Legislature(2011 - 2012)CAPITOL 106
02/14/2012 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB209 | |
| HB310 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 310 | TELECONFERENCED | |
| += | HB 209 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
February 14, 2012
3:07 p.m.
MEMBERS PRESENT
Representative Wes Keller, Chair
Representative Alan Dick, Vice Chair
Representative Bob Herron
Representative Paul Seaton
Representative Bob Miller
Representative Charisse Millett
MEMBERS ABSENT
Representative Beth Kerttula
OTHER LEGISLATORS PRESENT
Senator Cathy Giessel
COMMITTEE CALENDAR
HOUSE BILL NO. 209
"An Act requiring a health care insurer to provide coverage for
tobacco cessation treatment."
- HEARD & HELD
HOUSE BILL NO. 310
"An Act temporarily reinstating the child and adult immunization
program in the Department of Health and Social Services; and
providing for an effective date."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: HB 209
SHORT TITLE: INSURANCE COVERAGE FOR TOBACCO CESSATION
SPONSOR(s): REPRESENTATIVE(s) HERRON
03/25/11 (H) READ THE FIRST TIME - REFERRALS
03/25/11 (H) HSS, L&C
04/07/11 (H) HSS AT 3:00 PM CAPITOL 106
04/07/11 (H) Heard & Held
04/07/11 (H) MINUTE(HSS)
02/14/12 (H) HSS AT 3:00 PM CAPITOL 106
BILL: HB 310
SHORT TITLE: STATE IMMUNIZATION PROGRAM
SPONSOR(s): REPRESENTATIVE(s) HERRON
02/01/12 (H) READ THE FIRST TIME - REFERRALS
02/01/12 (H) HSS, FIN
02/14/12 (H) HSS AT 3:00 PM CAPITOL 106
WITNESS REGISTER
LIZ CLEMENTS, Staff
Representative Bob Herron
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: During discussion of HB 209, responded to
questions on behalf of the bill sponsor, Representative Bob
Herron.
LOIS KEITHLY, Director
Massachusetts Tobacco Control Program
Surveillance and Evaluation Director
Tobacco Control Program
Massachusetts Department of Public Health
Boston, Massachusetts
POSITION STATEMENT: Testified during discussion of HB 209.
JAMIE MORGAN
Senior Government Relations Director
American Heart Association (AHA)
Western States Affiliate
Sacramento, California
POSITION STATEMENT: Testified in support of HB 209.
PAT REYNAGA, Nurse
Lead Advocacy Volunteer
American Cancer Society
Cancer Action Network
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 209.
SHEELA TALLMAN
Premera Blue Cross
Seattle, Washington
POSITION STATEMENT: Testified against HB 209.
GEORGE BROWN, MD
Glacier Pediatrics
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 310.
ROSALYN SINGLETON, MD
Alaska Native Tribal Health Consortium (ANTHC)
Immunization Program
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 310.
RANDI SWEET, Director
Community Action
United Way of Anchorage
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 310.
MARY SULLIVAN
Alaska Primary Care Association (APCA)
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 310.
CARL ROSE, Executive Director
Association of Alaska School Boards (AASB)
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 310.
WARD HURLBURT, M.D., Chief Medical Officer/Director
Division of Public Health
Central Office
Department of Health and Social Services
Anchorage, Alaska
POSITION STATEMENT: Answered questions during discussion of HB
310.
ACTION NARRATIVE
3:07:15 PM
CHAIR WES KELLER called the House Health and Social Services
Standing Committee meeting to order at 3:07 p.m.
Representatives Keller, Seaton, Miller, and Herron were present
at the call to order. Representatives Dick and Millett arrived
as the meeting was in progress.
HB 209-INSURANCE COVERAGE FOR TOBACCO CESSATION
3:07:38 PM
CHAIR KELLER announced that the first order of business would be
HOUSE BILL NO. 209, "An Act requiring a health care insurer to
provide coverage for tobacco cessation treatment."
