Legislature(2007 - 2008)CAPITOL 106
04/10/2008 03:00 PM House HEALTH, EDUCATION & SOCIAL SERVICES
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| SB170 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | SB 170 | TELECONFERENCED | |
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE
April 10, 2008
3:01 p.m.
MEMBERS PRESENT
Representative Peggy Wilson, Chair
Representative Bob Roses, Vice Chair
Representative Anna Fairclough
Representative Wes Keller
Representative Paul Seaton
Representative Sharon Cissna
Representative Berta Gardner
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
CS FOR SENATE BILL NO. 170(FIN)
"An Act requiring that health care insurers offer insurance
coverage for well-baby exams."
- MOVED HCS CSSB 170(HES) OUT OF COMMITTEE
PREVIOUS COMMITTEE ACTION
BILL: SB 170
SHORT TITLE: INSURANCE COVERAGE FOR WELL-BABY EXAMS
SPONSOR(s): SENATOR(s) MCGUIRE
05/03/07 (S) READ THE FIRST TIME - REFERRALS
05/03/07 (S) L&C, HES, FIN
05/09/07 (S) L&C AT 1:30 PM BELTZ 211
05/09/07 (S) --Meeting Postponed to Thursday, May
10--
05/10/07 (S) L&C RPT CS 2DP 2AM SAME TITLE
05/10/07 (S) DP: ELLIS, DAVIS
05/10/07 (S) AM: BUNDE, STEVENS
05/10/07 (S) L&C AT 1:30 PM BELTZ 211
05/10/07 (S) -- Rescheduled from 05/09/07 --
02/11/08 (S) HES AT 1:30 PM BUTROVICH 205
02/11/08 (S) Moved CSSB 170(L&C) Out of Committee
02/11/08 (S) MINUTE(HES)
02/13/08 (S) HES RPT CS(L&C) 2DP 2AM
02/13/08 (S) DP: DAVIS, ELTON
02/13/08 (S) AM: THOMAS, DYSON
02/15/08 (S) HES LETTER OF INTENT RECEIVED
02/20/08 (S) FIN AT 9:00 AM SENATE FINANCE 532
02/20/08 (S) Heard & Held
02/20/08 (S) MINUTE(FIN)
03/04/08 (S) FIN RPT CS 5DP NEW TITLE
03/04/08 (S) DP: HOFFMAN, STEDMAN, ELTON, THOMAS,
OLSON
03/04/08 (S) FIN AT 9:00 AM SENATE FINANCE 532
03/04/08 (S) Moved CSSB 170(FIN) Out of Committee
03/04/08 (S) MINUTE(FIN)
03/17/08 (S) RETURNED TO RLS COMMITTEE
04/09/08 (S) TRANSMITTED TO (H)
04/09/08 (S) VERSION: CSSB 170(FIN)
04/10/08 (H) HES AT 3:00 PM CAPITOL 106
WITNESS REGISTER
SENATOR LESIL MCGUIRE
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented SB 170, as prime sponsor.
PAT SHIER, Director
Division of Retirement & Benefits
Department of Administration
Juneau, Alaska
POSITION STATEMENT: Testified during the hearing on SB 170.
DEBBIE GOLDEN, Nurse Consultant
Women, Children's and Family Health
Alaska Division of Public Health
Department of Health & Social Services
Anchorage, Alaska
POSITION STATEMENT: Testified in support of SB 170.
LINDA HALL, Director
Division of Insurance
Department of Commerce, Community, & Economic Development
(DCCED)
Anchorage, Alaska
POSITION STATEMENT: Testified during the hearing on SB 170.
ACTION NARRATIVE
CHAIR PEGGY WILSON called the House Health, Education and Social
Services Standing Committee meeting to order at 3:01:36 PM.
Representatives Wilson, Cissna, Gardner, and Keller were present
at the call to order. Representatives Fairclough, Roses, and
Seaton arrived as the meeting was in progress.
SB 170-INSURANCE COVERAGE FOR WELL-BABY EXAMS
3:02:40 PM
CHAIR WILSON announced that the only order of business would be
CS FOR SENATE BILL NO. 170(FIN), "An Act requiring that health
care insurers offer insurance coverage for well-baby exams."
3:03:12 PM
SENATOR LESIL MCGUIRE, Alaska State Legislature, introduced SB
170, as prime sponsor. She informed the committee that the bill
began as a mandatory coverage bill similar to those regarding
colorectal cancer screening and diabetes. The Committee
Substitute (CS) for SB 170 was a compromise position reached
with small businesses, such that rather than mandatory coverage
for everyone, insurance companies are required to offer coverage
to everyone. The bill defines well-baby exams, for newborns to
two year olds, to include vaccinations, medical assessments on
health, nutrition and development, and consultations with
parents. She referred to written information provided to the
committee that explains the mechanism of a mandated offering of
insurance coverage. Senator McGuire then pointed out that 70
percent of companies already offer well-baby coverage in order
to promote preventative care for good business and good health.
