Legislature(1993 - 1994)

03/21/1994 03:00 PM House HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
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           HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES                         
                       STANDING COMMITTEE                                      
                         March 21, 1994                                        
                            3:00 p.m.                                          
                                                                               
                                                                               
  MEMBERS PRESENT                                                              
                                                                               
  Rep. Con Bunde, Co-Chair                                                     
  Rep. Cynthia Toohey, Co-Chair                                                
  Rep. Al Vezey                                                                
  Rep. Gary Davis                                                              
  Rep. Bettye Davis                                                            
  Rep. Irene Nicholia                                                          
  Rep. Harley Olberg                                                           
  Rep. Tom Brice                                                               
  Rep. Pete Kott                                                               
                                                                               
  MEMBERS ABSENT                                                               
                                                                               
  None                                                                         
                                                                               
  COMMITTEE CALENDAR                                                           
                                                                               
  HB 414:   "An Act creating the Alaska Health Commission;                     
            relating to the delivery, quality, access, and                     
            financing of health care; relating to review and                   
            approval of rates and charges of health insurers;                  
            relating to certain civil actions against health                   
            care providers and health insurers; repealing                      
            Alaska Rule of Civil Procedure 72.1; and providing                 
            for an effective date."                                            
                                                                               
            HEARD AND HELD                                                     
                                                                               
  WITNESS REGISTER                                                             
                                                                               
  DR. DON LEHMAN, President                                                    
  Alaska State Medical Association                                             
  780 Katlian Street, Number E                                                 
  Sitka, Alaska  99835                                                         
  Phone: (907) 747-5861                                                        
  Position Statement:  Testified in support of HB 414                          
                       (spoke via teleconference)                              
                                                                               
  NANCY USERA, Commissioner                                                    
  Department of Administration                                                 
  P.O. Box 110200                                                              
  Juneau, Alaska  99811-0200                                                   
  Phone:  (907) 465-2200                                                       
  Position Statement:  Testified on HB 414                                     
                                                                               
  DON KOCH, Marketing Surveillance                                             
  Division of Insurance                                                        
  Department of Commerce and Economic Development                              
  P.O. Box 110805                                                              
  Juneau, Alaska  99811-0805                                                   
  Phone:  (907) 465-0805                                                       
  Position Statement:  Testified on HB 414                                     
                                                                               
  REED STOOPS, Lobbyist                                                        
  Aetna Insurance Company                                                      
  240 Main Street, Suite 600                                                   
  Juneau, Alaska  99801                                                        
  Phone:  (907) 463-3223                                                       
  Position Statement:  Testified in opposition to Amendment 16                 
                       and in support of Amendment 15 for HB
                       414                                                     
                                                                               
  GORDAN EVANS, Lobbyist                                                       
  Health Insurance Association of America                                      
  318 4th Street                                                               
  Juneau, Alaska  99801                                                        
  Phone:  (907) 586-3210                                                       
  Position Statement:  Testified in opposition to Amendment 16                 
                       and in support of Amendment 15 for HB
                       414                                                     
                                                                               
  BARBARA THURSTON, Actuary                                                    
  Division of Insurance                                                        
  Department of Commerce and Economic Development                              
  P.O. Box 110805                                                              
  Juneau, Alaska  99801-0805                                                   
  Phone:  (907) 465-2573                                                       
  Position Statement:  Testified on HB 414                                     
                                                                               
  JERRY REINWAND, Lobbyist                                                     
  Blue Cross of Washington and Alaska                                          
  Juneau, Alaska  99801                                                        
  Phone:  (907) 586-8966                                                       
  Position Statement:  Testified in support of Amendment 15                    
                       for HB 414                                              
                                                                               
  PREVIOUS ACTION                                                              
                                                                               
  BILL:  HB 414                                                                
  SHORT TITLE: COMPREHENSIVE HEALTH CARE                                       
  SPONSOR(S): RULES BY REQUEST OF THE GOVERNOR                                 
                                                                               
  JRN-DATE    JRN-PG                     ACTION                                
  01/28/94      2182    (H)   READ THE FIRST TIME/REFERRAL(S)                  
  01/28/94      2182    (H)   HES, JUDICIARY, FINANCE                          
  01/28/94      2182    (H)   -2 FISCAL NOTES (GOV, DCED)                      
                              1/28/94                                          
  01/28/94      2183    (H)   GOVERNOR'S TRANSMITTAL LETTER                    
  02/15/94              (H)   HES AT 03:00 PM CAPITOL 106                      
  02/15/94              (H)   MINUTE(HES)                                      
  03/04/94              (H)   HES AT 03:00 PM CAPITOL 106                      
  03/04/94              (H)   MINUTE(HES)                                      
  03/09/94              (H)   HES AT 03:00 PM CAPITOL 106                      
  03/09/94              (H)   MINUTE(HES)                                      
  03/12/94              (H)   HES AT 01:00 PM CAPITOL 106                      
  03/12/94              (H)   MINUTE(HES)                                      
  03/16/94              (H)   HES AT 03:00 PM CAPITOL 106                      
  03/16/94              (H)   MINUTE(HES)                                      
  03/21/94              (H)   HES AT 03:00 PM CAPITOL 106                      
                                                                               
                                                                               
  ACTION NARRATIVE                                                             
                                                                               
  TAPE 94-57, SIDE A                                                           
  Number 000                                                                   
                                                                               
  CHAIR BUNDE called the meeting to order at 3:07 p.m., noted                  
  members present and announced the calendar.  He brought HB
  414 to the table and announced the committee would work from                 
  version E, 3/19/94.  He noted that Anchorage, Barrow and                     
  Fairbanks were on teleconference for listening purposes                      
  only.  He said there were nine amendments to be addressed                    
  and asked DR. DON LEHMAN if he wanted to testify at this                     
  time.                                                                        
  HB 414 - COMPREHENSIVE HEALTH CARE                                           
                                                                               
  CSHB 414:  "An Act creating the Alaska Health Commission;                    
  relating to the delivery, quality, access, and financing of                  
  health care; relating to health insurers, health maintenance                 
  to certain civil actions against health care providers and                   
  health insurers; amending Alaska Rules of Civil Procedure 26                 
  and 27 and Alaska Rules of Evidence 802, 803, and 804;                       
  repealing Alaska Rule of Civil Procedure 82.1; and providing                 
  for an effective date."                                                      
                                                                               
  Number 019                                                                   
                                                                               
  DR. DON LEHMAN, President, Alaska State Medical Association,                 
  testified from Sitka and spoke in support of HB 414.  He                     
  said the association recognizes the bill provides a                          
  framework for the study and development of significant                       
  reforms.  He emphasized that Alaska is a diverse and unique                  
  state that warrants an Alaskan solution to its problems.                     
  Having said that, he addressed Amendment 16, relating to                     
  disability insurance claims processing.  He explained that                   
  the current delay in the processing of insurance claims is a                 
  problem that is increasing for small and rural clinics.  Dr.                 
  Lehman asserted that insurance companies do not make money                   
  by saying "yes," but by saying "no" and by saying nothing                    
  and doing nothing.  He said there is no reason why patients'                 
  insurance claims should remain in the ditch for longer than                  
  15 days and this amendment would improve health system                       
  efficiency which is a key to controlling health costs.                       
                                                                               
