Legislature(1993 - 1994)

02/23/1994 03:00 PM HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
txt
                                                                               
           HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES                         
                       STANDING COMMITTEE                                      
                        February 23, 1994                                      
                            3:00 p.m.                                          
                                                                               
  MEMBERS PRESENT                                                              
                                                                               
  Rep. Cynthia Toohey, Co-Chair                                                
  Rep. Con Bunde, Co-Chair                                                     
  Rep. Gary Davis, Vice Chair                                                  
  Rep. Al Vezey                                                                
  Rep. Pete Kott                                                               
  Rep. Harley Olberg                                                           
  Rep. Irene Nicholia                                                          
  Rep. Tom Brice                                                               
                                                                               
  MEMBERS ABSENT                                                               
                                                                               
  Rep. Bettye Davis                                                            
                                                                               
  OTHER LEGISLATORS PRESENT                                                    
                                                                               
  Rep. John Davies                                                             
                                                                               
  COMMITTEE CALENDAR                                                           
                                                                               
  HB 139:   "An Act establishing a loan guarantee and interest                 
            rate subsidy program for assistive technology."                    
                                                                               
            PASSED OUT OF COMMITTEE                                            
                                                                               
  *HB 451:  "An Act establishing the Alaska Health Insurance                   
            Corporation and requiring licensed health care                     
            providers to comply with certain statutes and                      
            regulations relating to the corporation; relating                  
            to disability insurance claims processing and to                   
            approval of rates for disability insurance,                        
            including health insurance; and providing for an                   
            effective date."                                                   
                                                                               
            HEARD AND HELD                                                     
                                                                               
  (* First public hearing.)                                                    
                                                                               
  WITNESS REGISTER                                                             
                                                                               
  RUPE ANDREWS, Representative                                                 
  American Association of Retired Persons                                      
  9416 Long Run Dr.                                                            
  Juneau, Alaska 99801                                                         
  Phone:  (907) 789-7422                                                       
  Position Statement:  Testified in support of HB 139                          
                                                                               
  STAN RIDGEWAY, Deputy Director                                               
  Division of Vocational Rehabilitation                                        
  Department of Education                                                      
  801 W. 10th St., Ste. 200                                                    
  Juneau, Alaska 99801-1894                                                    
  Phone:  (907) 465-6932                                                       
  Position Statement:  Testified in support of HB 139                          
                                                                               
  DR. THOMAS NIGHSWANDER, Chairman                                             
  Health System Reform Work Group                                              
  255 Gambell St.                                                              
  Anchorage, Alaska 99501                                                      
  Phone:  (907) 257-1234                                                       
  Position Statement:  Testified in support of HB 451                          
                                                                               
  NANCY CORNWELL, Member                                                       
  Health System Reform Work Group                                              
  2411 West 69th Ave.                                                          
  Anchorage, Alaska 99502                                                      
  Phone:  (907) 243-8326                                                       
  Position Statement:  Answered questions on HB 451                            
                                                                               
                                                                               
  PREVIOUS ACTION                                                              
                                                                               
  BILL:  HB 139                                                                
  SHORT TITLE: ASSISTIVE TECHNOLOGY LOAN GUARANTEES                            
  SPONSOR(S): REPRESENTATIVE(S) DAVIES,Brice,Brown,B.Davis,                    
  Grussendorf,James,Larson,Nordlund,Sitton,Ulmer,Menard,                       
  Hudson,Mackie,MacLean,Porter,Foster,Hanley,Kott                              
  JRN-DATE    JRN-PG                     ACTION                                
  05/01/03              (S)   JUD AT 12:00 PM BELTZ ROOM 211                   
  02/08/93       254    (H)   READ THE FIRST TIME/REFERRAL(S)                  
  02/08/93       254    (H)   L&C, HES, JUDICIARY, FINANCE                     
  03/25/93              (H)   L&C AT 03:00 PM CAPITOL 124                      
  03/25/93              (H)   MINUTE(L&C)                                      
  03/26/93       784    (H)   L&C RPT  CS(L&C)  5DP                            
  03/26/93       784    (H)   DP: GREEN, WILLIAMS,MULDER,                      
                              SITTON,HUDSON                                    
  03/26/93       784    (H)   -FISCAL NOTE  (DOE)  3/26/93                     
  05/01/93              (S)   JUD AT 00:00 AM BELTZ ROOM 211                   
  01/21/94      2127    (H)   COSPONSOR(S):  MACKIE                            
  02/03/94      2247    (H)   COSPONSOR(S):  MACLEAN                           
  02/09/94      2327    (H)   COSPONSOR(S):  PORTER,FOSTER,                    
                              HANLEY,KOTT                                      
  02/23/94              (H)   HES AT 03:00 PM CAPITOL 106                      
                                                                               