3:08:13 PM
REPRESENTATIVE HERRON, introducing HB 209 as the prime sponsor
of the bill, emphasized that dependence on tobacco was chronic,
and it negatively affected the health, productivity, and well-
being of all Alaskans who indulged in its use. He reported that
tobacco was a leading cause of death for Alaskans, more than
suicide, motor vehicle crashes, and liver disease combined. He
added that the negative economic impact was huge, as it cost
Alaskans more than $300 million in direct medical expenditures,
with an additional $177 million in lost productivity. He
declared "it's a hard habit to kick." He clarified that the
proposed bill offered Alaskans an opportunity for the resources
to end their tobacco addiction, through cessation treatments
offered by insurance companies. He offered to listen to
testimony whether to mandate this.
3:11:28 PM
CHAIR KELLER expressed his concern with a mandate for private
insurance. He asked to clarify that Representative Herron would
offer proposed HB 209 as an insurance policy option to buy, not
as a mandated coverage.
3:12:03 PM
REPRESENTATIVE HERRON confirmed that testimony would determine
if it was practical to delete "provide", and insert "offer," in
the bill.
3:12:48 PM
CHAIR KELLER asked if there was other insurance coverage which
had to be available, but was not mandated.
REPRESENTATIVE HERRON replied that he would research this.
CHAIR KELLER offered his belief that there was other coverage,
and he expressed a desire to know how this had been received.
3:13:28 PM
REPRESENTATIVE SEATON directed attention to the proposed bill,
page 2, Section 1, subsection (c)(3), which read: "Coverage for
tobacco cessation treatment may not require an individual to
participate in a counseling session in order to receive coverage
for medication;" and asked for clarification with page 1,
proposed Section 1, subsection (b)(1), which read: "coverage
for a course of tobacco cessation treatment must include the
cost of not less than four tobacco cessation counseling sessions
provided by a qualified counselor ...."
3:14:36 PM
LIZ CLEMENTS, Staff, Representative Bob Herron, Alaska State
Legislature, replied that the insurance company would be
required to cover at least four counseling sessions per course
of treatment, but that individual consumers would not be forced
to attend counseling sessions as a condition of the treatment
coverage. She declared that experience had shown that success
was higher when the participant was able to determine "how they
choose to quit."
3:18:10 PM
REPRESENTATIVE SEATON, directing attention to page 1, line 9,
proposed Section 1(b)(1), "not less than four tobacco cessation
counseling sessions provided by a qualified counselor," asked if
there was a limit to the number of counseling sessions.
Directing attention to proposed Section 1(b)(2), "over the
counter medication or prescribed medication," he asked if the
transition between paragraphs (1) and (2) was for "and," "or,"
or "and/or."
3:19:04 PM
MS. CLEMENTS, in response to Representative Seaton, agreed that
the minimum number of counseling sessions requiring coverage
would be four. She offered her belief that proposed HB 209
should include "and" between Section 1(b)(1) and (2).
3:19:51 PM
CHAIR KELLER suggested a similar review for the transitions
between paragraphs (1), (2), (3), and (4) of proposed Section
1(c) as well.
REPRESENTATIVE SEATON suggested that Legislative Legal and
Research Services be consulted.
3:20:35 PM
REPRESENTATIVE HERRON clarified that proposed HB 209 did not
want to legislate over the counter medications.
3:20:57 PM
CHAIR KELLER opened public testimony.
3:21:11 PM
LOIS KEITHLY, Director, Massachusetts Tobacco Control Program,
Surveillance and Evaluation Director, Tobacco Control Program,
Massachusetts Department of Public Health, reported that, in
2006, a cessation benefit had been developed for the Medicaid
population. She declared that access to all FDA-approved
medications, "with 16 face to face counseling sessions," and low
co-payments, had resulted in 40 percent use of the benefit, and
a smoking prevalence decrease of 10 percent. She relayed that a
review of the claims data from those smokers utilizing the
benefit found a 46 percent decrease in the possibility of
hospitalization for heart attack and a 49 percent decrease in
the probability of hospitalization for acute coronary heart
disease. She directed attention to a recent return of
investment study by George Washington University which applied
the findings of the aforementioned Medicaid benefit. The report
estimated that every dollar spent for the benefit resulted in a
$3.12 savings for decreased cardiac hospitalization. She opined
that this was strong evidence that encouraging smokers to quit
could offset health care costs.