  DR. LEHMAN then addressed Amendment 17 and said the concept                  
  of a "market based single payer" system, developed by a                      
  doctor from Anchorage, is a uniquely Alaskan solution.  He                   
  said this proposal combines the efficiency of a single payer                 
  with the economic reality of a market driven system.  He                     
  stated it includes provider defined fees, patient                            
  copayments, sliding scale copayments, posted fees,                           
  comparison lists for consumers, voluntary expenditure                        
  targets, and provider peer reviews.                                          
                                                                               
  Number 062                                                                   
                                                                               
  REP. G. DAVIS asked Dr. Lehman what he envisioned as the                     
  possible result of this proposed legislation as compared to                  
  the compromised bill.                                                        
                                                                               
  Number 065                                                                   
                                                                               
  DR. LEHMAN said the compromised bill was an all-encompassing                 
  proposal that investigated the problem and had a definite                    
  solution.  He said he viewed the Governor's proposal as an                   
  outline from which further study could be done.  He said                     
  development of an outline for health care system reform is                   
  clearly an important step to take in order to safeguard                      
  Alaskans from what bureaucrats in Washington might devise as                 
  a solution.  He said he feels like a managed care system                     
  would not work in Alaska where there is one large urban area                 
  and scattered populations throughout the rest of the state.                  
  He stated the problem with the compromised bill is that it                   
  is unrealistic during this session.                                          
                                                                               
  (Chair Bunde indicated that Rep. Nicholia arrived at 3:12                    
  p.m.)                                                                        
                                                                               
  CHAIR BUNDE indicated that because Rep. Olberg was not yet                   
  at the meeting, Amendment 15 would be overlooked at this                     
  time.                                                                        
                                                                               
  CHAIR BUNDE asked that Amendment 16 be moved.                                
                                                                               
  REP. B. DAVIS moved to adopt Amendment 16.                                   
                                                                               
  Number 090                                                                   
                                                                               
  CHAIR BUNDE objected for discussion purposes.  He asked Rep.                 
  Toohey if she cared to speak to the amendment.                               
                                                                               
  REP. TOOHEY said she would feel more comfortable if                          
  COMMISSIONER NANCY USERA addressed the amendment.                            
                                                                               
  Number 096                                                                   
                                                                               
  NANCY USERA, Commissioner, Department of Administration                      
  (DOA), said Amendment 16 deals specifically with insurance                   
  claims processing.  She stated the department thinks it is                   
  conceptually a good idea to expedite matters, although she                   
  questioned if mandating these new requirements would be                      
  adding costs to the system.  She pointed out that DOA's                      
  interest was in streamlining and while this amendment would                  
  be advantageous to consumers filing claims, she was                          
  uncertain as to the additional costs to insurers.  She                       
  mentioned that the Division of Insurance and several                         
  Representatives were in the audience and could possibly                      
  address this issue.                                                          
                                                                               
  Number 110                                                                   
                                                                               
  CHAIR BUNDE acknowledged the presence of Commissioner Lowe.                  
                                                                               
  (Chair Bunde indicated that Rep. Olberg arrived at 3:16                      
  p.m.)                                                                        
                                                                               
  Number 115                                                                   
                                                                               
  DON KOCH, Marketing Surveillance, Division of Insurance,                     
  Department of Commerce and Economic Development, testified                   
  on HB 414.  He expressed concern that cost was being added                   
  in the form of an interest payment.  He further stated that                  
  he did not come prepared to adequately address these                         
  concerns. (the tape was somewhat indiscernible)                              
                                                                               
  Number 135                                                                   
                                                                               
  CHAIR BUNDE said he understood Mr. Koch's point that there                   
  was insufficient preparation time for a detailed analysis.                   
  He then asked Mr. Koch if he cared to comment on                             
  "enforcement" when an insurer does not pay and the insurance                 
  is due.                                                                      
                                                                               
  Number 137                                                                   
                                                                               
  MR. KOCH responded that conjecturing was difficult because                   
  there was no track record in dealing with this sort of                       
  provision.  He said he would refer to consumer complaints to                 
  see if there were any statistics on late payments, but he                    
  suspected that a lot of this information does not get                        
  reported.  He said there are specific time frames that                       
  inform insurers how quickly they have to pay.                                
                                                                               
  Number 148                                                                   
                                                                               
  CHAIR BUNDE wondered if he was correct in assuming that                      
  enforcement would follow if a complaint was filed with the                   
  division.                                                                    
                                                                               
  Number 150                                                                   
                                                                               
  REP. TOOHEY asked if 15 days seemed reasonable.  She                         
  commented that it seemed to be unreasonably short especially                 
  if planes were not flying in or out of Juneau for several                    
  days, thereby leaving only about a week to process a claim.                  
                                                                               
  Number 153                                                                   
                                                                               
  MR. KOCH said there may be some requirements (indiscernible)                 
  and he apologized for not knowing more about these                           
  regulations.                                                                 
                                                                               
  Number 174                                                                   
                                                                               
  REP. VEZEY asked why Alaska Statute 45.45.010 was adopted as                 
  the specified interest rate.  He added that he thought this                  
  was an inappropriate rate.                                                   
                                                                               
  Number 181                                                                   
                                                                               
  DR. LEHMAN said he could not speak to that issue and was                     
  uncertain where the rate originated.                                         
                                                                               
  Number 186                                                                   
                                                                               
  REP. VEZEY commented that 45.45.010 specifies a 10.5 percent                 
  fixed interest rate not compounded, and given today's market                 
  conditions, this is an inappropriate rate if equitable                       
  treatment is the objective.  He said he thought the rate was                 
  more appropriate as a penalty measure.                                       
                                                                               
  Number 190                                                                   
                                                                               
  DR. LEHMAN said he thought this rate was set as a penalty                    
  measure as there currently is no penalty for delayed claims.                 
  In reference to Rep. Toohey's earlier question, he clarified                 
  that "15 days" refers to paying a claim 15 days after a                      
  claim is received, not after services are provided.                          
                                                                               
