Legislature(2017 - 2018)GRUENBERG 120

03/29/2017 01:00 PM JUDICIARY

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ HB 43 NEW DRUGS FOR THE TERMINALLY ILL TELECONFERENCED
Heard & Held
-- Public Testimony --
+= HB 108 FIDUCIARY ACCESS TO DIGITAL ASSETS TELECONFERENCED
Moved CSHB 108(JUD) Out of Committee
+ Bills Previously Heard/Scheduled TELECONFERENCED
+= HB 123 DISCLOSURE OF HEALTH CARE COSTS TELECONFERENCED
Moved CSHB 123(HSS) Out of Committee
+= HB 42 FORFEITURE & SEIZURE: PROCEDURE; LIMITS TELECONFERENCED
Moved CSHB 42(JUD) Out of Committee
                   FALASKA STATE LEGISLATURE                                                                                  
               HOUSE JUDICIARY STANDING COMMITTEE                                                                             
                         March 29, 2017                                                                                         
                           1:02 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Matt Claman, Chair                                                                                               
Representative Zach Fansler, Vice Chair                                                                                         
Representative Jonathan Kreiss-Tomkins                                                                                          
Representative Gabrielle LeDoux                                                                                                 
Representative David Eastman                                                                                                    
Representative Chuck Kopp                                                                                                       
Representative Lora Reinbold                                                                                                    
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Representative Charisse Millett                                                                                                 
Representative Louise Stutes                                                                                                    
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
HOUSE BILL NO. 43                                                                                                               
"An Act  relating to  prescribing, dispensing,  and administering                                                               
an  investigational  drug,  biological   product,  or  device  by                                                               
physicians  for  patients  who   are  terminally  ill;  providing                                                               
immunity  related to  manufacturing,  distributing, or  providing                                                               
investigational  drugs,  biological  products,  or  devices;  and                                                               
relating to licensed health care facility requirements."                                                                        
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
HOUSE BILL NO. 108                                                                                                              
"An Act  adopting and relating  to the Revised  Uniform Fiduciary                                                               
Access to Digital Assets Act."                                                                                                  
                                                                                                                                
     - MOVED CSHB 108(JUD) OUT OF COMMITTEE                                                                                     
                                                                                                                                
HOUSE BILL NO. 42                                                                                                               
"An Act relating  to seizure of property;  relating to forfeiture                                                               
to the state; relating to criminal  law; amending Rules 3, 4, 11,                                                               
12,  16, 32,  32.2,  32.3,  39, 39.1,  and  42,  Alaska Rules  of                                                               
Criminal  Procedure, Rules  501, 801,  and 803,  Alaska Rules  of                                                               
Evidence, and Rules 202, 209,  and 217, Alaska Rules of Appellate                                                               
Procedure; and providing for an effective date."                                                                                
                                                                                                                                
     - MOVED CSHB 42(JUD) OUT OF COMMITTEE                                                                                      
                                                                                                                                
HOUSE BILL NO. 123                                                                                                              
"An Act relating to disclosure of health care services and price                                                                
information; and providing for an effective date."                                                                              
                                                                                                                                
     - MOVED CSHB 123(HSS) OUT OF COMMITTE                                                                                      
                                                                                                                                
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: HB 43                                                                                                                   
SHORT TITLE: NEW DRUGS FOR THE TERMINALLY ILL                                                                                   
SPONSOR(s): REPRESENTATIVE(s) GRENN                                                                                             
                                                                                                                                
01/18/17       (H)       PREFILE RELEASED 1/13/17                                                                               
01/18/17       (H)       READ THE FIRST TIME - REFERRALS                                                                        
01/18/17       (H)       HSS, JUD                                                                                               
02/28/17       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
02/28/17       (H)       Heard & Held                                                                                           
02/28/17       (H)       MINUTE (HSS)                                                                                           
03/02/17       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
03/02/17       (H)       Heard & Held                                                                                           
03/02/17       (H)       MINUTE (HSS)                                                                                           
03/07/17       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
03/07/17       (H)       Moved HB 43 Out of Committee                                                                           
03/07/17       (H)       MINUTE (HSS)                                                                                           
03/08/17       (H)       HSS RPT 5DP 1NR 1AM                                                                                    
03/08/17       (H)       DP: JOHNSTON, TARR, EDGMON, SULLIVAN-                                                                  
                         LEONARD, SPOHNHOLZ                                                                                     
03/08/17       (H)       NR: KITO                                                                                               
03/08/17       (H)       AM: EASTMAN                                                                                            
03/29/17       (H)       JUD AT 1:00 PM GRUENBERG 120                                                                           
                                                                                                                                
BILL: HB 108                                                                                                                  
SHORT TITLE: FIDUCIARY ACCESS TO DIGITAL ASSETS                                                                                 
SPONSOR(s): REPRESENTATIVE(s) CLAMAN                                                                                            
                                                                                                                                
02/08/17       (H)       READ THE FIRST TIME - REFERRALS                                                                        
02/08/17       (H)       L&C, JUD                                                                                               
03/08/17       (H)       L&C AT 3:15 PM BARNES 124                                                                              
03/08/17       (H)       Heard & Held                                                                                           
03/08/17       (H)       MINUTE (L&C)                                                                                           
03/10/17       (H)       L&C AT 3:15 PM BARNES 124                                                                              
03/10/17       (H)       Moved HB 108 Out of Committee                                                                          
03/10/17       (H)       MINUTE (L&C)                                                                                           
03/13/17       (H)       L&C RPT 7DP                                                                                            
03/13/17       (H)       DP: SULLIVAN-LEONARD, STUTES, WOOL,                                                                    
                         JOSEPHSON, BIRCH, KNOPP, KITO                                                                          
03/24/17       (H)       JUD AT 1:00 PM GRUENBERG 120                                                                           
03/24/17       (H)       Heard & Held                                                                                           
03/24/17       (H)       MINUTE (JUD)                                                                                           
03/29/17       (H)       JUD AT 1:00 PM GRUENBERG 120                                                                           
                                                                                                                                
BILL: HB 42                                                                                                                   
SHORT TITLE: FORFEITURE & SEIZURE: PROCEDURE; LIMITS                                                                            
SPONSOR(s): REPRESENTATIVE(s) WILSON                                                                                            
                                                                                                                                
