Legislature(2011 - 2012)CAPITOL 106

02/21/2012 03:00 PM HEALTH & SOCIAL SERVICES


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Audio Topic
03:03:28 PM Start
03:04:04 PM HB288
03:20:14 PM SCR1
03:38:44 PM Presentation: Cancer Action Network
04:23:42 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
*+ HB 288 MED. ASSISTANCE ELIGIBILITY: PRISONERS TELECONFERENCED
Moved Out of Committee
+ SCR 1 LUPUS AWARENESS MONTH TELECONFERENCED
Moved Out of Committee
+ Presentation: American Cancer Society Action TELECONFERENCED
Network by Chris Hansen, President
                    ALASKA STATE LEGISLATURE                                                                                  
      HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                     
                       February 21, 2012                                                                                        
                           3:03 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Wes Keller, Chair                                                                                                
Representative Alan Dick, Vice Chair                                                                                            
Representative Bob Herron                                                                                                       
Representative Paul Seaton                                                                                                      
Representative Beth Kerttula                                                                                                    
Representative Bob Miller                                                                                                       
Representative Charisse Millett                                                                                                 
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
All members present                                                                                                             
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
HOUSE BILL NO. 288                                                                                                              
"An Act prohibiting denial or withholding of medical assistance                                                                 
eligibility or coverage for a prisoner."                                                                                        
                                                                                                                                
     - MOVED HB 288 OUT OF COMMITTEE                                                                                            
                                                                                                                                
CS FOR SENATE CONCURRENT RESOLUTION NO. 1(STA)                                                                                  
Designating May of each year as Lupus Awareness Month.                                                                          
                                                                                                                                
     - MOVED CSSCR 1 (STA) OUT OF COMMITTEE                                                                                     
                                                                                                                                
PRESENTATION:  CANCER ACTION NETWORK                                                                                            
                                                                                                                                
     - HEARD                                                                                                                    
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: HB 288                                                                                                                  
SHORT TITLE: MED. ASSISTANCE ELIGIBILITY: PRISONERS                                                                             
SPONSOR(s): REPRESENTATIVE(s) KELLER                                                                                            
                                                                                                                                
01/17/12       (H)       READ THE FIRST TIME - REFERRALS                                                                        
01/17/12       (H)       HSS, FIN                                                                                               
02/21/12       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
BILL: SCR 1                                                                                                                   
SHORT TITLE: LUPUS AWARENESS MONTH                                                                                              
SPONSOR(s): SENATOR(s) DAVIS                                                                                                    
                                                                                                                                
01/19/11       (S)       READ THE FIRST TIME - REFERRALS                                                                        
01/19/11       (S)       STA, HSS                                                                                               
03/01/11       (S)       STA AT 9:00 AM BUTROVICH 205                                                                           
03/01/11       (S)       Heard & Held                                                                                           
03/01/11       (S)       MINUTE(STA)                                                                                            
03/08/11       (S)       STA AT 9:00 AM BUTROVICH 205                                                                           
03/08/11       (S)       Moved CSSCR  1(STA) Out of Committee                                                                   
03/08/11       (S)       MINUTE(STA)                                                                                            
03/09/11       (S)       STA RPT CS  5DP    NEW TITLE                                                                           
03/09/11       (S)       DP: WIELECHOWSKI, KOOKESH, PASKVAN,                                                                    
                         MEYER, GIESSEL                                                                                         
03/14/11       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
03/14/11       (S)       Moved CSSCR  1(STA) Out of Committee                                                                   
03/14/11       (S)       MINUTE(HSS)                                                                                            
03/16/11       (S)       HSS RPT CS(STA)  5DP                                                                                   
03/16/11       (S)       DP: DAVIS, MEYER, ELLIS, EGAN, DYSON                                                                   
04/06/11       (S)       TRANSMITTED TO (H)                                                                                     
04/06/11       (S)       VERSION: CSSCR 1(STA)                                                                                  
04/07/11       (H)       READ THE FIRST TIME - REFERRALS                                                                        
04/07/11       (H)       HSS                                                                                                    
04/14/11       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
04/14/11       (H)       -- MEETING CANCELED --                                                                                 
02/21/12       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
JIM POUND, Staff                                                                                                                
Representative Wes Keller                                                                                                       
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Introduced HB 288 on behalf of the prime                                                                 
sponsor, Representative Wes Keller.                                                                                             
                                                                                                                                
JON SHERWOOD, Medicaid Special Projects                                                                                         
Office of the Commissioner                                                                                                      
Department of Health and Social Services (DHSS)                                                                                 
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified during discussion on HB 288.                                                                   
                                                                                                                                