  Number 205                                                                   
                                                                               
  REED STOOPS, Lobbyist, Aetna Insurance Company, testified in                 
  opposition to Amendment 16.  He said in spite of the                         
  requirement for completion of the claim, this does not                       
  guarantee that all necessary information has been submitted                  
  to the insurer.  He offered this as a possible explanation                   
  as to why it might take longer than 15 days to process a                     
  claim.  He said according to his clients, more than 80                       
  percent are paid within 15 days, but those that are delayed                  
  often lack the necessary information from the provider to                    
  justify the claim.  He said the second problem with this                     
  amendment is that on the request of the client, Aetna makes                  
  payments by batches to large providers.  He explained that                   
  the 15 day payment schedule might not mesh with a monthly                    
  batch payment schedule.  The third problem he mentioned was                  
  that interest beginning on the 15th day at the rate cited by                 
  Rep. Vezey seemed unreasonable.  He said he knew of no other                 
  state with a similar provision and added that this interest                  
  would be triggered even if the information necessary to make                 
  a judgement was not provided.                                                
                                                                               
  DR. LEHMAN responded by pointing out that "the claim form                    
  must be fully completed."                                                    
                                                                               
  Number 240                                                                   
                                                                               
  GORDAN EVANS, Lobbyist, Health Insurance Association of                      
  America (HIAA), stated he associated with the comments made                  
  by Mr. Stoops, and thereby testified in opposition to                        
  Amendment 16.                                                                
                                                                               
  Number 249                                                                   
                                                                               
  REP. B. Davis asked that Mr. Stoops repeat the reasons for                   
  opposition to Amendment 16.  She asked if he maintained                      
  opposition to the amendment given that it specifies that the                 
  claim form must be completed.                                                
                                                                               
  Number 253                                                                   
                                                                               
  MR. STOOPS said he did not believe his statement was                         
  inaccurate and said, "In spite of the fact that the bill                     
  says that a claim form is fully completed doesn't                            
  necessarily mean that the information necessary to justify a                 
  particular claim is present.  Line 16 on the claim form                      
  might be filled out, but it might not be filled out with                     
  enough information to justify a particular procedure which                   
  has been accomplished, and if the insurer then comes back                    
  and says `we don't think you have given us the information                   
  that is required under our contract' there could be a                        
  dispute about whether the claim form has been completed."                    
                                                                               
  MR. STOOPS said this discussion was about terminology, but                   
  it would be better if the amendment was clarified to                         
  indicate that the information necessary to make the decision                 
  was available.                                                               
                                                                               
  Number 265                                                                   
                                                                               
  REP. B DAVIS agreed that perhaps modifications should be                     
  made to include the language Mr. Stoops used.  She said she                  
  understood that just because pages on a form were completed,                 
  this does not guarantee that the necessary information has                   
  been included.  She asked if this would be acceptable to Mr.                 
  Stoops.                                                                      
                                                                               
  Number 270                                                                   
                                                                               
  MR. STOOPS said this would address the problem relating to                   
  subsection (b), but the other two concerns would remain.  He                 
  restated those other concerns as:  1) an inconsistency                       
  between monthly batch payments and the 15 day billing period                 
  and 2) interest accruing on the 15th day as being an                         
  unreasonable provision.                                                      
                                                                               
  Number 282                                                                   
                                                                               
  CHAIR BUNDE said he would like to give the Division of                       
  Insurance more time to respond to this amendment, so with                    
  the concurrence of Rep. B. Davis, he would table this                        
  amendment until the next hearing of HB 414.  Chair Bunde                     
  indicated that with the presence of Rep. Olberg the                          
  committee could now address Amendment 15.                                    
                                                                               
  Number 290                                                                   
                                                                               
  REP. OLBERG moved Amendment 15.  He mentioned there might be                 
  cross-reference problems because the amendment relates to                    
  the 3/11/94 version of the work draft rather than the                        
  3/14/94 draft.                                                               
                                                                               
  CHAIR BUNDE objected for discussion purposes.                                
                                                                               
  REP. OLBERG said the amendment takes the health commission                   
  out of the rate approval business and out of the rate review                 
  business as well.                                                            
                                                                               
  Number 304                                                                   
                                                                               
  COMMISSIONER USERA said this amendment does two things:                      
  1) it removes any review or relationship to insurance rates                  
  from the commission and places it with the Division of                       
  Insurance and 2) it dilutes the rate approval authority                      
  because the only requirement is that rates be filed with the                 
  division.  She said the implications of this would be a                      
  reduction of the fiscal note associated with the rate review                 
  process and would probably, depending on regulatory                          
  requirements, effectively allow for the collection of                        
  additional data that is presently unavailable to the state.                  
                                                                               
  Number 326                                                                   
                                                                               
  REP. G. DAVIS mentioned this would not preclude the                          
  authority from establishing a subcommittee to review rates                   
  or anything else related to insurance.                                       
                                                                               
  Number 334                                                                   
                                                                               
  COMMISSIONER USERA said she saw no provision requiring the                   
  Division of Insurance to provide any of this information to                  
  the commission, and further stated she did not know what                     
  confidentiality constraints were being placed on this                        
  information.  She said as a practical matter her preference                  
  would be that the division put together aggregate                            
  information and report that to the commission.                               
                                                                               
  Number 354                                                                   
                                                                               
  REP. OLBERG said if rates were going to be regulated, then                   
  either everybody's rates or nobody's rates should be                         
  addressed, and this indicates that nobody's rates are going                  
  to be regulated.                                                             
                                                                               
  Number 357                                                                   
                                                                               
  REP. TOOHEY said basically this leaves it as status quo in                   
  that there is no regulation now.                                             
                                                                               
  Number 362                                                                   
                                                                               
  CHAIR BUNDE asked to hear from the Division of Insurance on                  
  Amendment 15 and on the fact of current regulation.                          
                                                                               
  Number 364                                                                   
                                                                               
  BARBARA THURSTON, Actuary, Division of Insurance, Department                 
  of Commerce and Economic Development, testified on HB 414.                   
  She stated that currently the division does not regulate                     
  rates for most medical or disability insurance.  She said                    
  that the only disability company they receive rate filings                   
  from is Blue Cross.  She pointed out that this amendment                     
  would strengthen that situation and they would receive rate                  
  filings from other companies as well.  She said this                         
  amendment would give the division more authority, but her                    
  concern was that it does not have any teeth in that if                       
  someone files an inappropriate rate, there is not much                       
  recourse from the division other than providing consumer                     
  information.  Ms. Thurston wanted to clarify something from                  
  the previous week's testimony and she explained that                         
  companies do not file specific rates for each person because                 
  rates are set according to a formula.                                        
                                                                               
  Number 390                                                                   
                                                                               
  CHAIR BUNDE asked if all kinds of insurance was handled in                   
  the same way.                                                                
                                                                               
  Number 395                                                                   
                                                                               
  MS. THURSTON said the division both reviews and approves for                 
  most of the property casualty.                                               
                                                                               
  REP. TOOHEY asked how many carriers were used for auto                       
  insurance.                                                                   
                                                                               
  Number 401                                                                   
                                                                               
  MS. THURSTON said a dozen do the vast bulk of the market.                    
  She said a lot of companies file but may not write.  She                     
  added that they want to be able to write in all 50 states.                   
                                                                               