01/18/17       (H)       PREFILE RELEASED 1/13/17                                                                               
01/18/17       (H)       READ THE FIRST TIME - REFERRALS                                                                        
01/18/17       (H)       JUD, FIN                                                                                               
01/23/17       (H)       JUD AT 1:00 PM GRUENBERG 120                                                                           
01/23/17       (H)       Heard & Held                                                                                           
01/23/17       (H)       MINUTE (JUD)                                                                                           
03/01/17       (H)       JUD AT 1:00 PM GRUENBERG 120                                                                           
03/01/17       (H)       Heard & Held                                                                                           
03/01/17       (H)       MINUTE (JUD)                                                                                           
03/13/17       (H)       JUD AT 1:00 PM GRUENBERG 120                                                                           
03/13/17       (H)       Scheduled but Not Heard                                                                                
03/22/17       (H)       JUD AT 1:00 PM GRUENBERG 120                                                                           
03/22/17       (H)       Heard & Held                                                                                           
03/22/17       (H)       MINUTE (JUD)                                                                                           
03/27/17       (H)       JUD AT 1:00 PM GRUENBERG 120                                                                           
03/27/17       (H)       Heard & Held                                                                                           
03/27/17       (H)       MINUTE (JUD)                                                                                           
03/29/17       (H)       JUD AT 1:00 PM GRUENBERG 120                                                                           
                                                                                                                                
BILL: HB 123                                                                                                                  
SHORT TITLE: DISCLOSURE OF HEALTH CARE COSTS                                                                                    
SPONSOR(s): REPRESENTATIVE(s) SPOHNHOLZ                                                                                         
                                                                                                                                
02/13/17       (H)       READ THE FIRST TIME - REFERRALS                                                                        
02/13/17       (H)       HSS, JUD                                                                                               
03/02/17       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
03/02/17       (H)       Heard & Held                                                                                           
03/02/17       (H)       MINUTE (HSS)                                                                                           
03/09/17       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
03/09/17       (H)       Moved CSHB 123(HSS) Out of Committee                                                                   
03/09/17       (H)       MINUTE (HSS)                                                                                           
03/10/17       (H)       HSS RPT CS (HSS) 5DP 2NR                                                                               
03/10/17       (H)       DP: JOHNSTON, TARR, EDGMON, SULLIVAN-                                                                  
                         LEONARD, SPOHNHOLZ                                                                                     
03/10/17       (H)       NR: KITO, EASTMAN                                                                                      
03/24/17       (H)       JUD AT 1:00 PM GRUENBERG 120                                                                           
03/24/17       (H)       Heard & Held                                                                                           
03/24/17       (H)       MINUTE (JUD)                                                                                           
03/27/17       (H)       JUD AT 1:00 PM GRUENBERG 120                                                                           
03/27/17       (H)       Heard & Held                                                                                           
03/27/17       (H)       MINUTE (JUD)                                                                                           
03/29/17       (H)       JUD AT 1:00 PM GRUENBERG 120                                                                           
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
REPRESENTATIVE JASON GRENN                                                                                                      
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented HB 43 as prime sponsor, and read                                                               
a letter written by Jason Norris into the record.                                                                               
                                                                                                                                
BROOKE IVY, Staff                                                                                                               
Representative Jason Grenn                                                                                                      
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  During the hearing of HB 43, offered a                                                                   
PowerPoint presentation.                                                                                                        
                                                                                                                                
JASON NORRIS                                                                                                                    
Unknown location                                                                                                                
POSITION STATEMENT:  During the hearing of HB 43, Representative                                                              
Grenn read a letter from Mr. Norris.                                                                                            
                                                                                                                                
ELIZABETH KROME                                                                                                                 
Wasilla, Alaska                                                                                                                 
POSITION STATEMENT:  During the hearing of HB 43, offered                                                                     
support for the legislation.                                                                                                    
                                                                                                                                
MICHAEL MAHARREY                                                                                                                
National Communications Director                                                                                                
Tenth Amendment Center                                                                                                          
Lexington, Kentucky                                                                                                             
POSITION STATEMENT:  During the hearing of HB 43, offered                                                                     
support for the legislation.                                                                                                    
                                                                                                                                
KEN LANDFIELD                                                                                                                   
Homer, Alaska                                                                                                                   
POSITION STATEMENT:  During the hearing of HB 43, offered                                                                     
support for the legislation.                                                                                                    
                                                                                                                                
STARLEE COLEMAN, Vice President of Communications                                                                               
Goldwater Institute                                                                                                             
Phoenix, Arizona                                                                                                                
POSITION  STATEMENT:    During  the hearing  of  HB  43,  offered                                                             
support for the legislation.                                                                                                    
                                                                                                                                
EBRAHIM DELPASSAND, M.D.                                                                                                        
Excel Diagnostics & Nuclear Oncology Center                                                                                     
Houston, Texas                                                                                                                  
POSITION  STATEMENT:   During the  hearing of  HB 43,  testified,                                                             
answered questions, and offered support for the legislation.                                                                    
                                                                                                                                
DEBORAH BEHR, Member                                                                                                            
Alaska Uniform Law Delegation                                                                                                   
Juneau, Alaska                                                                                                                  
POSITION  STATEMENT:   During  the hearing  of  HB 108,  answered                                                             
questions.                                                                                                                      
                                                                                                                                
REPRESENTATIVE IVY SPONHOLTZ                                                                                                    
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION  STATEMENT:   During the  hearing  of HB  123, spoke  to                                                             
certain amendments, and answered questions.                                                                                     
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
1:02:23 PM                                                                                                                    
                                                                                                                                
CHAIR MATT  CLAMAN called the House  Judiciary Standing Committee                                                             
meeting to  order at 1:02 p.m.  Representatives Claman, Reinbold,                                                               
Kopp, Fansler,  and Eastman  were present at  the call  to order.                                                               
Representatives Kreiss-Tomkins and LeDoux  arrived as the meeting                                                               
was in progress.                                                                                                                
                                                                                                                                