                                                                               
  BILL:  HB 451                                                                
  SHORT TITLE: COMPREHENSIVE HEALTH INSURANCE ACT                              
  SPONSOR(S): HEALTH, EDUCATION AND SOCIAL SERVICES BY REQUEST                 
  JRN-DATE    JRN-PG                     ACTION                                
  02/09/94      2315    (H)   READ THE FIRST TIME/REFERRAL(S)                  
  02/09/94      2315    (H)   HES, LABOR & COMMERCE, FINANCE                   
  02/23/94              (H)   HES AT 03:00 PM CAPITOL 106                      
                                                                               
                                                                               
  ACTION NARRATIVE                                                             
                                                                               
  TAPE 94-27, SIDE A                                                           
  Number 000                                                                   
                                                                               
  CHAIR TOOHEY called the meeting to order at 3:06 p.m., noted                 
  members present and announced the calendar.  She brought HB
  139 to the table.                                                            
  HB 139 - ASSISTIVE TECHNOLOGY LOAN GUARANTEES                                
                                                                               
  REP. JOHN DAVIES, Prime Sponsor of HB 139, addressed the                     
  bill.  He stated that people with disabilities often have                    
  difficulties qualifying for conventional loans to purchase                   
  assistive technology.  Assistive technology includes items                   
  such as hearing aids, walkers, talking computers, wheel                      
  chairs, and wheel chair lift equipment.  He explained that                   
  HB 139 would set up a fund to guarantee up to 90% of a bank                  
  loan received by a qualified individual for the purpose of                   
  purchasing needed assisted technology.  In addition, the                     
  state could subsidize on a needs basis or part of the                        
  interest on the loan.  He said the fund would be capitalized                 
  with $100,000 of federal money, as indicated on the fiscal                   
  note.  He further mentioned that there could possibly be                     
  some additions to the fiscal note if the program is                          
  reauthorized; more funds may be available in the out years.                  
  He maintained that this year's fiscal note would not be                      
  affected.  He said the National Multiple Sclerosis Society,                  
  Denali State Bank, Deaf Community Services, and Access                       
  Alaska support the legislation.                                              
                                                                               
  REP. DAVIES said that the Department of Education (DOE)                      
  estimates that there are at least 4000 people in Alaska that                 
  would benefit from the proposed legislation.  He provided a                  
  committee substitute (CS) that indicated changes on page 2                   
  where loans for businesses have been omitted.  Also, on page                 
  2, line 15, there is a provision which allows for loans to                   
  modify vehicles but not to purchase a vehicle.  He further                   
  stated that page 2, line 18, establishes the loan technology                 
  committee.                                                                   
                                                                               
  Number 173                                                                   
                                                                               
  CHAIR TOOHEY asked if there was any other conduit that                       
  people with disabilities could use to obtain the needed                      
  funds.                                                                       
                                                                               
  REP. DAVIES replied that the bill requests that people                       
  exhaust all other possible conduits first before utilizing                   
  this program.  He said one of the features of the bill is                    
  that it allows the interest rate to be brought down out of                   
  the loan funds, thereby making the loan more affordable.                     
                                                                               
  Number 185                                                                   
                                                                               
  CHAIR TOOHEY asked how many people in Alaska would benefit                   
  from the proposal.                                                           
                                                                               
  REP. DAVIES reiterated that the Department of Education                      
  estimates there to be 4000 eligible people.                                  
                                                                               
  CHAIR TOOHEY asked if there were enough funds available for                  
  that number of people.                                                       
                                                                               
  REP. DAVIES said the average loan application would be for                   
  $700.  He said it is a type of revolving loan as people                      
  would pay the loan back as money becomes available.                          
                                                                               
  CHAIR TOOHEY asked what happens when people default on the                   
  loan.                                                                        
                                                                               