  REP. TOOHEY asked if that information was brought to the                     
  awareness of the public.  She asked how to go about choosing                 
  the best auto insurance.                                                     
                                                                               
  Number 405                                                                   
                                                                               
  MS. THURSTON said there are two ways:  1) one could dig                      
  through the files which contain public information on rate                   
  filings, or 2) the division publishes auto and homeowners'                   
  rate comparisons twice a year and distributes the                            
  publication to various consumers throughout the state.                       
                                                                               
  CHAIR BUNDE commented that an informed consumer would shop                   
  around and call several agents.                                              
                                                                               
  Number 415                                                                   
                                                                               
  REP. TOOHEY asked if this same sort of thing would be done                   
  with health insurance.                                                       
                                                                               
  Number 417                                                                   
                                                                               
  MS. THURSTON said this certainly could be done with health                   
  insurance and it seemed like a reasonable thing to do.  She                  
  said if the division received rates on disability there                      
  would be a good chance of doing it.                                          
                                                                               
  Number 420                                                                   
                                                                               
  REP. TOOHEY asked if consumers would be able to understand                   
  the ratings information.                                                     
                                                                               
  Number 422                                                                   
                                                                               
  MS. THURSTON explained that with the auto publication, which                 
  is analogous, the rates are based on fictitious scenarios.                   
  She explained that this gives a person an idea of which                      
  companies would have the best rates for a situation which                    
  approximates one's own specific situation.  She added that a                 
  consumer could then call the agents of those companies.                      
                                                                               
  Number 434                                                                   
                                                                               
  CHAIR BUNDE asked about distribution of the auto insurance                   
  publication.                                                                 
                                                                               
  Number 436                                                                   
                                                                               
  MS. THURSTON said a booklet called "Rating Examples" is                      
  published and mailed to anyone interested who is on the                      
  mailing list.                                                                
                                                                               
  (Chair Bunde indicated that Rep. Brice arrived at 3:40 p.m.)                 
                                                                               
  CHAIR BUNDE asked for further public testimony on Amendment                  
  15.                                                                          
                                                                               
  Number 455                                                                   
                                                                               
  MR. STOOPS referred to a chart, previously provided, which                   
  illustrated how other states regulate health insurance.  He                  
  summarized and said eight states do not regulate at all, six                 
  states have a prior approval system requiring the division's                 
  approval before implementation, and the remaining states                     
  have a file and use system similar to the one proposed under                 
  this amendment.  He pointed out that Alaska would move from                  
  having no regulation to having more mainstream regulation.                   
  He also stated that 90 plus percent of the claim dollars pay                 
  for medical fees and therefore regulating health insurance                   
  rates really addresses a small percentage of the problem and                 
  certainly does not address the lion's share of the cost.  He                 
  mentioned an equity issue of regulating both insurance rates                 
  and provider rates if the object is to reduce costs.  Mr.                    
  Stoops endorsed approval of Amendment 15.                                    
                                                                               
  Number 479                                                                   
                                                                               
  MR. EVANS associated with the comments made by Mr. Stoops.                   
  He said this particular amendment approximated procedures                    
  used by Idaho, Montana, and several other western states.                    
                                                                               
  Number 487                                                                   
                                                                               
  JERRY REINWAND, Lobbyist, Blue Cross of Washington and                       
  Alaska, said he agreed, thereby testifying in support of                     
  Amendment 15.                                                                
                                                                               
  Number 493                                                                   
                                                                               
  CHAIR BUNDE said one concern previously expressed was the                    
  passing on of this information.  He asked Rep. Olberg if                     
  there was an interest in having some indication in Amendment                 
  15 that the division, when finished with its work, would                     
  pass information on to the health commission.                                
                                                                               
  Number 499                                                                   
                                                                               
  (Chair Bunde indicated that Rep. Kott arrived at 3:45 p.m.)                  
                                                                               
  TAPE 94-57, SIDE B                                                           
  Number 068                                                                   
                                                                               
  COMMISSIONER USERA referred to Sec. 44.19.626 page 15, line                  
  19, and said the commission may obtain information from a                    
  wide variety of people who must provide it, and obviously                    
  the Division of Insurance would be one of those entities.                    
  She said the commission would require through some                           
  regulatory process that the division provide the information                 
  in an appropriate form.                                                      
                                                                               
  Number 082                                                                   
                                                                               
  REP. G. DAVIS added that page 13, line 4, reads that the                     
  purpose of the commission is to improve health care in this                  
  state by "establishing and implementing a system for                         
  collecting and analyzing information and data relating to                    
  the individual and public health care needs of and services                  
  provided to residents of the state."                                         
                                                                               
  Number 085                                                                   
                                                                               
  REP. TOOHEY stated her support of Amendment 15 and said,                     
  "The thicker this gets the less chance it has of going                       
  anywhere... and I kind of like this sort of a step                           
  backward."                                                                   
                                                                               
  Number 094                                                                   
                                                                               
  CHAIR BUNDE thanked Rep. Toohey for her support.  Chair                      
  Bunde asked for further public testimony on Amendment 15.                    
  Hearing none, Chair Bunde closed public testimony on                         
  Amendment 15.                                                                
                                                                               
  (Chair Bunde took a brief at-ease from 3:48 to 3:50 p.m.)                    
                                                                               
  CHAIR BUNDE noted that Amendment 15 was before the                           
  committee, withdrew his previous objection and asked for the                 
  pleasure of the committee.                                                   
                                                                               
  Number 112                                                                   
                                                                               
  REP. B DAVIS moved Amendment 15.                                             
                                                                               
  Number 113                                                                   
                                                                               
  CHAIR BUNDE indicated that Amendment 15 had been previously                  
  moved by Rep. Olberg.  He asked if there were any                            
  objections.  Hearing none, declared that Amendment 15 was so                 
  adopted.                                                                     
                                                                               
  CHAIR BUNDE directed the committee's attention to Amendment                  
  17 and asked Rep. Toohey to move the amendment.                              
                                                                               
  REP. TOOHEY moved to adopt Amendment 17.                                     
                                                                               
  REP. BRICE objected to the amendment.                                        
                                                                               
  REP. TOOHEY asked that DR. LEHMAN and COMMISSIONER USERA                     
  speak to this amendment.                                                     
                                                                               
  Number 127                                                                   
                                                                               
  CHAIR BUNDE said he realized DR. LEHMAN had previously                       
  spoken to this issue and asked if he would give a summation.                 
                                                                               
  DR. LEHMAN said the proposal combines the efficiency of a                    
  single payer system with the economic reality of a market                    
  driven system.  (the tape was indiscernible at this point)                   
                                                                               
  CHAIR BUNDE, in response to Dr. Lehman's comment, noted for                  
  the record that not one bureaucrat smiled at the mention of                  
  the phrase "single payer" and suggested that perhaps they                    
  were restraining their glee.  He asked Commissioner Usera if                 
  she cared to comment on Amendment 17.                                        
                                                                               