3:25:33 PM
REPRESENTATIVE SEATON asked to have the George Washington
University study forwarded to the committee.
3:25:57 PM
REPRESENTATIVE MILLER asked to clarify the savings.
3:26:33 PM
MS. KEITHLY, in response to Representative Miller, replied that
the savings reflected every dollar spent, which included
medications, counseling, promotion, and staff time, which
compared to the costs of the aforementioned acute cardiac
conditions.
REPRESENTATIVE MILLER summarized that "it was profitable."
3:27:35 PM
REPRESENTATIVE SEATON asked if the counseling sessions were
local, or centralized, and if the project paid the participants'
transportation costs.
MS. KEITHLY replied that, in Massachusetts, transportation was
never considered a cost. She reported that only 1 - 3 percent
of the claims were for counseling, and the claims could only be
submitted if the counseling was conducted in a hospital or
community health setting.
CHAIR KELLER asked if the program was provided by a government
or a private insurance plan.
MS. KEITHLY replied that this was a Medicaid program, which had
been mandated by the Massachusetts State Legislature.
3:30:07 PM
CHAIR KELLER agreed to the benefits for tobacco cessation, but
acknowledged the question of who would pay for the program.
3:30:22 PM
CHAIR KELLER closed public testimony.
3:30:42 PM
REPRESENTATIVE SEATON asked if a program benefit would include
transportation for the tobacco counseling sessions.
REPRESENTATIVE HERRON offered to clarify this in proposed HB
209.
3:31:59 PM
CHAIR KELLER asked if other private medical insurance would
cover counseling for similar programs.
MS. CLEMENTS replied that she would research this.
REPRESENTATIVE MILLETT asked if the State of Alaska covered
tobacco cessation programs.
MS. CLEMENTS replied that she would defer to the Department of
Health and Social Services.
3:33:23 PM
CHAIR KELLER asked if there was medical insurance coverage for
over the counter medications. Directing attention to proposed
Section 2, he offered his belief that lack of a requirement for
pre-authorization implied that a person "could buy a tobacco
cessation medication and then just directly submit the bill for
the coverage. It just seems like that's out of the norm."
REPRESENTATIVE HERRON replied that he would research this.
3:35:02 PM
REPRESENTATIVE MILLETT, directing attention to the over the
counter medication, asked if cost was an issue for tobacco
cessation.
MS. CLEMENTS replied that several people had indicated that cost
was a primary impediment.
3:35:41 PM
REPRESENTATIVE MILLETT asked if there was any money from the
1998 Tobacco Master Settlement Agreement award to offer for
payment toward over the counter tobacco cessation products.
MS. CLEMENTS replied that she would research this.
3:36:32 PM
CHAIR KELLER opened public testimony.
3:36:46 PM
JAMIE MORGAN, Senior Government Relations Director, American
Heart Association (AHA), Western States Affiliate, testified
that the AHA supported proposed HB 209. She said that
addressing the problem of smoking was a core component of the
AHA mission, and that "unrestricted access to smoking cessation
treatment dramatically improves the success of the patient
attempts, in some cases more than a doubling of the odds for
successfully quitting." She reported that after one year of
smoking cessation, the excess risk of coronary disease caused by
smoking was reduced by half, and after 15 years, these coronary
disease risks were similar to those who had never smoked. She
stated that smoking was the leading cause of preventable death
and a major risk factor for heart disease, stroke, and cancer.
She said that unrestricted access to evidence based cessation
treatment lead to a greater likelihood for successfully quitting
smoking. She offered her belief that proposed HB 209 would
"mean improved public health, cost reduction for treating
chronic disease, and it will result in widespread economic
gain." She urged support for proposed HB 209.
3:38:53 PM
REPRESENTATIVE MILLER, reflecting that many ailments were
negatively impacted by tobacco use, asked if smoking increased
the incidence of miscarriages.
MS. MORGAN replied that this was correct.