In fact, the administration decided to add well-baby care to its
insurance coverage due to the following data published by the
National Business Group on Health: Medicare enrolled children,
who are up-to-date on their exams through two years of age, are
48 percent less likely to experience an avoidable
hospitalization; children with incomplete care are 60 percent
more likely to visit an emergency department than children who
are up-to-date; routine childhood immunizations return $4.30 in
direct medical cost savings for each $1.00 invested; infant
vision screening savings for reduced disability treatment costs;
and newborn hearing screening is deemed cost-effective and is a
quality of life issue. Senator McGuire concluded that these are
some of the reasons that this is a good health bill and a good
business issue as well. She closed by noting that there is a
committee substitute that amended the original bill to include
the term "health aide" in the definition of health care
professional on page 1, line [12], of the bill.
3:11:08 PM
REPRESENTATIVE GARDNER agreed that this was an important bill,
and referred to the State of Alaska Select Benefits Well-Baby
Analysis Information that indicated a cost estimate of $1.18 per
month. She noted that Premera's estimate was higher and asked
for a comparison of the estimates.
3:11:57 PM
SENATOR MCGUIRE deferred the question to the Department of
Administration.
3:12:38 PM
REPRESENTATIVE ROSES moved HCS CSSB 170, Version 25-LS0868\V,
Bailey, 4/10/08, as the working document. There being no
objection, Version V was before the committee.
3:12:49 PM
PAT SHIER, Director, Division of Retirement & Benefits,
Department of Administration, referred to the Buck Consultant's
document and read:
... return on investment for coverage of fairly non-
specific well-baby care, pre- and post-natal, is
difficult to scientifically quantify.
MR. SHIER explained that the Department of Administration
depended upon the information from Medicaid enrolled children
that is compared to kids without coverage. He said that he was
not concerned about the difference in the costs, but in the
estimate of the cost to the state of between $.25 and $.50 per
member per month, which is a significant return on investment.
3:14:40 PM
CHAIR WILSON related a personal experience to illustrate what
can happen when there is a lack of continuing well-baby care
after delivery.
3:17:19 PM
DEBBIE GOLDEN, Nurse Consultant, Women, Children's and Family
Health, Division of Public Health, Department of Health & Social
Services, stated her support for the bill and paraphrased from a
prepared statement, which read as follows [original punctuation
provided]:
The first twenty four months of a child's life
consists of rapid changes physically, developmentally
and socially. These months are considered some of the
most critical in a child's life to assure later
success in school and transition into adolescence.
One of the primary purposes of well-child visit is to
identify children affected by a physical, mental, or
developmental problem as early in life as possible.
Approximately 16-18percent of children in the U.S. are
diagnosed with disabilities that include speech-
language impairments, mental retardation, learning
disabilities and emotional/behavioral disturbances.
Yet only 20 percent to 30 percent of children with
disabilities are diagnosed and start treatment before
beginning school (Campbell KP, 2007).
Children with disabilities who enter early
intervention program prior to starting kindergarten
are more likely to complete high school; enter and
remain in the workforce; and avoid teen pregnancy,
delinquency, and violent crimes. Research shows that
for every dollar spent on early intervention services
for children with disabilities, $13.00 are saved
(Campbell, KP, 2007)
The Council for Affordable Health Insurance reported
in their "2007 Health Insurance Mandates in States"
publication, 31 states mandate well child care as part
of their insurance packages at an estimated cost of <1
percent of the total cost of the package. In Alaska,
most major private employers such as Providence and
Carrs-Safeway are self-insured and offer preventative
health care not only to children through age 21 or
older, but also for the adult employees and spouses.
The American Academy of Pediatrics and the American
Academy of Family Practice physicians recommend a
schedule of routine visits that coincide with expected
developmental targets of children during not only the
first twenty four months of life, but through toddler-
hood, childhood and teen years. These visits include
a full head to toe physical assessment, as well as
screening for visual problems such as neonatal
cataracts or amblyopia, dental caries, hearing loss,
inappropriate weight-indicating over feeding or
underfeeding, signs of physical abuse, mental health
and bonding status, and developmental milestones. Well
child visits are designed to help parents learn how to
care for their children and address common problems.
Such guidance on topics ranging from injury
prevention, discipline and handling behavioral
problems and nutrition reduce parental stress, improve
productivity and reduce lost work days due to child
illness.
A search of the literature identified several studies
citing the cost benefit to well child/preventative
care. One study conducted in 2002 in the Archives of
Pediatric and Adolescent Medicine demonstrated that
among children with incomplete well child care visits
in the first 6 months of life, there was an increased
risk of having an emergency room visit for an upper
respiratory tract infection, gastroenteritis, asthma
and all causes (Hakim and Ronsaville), 2002). In
another study published in 2002, 16 percent of
children's emergency room visits were found to be for
non-urgent issues (Chung and Schuster, 2004). In 2004,
research published in the Journal of Pediatrics stated
that children who received preventative care from a
pediatric medical home were 73 percent less likely to
utilize the ED if insured. Uninsured children were
nearly 4 times more likely to use the ED than insured
children (Johnson and Rimsza, 2004).