  Number 144                                                                   
                                                                               
  COMMISSIONER USERA stated her appreciation of Dr. Lehman's                   
  comments and said her concern with this amendment was that                   
  it was very specific and that if any of the provisions were                  
  to drop out it would significantly change the definition.                    
  She suggested, on line 3, the deletion of "including                         
  provider defined fees" and the insertion of "and may                         
  include."                                                                    
                                                                               
  Number 163                                                                   
                                                                               
  DR. LEHMAN said he had no objection to Commissioner Usera's                  
  suggestion.                                                                  
                                                                               
  Number 166                                                                   
                                                                               
  CHAIR BUNDE, in response to Commissioner Usera, acknowledged                 
  that in previous discussions there was no hidden agenda with                 
  the inclusion of "single payer."                                             
                                                                               
  Number 171                                                                   
                                                                               
  REP. BRICE asked for clarity on this issue, and after some                   
  discussion commented that the terminology of "market based                   
  single payer" was as confusing as saying "competitive                        
  monopoly."                                                                   
                                                                               
  Number 189                                                                   
                                                                               
  REP. TOOHEY said possibly Dr. Lehman could address the issue                 
  of using the phrase "market based single payer."                             
                                                                               
  Number 196                                                                   
                                                                               
  DR. LEHMAN said his basic understanding of positioning the                   
  phrase "market based" with the phrase "single payer" was                     
  that there would still be one payer involved, although                       
  market forces would come into play as providers would be                     
  required to quote their fees.  Patients would still elect to                 
  choose any provider that they wanted, recognizing that                       
  certain providers might be charging different fees for those                 
  same services.                                                               
                                                                               
  Number 218                                                                   
                                                                               
  COMMISSIONER USERA responded to Rep. Brice by asserting that                 
  "market based single payer" is a coined phrase.  She said it                 
  is the moniker that has been placed on the primary                           
  comprehensive reform bill that has been introduced, and is                   
  meaningful within the current context only.                                  
                                                                               
  Number 240                                                                   
                                                                               
  CHAIR BUNDE asked if there was any further discussion on                     
  Amendment 17.  Seeing none, he closed public testimony and                   
  brought the amendment to the attention of the committee.                     
                                                                               
  Number 244                                                                   
                                                                               
  REP. B. DAVIS asked if including a definition section on                     
  "market based single payer" would be an improvement.  After                  
  some discussion, she was informed that a definition was                      
  included in the amendment.                                                   
                                                                               
  Number 261                                                                   
                                                                               
  REP. OLBERG brought up the spelling of "payor" and "payer,"                  
  noting that "payor" was not located in the dictionary.                       
                                                                               
  Number 273                                                                   
                                                                               
  CHAIR BUNDE commented that the question before the committee                 
  involved addressing whether or not "single payer" was as bad                 
  as some people thought "single payer" might be.                              
                                                                               
  Number 280                                                                   
                                                                               
  REP. TOOHEY stated her support of the amendment and of                       
  striking the phrase "single payer" and using the phrase                      
  "market based."                                                              
                                                                               
  Number 285                                                                   
                                                                               
  CHAIR BUNDE asked for the pleasure of the committee.  He                     
  confirmed that Rep. Brice maintained his objection.  Chair                   
  Bunde stated that there had been an amendment to the                         
  amendment so that line 3 of the second section of the                        
  amendment would read, "is based on market forces and may                     
  include" as opposed to "including."                                          
                                                                               
  Number 296                                                                   
                                                                               
  REP. TOOHEY moved to move the amendment to the amendment.                    
                                                                               
  CHAIR BUNDE acknowledged that the amendment to the amendment                 
  had been moved and asked for further discussion.                             
                                                                               
  Number 298                                                                   
                                                                               
  REP. BRICE said his major concern was that the language had                  
  been watered down with "mays" instead of requirements.  He                   
  stated this was the reason for his objection to the                          
  amendment to the amendment.                                                  
                                                                               
  Number 304                                                                   
                                                                               
  CHAIR BUNDE called for the vote on the amendment to the                      
  amendment that refers to the use of the term "may."  Reps.                   
  Toohey, Bunde, Vezey, Kott, and Olberg voted "Yea" and Reps.                 
  G. Davis, B. Davis, Nicholia and Brice voted "Nay."                          
                                                                               
  CHAIR BUNDE declared that Amendment 17 in its amended form                   
  was now before the committee.  He confirmed that Rep. Brice                  
  wished to maintain his objection and called for the vote.                    
  Reps. Bunde, G. Davis, Vezey, Kott, Olberg and Toohey voted                  
  "Yea" and Reps. B. Davis, Nicholia, and Brice voted "Nay."                   
  Chair Bunde stated that Amendment 17 as amended was so                       
  moved.                                                                       
                                                                               
  CHAIR BUNDE directed the committee's attention to Amendment                  
  18 and asked Rep. B. Davis to move the amendment.                            
                                                                               
  Number 326                                                                   
                                                                               
  REP. B DAVIS moved to adopt Amendment 18.                                    
                                                                               
  CHAIR BUNDE objected for discussion purposes and asked                       
  Commissioner Usera for comment.                                              
                                                                               
  Number 335                                                                   
                                                                               
  COMMISSIONER USERA spoke in support of this amendment,                       
  saying it was good consumerism in that it requires                           
  disclosure and is designed to be very specific so consumers                  
  would consequently have a clearer idea of what would and                     
  would not be included in their insurance policy.                             
                                                                               
  Number 344                                                                   
                                                                               
  CHAIR BUNDE said he would like to hear from the Division of                  
  Insurance.                                                                   
                                                                               
  Number 345                                                                   
                                                                               
  MS. THURSTON said the division supports this and                             
  theoretically this is already being done in policy form, but                 
  not every consumer reads the policy.                                         
                                                                               
  Number 356                                                                   
                                                                               
  REP. G. DAVIS said he has seen this in policies, but it is                   
  in legalese and very small print.                                            
                                                                               
  Number 360                                                                   
                                                                               
  REP. TOOHEY agreed with Rep. Davis that this would promote                   
  consumer confidence but then asked what the cost would be.                   
                                                                               
  Number 365                                                                   
                                                                               
  MS. THURSTON responded that if this refers to a separate                     
  disclosure form provided by the insurance company, there                     
  would be an additional cost to the insurance company.  She                   
  said she did not know what the cost would be.                                
                                                                               
  Number 371                                                                   
                                                                               
  CHAIR BUNDE observed that clarification was needed as to                     
  whether this was going to be provided by the state or by the                 
  insurance company.                                                           
                                                                               
  Number 376                                                                   
                                                                               
  MS. THURSTON said the division would probably need more                      
  specific authority in the statute if it was going to                         
  prescribe the format of this disclosure statement.  She said                 
  the way it is written each insurance company designs its own                 
  statement.                                                                   
                                                                               