3:40:25 PM
PAT REYNAGA, Nurse, Lead Advocacy Volunteer, American Cancer
Society, Cancer Action Network, stated that "tobacco has had and
continues to have devastating, adverse health effects on
Alaskans." She shared that in prior years, the legislature had
supported comprehensive programs, and she stated that tobacco
cessation coverage was one of the most cost effective health
insurance benefits, and that cessation was possible with
evidence based programs.
3:41:13 PM
CHAIR KELLER asked how many times a smoker would try to quit
before success.
MS. REYNAGA replied that there were up to 10 attempts, and she
pointed out that 71 percent of Alaskan adult smokers wanted to
quit.
3:42:24 PM
SHEELA TALLMAN, Premera Blue Cross, testified that Premera Blue
Cross was in opposition to the current proposed version of HB
209. She said that Premera had submitted a letter outlining its
concerns, and offering suggested amendments to the proposed
bill. She reported that Premera currently provided
comprehensive coverage to programs focused on wellness and
prevention. She relayed that the majority of Premera plans
covered tobacco cessation counseling and treatment programs, as
well as certain prescription drugs. She said that the federal
Patient Protection and Affordable Care law declared that insured
and self-insured health plans must include preventive services
such as tobacco cessation and counseling without cost sharing.
She expressed concern that the proposed bill removed cost
control tools such as prior authorization. She pointed out that
federal law stated that nothing would prohibit insurers from
implementing reasonable medical management techniques, and that
the proposed bill went against this.
3:45:07 PM
REPRESENTATIVE MILLER asked for specifics about the cost sharing
and cost control measures.
MS. TALLMAN, in response, said that cost sharing referenced any
out of pocket cost to a member. She defined cost control tools
as medical management techniques which included pre-
authorization and frequency of services and treatments, in order
for insurers to manage overall costs.
3:47:10 PM
REPRESENTATIVE MILLETT asked if insurance plans covered over the
counter drugs.
MS. TALLMAN replied that she was not sure with respect to
smoking cessation. She offered her belief that many of these
could also be paid for through health care flexible spending
accounts.
3:48:03 PM
REPRESENTATIVE MILLETT asked whether Premera supported that the
proposed bill contained no connection between mandatory tobacco
cessation counseling and use of over the counter medications.
MS. TALLMAN replied that the majority of the Premera plans
covered cessation counseling and treatment programs.
REPRESENTATIVE MILLETT opined that the two should go hand in
hand.
3:50:29 PM
CHAIR KELLER closed public testimony.
[HB 209 was held over.]
HB 310-STATE IMMUNIZATION PROGRAM
3:50:48 PM
CHAIR KELLER announced that the final order of business would be
HOUSE BILL NO. 310, "An Act temporarily reinstating the child
and adult immunization program in the Department of Health and
Social Services; and providing for an effective date."
3:51:04 PM
REPRESENTATIVE HERRON, introducing HB 310 as the prime sponsor
of the bill, said that the Alaska immunization program had
benefited from federal grant money for vaccines to underinsured
children and adults who would not, otherwise, have had access.
He pointed out that recent reductions to federal grants had
resulted in an 84 percent loss of funding. He reported that,
thanks to the vaccines, many common, life threatening diseases
were now virtually unheard of. He confirmed that, although the
Alaska Health Care Commission did not specifically endorse
legislation, its report encouraged the State of Alaska to
"adequately support a program that improves immunization rates
in order to protect Alaskans from serious, preventable diseases
and their complications." He opined that this legislation would
benefit all Alaskans.
3:53:57 PM
CHAIR KELLER confirmed that, as a member of the health
commission, he had "become painfully aware of the dangers of
continually expanding health care coverage, but this particular
one is probably a cost savings measure. I think I'm probably
convinced." He allowed that immunizations costs had been paid
for many years, but that $4.9 million of federal money was no
longer available for immunizations. He offered his belief that
similar situations would be forthcoming unless health care costs
were managed.
3:56:10 PM
REPRESENTATIVE MILLER expressed his concern with page 3, lines
3-7 of the proposed bill, and asked about the uses of
"recommended" and "approved." He asked for discussion to the
exclusion of approval for two specific vaccines.