LESLIE HOUSTON, Director                                                                                                        
Central Office                                                                                                                  
Division of Administrative Services                                                                                             
Department of Corrections (DOC)                                                                                                 
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified during discussion of HB 288.                                                                   
                                                                                                                                
CELESTE HODGE, Staff                                                                                                            
Senator Bettye Davis                                                                                                            
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION  STATEMENT:   Introduced SCR  1 on  behalf of  the prime                                                             
sponsor, Senator Bettye Davis.                                                                                                  
                                                                                                                                
ANNA TILLMAN, Executive Director                                                                                                
Lupus Foundation of America                                                                                                     
Alaska Chapter                                                                                                                  
Anchorage, Alaska                                                                                                               
POSITION  STATEMENT:   Testified during  discussion of  Lupus and                                                             
SCR 1.                                                                                                                          
                                                                                                                                
SARA CHANG                                                                                                                      
Government Relations                                                                                                            
Lupus Foundation of America, Inc.                                                                                               
National Office                                                                                                                 
Washington, D.C.                                                                                                                
POSITION  STATEMENT:   Testified during  discussion of  Lupus and                                                             
SCR 1.                                                                                                                          
                                                                                                                                
CHRIS HANSEN, President                                                                                                         
American Cancer Society                                                                                                         
Cancer Action Network                                                                                                           
Washington, D.C.                                                                                                                
POSITION  STATEMENT:   Presented  an overview  from the  American                                                             
Cancer Society and the Cancer Action Network.                                                                                   
                                                                                                                                
EMILY NENON, Alaska Government Relations Director                                                                               
American Cancer Society                                                                                                         
Cancer Action Network                                                                                                           
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:   Testified during the  presentation from the                                                             
Cancer Action Network.                                                                                                          
                                                                                                                                
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
3:03:28 PM                                                                                                                    
                                                                                                                                
CHAIR  WES KELLER  called the  House Health  and Social  Services                                                             
Standing   Committee    meeting   to    order   at    3:03   p.m.                                                               
Representatives  Keller,   Seaton,  Miller,  and   Kerttula  were                                                               
present at the call to order.  Representatives Dick, Millett,                                                                   
and Herron arrived as the meeting was in progress.                                                                              
                                                                                                                                
         HB 288-MED. ASSISTANCE ELIGIBILITY: PRISONERS                                                                      
                                                                                                                                
3:04:04 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER announced that the first order of business would be                                                                
HOUSE BILL NO. 288, "An Act prohibiting denial or withholding of                                                                
medical assistance eligibility or coverage for a prisoner."                                                                     
                                                                                                                                
3:04:32 PM                                                                                                                    
                                                                                                                                
JIM POUND, Staff, Representative Wes Keller, Alaska State                                                                       
Legislature, introduced HB 288, on behalf of the prime sponsor,                                                                 
Representative Keller.  He read from a prepared statement:                                                                      
                                                                                                                                
     House  Bill  288  is  based  on the  fact  that  if  an                                                                    
     individual is  convicted of a crime,  he's sentenced to                                                                    
     jail.  The  State of Alaska assumes custody  ... but we                                                                    
     also assume  the medical costs.   Some of these  can be                                                                    
     extremely expensive,  and under our  current regulatory                                                                    
     process,  we  cannot  share   that  cost  with  anyone,                                                                    
     including  Medicaid.   Medicaid sharing  by inmates  is                                                                    
     forbidden  by state  regulation,  not state  law.   The                                                                    
     regulation is  based on a federal  understanding of the                                                                    
     rules; in  fact there is  no federal law  that requires                                                                    
     it, either.   It's a grey area that  says inmates under                                                                    
     state   custody  cannot   receive  Medicaid,   but  the                                                                    
     interpretation  of that  is  rapidly  changing in  that                                                                    
     several   states  already   seek  Medicaid   funds  for                                                                    
     inmates.    For  those  inmates  in  facilities  in  an                                                                    
     infirmary,  the  rule is  essentially  the  same as  in                                                                    
     state custody.   Where the condition  places the inmate                                                                    
     under the care of a  hospital, the rules are different.                                                                    
     Medicaid may  be used for that  type of care.   For the                                                                    
     State  of Alaska,  up to  50 percent  of that  money is                                                                    
     federal  money.   The state  needs to  look at  ways to                                                                    
     save money.   This  is a golden  opportunity for  us to                                                                    
     look at a $32 million  budget for this coming up fiscal                                                                    
     year.  How  much we can save will depend  on the number                                                                    
     of inmates who qualify.   Potential changes in the U.S.                                                                    
     health care laws may also  greatly increase that amount                                                                    
     in 2014.   We urge your support of this  bill; it moves                                                                    
     us in the right direction.                                                                                                 
                                                                                                                                