  Number 384                                                                   
                                                                               
  REP. G. DAVIS commented if this was going to be left to the                  
  commission's discretion, then the amendment should be left                   
  as is.                                                                       
                                                                               
  Number 393                                                                   
                                                                               
  CHAIR BUNDE closed public discussion on Amendment 18 and                     
  asked if there was further debate in the committee.                          
                                                                               
  REP. TOOHEY moved Amendment 18.                                              
                                                                               
  CHAIR BUNDE observed that the motion had been made and he                    
  removed his objection.  He asked if there were any                           
  objections.  Hearing none, Chair Bunde stated that Amendment                 
  18 was so adopted.                                                           
                                                                               
  CHAIR BUNDE brought Amendment 19 to the committee's                          
  attention.                                                                   
                                                                               
  REP. B. DAVIS moved Amendment 19.                                            
                                                                               
  CHAIR BUNDE objected for discussion purposes and asked for                   
  Rep. B. Davis's presentation of the amendment.                               
                                                                               
  Number 448                                                                   
                                                                               
  REP. B. DAVIS referred to page 16, line 10, and after                        
  considerable discussion about the exact location, Rep. B.                    
  Davis said she wanted to insert the language listed.                         
                                                                               
  Number 450                                                                   
                                                                               
  CHAIR BUNDE asked Commissioner Usera for further comment on                  
  the amendment.                                                               
                                                                               
  Number 454                                                                   
                                                                               
  COMMISSIONER USERA said this was part of subsection (b)                      
  where it says "the commission shall" and it adds two                         
  additional mandates, one is the incentive program bringing                   
  incentive providers to the state and the other is                            
  establishing advisory committees to make recommendations on                  
  cost containment.  She referred to subsection (9) and said                   
  it was her understanding that cost containment had to be                     
  part of a comprehensive plan, but as this is premised the                    
  commission's analysis would be on packaged plans presented                   
  to the commission as opposed to the commission taking bits                   
  and pieces.  She said she didn't necessarily object to                       
  establishing an advisory committee on cost containment,                      
  although she would prefer to have this under the "may"                       
  section because it is not necessarily a primary                              
  responsibility.  She referred to (8) and said there had been                 
  a number of programs discussed in attempts to attract                        
  providers and they had all been costly.  She said her                        
  understanding was that this refers to the design of an                       
  incentive program, not necessarily the implementation of                     
  that program.  She stated again that her preference was to                   
  have this under the "may" section rather than the "shall"                    
  section because the resources were not available to the                      
  commission to do all of this and doing so would initially                    
  add significantly to the fiscal note.                                        
                                                                               
  Number 486                                                                   
                                                                               
  REP. TOOHEY asked if "may" could be added in or after                        
  subsection (9).                                                              
                                                                               
  Number 489                                                                   
                                                                               
  COMMISSIONER USERA referred to page 15, subsection (a),                      
  where it reads, "the commission may" and clarified this                      
  would be subsection (4) and (5) of that provision as opposed                 
  to subsection (b) which reads, "the commission shall."                       
                                                                               
  Number 493                                                                   
                                                                               
  REP. G. DAVIS said paragraph (9) seemed to reemphasize what                  
  was inserted under the public health initiative and asked                    
  Rep. B. Davis for comment.                                                   
                                                                               
  Number 500                                                                   
                                                                               
  REP. B. DAVIS said everything under the public health                        
  section says "may" and this says "shall."                                    
                                                                               
  Number 502                                                                   
                                                                               
  REP. G. DAVIS said these items seem to fit under the purview                 
  of the public health aspects and after considerable                          
  discussion he pointed out to Rep. B. Davis that subsection                   
  (9) seemed like a duplication.                                               
                                                                               
  TAPE 94-58, SIDE A                                                           
  Number 020                                                                   
                                                                               
  REP. B. DAVIS said after more discussion that she would be                   
  willing to delete subsection (9).                                            
                                                                               
  Number 023                                                                   
                                                                               
  CHAIR BUNDE said the committee could amend the amendment.                    
                                                                               
  REP. G. DAVIS moved to amend Amendment 19 by deleting                        
  paragraph (9).                                                               
                                                                               
  CHAIR BUNDE asked if there was any objection.                                
                                                                               
  REP. BRICE objected and asked for further clarification.                     
                                                                               
  CHAIR BUNDE asked Rep. G. Davis for comment.                                 
                                                                               
  Number 033                                                                   
                                                                               
  REP. G. DAVIS said paragraph (9) appears to contain the cost                 
  of health care to include the public health initiatives.  He                 
  added that he considers these to be general duties and                       
  inclusions of a public health policy.                                        
                                                                               
  Number 038                                                                   
                                                                               
  CHAIR BUNDE then referred Rep. Brice to page 16.                             
                                                                               
  Number 040                                                                   
                                                                               
  REP. BRICE said he understood and withdrew his objection.                    
                                                                               
  Number 041                                                                   
                                                                               
  CHAIR BUNDE said the amendment as amended includes paragraph                 
  (8) only as (9) had been deleted.  Chair Bunde mentioned                     
  that the student loan program was still operating at a                       
  deficit and could not afford a forgiveness program.  He also                 
  pointed out that it would cost half a million dollars a year                 
  to establish a family residency program in Anchorage.  He                    
  said the question is, "Do we want to encourage them to do                    
  something that is probably not likely to be funded?"                         
                                                                               
  Number 050                                                                   
                                                                               
  REP. G. DAVIS said he liked the amendment and thought that                   
  the inclusion of a student loan forgiveness program would                    
  shoot the amendment down.                                                    
                                                                               
  REP. B DAVIS acknowledged there were some problems with the                  
  health care program, but said she did not know why the                       
  comparison was being made between the two and asked for                      
  further clarification.                                                       
                                                                               
  Number 067                                                                   
                                                                               
  REP. TOOHEY said her understanding was that it had been                      
  suggested to delete "a student loan forgiveness program"                     
  because "that, in itself, was unacceptable."                                 
                                                                               
  Number 072                                                                   
                                                                               
  REP. G. DAVIS responded to Rep. B. Davis and said he thought                 
  this was perceived as money outlay with no return and                        
  thought this would be detrimental to the amendment.                          
                                                                               
  Number 079                                                                   
                                                                               
  CHAIR BUNDE said his objection was not in reference to the                   
  notion of student loan forgiveness but that the student loan                 
  program currently operates at a deficit and any forgiveness                  
  program would increase that deficit.  He restated that the                   
  proposed residency program would cost half a million dollars                 
  per year and he was not sure this was a justifiable expense.                 
  He asserted that this amendment was intended to design a                     
  program and does not fund or mandate a program.  He said it                  
  could be assumed that the student loan forgiveness program                   
  relates to primary care providers even though it is not                      
  explicitly stated.                                                           
                                                                               