REPRESENTATIVE HERRON replied that testimony would be
forthcoming on that section of proposed HB 310. He suggested
not precluding the commissioner from making the determination of
approval for the two specific vaccines, meningococcal and human
papillomavirus vaccines. He affirmed that testimony would
discuss the advantages and disadvantages for the State of Alaska
to make the determination for these vaccines.
3:58:01 PM
CHAIR KELLER, referring to the recommended immunizations, asked
if the Department of Health and Social Services would determine
the provider.
REPRESENTATIVE HERRON agreed with a need for further discussion
to this.
3:59:12 PM
CHAIR KELLER opened public testimony.
3:59:43 PM
GEORGE BROWN, MD, Glacier Pediatrics, read from a letter from
Glacier Pediatrics [Included in members' packets]:
Please support HB 310. It is critical that children
and families in our great state receive and have
access to vaccinations, not only to ensure the overall
health of our youngest members but also to lessen the
possibility of dangerous infections ravishing our
state. As a state that is working on improving our
vaccine rates (we have been in the lowest 10 percent
for the past several years), it can only happen if we
continue to have vaccines available for all of our
citizens. As pediatric health care providers, we know
that if the Alaska vaccine program decreases or ends
its' subsidy, the people who will suffer are the
working underinsured. We urge you to support House
Bill 310.
4:01:32 PM
DR. BROWN agreed that it was necessary to have concern for cost,
but he emphasized that providing vaccines saved money. He
stated that in the past decade it had been shown that every
dollar spent for measles, mumps, and rubella vaccines had saved
$16. He referred to a recent whooping cough outbreak in Juneau,
and pointed out that these bacterial infections, including
diphtheria and tetanus, required boosters. He allowed that
without the vaccines, this outbreak would have been far worse.
At that time, the vaccine cost $3 or less per person, and the
average cost of treatment was several thousand per
hospitalization. He emphasized that this bill would save a lot
of money, and "some major catastrophes."
4:04:40 PM
DR. BROWN, in response to Representative Miller, said that the
Tdap vaccine was for tetanus, diphtheria, and pertussis.
4:05:41 PM
ROSALYN SINGLETON, MD, Alaska Native Tribal Health Consortium
(ANTHC) Immunization Program, shared some background information
on the use of vaccines in Alaska. She declared that vaccines
were critical to the health of Alaskans. Speaking about
Hepatitis A, she reported that before vaccines there had been
massive epidemics every seven to ten years which had cost
hundreds of thousands of dollars in health response. Since
effective Hepatitis A vaccines were developed in 1995,
infections had dramatically declined, and Alaska now had one of
the lowest rates in the U.S., with the resultant savings of
public health dollars. She reported that in the 1960s, five
percent of the infants in Southwest Alaska, one to eleven months
of age, died, with half of these deaths secondary to measles or
pertussis. Since 1997, Alaska has been free of outbreaks from
measles because of vaccines. She reminded that, because of the
staged federal funding decreases in 2011, Alaska no longer
provided adult vaccines; and, in 2012, Alaska would no longer
provide vaccines to children who were not eligible for federally
funded vaccinations. She pointed out that proposed HB 310 would
reinstate these vaccines until there was a longer term solution.
She stated that many small medical practices would stop
providing vaccines, and that many parents were deferring them
until the vaccine was necessary for school attendance. She
opined that a decrease in coverage could lead to an increased
risk of outbreaks, and it would also leave Alaska without an
adequate vaccine supply to respond to outbreaks.
4:10:44 PM
DR. SINGLETON explained that meningococcal and human
papillomavirus vaccines were not included in proposed HB 310
because of cost. She said they were important vaccines, but as
they were costly, they were left out of the proposed bill.
4:11:20 PM
CHAIR KELLER directed attention to the fiscal note, which
confirmed the cost benefit ratio for these vaccines.
4:12:00 PM
REPRESENTATIVE DICK asked if Hepatitis A existed in Alaska
before contact with Europeans.