CHAIR KELLER asked the committee if there were any questions.                                                                   
                                                                                                                                
3:06:41 PM                                                                                                                    
                                                                                                                                
JON   SHERWOOD,  Medicaid   Special  Projects,   Office  of   the                                                               
Commissioner, Department  of Health  and Social  Services (DHSS),                                                               
explained that,  although the  area of  coverage by  Medicaid for                                                               
inmates  was "somewhat  ambiguous,"  states were  able "to  cover                                                               
inmates  when they  are staying  overnight in  in-patient medical                                                               
institutions."   He expressed a  need to move carefully,  as this                                                               
issue  had "a  good deal  of  federal oversight."   He  commented                                                               
that, as  Medicaid billing was  monthly, the billing  of Medicaid                                                               
coverage   solely  for   an   in-patient   setting  outside   the                                                               
correctional  facility  would  be   a  challenge  for  the  DHSS,                                                               
requiring some structural adjustments to the billing system.                                                                    
                                                                                                                                
3:08:40 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER  reflected on  the irony for  his introduction  of a                                                               
bill to expand Medicaid, but,  as it was balanced against general                                                               
fund funding,  he declared  "it just  seemed like  something that                                                               
just is the right thing to do."                                                                                                 
                                                                                                                                
3:09:18 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  MILLER asked  for a  definition of  prisoner, and                                                               
when there would be [Medicaid] coverage.                                                                                        
                                                                                                                                
LESLIE   HOUSTON,   Director,   Central   Office,   Division   of                                                               
Administrative  Services,  Department  of Corrections  (DOC),  in                                                               
response, stated that the focus  was to those people incarcerated                                                               
in  the state  correctional facilities.   She  admitted that  the                                                               
proposed bill  could include  people with  electronic monitoring,                                                               
as well as those in community residential centers (CRCs).                                                                       
                                                                                                                                
REPRESENTATIVE SEATON asked for  clarification about a person who                                                               
was in the custody of the state.                                                                                                
                                                                                                                                
MS.  HOUSTON  explained  that the  proposed  bill  would  include                                                               
people   under  electronic   monitoring,  supervised   probation,                                                               
residents of  half way  houses (CRCs),  as well  as those  in DOC                                                               
facilities.                                                                                                                     
                                                                                                                                
3:11:35 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON, noting a  difference between her testimony                                                               
and the proposed  bill, asked to clarify  whether, initially, the                                                               
state  was  only going  to  claim  coverage  for prisoners  in  a                                                               
correctional institution, and not  claim coverage for everyone in                                                               
custody.                                                                                                                        
                                                                                                                                
MS. HOUSTON,  in response, said  that it would begin  the process                                                               
with  those incarcerated  in facilities,  as this  was an  easier                                                               
point  to  assess eligibility.    She  agreed  that it  would  be                                                               
expanded "to reach every single area possible."                                                                                 
                                                                                                                                
3:12:53 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SEATON  asked to  clarify  that  proposed HB  288                                                               
allowed DOC and DHSS to narrow or broaden the coverage.                                                                         
                                                                                                                                
MS. HOUSTON expressed her agreement.                                                                                            
                                                                                                                                
3:13:12 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER,  directing attention  to the formula  on page  2 of                                                               
the memorandum  from Legislative  Research Services  [Included in                                                               
members' packets], stated  that the savings to  the state general                                                               
fund would  be a  minimum of  $3 million.   He allowed  that this                                                               
savings  did  not  calculate  any   cost  for  administering  the                                                               
program.                                                                                                                        
                                                                                                                                
3:15:42 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER closed public testimony.                                                                                           
                                                                                                                                
3:16:24 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE DICK moved to report  HB 288 out of committee with                                                               
individual  recommendations and  the  accompanying fiscal  notes.                                                               
There  being no  objection, HB  288 was  reported from  the House                                                               
Health and Social Services Standing Committee.                                                                                  
                                                                                                                                
3:17:07 PM                                                                                                                    
                                                                                                                                
The committee took a brief at-ease.                                                                                             
                                                                                                                                
                  SCR 1-LUPUS AWARENESS MONTH                                                                               
                                                                                                                                
3:20:14 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER announced  that the next order of  business would be                                                               
CS FOR  SENATE CONCURRENT RESOLUTION NO.  1(STA), Designating May                                                               
of each year as Lupus Awareness Month.                                                                                          
                                                                                                                                
