Legislature(2011 - 2012)CAPITOL 106

02/14/2012 03:00 PM HEALTH & SOCIAL SERVICES

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Heard & Held
Heard & Held
                    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                                                                     
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
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                                                               
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
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                                                               
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                                                               
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                                                               
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                                                               
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                                                               
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                                                               
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                                                               
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                                                               
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                                                               
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                                                                                                                    
There being no  further business before the  committee, the House                                                               
Health  and  Social  Services   Standing  Committee  meeting  was                                                               
adjourned at 4:50 p.m.                                                                                                          

Document Name Date/Time Subjects
02 Sponsor Statement HB 209.docx HHSS 2/14/2012 3:00:00 PM
HB 209
HB209.pdf HHSS 2/14/2012 3:00:00 PM
HB 209
HB209-DCCED-INS-12-28-11fiscasl note.pdf HHSS 2/14/2012 3:00:00 PM
HB 209
04 Supporting Data Summary HB 209.docx HHSS 2/14/2012 3:00:00 PM
HB 209
05 AK Tobacco Facts 2009 Update.pdf HHSS 2/14/2012 3:00:00 PM
06 Tobacco in the Great Land HB 209.pdf HHSS 2/14/2012 3:00:00 PM
HB 209
07 HB209 American Cancer Society Cancer Action Network.pdf HHSS 2/14/2012 3:00:00 PM
HB 209
01 - HB 310 27-LS1273.A.pdf HHSS 2/14/2012 3:00:00 PM
HB 310
02 - HB 310 sponsor statement 27-LS1273.pdf HHSS 2/14/2012 3:00:00 PM
HB 310
2.5HB310-DHSS-EPI-2-10-12.pdf HHSS 2/14/2012 3:00:00 PM
HB 310
03 - SB 144 Leg Legal Sectional Analysis (HB310 MODIFICATION HAS BEEN REQUESTED).pdf HHSS 2/14/2012 3:00:00 PM
HB 310
SB 144
04 - DHSSdph Epidemiology Bulletin 2010.10.06.pdf HHSS 2/14/2012 3:00:00 PM
4.5 - DHSSdph Epidemiology Bulletin 2010.10.19.pdf HHSS 2/14/2012 3:00:00 PM
05 - Alaska Health Care Commission 2011 Report exerpt.pdf HHSS 2/14/2012 3:00:00 PM
06 - HB 310 support letter Dr. Rosalyn Singleton.pdf HHSS 2/14/2012 3:00:00 PM
HB 310
07 - HB 310 support letter PremeraBCBS.pdf HHSS 2/14/2012 3:00:00 PM
HB 310
08 - HB 310 support letter Dr. Mary Ann Jacob.pdf HHSS 2/14/2012 3:00:00 PM
HB 310
Amendment HB 209.pdf HHSS 2/14/2012 3:00:00 PM
HB 209