             HB 43-NEW DRUGS FOR THE TERMINALLY ILL                                                                         
                                                                                                                                
1:02:59 PM                                                                                                                    
                                                                                                                                
CHAIR CLAMAN announced that the  first order of business would be                                                               
HOUSE BILL NO.  43, "An Act relating  to prescribing, dispensing,                                                               
and  administering an  investigational drug,  biological product,                                                               
or  device by  physicians for  patients who  are terminally  ill;                                                               
providing  immunity related  to  manufacturing, distributing,  or                                                               
providing   investigational   drugs,  biological   products,   or                                                               
devices;   and  relating   to  licensed   health  care   facility                                                               
requirements."                                                                                                                  
                                                                                                                                
1:03:23 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE JASON GREEN, Alaska State Legislature, read his                                                                  
testimony as follows:                                                                                                           
                                                                                                                                
     So, the goal  of HB 43, or "Right to  Try" is to create                                                                    
     a legal climate in which  a terminally ill patient, who                                                                    
     has exhausted  all FDA approved treatment  options, may                                                                    
     work with their doctor  and drug manufactures to access                                                                    
     investigational treatments that have  passed Phase 1 of                                                                    
     the  FDA  approval  process, but  are  not  yet  widely                                                                    
     available.  The Right to  Try laws have now been passed                                                                    
     in 33  states, 15 additional states,  including Alaska,                                                                    
     are considering the law.                                                                                                   
                                                                                                                                
     Each  year  it  is  estimated  that  over  one  million                                                                    
     Americans die from terminally  ill -- terminal illness.                                                                    
     For those who have  exhausted all FDA approved options,                                                                    
     clinical  trials become  the  next step.   However,  of                                                                    
     those  patients  who attempt  to  gain  entry into  the                                                                    
     clinical trial, it  is found that fewer  than 3 percent                                                                    
     are accepted.                                                                                                              
                                                                                                                                
     In  recognition of  the 97  percent of  patients denied                                                                    
     access to clinical trials, the  FDA does have a program                                                                    
     in  place for  accessing investigational  drugs outside                                                                    
     of  clinical trials  known  as  the "Compassionate  Use                                                                    
     Program."   Nevertheless,  it  is  estimated that  only                                                                    
     about  1,200  people  make   it  through  this  arduous                                                                    
     federal process each year.                                                                                                 
                                                                                                                                
     Given  this  information,  the  goal of  HB  43  is  to                                                                    
     provide  the   same  access   as  the   FDA's  existing                                                                    
     Compassionate Use  Program, but on a  shorter timeline.                                                                    
     By  ensuring --  by  ensuring  terminally ill  patients                                                                    
     have  more  timely  access to  safe,  but  experimental                                                                    
     drugs  in   consultation  with  their  doctor,   HB  43                                                                    
     attempts  to  offer  new hope  when  all  FDA  approved                                                                    
     options have been exhausted.                                                                                               
                                                                                                                                
1:05:31 PM                                                                                                                    
                                                                                                                                
BROOKE IVY, Staff, Representative Jason Grenn, Alaska State                                                                     
Legislature, paraphrased from the sectional analysis as follows                                                                 
[original punctuation provided]:                                                                                                
                                                                                                                                
     Section 1: Prohibits  disciplinary action of physicians                                                                  
     by the State Medical  Board for prescribing, dispensing                                                                    
     or  administering an  investigational drug,  biological                                                                    
     product or  device to terminally ill  patients that are                                                                    
     ineligible  or  unable  to  participate  in  a  current                                                                    
     clinical  trial, have  considered  all other  treatment                                                                    
     options approved  by the FDA and  have provided written                                                                    
     consent.                                                                                                                   
                                                                                                                                
     Defines  "investigational  drugs,  biological  products                                                                    
     and devices" as those  that have successfully completed                                                                    
     Phase 1  of the FDA  drug review process and  remain in                                                                    
     ongoing  Phase 2  or 3  clinical trials,  but have  not                                                                    
     been approved for general use.                                                                                             
                                                                                                                                
     Defines  "terminal  illness"  as a  disease  that  will                                                                    
     result in death  in the near future  or permanent state                                                                    
     of unconsciousness from which recovery is unlikely.                                                                        
                                                                                                                                
     Section   2:  Establishes   immunity  for   physicians,                                                                  
     medical  team members,  manufacturers and  distributors                                                                    
     in  the case  of injury  or death  of a  terminally ill                                                                    
     patient  from  the  use  of  an  investigational  drug,                                                                    
     biological   product  or   device,  provided   informed                                                                    
     consent  was obtained  from the  patient and  notice of                                                                    
     immunity was given in advance.                                                                                             
                                                                                                                                
     Establishes immunity  for physicians  and manufacturers                                                                    
     who choose  not to  participate in the  distribution of                                                                    
     an investigational drug, biological product or device.                                                                     
                                                                                                                                
     Section  3:  Amends  statute   limiting  the  sale  and                                                                  
     distribution of new  drugs (AS 17.20.110) so  as not to                                                                    
     apply  to   physicians  prescribing   or  administering                                                                    
     investigational drugs under  the conditions established                                                                    
     in Section 1.                                                                                                              
                                                                                                                                
     Section  4:  Prohibits  the Department  of  Health  and                                                                  
     Social Services  from requiring a licensed  health care                                                                    
     facility   to   increase   its   services   solely   to                                                                    
     accommodate   physicians  prescribing,   dispensing  or                                                                    
     administering investigational drugs to a patient.                                                                          
                                                                                                                                
1:07:42 PM                                                                                                                    
                                                                                                                                
MS. IVY turned to the  PowerPoint presentation titled "House Bill                                                               
43: The  Right to Try,"  slide 3,  "FDA Drug Review  Process" and                                                               
advised  that it  is helpful  to be  familiar with  the different                                                               
phases of the FDA drug review  process.  She explained that prior                                                               
to Phase  1, sponsors of a  drug are required to  submit the form                                                               
"Investigational New  Drug Application"  or IND  application, and                                                               
through this application process  the FDA reviews the applicant's                                                               
pre-clinical testing  results and determines whether  the drug is                                                               
reasonably safe  for human testing.   She then moved to  slide 4,                                                               
"Phase 1 -  Safety" wherein Phase 1 studies  occur after approval                                                               
of  the IND  application.    These studies  may  be conducted  on                                                               
healthy   volunteer   when   testing  Ibuprofen   or   an   anti-                                                               
inflammatory, or  individuals with specific diseases  or terminal                                                               
illnesses.  The goal of Phase  1 testing is to determine possible                                                               
side  effects and  toxicity levels,  wherein Phase  1 focuses  on                                                               
safety.                                                                                                                         
                                                                                                                                