3:20:40 PM                                                                                                                    
                                                                                                                                
CELESTE  HODGE,   Staff,  Senator  Bettye  Davis,   Alaska  State                                                               
Legislature,  reported  that proposed  SCR  1  designated May  as                                                               
Lupus  Awareness Month,  and encouraged  Alaskans to  observe the                                                               
month with  appropriate activities  which provided  education and                                                               
support for  those diagnosed with  the disease.  She  pointed out                                                               
that  Lupus was  a disease  which affected  the immune  system by                                                               
causing inflammation  and tissue  damage, although there  was not                                                               
total  understanding  of  the  causes  and  consequences  of  the                                                               
disease.   She shared that  Lupus can  affect any body  part, and                                                               
can  cause seizure,  strokes,  heart  attacks, miscarriages,  and                                                               
organ failure.   She noted  that it  most often strikes  women of                                                               
child bearing  age, with women  of color developing Lupus  at 2-3                                                               
times the  rate of Caucasians.   She declared the  difficulty for                                                               
diagnosis  as  its  symptoms  were  similar  to  those  of  other                                                               
illnesses,  and  that  the treatment  could  have  damaging  side                                                               
effects.   She confirmed  that each May  was designated  as Lupus                                                               
Awareness Month  to show  support for  the 1.5  million Americans                                                               
with Lupus.   She stated  that more  than 3000 Alaskans  had been                                                               
diagnosed with Lupus.  She declared  that SCR 1 would join Alaska                                                               
with  other states  in support  of an  increase for  awareness to                                                               
Lupus.                                                                                                                          
                                                                                                                                
3:22:55 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SEATON, directing  attention to  page 2,  line 8,                                                               
asked to clarify the age range for Lupus.                                                                                       
                                                                                                                                
3:23:23 PM                                                                                                                    
                                                                                                                                
MS. HODGE replied that age 10 was more accurate.                                                                                
                                                                                                                                
3:24:08 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE MILLETT asked about treatments for Lupus.                                                                        
                                                                                                                                
3:24:24 PM                                                                                                                    
                                                                                                                                
MS.  HODGE   replied  that  a   representative  from   the  Lupus                                                               
Foundation of America would explain the specific treatments.                                                                    
                                                                                                                                
3:24:44 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER opened public testimony.                                                                                           
                                                                                                                                
3:24:52 PM                                                                                                                    
                                                                                                                                
ANNA TILLMAN,  Executive Director,  Lupus Foundation  of America,                                                               
Alaska Chapter, stated  that Lupus was a breakdown  of the immune                                                               
system,  not   allowing  the  body  to   fight  against  viruses,                                                               
bacteria, and germs.   She stated that Lupus  was not contagious,                                                               
that 90  percent of those  with Lupus  were females, and  that it                                                               
was  unpredictable, and  potentially fatal.   Although  the cause                                                               
was still  unknown, she  listed some  factors that  could trigger                                                               
the genes prone to the  disease, including infection, ultraviolet                                                               
light, extreme stress, certain  prescription drugs, and hormones.                                                               
She described  some of  the different  types of  lupus, including                                                               
cutaneous  Lupus,  drug  induced  Lupus,  and  the  most  common,                                                               
systemic Lupus, which  affected the internal organs.   She listed                                                               
people of color  as being affected more than twice  as often than                                                               
Caucasians,  with  more than  5  percent  of offspring  of  Lupus                                                               
suffers also  having Lupus.   She noted that currently  there was                                                               
no generic screening test to  determine the development of Lupus,                                                               
adding that  it would often  take 3-5  years to diagnose,  as the                                                               
symptoms could come and go over  time.  She stated that there was                                                               
no single laboratory  test to determine Lupus, and  that it could                                                               
often strike between  15 and 44 years of age.   She reported that                                                               
the average annual  cost to a person with Lupus  was $12,643, and                                                               
that  successful  treatment  often   required  a  combination  of                                                               
medications.  She  noted that fatigue was a symptom  in almost 80                                                               
percent  of cases.    She  detailed some  of  the medications  to                                                               
include:   steroids,  an anti-malarial,  and non-steroidal  anti-                                                               
inflammatories.   She stated  that it had  taken almost  21 years                                                               
for her diagnosis, and that she had permanent damage from Lupus.                                                                
                                                                                                                                
3:30:06 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER asked for the number of cases in Alaska.                                                                           
                                                                                                                                
MS. TILLMAN replied that it was  estimated to be about 3,000.  In                                                               
response  to Chair  Keller, she  agreed  that the  age range  for                                                               
affliction, 10-87 years, was accurate.                                                                                          
                                                                                                                                