  REP. DAVIES responded that the funds are guaranteed by the                   
  federal government, and the loans are made by private                        
  lending institutions.  He explained that other states have                   
  experienced very low default rates on these types of loan.                   
                                                                               
  Number 249                                                                   
                                                                               
  REP. VEZEY, after explaining the high cost to a lending                      
  institution for granting small amount loans, asked if many                   
  lending institutions are interested in the program.                          
                                                                               
  REP. DAVIES indicated a letter of support from Gary Roth,                    
  President and Chief Executive Officer of Denali State Bank,                  
  Fairbanks.  He said Mr. Roth was very enthusiastic about the                 
  program.  He further stated that the loans would be made at                  
  standard private bank rates, and if the individual could not                 
  afford the interest rate, the fund would be allowed to buy                   
  down the interest rate.                                                      
                                                                               
  Number 329                                                                   
                                                                               
  REP. VEZEY asked what the origination costs of the loans                     
  would be.                                                                    
                                                                               
  REP. DAVIES said he did not know what the specific rates                     
  were.  He explained that the loan is processed through a                     
  bank at standard rates.                                                      
                                                                               
  REP. VEZEY asked why there were no administrative costs                      
  listed in the fiscal note.                                                   
                                                                               
  REP. DAVIES responded that the Division of Vocational                        
  Rehabilitation, Department of Education, estimates that                      
  their existing personnel can handle the required                             
  administration.                                                              
                                                                               
  Number 390                                                                   
                                                                               
  REP. VEZEY asked how fast $100,000 would be depleted.                        
                                                                               
  REP. DAVIES explained that it would depend on the decisions                  
  of the committees and banks as to how many loans need to be                  
  subsidized, what the default rates are, etc.  He further                     
  stated that the Clinton Administration has just reauthorized                 
  the program, requesting an additional $3 million nationwide.                 
  He said at least three to five years of federal money could                  
  be expected to go into the program, on an annual basis.                      
                                                                               
  REP. VEZEY asked if the $100,000 was currently available.                    
                                                                               
  REP. DAVIES answered yes.                                                    
                                                                               
  REP. VEZEY asked why the fiscal note was $100,000.                           
                                                                               
  REP. DAVIES said it represents federal receipts.                             
                                                                               
  Number 431                                                                   
                                                                               
  REP. G. DAVIS asked if the director referred to on page 2,                   
  line 18, was the director of the Division of Vocational and                  
  Rehabilitation, DOE.                                                         
                                                                               
  REP. DAVIES said yes.                                                        
                                                                               
  Number 441                                                                   
                                                                               
  CHAIR TOOHEY asked if there was a time frame for the program                 
  or would it go on indefinitely.                                              
                                                                               
  REP. DAVIES said it would go on forever as long as the                       
  federal program exists.  He also said that private monies                    
  are allowed into the program.  He further stated that with a                 
  certain amount of federal money going into the program each                  
  year, the program would operate somewhat like a revolving                    
  loan fund.                                                                   
                                                                               
  CHAIR TOOHEY asked if there would be a limit on how low the                  
  funds could become before loans would no longer be granted.                  
                                                                               
  REP. DAVIES said if there is no money the program does not                   
  exist.                                                                       
                                                                               
  CHAIR TOOHEY asked Rep. Olberg if it would be prudent to not                 
  grant loans until the fund has been replenished.                             
                                                                               
  REP. OLBERG responded no.  He explained that the funds are                   
  to guarantee a bank that they will be repaid.                                
                                                                               
  CHAIR TOOHEY asked if, once the amount is encumbered, no                     
  more loans would be granted.                                                 
                                                                               
  REP. OLBERG agreed and said that the entire $100,000 could                   
  be encumbered without any problems.                                          
                                                                               
  CHAIR TOOHEY said that nothing would be encumbered over the                  
  $100,00 amount.                                                              
                                                                               
  REP. OLBERG commented not if the loans are to be guaranteed.                 
                                                                               
  Number 498                                                                   
                                                                               
  REP. BRICE said that as payments are received on the loans                   
  the amount would be replenished accordingly.                                 
                                                                               
  REP. OLBERG, as a former colleague of Gary Roth, spoke to                    
  Mr. Roth's professionalism and expertise.  He stated that                    
  the program must have a great deal of merit if Mr. Roth was                  
  endorsing it.                                                                
                                                                               