1:08:43 PM                                                                                                                    
                                                                                                                                
MS. IVY turned  to slide 5, "Phase 2- Efficacy"  and advised that                                                               
Phase  2 studies  begin when  a drug  has passed  Phase 1  and is                                                               
considered relatively  safe, with  no unaccepted  toxicity level,                                                               
wherein Phase 2 focuses on  the drug's effectiveness.  She turned                                                               
to slide 6, "Phase 3, and  advised that if there was evidence the                                                               
drug was  effective, it would progress  to Phase 3.   During that                                                               
phase, she explained, more information  would be gained regarding                                                               
safety  and effectiveness,  particularly, in  varying populations                                                               
or different dosages in combination with other medications.                                                                     
                                                                                                                                
1:09:18 PM                                                                                                                    
                                                                                                                                
MS.  IVY  turned   to  slide  7,  "Review  Meeting   &  New  Drug                                                               
Application (NDA"  and advised  that after  Phase 3,  sponsors of                                                               
the drug  participate in a review  meeting with the FDA,  and the                                                               
sponsors go on  to complete a form titled  "New Drug Application"                                                               
(NDA).   In the event the  drug was approved, the  sponsors could                                                               
then market  their drug in the  United States.  From  that point,                                                               
the FDA  has 60  days to  decide whether  to officially  file the                                                               
application  for review  and, she  explained, filed  applications                                                               
are generally processed  within 10 months of filing.   She turned                                                               
to   slide  8,   and   said   that  within   HB   43,  the   term                                                               
"investigational  drug" discusses  those  drugs  that passed  the                                                               
safety testing in Phase 1,  and remain in ongoing clinical trials                                                               
under Phase 2 or 3 of the FDA approval process.                                                                                 
                                                                                                                                
1:09:44 PM                                                                                                                    
                                                                                                                                
MS. IVY  turned to  slide 9, "Compassionate  Use" and  noted that                                                               
the FDA  has an existing  Compassionate Use Program  designed for                                                               
terminally  ill patients  who do  not have  access to  a clinical                                                               
trial.   Within  this program,  patients can  still access  those                                                               
investigational  treatments outside  of the  clinical trial.   In                                                               
order  to start  this process,  a  patient must  work with  their                                                               
doctor and  apply to the FDA.   She commented that  for years, by                                                               
the FDA's own estimate, the  application form alone would take an                                                               
estimated  100  hours  for  the doctor  to  complete.    Although                                                               
recently,  she  pointed  out,  the  FDA  made  great  efforts  to                                                               
streamline  the application  process, but  it is  only the  first                                                               
step  in   the  process.    Manufacturers   must  submit  lengthy                                                               
documentation,  and once  application paperwork  is complete,  it                                                               
must  then  make  its  way  through  the  FDA  internal  approval                                                               
process, and  then to a  separate institutional review  board for                                                               
approval, which is often a lengthy process.                                                                                     
                                                                                                                                
1:10:59 PM                                                                                                                    
                                                                                                                                
MS. IVY  turned to  slide 10,  "The Right to  Try -  A Nationwide                                                               
Effort" and  reiterated that  33 states signed  The Right  to Try                                                               
into law,  and most states  have had overwhelming  bipartisan and                                                               
often unanimous support.                                                                                                        
                                                                                                                                
1:11:22 PM                                                                                                                    
                                                                                                                                
MS.  IVY referred  the  members to  a  document titled  "Clinical                                                               
Trials" included in  the packets, and said that HB  43 focuses on                                                               
terminally ill patients  who do not qualify  for clinical trials.                                                               
The sponsor  included these Alaskan  stories to  illustrate local                                                               
experiences  with terminal  illness, as  well as  the benefit  of                                                               
simply  having access  to  new treatment  options,  whether in  a                                                               
clinical trial or not.                                                                                                          
                                                                                                                                
CHAIR CLAMAN opened public testimony on HB 43.                                                                                  
                                                                                                                                
1:12:40 PM                                                                                                                    
                                                                                                                                
JASON NORRIS,  was unavailable and Representative  Grenn read Mr.                                                               
Norris's letter into the record, as follows:                                                                                    
                                                                                                                                
     I write  to you  today in  support of  HB 43,  with the                                                                    
     short  title "New  Drugs for  the Terminally  Ill."   I                                                                    
     understand that  your time  is limited  and; therefore,                                                                    
     I'll make an effort to be as brief as possible.                                                                            
                                                                                                                                
     In  June of  2011, my  father was  diagnosed with  ALS,                                                                    
     sometimes  known as  Lou Gehrig's  disease.   For those                                                                    
     unfamiliar,  this   disease  slowly  saps   a  person's                                                                    
     ability to move, rendering  them bedridden.  Eventually                                                                    
     it takes away their ability  to breathe, at which point                                                                    
     they die.   It should  be noted that this  disease does                                                                    
     not  affect  a  person's   mind;  therefore,  they  are                                                                    
     acutely  aware   of  their  daily   deterioration,  and                                                                    
     because of this the mind  becomes a prisoner within the                                                                    
     body.    For my  father,  this  began  in June  with  a                                                                    
     reduced  range of  motion in  his  left leg.   At  this                                                                    
     point  he had  been working  12-hour days,  5-6 days  a                                                                    
     week,  per  week  as  a  machinist.   I  feel  this  is                                                                    
     important to  point out because  of the  extended hours                                                                    
     and  physical  nature of  the  job.    He was,  by  all                                                                    
     accounts, a very strong and  healthy man at the time of                                                                    
     diagnosis.   But, by late  fall he had  completely lost                                                                    
     his ability  to walk, and  at Thanksgiving he  held our                                                                    
     5-month old  son for the  last time  in his arms  as he                                                                    
     became too weak to trust  him with such precious cargo.                                                                    
     When  he finally  lost all  movement in  his limbs,  he                                                                    
     would  hug our  children by  nuzzling his  face against                                                                    
     them.  As we entered into  the depths of winter, he and                                                                    
     I  carried on  what conversations  we could,  trying to                                                                    
     accelerate what should have been  more years of passing                                                                    
     knowledge  and  wisdom  from  father  to  son.    These                                                                    
     conversations  became  increasingly  difficult  as  the                                                                    
     disease  made his  breathing quite  labored, even  with                                                                    
     the assistance of  a BiPAP machine.   While the painful                                                                    
     and emotional  moments are too  many to list,  the most                                                                    
     painful came when I asked  him a simple question: "Dad,                                                                    
     are you angry?"   He responded with  uncommon grace and                                                                    
     humility  by  uttering  one  word  with  every  labored                                                                    
     breath, "I'm not  angry, I'm just sad that  I won't see                                                                    
     your  kids grow  up."   And,  in the  early morning  of                                                                    
     February 1, 2012,  he died at the all too  young age of                                                                    
     58.                                                                                                                        
                                                                                                                                