3:31:29 PM                                                                                                                    
                                                                                                                                
SARA CHANG,  Government Relations,  Lupus Foundation  of America,                                                               
Inc., National Office,  shared that raising awareness  was one of                                                               
the  largest priorities  for the  Lupus Foundation.   She  stated                                                               
that almost  1.5 million  Americans, about 1  in 181  people, had                                                               
some  form of  Lupus,  and almost  90 percent  were  women.   She                                                               
reported   that  Lupus   could   strike   without  warning,   had                                                               
unpredictable effects, and had no  known cause or cure, making it                                                               
difficult  to diagnose.   She  shared that  the average  time for                                                               
diagnosis  was four  years.   She declared  that SCR  1 would  be                                                               
beneficial for Alaskan education and  awareness to the effects of                                                               
Lupus.  She  stated that the direct and indirect  cost to America                                                               
from Lupus was about $31 billion.                                                                                               
                                                                                                                                
3:35:12 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER closed public testimony.                                                                                           
                                                                                                                                
3:35:47 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  DICK   moved  to  report  CSSCR   1(STA)  out  of                                                               
committee  with individual  recommendations and  the accompanying                                                               
zero fiscal  note.   There being no  objection, CSSCR  1(STA) was                                                               
reported  from  the House  Health  and  Social Services  Standing                                                               
Committee.                                                                                                                      
                                                                                                                                
3:36:29 PM                                                                                                                    
                                                                                                                                
The committee took a brief at-ease.                                                                                             
                                                                                                                                
^Presentation:  Cancer Action Network                                                                                           
              Presentation: Cancer Action Network                                                                           
                                                                                                                              
3:38:44 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER announced that the  final order of business would be                                                               
a presentation by the Cancer Action Network.                                                                                    
                                                                                                                                
3:39:13 PM                                                                                                                    
                                                                                                                                
CHRIS HANSEN,  President, American Cancer Society,  Cancer Action                                                               
Network, stated that the American  Cancer Society was the largest                                                               
voluntary  health organization  in the  world devoted  to cancer,                                                               
and, measured  by its contributors,  it was the  largest not-for-                                                               
profit  organization  in the  world.    He described  the  Cancer                                                               
Action Network (CAN) as a  grass roots organization, in existence                                                               
for  more than  10 years,  with 1400  volunteers in  Alaska.   He                                                               
noted  that  there  were  more  than  1  million  CAN  volunteers                                                               
nationwide, and  that CAN  was the  largest, most  powerful, most                                                               
successful   volunteer-led  movement   dealing  with   government                                                               
decisions having  to do with cancer.   He shared that  there were                                                               
12  million   cancer  survivors   nationwide,  noting   that  the                                                               
organization was unique,  as it was "trying to  put ourselves out                                                               
of business."  He agreed that  a goal of the organization was "to                                                               
create birthdays."   He  declared that  1500 Americans  would die                                                               
today from cancer,  and that 1000 Alaskans  and 577,000 Americans                                                               
would die this  year from cancer.  He pointed  to the trend lines                                                               
indicating  that this  would double  by  2020.   He shared  that,                                                               
while  survival  rates were  up,  incidence  rates were  also  up                                                               
because of the aging population and  the increase in obesity.  He                                                               
listed pancreatic cancer, kidney cancer,  and liver cancer as the                                                               
most deadly cancers.  He  shared that the American Cancer Society                                                               
was the largest  private funder of cancer research  in the world.                                                               
He directed  attention to  polls indicating  that cancer  was the                                                               
most feared disease in the world.                                                                                               
                                                                                                                                
3:44:19 PM                                                                                                                    
                                                                                                                                
MR. HANSEN stated  that 50 percent of all men,  and 33 percent of                                                               
all women, would  have a cancer diagnosis  during their lifetime,                                                               
and  that  1.4  million  Americans and  3640  Alaskans  would  be                                                               
diagnosed with  cancer this year.   He  pointed to the  toll this                                                               
placed on the U.S. economy,  almost $226.8 billion for direct and                                                               
indirect medical expenses annually.   He shared that globally the                                                               
economic loss  was almost one  trillion dollars.  He  stated that                                                               
the American Cancer Society was  now working internationally.  He                                                               
declared that,  although smoking  rates in  the U.S.  had leveled                                                               
out  at 20  percent over  the last  6 years,  they had  increased                                                               
around  the world.   He  described that  the connections  between                                                               
obesity and  cancer were "numerous  and dramatic."   He reflected                                                               
that when the war on cancer  had been declared 40 years prior, it                                                               
was  thought that  a cure  could be  found, but  that it  was now                                                               
realized  that cancer  was a  family of  more than  200 diseases,                                                               
with the  similarity being  they metastasize.   He  declared that                                                               
prevention and  early detection  were the  keys to  "beating this                                                               
disease."   He pointed out  that one  third of all  cancer deaths                                                               
were a direct result of tobacco  usage.  He reported that for any                                                               
type of cancer,  it was now possible to determine  a treatment if                                                               
the person's protein specificity was determined.                                                                                
                                                                                                                                