  Number 525                                                                   
                                                                               
  REP. DAVIES said the committee that the director shall                       
  establish will include a representative of a financial                       
  institution.  The committee would establish the percentage                   
  of money that may be used for subsidizing interest rates.                    
                                                                               
  Number 546                                                                   
                                                                               
  RUPE ANDREWS, Representative, American Association of                        
  Retired Persons (AARP), testified in support of HB 139.  He                  
  stated that the state legislative committee is in full                       
  support of the proposal.  He said the bill would ensure                      
  access to quality living for all generations, not just                       
  senior citizens.                                                             
                                                                               
  CHAIR TOOHEY asked if senior citizens would be using the                     
  program.                                                                     
                                                                               
  REP. DAVIES said there are no age restrictions.                              
                                                                               
  (CHAIR TOOHEY stated for the record that Rep. Olberg arrived                 
  at 3:08 p.m., Rep. Kott arrived at 3:23 p.m., and Rep. Brice                 
  arrived at 3:10 p.m.)                                                        
                                                                               
  Number 589                                                                   
                                                                               
  STAN RIDGEWAY, Deputy Director, Division of Vocational                       
  Rehabilitation, Department of Education, testified in                        
  support of HB 139.  He stated that within the Division of                    
  Vocational Rehabilitation there is a program called                          
  Assistive Technologies of Alaska.  He said assistive                         
  technology is the mechanism that allows federal funds to the                 
  state to fund the loan program.  He said President Clinton                   
  had just signed the reauthorization for the federal program,                 
  and with that information he foresees the program being                      
  funded for the next five years with a minimum of $100,000.                   
  He said it was good leverage to make loans with.  Mr.                        
  Ridgeway said the program is not a revolving loan, it's a                    
  loan guarantee.  He further stated that the $100,000 that                    
  would be set aside in the treasury would be a guarantee to                   
  back the loans.  He indicated that there were several ways                   
  for the loans to be leveraged.  He explained there is an                     
  estimate that the $100,000 would leverage approximately                      
  $750,000 in loans, depending how much money the loan                         
  committee would set aside to buy down interest rates.  He                    
  said there are 42 other states with the program, and three                   
  states are fully funded by the federal government.  He said                  
  the banks would incur either the same cost or less to make                   
  the assistive loans.  He indicated that most states have a                   
  limit of $5000 on the loans.                                                 
                                                                               
  Number 583                                                                   
                                                                               
  REP. VEZEY commented that if $100,000 is leveraged for                       
  $750,000 in loans, the state could be responsible for                        
  $650,000 in defaulted loans.  He said it's either a loan                     
  guarantee or not.                                                            
                                                                               
  MR. RIDGEWAY agreed, saying that one of the possibilities on                 
  loan guarantee is that part of the $100,000 could be used to                 
  buy "an insurance policy that would guarantee those loans."                  
  He said the committee could decide to loan $100,000 against                  
  $100,000 for the first year.                                                 
                                                                               
  REP. VEZEY asked if Mr. Ridgeway had any experience with                     
  loan insurance.                                                              
                                                                               
  MR. RIDGEWAY answered that he had a report that he could                     
  extract that information from.                                               
                                                                               
  REP. VEZEY commented that Alaska has had such a terrible                     
  loss experience with loan insurance that he did not think                    
  loan insurance policies would be available at a reasonable                   
  cost.                                                                        
                                                                               
  Number 759                                                                   
                                                                               
  REP. G. DAVIS stated if all the money was allocated and                      
  there were no defaults, it would be conceivable that the                     
  $100,000 could accumulate up to $500,000.                                    
                                                                               
  REP. DAVIES concurred.                                                       
                                                                               
  Number 777                                                                   
                                                                               
  CHAIR TOOHEY asked the pleasure of the committee.                            
                                                                               
  REP. VEZEY asked if the bill was before the committee for                    
  amendment.  After some discussion, Rep. Vezey moved to adopt                 
  the committee substitute for HB 139.                                         
                                                                               
  CHAIR TOOHEY, hearing no objections, said the CS for HB 139                  
  was so moved.                                                                
                                                                               
  Number 799                                                                   
                                                                               
  REP. VEZEY said the CS should be amended to ensure that the                  
  state would not be responsible for any defaults on loans.                    
                                                                               
  CHAIR TOOHEY suggested that Rep. Vezey and Rep. Davies get                   
  together to address that issue and that the bill would be                    
  brought up again at a future time.                                           
                                                                               