     My  father  was a  good  man  and  my  hero, he  was  a                                                                    
     tireless  worker,  and  a  great  role  model,  and  an                                                                    
     unparalleled family  man.  He  took a chance  on Alaska                                                                    
     in 1996,  when he moved  his family from the  only home                                                                    
     he  had  only   known  to  a  place  that   we  had  no                                                                    
     connections,  no network,  no family,  and no  friends.                                                                    
     The  gamble  paid off  for  all  of  us.   He  saw  the                                                                    
     potential in  this state, he  fought like we all  do to                                                                    
     make a life  here, and in the end I  wish the state had                                                                    
     afforded him the  right to fight this  disease with the                                                                    
     same ferocity.                                                                                                             
                                                                                                                                
     Recently, in  the Washington Post there  was an article                                                                  
     detailing  the experience  of  a man  who  had for  all                                                                    
     intents  and  purposes   beaten  ALS  through  advanced                                                                    
     therapies pioneered  by doctors  at the ALS  Center, in                                                                    
     Atlanta, Georgia.   In reading about this  man I became                                                                    
     aware of the  Right to Try movement.   Soon thereafter,                                                                    
     I became aware  of the bill of which I  write to you in                                                                    
     support of today.  I implore  you to pass this bill and                                                                    
     encourage  your  colleagues in  the  Senate  to do  the                                                                    
     same.    I cannot  say  that  these advanced  therapies                                                                    
     would have helped  save my father's life,  but they may                                                                    
     yet save  someone else's  father, mother,  daughter, or                                                                    
     son.    Thank  you   for  your  consideration  on  this                                                                    
     important legislation.                                                                                                     
                                                                                                                                
1:15:56 PM                                                                                                                    
                                                                                                                                
ELIZABETH  KROME said  she supports  HB 43,  has been  a licensed                                                               
nurse  since 1979,  and practiced  in a  hospital setting  for 30                                                               
years.   Hope is one  thing all  humans require, she  said, after                                                               
being diagnosed with a terminal  condition some patients hope for                                                               
a peaceful  death at home,  for others their  hope is to  live to                                                               
see the  birth of a grandchild,  or a child graduating  from high                                                               
school.   Hope is so  very important to individuals,  she pointed                                                               
out, and the Right to Try allows  a treatment that may or may not                                                               
prolong a life, and allows hope  to continue.  She said she would                                                               
love to  see Alaska  give individuals  the right  to try,  and to                                                               
give them  hope for the next  stage of their life  no matter what                                                               
it might be.                                                                                                                    
                                                                                                                                
1:18:03 PM                                                                                                                    
                                                                                                                                
MICHAEL   MAHARREY,  National   Communications  Director,   Tenth                                                               
Amendment  Center,  said  his  organization  has  supported  this                                                               
legislation across the United States  since its beginning, and he                                                               
called  it "our  no  brainer  issue."   Law  and regulations  are                                                               
supposed to  protect people, but  the regulatory scheme  tends to                                                               
create bureaucracy and  red tape that can cause harm.   Even with                                                               
the FDA's expanded use program, it  does not begin to address the                                                               
black  hole between  the end  of  clinical trials  and the  final                                                               
approval of  treatment.  This process  can take up to  10 months,                                                               
leaving patients in limbo and  between the end of clinical trials                                                               
and the  final approval, patients  do not have  any alternatives.                                                               
He  offered  a  situation  wherein  more  than  70  Texas  cancer                                                               
patients  and a  doctor  began clinical  trials  when the  doctor                                                               
found a successful  treatment for a specific type  of cancer, and                                                               
when the  clinical trials were  close to  the end, the  FDA still                                                               
hadn't given final  approval for the drug.  He  remarked that the                                                               
FDA  basically  told the  doctor  he  had  to stop  treating  his                                                               
patients, except  he was  able to begin  treating them  under the                                                               
Right to Try  new state law in Texas.   Mr. Maharrey related that                                                               
Right to  Try has been so  successful in the State  of Texas that                                                               
the  Texas   legislature  is  considering   a  bill   to  include                                                               
chronically ill  patients.  This type  of legislation illustrates                                                               
the  "beauty of  our  federated structure"  wherein the  American                                                               
system was  never to run based  on a one-size fits  all solutions                                                               
imposed from  Washington, D.C., he  pointed out.   In conclusion,                                                               
he  said, Right  to Try  is a  specific example  of states  using                                                               
their rightful  authority to exercise control  over local issues,                                                               
and if Right  to Try helps even one Alaskan  patient, it is worth                                                               
putting this legislation on the books.                                                                                          
                                                                                                                                
1:20:43 PM                                                                                                                    
                                                                                                                                
KEN LANDFIELD said  he was not aware of any  downside to enacting                                                               
this legislation,  and the  idea of  creating false  hope appears                                                               
disingenuous as terminal is terminal.   This is an easy call and,                                                               
he  pointed out,  within the  Constitution of  the United  States                                                               
there is  a guarantee for the  right to the pursuit  of happiness                                                               
and   it  appears   making  potentially   lifesaving  medications                                                               
available would fall under that category, he said.                                                                              
                                                                                                                                