3:49:28 PM                                                                                                                    
                                                                                                                                
MR. HANSEN  spoke about  some recent  discoveries, funded  by the                                                               
National Institute of Health (NIH),  which included a look at the                                                               
dietary habits  of the Yupik.   This  study showed that  a higher                                                               
intake  of Omega  3 fatty  acids helped  prevent obesity  related                                                               
cancers.   He gave  some background  about the  work at  NIH, and                                                               
pointed out that  the economic and health benefits  from this NIH                                                               
research  were  rewarded with  a  $300  million increase  to  its                                                               
budget.   He  declared that  budget  cuts could  affect the  life                                                               
sciences research at  University of Alaska.  He  pointed out that                                                               
cancer screenings, including colonoscopies  and pap smears, saved                                                               
lives and  money, as  early detection was  cheaper and  easier to                                                               
deal with.   He  noted that  only one third  of the  eligible low                                                               
income  and  underserved  women were  utilizing  the  breast  and                                                               
cervical  cancer   early  detection  programs.     He  offered  a                                                               
complement  to  the State  of  Alaska  in  its role  for  tobacco                                                               
cessation,  as Alaska  was  the  first state  to  have a  tobacco                                                               
prevention and control  program.  He referred to  the increase to                                                               
tobacco   taxes  in   Alaska,  which   he  said   were  excellent                                                               
disincentives  for  the product,  and  also  generated a  lot  of                                                               
revenue.   He  noted that  every 10  percent increase  to tobacco                                                               
price was  followed by  a 7 percent  reduction in  youth smoking,                                                               
and  a 4  percent overall  reduction in  smoking.   He referenced                                                               
that the  Alaska Native  youth smoking rate  had dropped  from 62                                                               
percent  in 1995  to 43  percent  in 2009.   He  shared that  the                                                               
national  teen smoking  rate was  20 percent,  compared with  the                                                               
Alaska teen  smoking rate  of 16  percent.   He pointed  out that                                                               
this was the only legal product  that "when used as directed will                                                               
kill you."  He reported that  Alaska spent $169 million each year                                                               
on  medical costs  to  treat tobacco  related  diseases, with  an                                                               
additional $170 million of lost  productivity for tobacco related                                                               
illness;  whereas,  every  pack  of  cigarettes  sold  in  Alaska                                                               
generated $7.89  in health care  spending.  He declared  that the                                                               
tobacco companies  spent $10.5 billion annually,  and $20 million                                                               
in Alaska,  to "entice  kids to  pick up the  habit."   He shared                                                               
that  the U.S.  marketing expenditures  by tobacco  companies had                                                               
doubled since  the Tobacco Master  Settlement Agreement  (MSA) in                                                               
1998.                                                                                                                           
                                                                                                                                
3:55:39 PM                                                                                                                    
                                                                                                                                
MR. HANSEN shared  that 53 percent of Alaskans worked  in a smoke                                                               
free  environment, pointing  out  that second  hand smoke  killed                                                               
50,000 Americans every year.   He pointed to studies which showed                                                               
that  businesses did  better with  smoke free  environments.   He                                                               
stated  that  one  third  of   all  cancer  deaths  were  due  to                                                               
overweight and obesity.  He  reported that nationally, 67 percent                                                               
of adults  and 18 percent  of children were obese  or overweight,                                                               
while 65 percent of Alaskan adults  and 26 percent of high school                                                               
students were obese  or overweight.  He stated that  the rate for                                                               
obese Alaskan adults  had doubled to 27 percent  since 1991, with                                                               
overall state  health care spending  of $459 million  for medical                                                               
conditions connected to overweight or  obese.  He lauded that the                                                               
obesity prevention and control program was a good investment.                                                                   
                                                                                                                                
3:57:42 PM                                                                                                                    
                                                                                                                                
MR.  HANSEN spoke  about the  quality of  life initiative,  which                                                               
brought care and comfort together.   He directed attention to the                                                               
handout, "Palliative  Care at a  Glance."  [Included  in members'                                                               
packets.]    He  discussed legislation  being  considered,  which                                                               
would teach physicians more options  to give patients for quality                                                               
of care.                                                                                                                        
                                                                                                                                