  Number 092                                                                   
                                                                               
  COMMISSIONER USERA asked if this was an assignment for the                   
  commission itself and not its public health committee.  She                  
  noted that this really seemed like a public health matter of                 
  having adequate health providers in the state and she                        
  questioned if this would be better handled by the public                     
  health committee.                                                            
                                                                               
  Number 107                                                                   
                                                                               
  REP. B. DAVIS said she thought the role of the commission                    
  was to be responsible for overseeing all of this.  She said                  
  this amendment was designed to work specifically  with                       
  bringing in incentives that would allow other primary care                   
  providers to come to Alaska.                                                 
                                                                               
  Number 118                                                                   
                                                                               
  COMMISSIONER S. USERA said she was addressing where this                     
  would best fit in the bill.  She referred to page 15 and                     
  read, "established a public health advisory committee," and                  
  on the bottom of page 16 she read, "includes (a) analysis,                   
  (b) assessment, (c) delineation, (d)documentation,                           
  (e)identification, and (f) recommendations..."  She said the                 
  phrase, "a program to give incentives to primary care                        
  providers" might be inserted under (f) where it says                         
  "pertaining to the following."                                               
                                                                               
  Number 137                                                                   
                                                                               
  REP. B. DAVIS agreed with Commissioner Usera that this                       
  probably could fit.                                                          
                                                                               
  CHAIR BUNDE asked Rep. B. Davis if she would consider ending                 
  the amendment after the phrase in section (8) that reads,                    
  "underserved areas of the state."                                            
                                                                               
  Number 142                                                                   
                                                                               
  REP. B. DAVIS said this did not go as far as she would like,                 
  but "sometimes half a loaf is better than none" and said she                 
  would consider this.                                                         
                                                                               
  Number 148                                                                   
                                                                               
  CHAIR BUNDE said with the given modification he would                        
  consider supporting the amendment.                                           
                                                                               
  Number 149                                                                   
                                                                               
  REP. VEZEY asked, "If we want to provide incentives, why                     
  don't we just pay them more money?"                                          
                                                                               
  Number 151                                                                   
                                                                               
  CHAIR BUNDE replied by saying, "That's premiums on prices."                  
  He indicated that premiums on prices for health care                         
  providers translates into regulating rates.                                  
                                                                               
  Number 155                                                                   
                                                                               
  REP. VEZEY said it seemed like the rates being offered would                 
  not attract providers, so other forms of compensation would                  
  have to be designed.                                                         
                                                                               
  Number 160                                                                   
                                                                               
  CHAIR BUNDE responded that the reason rural and underserved                  
  areas are underserved is not based entirely on price.  He                    
  said it also has to do with where people choose to live.                     
                                                                               
  Number 165                                                                   
                                                                               
  REP. B. DAVIS said she wanted to amend the amendment                         
  according to Chair Bunde's and Commissioner Usera's                          
  suggestion.                                                                  
                                                                               
  Number 169                                                                   
                                                                               
  COMMISSIONER USERA clarified this was on page 17, line 17,                   
  subsection (v), under the "may" section but is included in                   
  the task of the public health commission under the section                   
  (f) that reads, "recommendations, including recommendations                  
  for specific legislative action when necessary, pertaining                   
  to the following."                                                           
                                                                               
  Number 177                                                                   
                                                                               
  REP. TOOHEY asked if the phrase "student loan forgiveness                    
  program" was removed.                                                        
                                                                               
  Number 179                                                                   
                                                                               
  CHAIR BUNDE responded that everything after "underserved                     
  areas of the state" was being removed.                                       
                                                                               
  CHAIR BUNDE stated that the amendment to the amendment                       
  deletes everything in section (8) beginning with the word                    
  "incentives."                                                                
                                                                               
  REP. B. DAVIS read, "...design a program to give incentives                  
  to primary care providers to practice in the state,                          
  especially in rural and underserved areas of the state."                     
                                                                               
  Number 188                                                                   
                                                                               
  CHAIR BUNDE asked if there were any objections.  Hearing                     
  none, the amendment to the amendment passed.  Chairman Bunde                 
  stated that Amendment 19 as amended was before the                           
  committee.  He identified the location on page 17, line 17,                  
  section (v) and asked if there was any further objection.                    
  Hearing none, the amended Amendment 19 was so moved.                         
                                                                               
  CHAIR BUNDE brought the committee's attention to Amendment                   
  20.                                                                          
                                                                               
  REP. B. DAVIS moved to adopt Amendment 20.                                   
                                                                               
  CHAIR BUNDE indicated that the amendment had been moved and                  
  objected to and asked Rep. B. Davis for comment.                             
                                                                               
  REP. B. DAVIS said "the amendment speaks for itself" and                     
  indicated that if there were any objections she had no                       
  compromise to make and so therefore stated that she would                    
  like for a vote to be taken on the amendment.                                
                                                                               
  Number 212                                                                   
                                                                               
  CHAIR BUNDE asked Commissioner Usera if this would impact                    
  the fiscal note.                                                             
                                                                               
  Number 213                                                                   
                                                                               
  COMMISSIONER USERA spoke in opposition to the amendment.                     
                                                                               
  Number 215                                                                   
                                                                               
  REP. B. DAVIS asked if the administration would accept                       
  "five" instead of "three."  She said she did not think three                 
  people would be able to manage the workload and asked for a                  
  recommendation from the administration regarding this.                       
                                                                               
  Number 220                                                                   
                                                                               
  COMMISSIONER USERA said the administration's concept was                     
  that three people would direct the work of the commission                    
  and a support staff would be available to do much of the                     
  day-to-day analysis.                                                         
                                                                               
  Number 226                                                                   
                                                                               
  REP. B. DAVIS maintained that she wanted the amendment to be                 
  voted on and she encouraged committee members to do what                     
  they thought was best and to vote in favor of the amendment.                 
                                                                               
  Number 231                                                                   
                                                                               
  REP. BRICE moved that an amendment to the amendment be made                  
  by changing Step "C" to "A" and Range "26" to "10" on page                   
  14, line 28.                                                                 
                                                                               
  Number 256                                                                   
                                                                               
  REP. OLBERG said his fiscal note indicated nine employees                    
  and $150,000 worth of technical and legal assistance.                        
                                                                               
  CHAIR BUNDE said there was an amendment to the amendment.                    
  After hearing an objection from Rep. Toohey, Chair Bunde                     
  called for the vote.  Reps. Kott and Brice voted "Yea" and                   
  Reps. G. Davis, Vezey, Olberg, B. Davis, Nicholia, Toohey,                   
  and Bunde voted "Nay."                                                       
                                                                               
  CHAIR BUNDE stated that Amendment 20, which would increase                   
  the members of the commission to five and further define the                 
  membership of the commission, was before the committee.                      
  There being no further discussion, Chair Bunde called for                    
  the vote.  Reps. B. Davis, Nicholia, and Brice voted "Yea"                   
  and Reps. Vezey, Kott, Olberg, Toohey, Bunde, and G. Davis                   
  voted "Nay."  Chair Bunde declared that Amendment 20 failed                  
  to be adopted.                                                               
                                                                               