1:22:18 PM                                                                                                                    
                                                                                                                                
STARLEE  COLEMAN,  Vice  President of  Communications,  Goldwater                                                               
Institute,  advised  that  the Goldwater  Institute  crafted  the                                                               
model  Right to  Try law  upon  which this  bill is  based.   She                                                               
offered that it is important  for Alaskans to understand that the                                                               
organization reached out to doctors  at major research facilities                                                               
across the  country as to why  they don't use the  FDA's existing                                                               
Compassionate  Use  Program.   She  said  that  one of  the  best                                                               
examples  of  why, was  from  a  doctor  who had  previously  run                                                               
clinical trials for  the Indy Anderson Cancer  Center in Houston,                                                               
Texas, and this doctor advised that  she was possibly able to get                                                               
one person  each year  through the FDA's  expanded process.   Ms.                                                               
Colman  said that  if  only one  person a  year,  at the  largest                                                               
cancer  trial center  in  the world,  can get  access  to a  drug                                                               
through the FDA's  process, imagine what it is like  for a person                                                               
in Alaska  who has  seen the community  oncologist who  has never                                                               
run a  clinical trial and  doesn't know who  to call at  the FDA.                                                               
The  chances are  not  good  that this  patient  would be  helped                                                               
through  this program  because the  FDA program  is actually  for                                                               
patients  being treated  at major  research hospitals  performing                                                               
clinical trials  all the time, they  know who to call  and how to                                                               
navigate that system.   She commented that it is  not for regular                                                               
people,  although  it is  known  that  Right  to Try  is  already                                                               
working in Texas, Oregon, and  Florida in accessing new treatment                                                               
options.   These  are real  people  with real  families who  need                                                               
help.   She said she  had received updated information  and Right                                                               
to Try  has now  been adopted in  34 states due  to the  State of                                                               
Kentucky.   She remarked that "no  one who is dying  expects that                                                               
an investigational treatment  will cure them," but  they want the                                                               
right to try  and the choice to take the  same medication used in                                                               
clinical  trials.   The Goldwater  Institute believes  that dying                                                               
people and their families are owed that opportunity, she said.                                                                  
                                                                                                                                
1:25:32 PM                                                                                                                    
                                                                                                                                
CHAIR  CLAMAN,  after  ascertaining  no one  wished  to  testify,                                                               
closed public testimony on HB 43.                                                                                               
                                                                                                                                
1:25:42 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  LEDOUX apologized  for coming  in late  and asked                                                               
how a person is able to receive the experimental drugs.                                                                         
                                                                                                                                
MS. IVY  responded that the  FDA has a Compassionate  Use Program                                                               
wherein  a  person can  apply  to  for investigational  drugs  in                                                               
conjunction with their  doctor.  Currently, she  explained, it is                                                               
an application process, and once  the application has been turned                                                               
in, the FDA has  up to 30 days to review  the application and, in                                                               
the event  a question comes up  during the 30 day  period, the 30                                                               
day  clock can  be  reset.   After  that  point,  if the  patient                                                               
receives  approval from  the FDA,  the patient  and their  doctor                                                               
must seek out  an external institutional review  board (IRB), and                                                               
"they have  no requirements" when  they have  to get back  to the                                                               
person  or approve  the application.    In the  event the  review                                                               
board  only meets  every six  months, the  patient would  have to                                                               
wait for the  review and approval of the request.   She said that                                                               
outside of a clinical trial, that  is the only way a person could                                                               
access those investigational drugs.                                                                                             
                                                                                                                                
1:27:12 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE LEDOUX  noted her  understanding that HB  43 would                                                               
not subject a doctor to  disciplinary action, and asked how would                                                               
a person obtain the drugs and from what manufacturer.                                                                           
                                                                                                                                
MS.  IVY  explained  that  to  be eligible,  a  patient  must  be                                                               
diagnosed  as  terminally ill,  their  doctor  has exhausted  all                                                               
other treatment options for whatever  terminal illness they have,                                                               
and they've attempted  to access a clinical trial.   After all of                                                               
those steps have  been taken, the person or  doctor would contact                                                               
the  manufacturer  and  request  its consent  to  providing  that                                                               
medication,   outside   of   the   clinical   trial,   with   the                                                               
Compassionate Use  Program.   The person,  their doctor,  and the                                                               
manufacturer would all have to  consent to that relationship, she                                                               
said.                                                                                                                           
                                                                                                                                
1:28:36 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE LEDOUX asked whether  this type of legislation was                                                               
law in other states, and inquired  as to how cooperative the drug                                                               
companies are to dispensing the  drugs under the circumstances in                                                               
which these types of laws have been enacted.                                                                                    
                                                                                                                                
MS. IVY responded  that similar Right to Try laws  have passed in                                                               
34 states, and  are pending in 14 states, including  Alaska.  She                                                               
acknowledged  that no  action  could  be taken  to  force a  drug                                                               
manufacturer    to   provide    access    to   the    medication.                                                               
Interestingly,  she  offered, due  to  a  new federal  law,  drug                                                               
manufacturers  are required  to list  drug on  their websites  to                                                               
make  the   drug  more  accessible   if  the   drug  manufacturer                                                               
participates  in the  Compassionate Use  Program, and  also lists                                                               
who to  contact.   She said  it is  becoming more  accessible for                                                               
those seeking access  to the Compassionate Use  Program and those                                                               
seeking access outside of that program, she said.                                                                               
                                                                                                                                
1:29:57 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE LEDOUX  questioned whether any of  these drugs are                                                               
available  in  other  countries,  even  when  they  haven't  been                                                               
approved by the FDA.                                                                                                            
                                                                                                                                
MS. IVY  described Representative  LeDoux's question  as powerful                                                               
because  when discussing  this  legislation  people are  thinking                                                               
about experimental  drugs the nation  had never seen  before, but                                                               
some of  the treatments  going through  the FDA  approval process                                                               
are currently in  use.  For example, in  Europe cancer treatments                                                               
have been in use for  15 years successfully, but those treatments                                                               
still  have to  go  through  the FDA  process,  which could  take                                                               
anywhere from 10  - 15 years to  reach approval.  In  the event a                                                               
treatment  passes   Phase  1  of   the  FDA  process,   per  this                                                               
legislation, a  person would  be able to  work with  their doctor                                                               
and the manufacturer to access that treatment.                                                                                  
                                                                                                                                