  REP. BRICE suggested that the bill be passed out of                          
  committee to the Finance Committee.  He felt that financial                  
  decisions would be better made there.                                        
                                                                               
  REP. VEZEY said to amend the bill would take a total of two                  
  days.                                                                        
                                                                               
  REP. BRICE recommended sending the amendment on to Finance.                  
                                                                               
  Number 853                                                                   
                                                                               
  REP. KOTT said he would work with Rep. Vezey on the                          
  amendment and offer the amendment to the Judiciary                           
  Committee, the next committee of referral.                                   
                                                                               
  REP. G. DAVIS concurred with Rep. Kott.                                      
                                                                               
  Number 874                                                                   
                                                                               
  CHAIR TOOHEY asked the pleasure of the committee.                            
                                                                               
  REP. G. DAVIS made a motion to pass the CS for HB 139 out of                 
  committee to the Judiciary committee with attached fiscal                    
  notes and individual recommendations.                                        
                                                                               
  CHAIR TOOHEY, hearing no objections, declared the bill was                   
  so moved.  She then brought HB 451 to the table.                             
  HB 451 - COMPREHENSIVE HEALTH INSURANCE ACT                                  
                                                                               
  CHAIR TOOHEY stated that Dr. Nighswander would join the                      
  meeting via offnet from Anchorage, and Nancy Cornwell would                  
  be available for technical questions in Juneau.  She                         
  indicated that the meeting was being teleconferenced for                     
  observers only.                                                              
                                                                               
  Number 902                                                                   
                                                                               
  DR. NIGHSWANDER, Chairman, Health System Reform Work Group,                  
  testified on HB 451.  He gave a history of the process                       
  behind HB 451 that lead up to the committee meeting.  He                     
  said the primary concern of the work group was to keep                       
  Alaskan's healthy and to direct people in need of services                   
  of quality care at a reasonable cost.  He said the                           
  fundamental issue was whether to take action now or wait to                  
  see what happens at the federal level.  He felt the question                 
  should be what is right for Alaskans and listed some major                   
  points of concern.  Dr. Nighswander stated that the issues                   
  of long term care and access of services to rural                            
  communities continue to be of keen interest to everyone.  He                 
  said there are 76,000 Alaskans that are completely                           
  uninsured.                                                                   
                                                                               
  DR. NIGHSWANDER said a total of six very public meetings had                 
  taken place prior to the day's meeting.  He said there was a                 
  large cross-section of the public and of professionals in                    
  attendance at those meetings.  He felt it was a very healthy                 
  exchange.                                                                    
                                                                               
  DR. NIGHSWANDER stated that the bill does not define a                       
  benefit package, therefore there is no "sticker price" for                   
  the plan.  He said the legislation does suggest some                         
  financing options, but it does not specify those options.                    
  He explained that the bill is a phased approach in                           
  considering health reform.  It proscribes a very public                      
  concept that provides universal coverage of a standard                       
  benefit package to all residents of the state.  He stated                    
  that there is a well defined public health initiative within                 
  the bill that focuses on wellness and prevention.  He                        
  further stated that the bill would allow persons to choose                   
  their own physician.                                                         
                                                                               
  DR. NIGHSWANDER stated that a voluntary cost control                         
  mechanism is provided for in the legislation.  Also, he said                 
  a peer group would be established to monitor quality and                     
  utilization of health care.  He said the bill would not                      
  prohibit an individual from buying services that would not                   
  be covered by the state plan.                                                
                                                                               
  DR. NIGHSWANDER asserted that the bill would establish the                   
  Alaska Health Corporation, which would be separated from the                 
  federal government as much as possible.  He said the board                   
  would have public representation and would act independently                 
  of government concerns.                                                      
                                                                               
  TAPE 94-27, SIDE B                                                           
  Number 000                                                                   
                                                                               
  DR. NIGHSWANDER said the corporation would collect data from                 
  all health care providers regarding the services being                       
  rendered and relative costs.  The proposal requires state                    
  waivers to obtain that information from the federal                          
  government.  He further stated that the corporation would be                 
  charged with developing a benefit package and reviewing any                  
  options for financing, and subsequently the findings would                   
  be presented to the legislature.  He said there are                          
  incentives within the bill for rural providers.                              
                                                                               