4:00:14 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON asked  if Mr. Hansen was  familiar with the                                                               
Alaska resolution [House Concurrent  Resolution 5] which directed                                                               
the State of  Alaska to move toward prevention of  disease as the                                                               
primary model  of health care and  for education to the  need for                                                               
sufficient levels  of Vitamin D.   He declared that the  focus of                                                               
the House Health  and Social Services Standing  Committee was for                                                               
prevention  not   for  treatment.     He  asked  where   ACN  was                                                               
positioned.                                                                                                                     
                                                                                                                                
4:01:51 PM                                                                                                                    
                                                                                                                                
MR. HANSEN  replied that he was  aware of the resolution,  and he                                                               
agreed  that it  was a  good  direction.   He said  that CAN  was                                                               
focused  on prevention,  noting  that preventative  care was  far                                                               
less expensive.                                                                                                                 
                                                                                                                                
4:02:56 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER  expressed his  surprise for the  tie in  of obesity                                                               
with cancer.  He asked what legislators could do specifically.                                                                  
                                                                                                                                
4:03:37 PM                                                                                                                    
                                                                                                                                
MR.  HANSEN   replied  that  the  recent   understanding  of  the                                                               
relationship  between obesity  and  cancer had  occurred when  an                                                               
epidemiologist  had recognized  a  statistical relationship,  and                                                               
then compared  the physiological causes.   He lauded  the Obesity                                                               
and  Prevention  Control  program   in  Alaska,  and  stated  the                                                               
importance for  funding at a  level that would allow  the program                                                               
to progress.                                                                                                                    
                                                                                                                                
4:05:07 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KERTTULA  asked   about  the  connection  between                                                               
obesity and cancer.                                                                                                             
                                                                                                                                
MR.  HANSEN replied  that there  were at  least 50  physiological                                                               
changes from obesity  that caused cancer effects,  more likely in                                                               
women, especially in reproductive systems and breasts.                                                                          
                                                                                                                                
REPRESENTATIVE   KERTTULA  asked   for  more   information  about                                                               
smokeless tobacco and snuff.                                                                                                    
                                                                                                                                
MR. HANSEN emphasized that smokeless  tobacco was very dangerous,                                                               
as some  people believed  that this was  healthier.   He declared                                                               
smokeless tobacco  to be just  another way to keep  people hooked                                                               
on nicotine, and that nicotine  was carcinogenic.  He offered his                                                               
belief that  smokeless tobacco  was "a really  bad thing  to use,                                                               
and it's a really bad thing to  sell, and it's a really bad thing                                                               
to promote."   He declared that there was no  upside to smokeless                                                               
tobacco.                                                                                                                        
                                                                                                                                
4:07:32 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  MILLETT  asked  if  there  were  other  insurance                                                               
mandates for preventative care that CAN was working toward.                                                                     
                                                                                                                                
MR.  HANSEN  directed  attention  to  colorectal  screening,  and                                                               
stated  that it  was not  covered  for retirees  by state  health                                                               
insurance.    He   declared  that  colon  cancer   was  far  more                                                               
aggressive from ages 50 to 65 years.   He declared this to be the                                                               
worst time not  to be covered.  He reported  that CAN was working                                                               
toward  a  national standard  of  coverage  for screenings.    He                                                               
shared   that   while   some   insurance   companies   paid   for                                                               
colonoscopies  as  a screening,  polyp  removal  was not  covered                                                               
under  the screening,  and that  CAN  was trying  to close  these                                                               
coverage gaps.                                                                                                                  
                                                                                                                                
4:10:14 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE MILLER  asked if the federal  government was still                                                               
subsidizing  tobacco, corn,  and  sugar.   He  asked  if CAN  was                                                               
involved with any programs to eliminate these subsidies.                                                                        
                                                                                                                                
MR. HANSEN, in response to  Representative Miller, said that corn                                                               
subsidies were complex,  but that CAN, recognizing  the danger of                                                               
corn  used  as a  sweetener,  had  tried  to  get the  public  to                                                               
understand the dangers of sugar  sweetened beverages.  He pointed                                                               
out that supersized sweetened beverages increased the appetite.                                                                 
                                                                                                                                
REPRESENTATIVE MILLER declared his  desire to see those subsidies                                                               
removed.                                                                                                                        
                                                                                                                                
4:13:31 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE HERRON  asked about the use  of chemical compounds                                                               
to make foods taste better.                                                                                                     
                                                                                                                                
MR.  HANSEN  explained  that  the  American  Cancer  Society  was                                                               
scientifically evidence  based, and  although they  had concerns,                                                               
they would not comment until they  had the science evidence for a                                                               
conclusion.                                                                                                                     
                                                                                                                                
4:14:51 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE HERRON  asked if the federal  government would ban                                                               
substances such as snus and other nicotine laced products.                                                                      
                                                                                                                                