4:12:31 PM
DR. SINGLETON replied that testing for Hepatitis A had only
begun about 30 years ago, but that "people have had hepatitis
and yellow jaundice for many years." She spoke about the
successes for eliminating chronic Hepatitis B, with Alaska
Natives now having the lowest rate for any racial or ethnic
group in the U.S.
4:14:54 PM
RANDI SWEET, Director, Community Action, United Way of
Anchorage, expressed support for proposed HB 310, and its
stopgap funding for the Alaska immunization program through
2015. She lauded the framing and analysis for development of a
long term funding resolution so that vulnerable children and
adults would receive needed vaccines. She stated that access to
vaccines was necessary for quality health care. She remarked on
the economic attraction of a healthy Alaska to businesses. She
pointed to the Alaska Constitution, which stated that the
legislature shall "provide for the promotion and protection of
public health." She stated that through this temporary
solution, the legislature would "promote prevention of illness
and protect the public health of Alaskans from unnecessary
exposure to and spreading of disease and associated illness or
death."
4:16:14 PM
MARY SULLIVAN, Alaska Primary Care Association (APCA), confirmed
that APCA represented the 143 community health centers in
Alaska. She reported that these mostly small clinics would be
severely impacted with this loss of funding. She announced that
some clinics had already overspent their immunization budget,
with an expectation of zero compliance and an increase to
serious public health risk from measles, mumps, rubella, and
pertussis. She reported that many of the APCA providers were
less concerned with the language about meningococcal. She
suggested that a better funding stream could include more
expensive serums, as some providers had suggested that increased
funding could free up money in immunization budgets to purchase
the more expensive vaccines.
4:20:12 PM
REPRESENTATIVE MILLETT asked if shingles was recognized as an
adult vaccination.
MS. SULLIVAN offered her belief that shingles was covered by
Medicare.
4:21:07 PM
CARL ROSE, Executive Director, Association of Alaska School
Boards (AASB), submitted a letter in support of proposed HB 310.
Chair Keller read the letter from Mr. Rose:
AASB supports HB 310/SB 144. AASB believes that the
health, welfare, safety and education of Alaska's
children and youth are our highest priority. As such,
AASB supports the establishment of a child and adult
immunization program in the Department of Health and
Social Services. Thank you for reading my statement
of support to the House Health and Social Services
Standing Committee.
4:22:11 PM
CHAIR KELLER declared that he would leave public testimony open.
4:22:50 PM
WARD HURLBURT, M.D., Chief Medical Officer/Director, Division of
Public Health, Central Office, Department of Health and Social
Services, mentioned that Hepatitis B had resulted in a huge
number of liver cancer cases, but that vaccines had reduced it
to an uncommon cancer. He pointed out that measles, pneumonia
and encephalitis no longer threatened the lives of infants. He
reported that the Centers for Disease Control and Prevention
(CDC) offered statistics for immunizations which showed that
every $1 spent would save $16 in overall direct health care
costs and time lost from work. He stated that although vaccines
were not 100 percent effective, they provided herd immunity,
which meant that the whole population was protected if about 80
percent of the population were vaccinated. He noted that the
American Committee on Immunization Practices (ACIP) and the
American Academy of Pediatrics (AAP) both made regular
recommendations about new vaccines. He noted that most states,
including Alaska, mandated certain vaccines for school
attendance, although these were fewer than on the recommended
list. He explained that therapeutic and preventative
interventions were often determined by a quality adjusted life
year (QALY), which involved input from statisticians and
clinicians, and required a philosophical decision. He referred
to the proposed bill, which would provide vaccinations to the 25
percent of kids in Alaska who were under insured. He noted that
currently almost half the kids in Alaska received vaccines paid
by the federal government under the Vaccines for Children
program, but there were still 25 percent of the kids who were
not covered. He addressed the ACIP list of recommended
vaccines, which was used to determine the Alaska vaccine list.
He shared that the QALY value had to be less than $25,000 each
year for a vaccine to be included. He reported that, for
adults, this list included the flu and pneumococcal vaccines, as
these were especially effective for herd immunity. He offered
his belief that the intent of proposed HB 310 was to leave some
flexibility for vaccine choice to the Department of Health and
Social Services.