REPRESENTATIVE  LEDOUX  referred  to  drugs  available  in  other                                                               
countries   which  are   unavailable  from   the  United   States                                                               
manufacturers,  and asked  what  it would  take  to import  those                                                               
drugs as she assumed this bill doesn't do it.                                                                                   
                                                                                                                                
MS. IVY  replied that she  was unsure  that would be  legal under                                                               
federal  law,  and the  patient  would  have  to travel  to  that                                                               
country to utilize the drug.                                                                                                    
                                                                                                                                
1:32:33 PM                                                                                                                    
                                                                                                                                
EBRAHIM DELPASSAND,  M.D., Excel  Diagnostics &  Nuclear Oncology                                                               
Center,  said his  specialty is  Nuclear  Oncology, and  he is  a                                                               
professor  at the  University of  Texas, Department  of Radiation                                                               
Oncology.  He commented that  Houston, Texas has been using Right                                                               
to Try  to offer  high power  targeted radiation  nuclear therapy                                                               
for a (indisc.) cancer, which are  rare cancers in terms of other                                                               
common  cancers  such as,  breast,  prostrate,  or colon  cancer.                                                               
There is  a special targeted  therapy that was given  to patients                                                               
more than 10 years ago in  Europe, and his patients had to travel                                                               
to Europe  to receive  those treatments.   In  2007, he  found an                                                               
investigation for  new drug  applications with  the FDA  to offer                                                               
these treatments in  Houston.  He said it  took him approximately                                                               
2.5 years to  go through the FDA process and  receive approval to                                                               
start  the investigation  of  trial to  give  patients access  to                                                               
these treatments.  He explained  that he received permission from                                                               
the  drug's owner  to start  these  trials in  the United  States                                                               
because, at that  time, the drug was not ready  to start a trial.                                                               
He said they went through all  of the hoops, and finally made the                                                               
treatments available  to their patients  with the FDA's  "sort of                                                               
approval,"   and  in   2015,  their   Investigational  New   Drug                                                               
Application  (IND) was  active  at his  center  for treatment  of                                                               
these  patients.    Initially,   he  advised,  he  requested  the                                                               
treatment for  60 patients,  then increased  it to  100 patients,                                                               
and  then 150  patients.   In February  2015, as  the center  was                                                               
moving closer to  a 150 patient enrollment,  he requested another                                                               
100  patients  from  the  FDA  because the  drug  was  still  not                                                               
commercially available.   The FDA responded that it  did not want                                                               
him to  increase the  number, not due  to complaints  because his                                                               
patients  had good  responses, the  drug had  a very  good safety                                                               
profile, and  there were many peer  reviewed medical publications                                                               
on this drug from other centers,  but rather because it felt that                                                               
would affect the  commercialization of the drug and  "This is why                                                               
you  have   to  stop."    He   said  he  advised  the   FDA  that                                                               
investigation  of  trial  approval  for  this  drug  had  already                                                               
completed  enrollment, and  actually his  center was  one of  the                                                               
main contributors to that clinical trial  so there was no way his                                                               
continuation of treating  these patients would have  an effect on                                                               
the commercialization  of the  drug.   (Indisc.) to  continue our                                                               
treatment while the FDA had  essentially stop them from providing                                                               
these treatments  to the patients.   He pointed out that  this is                                                               
one of  the scenarios  in which  the Right to  Try laws  can help                                                               
patients receive  their treatments while  the FDA reviews  all of                                                               
the data  to approve the drug  and then later commercialize.   He                                                               
stressed  that this  is the  gap in  which patients  will benefit                                                               
from this  law in receiving  their medication if it  is available                                                               
to them.                                                                                                                        
                                                                                                                                
1:38:25 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KOPP  referred   to  Dr.  Delpassand's  testimony                                                               
regarding the  FDA's decision affecting the  commercialization of                                                               
the  drug,  and asked  whether  he  had  ever witnessed  the  FDA                                                               
colluding with pharmaceutical companies.   Especially in the area                                                               
of  expediting or  delaying  approvals  of investigational  drugs                                                               
through  Phases  1-3  of  clinical  trials  that  Dr.  Delpassand                                                               
believed were harmful to a patient's interest.                                                                                  
                                                                                                                                
DR. DELPASSAND responded  that the nature of  the overall process                                                               
in obtaining approval  has been a lengthy process,  and there are                                                               
several reasons for  that, such as, some  clinical trials require                                                               
follow up  information and the  long term effect on  the patient,                                                               
especially when discussing oncology and  cancer.  He related that                                                               
that is  the nature of clinical  trials because the FDA  wants to                                                               
be sure the drug is safe  and also effective.  He explained there                                                               
are  several reasons  for that  length  of time  because after  a                                                               
review of  considerable data, the  final package is  submitted to                                                               
the FDA, and  thereafter, he said, it sometimes  takes between 12                                                               
and  18 months  until  the FDA  is actually  able  to review  the                                                               
entire  data and  come back  with its  opinion as  to whether  it                                                               
approves or  does not  approve the  drug.  It  is this  period of                                                               
time  wherein  lies  the  problem, especially  if  the  drug  had                                                               
already  shown  effectiveness,  had   many  publications  in  the                                                               
oncology community, or whatever  physicians groups, and this drug                                                               
becomes common  knowledge because then  patients come in  and ask                                                               
for the drug.  The physician,  knowing this drug could help their                                                               
patient, has nothing  to offer because the drug had  not yet been                                                               
approved and  this is  how Right  to Try law  comes into  play in                                                               
certain situations.   He stressed that this law does  not, by any                                                               
means, provide a  shortcut or cutting of corners for  the FDA, or                                                               
any kind  of due diligence  in terms of  making sure the  drug is                                                               
safe and effective.                                                                                                             
                                                                                                                                
1:42:09 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE FANSLER  asked whether  the exact bill  was passed                                                               
in every state.                                                                                                                 
                                                                                                                                
MS. IVY  answered that  most of the  other versions  included the                                                               
same  FDA criteria,  but there  were different  elements in  each                                                               
state.                                                                                                                          
                                                                                                                                
1:43:05 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  FANSLER referred  to a  letter, in  the committee                                                               
packet  recommending adding  amendments,  and  also changing  the                                                               
definition of terminal  illness, and he asked  Ms. Ivy's response                                                               
to the letter.                                                                                                                  
                                                                                                                                