  DR. NIGHSWANDER addressed the issues of cost control                         
  concepts.  He felt that Alaska could accomplish many things                  
  in this area that no other state could.  For example, he                     
  maintained that all orthopedic surgeons or ophthalmologists                  
  could be gathered around one table to discuss cost, quality,                 
  and utilization of services.                                                 
                                                                               
  DR. NIGHSWANDER explained the term market-based single-payer                 
  system.  He said the single-payer system is straight                         
  forward.  He said money for health care that includes                        
  deductibles and co-payments that is provided by the                          
  individual would be funnelled through a single payer.  The                   
  market base would allow for providers to publish price lists                 
  of their services and descriptions of the services they                      
  provide.  He said this would enable a person to cost shop.                   
  He said a statewide health expenditure target is provided                    
  for in the proposal.  The target would be based upon the                     
  data that would be collected early on by the corporation,                    
  focusing on cost and utilization of services.  He said from                  
  the data an accurate assessment could be made as to how much                 
  is being spent on health care.  He asserted that the target                  
  could be adjusted based on various factors; i.e., the                        
  consumer price index (CPI).  He further stated that the plan                 
  provides for voluntary compliance to the expenditure target.                 
                                                                               
                                                                               
  Number 250                                                                   
                                                                               
  CHAIR TOOHEY asked if there were comments or questions for                   
  Dr. Nighswander.                                                             
                                                                               
  DR. NIGHSWANDER said the question remains as to when the                     
  action would be taken on health care.                                        
                                                                               
  Number 296                                                                   
  REP. BRICE asked how the proposal would dovetail with the                    
  federal providers.                                                           
                                                                               
  DR. NIGHSWANDER stated that Senator Ted Stevens perceives                    
  the potential of a "seamless system" in the future whereby                   
  both federal care and private care would be amalgamated into                 
  a single (seamless) system.                                                  
                                                                               
  Number 362                                                                   
                                                                               
  CHAIR TOOHEY said the Oregon plan, which went into effect in                 
  January in the state of Oregon, has become three times                       
  larger than the state had anticipated.  She said that                        
  caution must be used before a plan is implemented in Alaska.                 
                                                                               
  DR. NIGHSWANDER said that was an appropriate concern and                     
  needed to be addressed as soon as possible.                                  
                                                                               
  Number 413                                                                   
                                                                               
  REP. NICHOLIA asked what type of impact HB 451 would have on                 
  Indian Health Services.                                                      
                                                                               
  DR. NIGHSWANDER said there might be a change in financing,                   
  but relatively there would be little impact.  He felt there                  
  would be more of an impact in urban areas.  He indicated                     
  that problems with corporations in the rural areas are                       
  addressed by President Clinton's health care plan.                           
                                                                               
  REP. NICHOLIA asked what the problem was that Dr.                            
  Nighswander referred to regarding corporations in the rural                  
  areas.                                                                       
                                                                               
  DR. NIGHSWANDER explained that in some rural areas there are                 
  no hospitals or providers.                                                   
                                                                               
  Number 534                                                                   
                                                                               
  REP. G. DAVIS suggested that perhaps those people who are                    
  not insured choose not to be insured.                                        
                                                                               
  DR. NIGHSWANDER deferred to Nancy Cornwell to answer the                     
  question.                                                                    
                                                                               
  Number 545                                                                   
                                                                               
  NANCY CORNWELL, Member, Health System Reform Work Group,                     
  answered questions on HB 451.  She acknowledged that there                   
  are some individuals who make the judgement that health care                 
  is not a priority.  She asserted that a great concern was                    
  for the low income individuals that are faced with the                       
  problem of not being able to afford health care.  She                        
  indicated that the percentage of a family's income that is                   
  devoted to health care had increased from 9% to 12%, and it                  
  is projected to be closer to 16% in the year 2000.  She felt                 
  there was little research to indicate the number of Alaskans                 
  who go without health care coverage for long periods of                      
  time.  Ms. Cornwell said there is an overall decline in the                  
  United States of those who have health care coverage.                        
                                                                               
  Number 632                                                                   
                                                                               
  DR. NIGHSWANDER asked where the 76,000 figure came from                      
  regarding the number of Alaskans with no coverage.                           
                                                                               