  CHAIR BUNDE, indicated that Amendment 21 had been moved and                  
  asked Rep. B. Davis address the amendment.                                   
                                                                               
  Number 286                                                                   
                                                                               
  REP. B. DAVIS referred to page 22, line 2, and said this                     
  would delete "(a)" and would also delete all material on                     
  lines 14-16 on page 22.                                                      
                                                                               
  Number 293                                                                   
                                                                               
  COMMISSIONER USERA said the administration received a letter                 
  of opinion from the Department of Law in response to Mr.                     
  Michael F. Ford's comments.  Her recollection of his                         
  testimony was that there was a problem with the Governor                     
  getting involved with the legislators' purview.  She stated                  
  that, in essence, the letter received says that because of                   
  the nature of the work of this commission, they do not know                  
  when a plan is going to be available for analysis and to                     
  have to go back to the legislature for a specific extension                  
  authority would not be very cost or time effective.                          
  Furthermore, one of the primary purposes of this commission                  
  is to provide management and implementation analysis for                     
  plans as they are presented and at this time it is not                       
  known, for example, when the primary federal plan is going                   
  to be firm enough to be workable.  The idea here is that the                 
  Governor would have the authority to extend the deadline for                 
  making that report.  She said the administration would                       
  certainly be amenable to making that more explicit but as a                  
  practical matter having to come back to the legislature just                 
  to say that the deadline has not been met does not seem to                   
  work very well.  Commissioner Usera noted that the letter                    
  had been made available that day.                                            
                                                                               
  Number 321                                                                   
                                                                               
  REP. B. DAVIS said even with the letter, the language needs                  
  to be more explicit.  She further stated that she did not                    
  quite see the validity of taking authority away from the                     
  legislature and giving it to the Governor, based on the                      
  possibility that there might be some difficulty with meeting                 
  the deadline.  She added that the window would be more than                  
  seven months and could possibly be one or two years.                         
                                                                               
  Number 328                                                                   
                                                                               
  COMMISSIONER USERA said they would be happy to talk about                    
  crafting something more narrow.  She suggested that perhaps                  
  it was because she was sued so often for not meeting                         
  deadlines that she was particularly sensitive to providing                   
  some flexibility.  She again suggested that the letter be                    
  taken into account and that crafting something more narrow                   
  be looked into.                                                              
                                                                               
  Number 336                                                                   
                                                                               
  REP. B. DAVIS withdrew her objection.                                        
                                                                               
  Number 337                                                                   
                                                                               
  CHAIR BUNDE brought Amendment 22 to the attention of the                     
  committee and asked Rep. B. Davis to address the amendment.                  
                                                                               
  Number 340                                                                   
                                                                               
  REP. B. DAVIS moved the amendment and explained that the                     
  date for the forms to be completed was set at July 1, 1995.                  
                                                                               
  Number 348                                                                   
                                                                               
  CHAIR BUNDE asked Commissioner Usera for comment.                            
                                                                               
  Number 349                                                                   
                                                                               
  COMMISSIONER USERA deferred to the Division of Insurance.                    
                                                                               
  Number 352                                                                   
                                                                               
  MS. THURSTON said she was unsure of the time lines involved                  
  and that the division would probably receive relevant                        
  information from one of the national organizations working                   
  on uniform claim forms.  She added that although she was                     
  unsure, she thought this timing sounded reasonable.                          
                                                                               
  Number  359                                                                  
                                                                               
  REP. TOOHEY said she had inquired at the Division of                         
  Insurance about this specific time line and the deputy                       
  commissioner said this time line was too close and that June                 
  30, 1995, was the date suggested as being most comfortable.                  
                                                                               
  Number 363                                                                   
                                                                               
  MS. THURSTON said the deputy director arrived...                             
  (indiscernible).                                                             
                                                                               
  Number 371                                                                   
                                                                               
  REP. TOOHEY withdrew her objection after it was pointed out                  
  that the difference between June 30, 1995, and July 1, 1995,                 
  was only one day.                                                            
                                                                               
  Number 373                                                                   
                                                                               
  COMMISSIONER USERA said there was not a big objection to                     
  this time frame, it seemed reasonable, and the division had                  
  avoided a specific time frame because they were waiting to                   
  see the national standards.  She said the division found                     
  this as an acceptable amendment.                                             
                                                                               
  Number 382                                                                   
                                                                               
  CHAIR BUNDE asked if there were any objections to Amendment                  
  22.  Hearing none, Amendment 22 was so adopted.                              
                                                                               
  Number 384                                                                   
                                                                               
  CHAIR BUNDE indicated that Amendment 23 was before the                       
  committee.                                                                   
                                                                               
  REP. B. DAVIS moved Amendment 23 and said she would like to                  
  delete "may" and insert "shall" on page 16, line 11.                         
                                                                               
  REP. TOOHEY objected.                                                        
                                                                               
  Number 398                                                                   
                                                                               
  COMMISSIONER USERA mentioned there had previously been                       
  extensive discussion on this and a compromise had been                       
  struck that the commission not be mandated but be allowed                    
  discretion.  She said, therefore, the administration                         
  believes the wording is appropriate as it is.                                
                                                                               
  Number 405                                                                   
                                                                               
  CHAIR BUNDE asked for further discussion.  Hearing none,                     
  Chair Bunde called for the vote.  Reps. B. Davis, and                        
  Nicholia voted "Yea" and Reps. Kott, Olberg, Toohey, Bunde,                  
  G. Davis and Vezey voted "Nay." (Indiscernible regarding                     
  Rep. Brice - the voting record showed that he did not vote.)                 
  Chair Bunde stated that Amendment 23 failed to be adopted.                   
                                                                               
  CHAIR BUNDE noted that the next meeting on HB 414 was                        
  scheduled for Wednesday, March 23, and Rep. Brice would have                 
  an amendment at that time.  Chair Bunde said he intended to                  
  move HB 414 from the HESS Committee at that time.                            
                                                                               
  Number 419                                                                   
                                                                               
  REP. B. DAVIS asked if another witness from insurance would                  
  address Amendment 16.                                                        
                                                                               
  Number 424                                                                   
                                                                               
  CHAIR BUNDE confirmed that Amendments 16 and 24 would be                     
  addressed.                                                                   
                                                                               
  Number 426                                                                   
                                                                               
  REP. B. DAVIS requested that there be further clarification                  
  from the administration as to the exact workings of this                     
  bill.                                                                        
                                                                               
  Number 431                                                                   
                                                                               
  CHAIR BUNDE said the current working draft committee                         
  substitute would be available to the committee members                       
  before the next meeting to allow for further study.                          
                                                                               
  Seeing no further business before the committee, CHAIR BUNDE                 
  adjourned the meeting at 4:55 p.m.                                           
                                                                               

Document Name Date/Time Subjects