4:32:51 PM
REPRESENTATIVE HERRON surmised that Dr. Hurlburt had put
parameters on the use of higher priced vaccines in order to
offer more of the other vaccines to more people.
DR. HURLBURT endorsed this to be the reasonable, prudent
decision when resources were limited.
4:34:45 PM
REPRESENTATIVE MILLER asked if there were any other vaccinations
more specific to Alaska which should be recommended.
4:35:25 PM
DR. HURLBURT replied "basically, our diseases are what are seen
elsewhere." He noted that the some, such as hepatitis A, had
already been addressed in Alaska with dramatic success. He
allowed that regional outbreaks did occur, such as a recent
outbreak of pertussis in California.
4:37:16 PM
REPRESENTATIVE MILLER, directing attention to the fiscal note
which mentioned rotavirus, asked why it was not included in the
proposed bill.
REPRESENTATIVE HERRON replied that he did not know.
DR. HURLBURT, in response to Representative Miller, said that
there were not unlimited dollars for the program, so the cost
benefit ratio was utilized in the decision. He opined that
rotavirus was a more common problem, and that he would suggest
it be added first if more money became available.
4:39:00 PM
REPRESENTATIVE MILLETT, reflecting on the 50 percent success for
shingles vaccine, asked about the success rate for the rotavirus
vaccine.
DR. HURLBURT said that he would find out.
4:39:34 PM
REPRESENTATIVE MILLETT asked about the increase to the fiscal
note if these two vaccines were included.
DR. HURLBURT, in response to Representative Millett, explained
that the equation used for determining vaccines had established
the additional cost to include rotavirus would be $409,000 and
to include the shingles vaccine would cost $980,000 each year.
4:41:23 PM
REPRESENTATIVE MILLETT asked if there were specific problems for
shingles in Alaska.
DR. HURLBURT replied that there was nothing out of the norm in
Alaska.
4:41:48 PM
CHAIR KELLER agreed with the necessity that "following the money
to try to figure these things out [was] a worthwhile thing to
do." He reviewed that proposed HB 310 offered coverage to 25
percent of Alaska children, and he asked to clarify what other
payment coverage, along with private insurance, covered the
remaining 75 percent.
DR. HURLBURT declared that the federal Vaccines for Children
program immunized anyone with Medicaid and all Alaska Native
children. He stated the immunization rates for Alaska Native
children to be "admirable." He pointed out that immunization to
the rest of the state's children only ranked 42nd in the U.S.
CHAIR KELLER asked for more information about the providers.
DR. HURLBURT explained that the vaccine would be significantly
less expensive if the State of Alaska procured the vaccine for
all the providers, and maintained a single stock of each
vaccine. He described that currently each provider had to
maintain separate refrigerators and supplies for the privately
insured patients and for the Medicaid patients. He said that
pediatricians, family medicine physicians, and nurse
practitioners provided vaccines. He noted that the federally
qualified health clinics and public health nurses could give
vaccines to uninsured kids. He emphasized that it was necessary
to find a way to procure vaccines from one source to make the
cost of the process reasonable for private practices, to ensure
they also participate.
4:45:44 PM
CHAIR KELLER asked if there was any danger to a central vaccine
supply.
4:46:36 PM
DR. HURLBURT replied that central procurement for vaccines was
through CDC. He stated that the Division of Public Health
maintained the handling chain for vaccines. He described
parental hesitancy, when parents were reluctant to have their
children immunized, as even a two-year old required 15 shots.
He reported that Alaska had the highest rate, 9 percent, of
parental hesitancy in the U.S. He stressed a need for education
about vaccines and the recommended schedule for shots. As an
example, he pointed to the debunked British physician and
researcher who had published a purported study that measles,
mumps and rubella vaccines lead to autism. He emphasized that
this had been proven to be a deliberate falsification of the
data, and the researcher had since lost his physician's license.
He repeated the need for education for patients and parents.
4:49:47 PM
CHAIR KELLER shared that one community health center in his
constituency had reported never having treated a child who was
up to date on immunizations.
[HB 310 was held over.]
4:50:25 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 4:50 p.m.