  MS. CORNWELL said the number was derived from the current                    
  population survey.  The number was derived by combining                      
  three years of data obtained from the Bureau of the Census.                  
                                                                               
  CHAIR TOOHEY asked what time of year the population survey                   
  was taken, indicating that there is a larger population at                   
  work in the summer.                                                          
                                                                               
  MS. CORNWELL said the population survey is ongoing.  She                     
  said the survey referred to as the March Supplement is where                 
  the statistics originate from and the survey is taken in the                 
  month of March.                                                              
                                                                               
  CHAIR TOOHEY said one half of those people would be employed                 
  in June.  She then asked what the percentage was of people                   
  who do not want to purchase coverage.                                        
                                                                               
  MS. CORNWELL said she did not know, and said it is very                      
  difficult information to obtain.  She further stated that                    
  only 9% of the 76,000 are unemployed.  She also said that                    
  people who work in small businesses have a difficult time                    
  receiving health care coverage through their employer.                       
                                                                               
  Number 708                                                                   
                                                                               
  DR. NIGHSWANDER agreed with Ms. Cornwell.  He related to the                 
  committee the scenario of a youth who is uninsured and is                    
  involved in a serious car accident.  He said the result of                   
  situations like that is cost shifting.                                       
                                                                               
  REP. G. DAVIS asked about volume control as opposed to cost                  
  control from the standpoint of prevention.                                   
                                                                               
  Number 750                                                                   
                                                                               
  DR. NIGHSWANDER stated that utilization could be controlled                  
  by the process of co-payments.  He also said the bill allows                 
  for less expensive options; i.e., nurse practitioners and                    
  physicians' assistants (PAs).                                                
                                                                               
  Number 791                                                                   
                                                                               
  MS. CORNWELL referred to page 18, line 2, and said that the                  
  peer review process would review the utilization, quality,                   
  and prices of health care services, after the fact.  Through                 
  the peer review process, there would be self-regulation.                     
  She said the process was modeled after the Maine Medical                     
  Assessment Foundation.  She explained that the process would                 
  cut down on much unwarranted medical procedures.                             
                                                                               
  REP. G. DAVIS agreed.                                                        
                                                                               
  DR. NIGHSWANDER indicated there would be a claims clearing                   
  house.                                                                       
                                                                               
  REP. G. DAVIS said that Indian Health Services (IHS) was                     
  making strides in that area.                                                 
                                                                               
  DR. NIGHSWANDER said that information is shared with other                   
  states.                                                                      
                                                                               
  Number 877                                                                   
                                                                               
  MS. CORNWELL asserted that the proposal would enable all                     
  claims to be brought into a single clearing house in the                     
  state, which would provide a tremendous amount of                            
  information not only for the corporation but everyone in the                 
  state.  She felt certain that the information would be a                     
  significant part of the information highway.                                 
                                                                               
  CHAIR TOOHEY asked who would be responsible for the fiscal                   
  note.  No one had an answer to that question.                                
                                                                               
  Number 920                                                                   
                                                                               
  REP. G. DAVIS referred to the presentation made by the trial                 
  lawyers, and asked Dr. Nighswander what the focal points                     
  were.                                                                        
                                                                               
  DR. NIGHSWANDER stated that the main focus was tort reform                   
  and malpractice reform.                                                      
                                                                               
  CHAIR TOOHEY said that the trial lawyers would be presenting                 
  two bills to the HESS Committee the following week.  She                     
  urged Dr. Nighswander to observe and stay abreast of the                     
  issues.  She asked for further questions.                                    
                                                                               
  REP. G. DAVIS said that it was his hope that much of the                     
  proposed legislation within HB 451 would be retained and                     
  implemented if a "final product" should come about.  He                      
  thanked Dr. Nighswander for his efforts.                                     
                                                                               
  DR. NIGHSWANDER thanked the committee.                                       
                                                                               
  CHAIR TOOHEY expressed her appreciation to both Dr.                          
  Nighswander and Nancy Cornwell for their efforts.                            
                                                                               
  DR. NIGHSWANDER said he was inspired by the whole process.                   
                                                                               
  CHAIR TOOHEY stated that now they both know how much                         
  educating needs to be done so that people can make informed                  
  choices pertaining to health care.                                           
                                                                               
  Seeing no further business before the committee, CHAIR                       
  TOOHEY ADJOURNED the meeting at 4:22 p.m.                                    

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