Unintentional injury is the leading cause of death for
children ages 1-4 years. In 2000, unintentional
injury caused nearly 41 percent of all deaths
nationally among children 5-9 years with 56 percent of
these injuries resulting from motor vehicle crashes.
In Alaska, the unintentional injury mortality rate per
100,000 is more than 5.5 times the national rate.
Injuries from motor vehicles, drowning and fire are
significantly higher than national rates.
Unintentional injury accounted for 14.2 percent of all
infant mortality in Alaska compared with 3.4 percent
for the United States as a whole. The economic impact
of injuries is well documented with economic losses
including a decrease in productivity, the potential
for long term disability, and the expense of treatment
and rehabilitation (MCH Fact Sheets, 2005).
Unintentional injuries to children aged 0-19 years
that occurred in 1996 imposed $81 billion in lifetime
resource and productivity costs. Children who
experienced injuries in the year studied lost
approximately 2.6 million quality adjusted years of
life with an average economic loss of $1,060 per
person. In 2000, this amount was recalculated for
children ages 0-14 with a lifetime costs of more than
$50 billion. In a study published in the Journal of
Pediatrics, injury prevention counseling for 0-4 year
olds during well child checks was found to achieve a
savings of $800 per child or $80.00 per visit. The
authors estimated that if all 19.2 million children
ages 0-4 received the standardized injury prevention
education, $230 million dollars would be saved
annually in medical spending and injury costs would
decrease by $3.4 billion. This means that for every
dollar spend on standardized childhood injury
prevention targeting 0-4 year olds, returns nearly
$13.00 (Miller and Gailbrath, 1995). Education with
parents on prevention and safety regarding the 5
leading causes of injury includes falls, MVA's, other
MV or cycle crashes, such as 3 and 4 wheelers,
injuries associated with being struck by or against
and object and cutting or piercing-these 5 account for
nearly 80 percent of the lifetime resource and
productivity costs.
The American Academy of Pediatrics recently published
their recommendations that pediatric visits at age 18
months and 24 months to include universal screening
specifically targeting autism spectrum disorders.
Given the Center for Disease Control and Prevention
estimations of 1 in 150 children who have an autism
spectrum disorder, the need to identify children early
and assist in connecting them with treatment services
such as early intervention is an important step to
improve long term outcomes.
Obesity is a major health issue facing our country.
Studies indicate that young children less than the age
of three with weights over the 90th percentile are at
risk for long term problems if their weight can not be
controlled with an appropriate diet and exercise. The
American Academies of Pediatrics and Family Medicine
recommend discussing weight and growth patterns with
parents and each visit with a focused discussion for
children who are at the 90th percentile or above at a
year to 18 months of age.
Parenting expectations and knowledge regarding
developmental readiness and their correlation to abuse
and neglect have been well noted in the literature.
Health visits are an opportune time to observe
parental behaviors, answer questions and provide
anticipatory guidance to parents regarding appropriate
expectations for children regarding issues such as
feeding, toilet training, management of inappropriate
behaviors and so on. These conversations are
inclusive of parents and other care providers and are
part of standard content in health supervision.
A focused and structured visit timed with
developmental milestones in a child's life provides
time for parents and their health care provider to
discuss their child, air their concerns and be
referred for problems identified early. If children
are only seen episodically for acute care problems in
urgent care settings (which might change due to the
timing of the problem and family's work schedule), the
child will not have the benefit of being seen when
well, will generally not have a consistent provider
looking at them and will not benefit from the
relationship that can develop between the health care
provider/medical home and the child's family.
Children can greatly benefit from a protective and
preventative system-one that helps families anticipate
upcoming needs, monitor problems as they arise and
coordinate services. The Department of Health and
Social Services supports the intent of this bill to
promote health, detect problems early and refer to
appropriate providers.
3:23:18 PM
REPRESENTATIVE CISSNA requested that copies of Ms. Golden's
testimony be provided to committee members.
3:24:03 PM
LINDA HALL, Director, Division of Insurance, Department of
Commerce, Community, & Economic Development (DCCED), informed
the committee that the Division of Insurance is not opposed to
well-baby care. She stated her approval that the bill directs a
mandatory offering as opposed to a mandate. In fact, 350,000
Alaskans are enrolled in private insurance plans and only
150,000 of those plans are regulated by the Division of
Insurance. Therefore, not every plan is overseen by AS Title 21
and the policy decisions about coverages; a mandate or an
offering for a benefit would apply to a limited group of
Alaskans. Ms. Hall agreed with Mr. Shier that this was a good
direction for the Select Benefits Plan to take toward providing
this coverage.
3:26:50 PM
CHAIR WILSON closed public testimony.
3:27:07 PM
REPRESENTATIVE ROSES moved to report HCS CSSB 170, Version 25-
LS0868\V, Bailey, 4/10/08, out of committee with individual
recommendations and the accompanying fiscal notes. There being
no objection, HCS CSSB 170(HES) was reported from the House
Health, Education and Social Services Standing Committee.
3:27:30 PM
ADJOURNMENT
There being no further business before the committee, the House
Health, Education and Social Services Standing Committee meeting
was adjourned at 3:27 p.m.
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