MR. HANSEN replied that nicotine  was carcinogenic and should not                                                               
be in any product.                                                                                                              
                                                                                                                                
4:15:44 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON  asked if CAN  was aware that it  was legal                                                               
to sell  nicotine to  minors in  Alaska.   He offered  his belief                                                               
that these  nicotine products  were "a  gateway mechanism  to get                                                               
people set up for tobacco products at a later time."                                                                            
                                                                                                                                
MR. HANSEN, in response, said that CAN was aware of this.                                                                       
                                                                                                                                
4:17:03 PM                                                                                                                    
                                                                                                                                
EMILY  NENON,  Alaska  Government  Relations  Director,  American                                                               
Cancer Society, Cancer  Action Network, stated that  CAN was very                                                               
concerned about  the emerging tobacco  products.   Speaking about                                                               
the use of these products by  kids, she declared that the tobacco                                                               
industry  should  not  be  allowed  to  "continue  its  predatory                                                               
practices on our children."                                                                                                     
                                                                                                                                
4:18:28 PM                                                                                                                    
                                                                                                                                
MR. HANSEN  shared that he  had discussed, with  tobacco industry                                                               
lobbyists, the business model for  finding ways to hook people on                                                               
nicotine.  He declared that there was nothing good about this.                                                                  
                                                                                                                                
4:19:22 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE MILLER described the use  of nicotine to kill mink                                                               
on mink farm.                                                                                                                   
                                                                                                                                
4:20:12 PM                                                                                                                    
                                                                                                                                
CHAIR  KELLER agreed  that tobacco  was a  known carcinogen,  but                                                               
that the data  for the association of cancer  with obesity should                                                               
not yet  be overstated.  He  offered his belief that  obesity was                                                               
also associated with other diseases.                                                                                            
                                                                                                                                
4:21:23 PM                                                                                                                    
                                                                                                                                
MR.   HANSEN,   in   response  to   Chair   Keller,   said   that                                                               
epidemiologists had  studied trends with obesity  and cancer, and                                                               
that  any number  of cancer  causes did  come from  obesity.   He                                                               
declared  that  there was,  indeed,  a  one to  one  relationship                                                               
between  obesity   and  certain  body  functions   which  created                                                               
cancers.  He agreed that not  all cancers were caused by obesity,                                                               
but  that the  relationships were  very complex,  unlike that  of                                                               
nicotine and cancer.                                                                                                            
                                                                                                                                
4:23:42 PM                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no  further business before the  committee, the House                                                               
Health  and  Social  Services   Standing  Committee  meeting  was                                                               
adjourned at 4:23 p.m.                                                                                                          

Document Name Date/Time Subjects
07 CSSCR1 2-17-12 Fiscal.pdf HHSS 2/21/2012 3:00:00 PM
02 SCR001 LS0099I.pdf HHSS 2/21/2012 3:00:00 PM
04 SCR1 Annual Report 2009-opt.pdf HHSS 2/21/2012 3:00:00 PM
HB0288A.PDF HHSS 2/21/2012 3:00:00 PM
HB 288
HB 288 Sponsor.pdf HHSS 2/21/2012 3:00:00 PM
HB 288
HB 288 regulations.pdf HHSS 2/21/2012 3:00:00 PM
HB 288
HB 288 NC Support.pdf HHSS 2/21/2012 3:00:00 PM
HB 288
HB 288 future info.pdf HHSS 2/21/2012 3:00:00 PM
HB 288
HB 288 Fed HSS rept.pdf HHSS 2/21/2012 3:00:00 PM
HB 288
HB 288 CFR info.pdf HHSS 2/21/2012 3:00:00 PM
HB 288
DOC Health Budget.pdf HHSS 2/21/2012 3:00:00 PM
Advisory Legal Opinion - Indigent care surtax, Medicaid & inmate health paym.pdf HHSS 2/21/2012 3:00:00 PM
2011 Alaska State Cancer Facts.pdf HHSS 2/21/2012 3:00:00 PM
ACS CAN one pager.pdf HHSS 2/21/2012 3:00:00 PM
Nutrition and Physical Activity Two-pager V2- FINAL 1-9-12.pdf HHSS 2/21/2012 3:00:00 PM
Palliative Care at a Glance Doc.pdf HHSS 2/21/2012 3:00:00 PM
HB288-DHSS-HCMS-2-17-12 Fiscal note.pdf HHSS 2/21/2012 3:00:00 PM
HB 288
HB288-DOC-OC-02-20-12 fiscal note.pdf HHSS 2/21/2012 3:00:00 PM
HB 288
HB 288 LegRes Save estimate.pdf HHSS 2/21/2012 3:00:00 PM
HB 288