                                               
have tried to get it.                                                                                                           
                                                                                                                                
3:08:25 PM                                                                                                                    
SENATOR  PASKVAN  asked  if  testimony  about  avoided  costs  is                                                               
accurate.                                                                                                                       
                                                                                                                                
MS. HALL  replied that she didn't  have any idea about  the other                                                               
costs.                                                                                                                          
                                                                                                                                
SENATOR GIESSEL asked  her why the cost of health  care is higher                                                               
in Alaska than in other states.                                                                                                 
                                                                                                                                
MS.  HALL   answered  no;  their   study  only  shows   what  the                                                               
differentials are  and that  Alaska has  the highest  health care                                                               
costs  in  the  country.  Correspondingly, Alaska  also  has  the                                                               
highest health  insurance premiums in the  country. She estimates                                                               
just between  Seattle and Anchorage  there is anywhere from  a 30                                                               
to 150 percent higher cost for procedures in Alaska.                                                                            
                                                                                                                                
CHAIR EGAN asked if the administration had a position on SB 74.                                                                 
                                                                                                                                
MS.  HALL  replied  that  the  administration  had  not  taken  a                                                               
position.                                                                                                                       
                                                                                                                                
SENATOR GIESSEL  said she  thought there  were things  they don't                                                               
know about the  impacts of adding this mandate to  the 15 percent                                                               
of Alaskans. Already,  16 percent of the  Alaska population can't                                                               
afford  health  insurance now  and  she  wanted more  information                                                               
about what the premiums would look like.                                                                                        
                                                                                                                                
SENATOR PASKVAN said they had heard  a lot of testimony about how                                                               
the avoided costs of early  treatment are so significant that the                                                               
cost of not  doing something to society is much  greater than the                                                               
cost of  the de minimis expenditure  at this time. He  would like                                                               
to move the bill.                                                                                                               
                                                                                                                                
SENATOR  DAVIS said  she  would like  to move  it,  too. But  she                                                               
stated that she  didn't think the impact would be  on just the 15                                                               
percent population and that other  agencies provide some services                                                               
for autism.                                                                                                                     
                                                                                                                                
SENATOR GIESSEL clarified  that the cost of this  will be shifted                                                               
to 15 percent of the population  who are at this time under state                                                               
regulated health insurance.  Her concern is that  this will shift                                                               
the cost  to small  businesses that are  struggling right  now to                                                               
provide insurance for their employees  and are managing to do it;                                                               
but additional cost will cause  those employers to maybe say they                                                               
can no longer provide insurance.  Moving that 15 percent piece of                                                               
the  pie over  to  the 16  percent of  uninsured  in Alaska  will                                                               
escalate health care problems.                                                                                                  
                                                                                                                                
SENATOR  PASKVAN  moved  to  report SB  74  from  committee  with                                                               
individual recommendations  and attached fiscal note.  There were                                                               
no objections and it was so ordered.                                                                                            
                                                                                                                                
3:14:56 PM                                                                                                                    
At ease from 3:14 PM to 3:16 PM.                                                                                                
                                                                                                                                

Document Name Date/Time Subjects