MS. IVY pointed  to the [3/7/17] letter from  Premera, Blue Cross                                                               
Blue  Shield   of  Alaska,  and   offered  that  the   first  two                                                               
suggestions were  clarifying language in that  a patient's health                                                               
care   insurance   plan   was   not   required   to   cover   the                                                               
investigational drugs or its possible  adverse effects.  She said                                                               
that coverage is  not required under federal or  state statute at                                                               
this time, it  could be included for  clarification purposes, but                                                               
it  is   not  something   the  sponsor   is  requiring   in  this                                                               
legislation.   Also,  she  noted, part  of  the written  informed                                                               
consent  form  required  in  the  bill  involves  a  conversation                                                               
between  a  patient  and  their  doctor  regarding  the  lack  of                                                               
coverage for the  investigational drug, which is  FDA guidance on                                                               
those informed  consent forms.   The third recommendation  had to                                                               
do with "what they may not  deny coverage for," and the sponsor's                                                               
reading was  that it may  add additional protections to  the bill                                                               
for the patient in that, "a  health insurer may not deny coverage                                                               
to a  patient for pre-existing conditions,  benefits that accrued                                                               
before  the  day  in  which  the patient  was  treated  with  the                                                               
unapproved investigational drug or  palliative care for a patient                                                               
previously  treated   who  is  no  longer   currently  using  the                                                               
investigational drug."  She opined  that a "majority of this" was                                                               
already mandated  in the Affordable  Care Act; however,  it could                                                               
be something the committee could  consider including if it wanted                                                               
to  look down  the  road  whether there  may  be  changes at  the                                                               
federal level.  She advised  that the sponsor's office spoke with                                                               
Legislative Legal  and Research Services regarding  this language                                                               
and it  didn't indicate there  were particular risks  involved in                                                               
including  the language.   Finally,  she advised,  the definition                                                               
Premera,  Blue  Cross  Blue  Shield  of  Alaska  suggested  would                                                               
streamline it with Medicare's definition  of terminal illness and                                                               
limit it to  those who may die  within the next six  months.  She                                                               
explained that the  sponsor believes the definition  is narrow in                                                               
that if a terminally ill patient  was given seven months to live,                                                               
they would not be eligible to  participate under the Right to Try                                                               
laws.   The sponsor  could not see  this narrow  definition, even                                                               
though   the  Compassionate   Use  Program,   and  he   does  not                                                               
necessarily support that amendment.                                                                                             
                                                                                                                                
1:46:33 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE FANSLER  thanked Ms.  Ivy for  the map  because it                                                               
depicted  the almost  universal acceptance  of this  program, and                                                               
noticed that  Hawaii vetoed  the legislation.   He  asked whether                                                               
she had any information as to the veto.                                                                                         
                                                                                                                                
MS.  IVY  answered  that previously,  California  Governor  Jerry                                                               
Brown had vetoed the Right to  Try law, and later the legislation                                                               
was brought  forward again  and Governor  Brown changed  his mind                                                               
based on its  success stories.  As far as  Hawaii, Governor David                                                               
Ige, in his veto statement listed  four reasons, as follows:  the                                                               
Compassionate Use  Program already  existed and  provided access;                                                               
this could interfere  with the overall FDA system  which may have                                                               
unintended  consequences in  delaying development  of potentially                                                               
lifesaving  drugs, of  which the  bill sponsor  would argue  that                                                               
this doesn't  impact the  Phases 1-3  clinical trial  process; it                                                               
violated  the Supremacy  Clause; and,  he was  unclear as  to the                                                               
actual benefits to the patient.                                                                                                 
                                                                                                                                
MS.  IVY,  in  response  to  Representative  Fansler,  agreed  to                                                               
provide the committee with Dr. Delpassand's written testimony.                                                                  
                                                                                                                                
1:49:50 PM                                                                                                                    
                                                                                                                                
MS. IVY,  in responded to Representative  Reinbold, answered that                                                               
this   bill  is   limited  solely   to  the   Right  to   Try  in                                                               
pharmaceuticals.                                                                                                                
                                                                                                                                
REPRESENTATIVE REINBOLD commented that  she was in pharmaceutical                                                               
sales  for  almost  10  years  in  Alaska,  and  in  response  to                                                               
Representative LeDoux's  previous question, answered  that within                                                               
the company  she worked  for, it took  approximately 17  years to                                                               
move  from inception  to the  FDA's final  approval.   In getting                                                               
Alaskans on clinical trials, the  company had to compete with big                                                               
states  because  it  is  easier   to  have  many  patients  in  a                                                               
concentrated  effort.    She  encouraged  continued  vetting  and                                                               
related that  the comment  about giving  "false hope"  was valid.                                                               
Recently,  she said,  a friend  was put  on a  clinical trial  in                                                               
California, was given great hope  that this would be a successful                                                               
drug for her,  and it ended up  that there was no  result at all.                                                               
She said  she appreciates the  bill coming forward and  that this                                                               
is an opportunity for Alaska to participate.                                                                                    
                                                                                                                                
1:52:54 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE EASTMAN  commented that  with the success  of this                                                               
legislation  in  34  states,  and states  trying  to  expand  the                                                               
program to  the chronically ill, asked  the sponsor's perspective                                                               
on an amendment  that may expand it to the  chronically ill based                                                               
upon its success.                                                                                                               
                                                                                                                                
MS.  IVY  responded  that  Texas  is the  one  state  looking  at                                                               
potentially  expanding  the  definition of  terminal  illness  to                                                               
debilitating diseases due to the  law's successes.  The Goldwater                                                               
Institute   offered  concerning   regarding   that  concept   and                                                               
preferred  the  initial  narrow definition  move  forward  before                                                               
looking to  expand because  it was a  new process  throughout the                                                               
different  states.     Additionally,  she  said,   there  is  the                                                               
potential for a  court challenge, and the bill  sponsor is trying                                                               
to  target  the existing  access  through  the Compassionate  Use                                                               
Program and  streamline that timing.   Expanding  the definition,                                                               
she  pointed out,  could  potentially get  into  questions as  to                                                               
whether  the legislation  was taking  on the  FDA's process  on a                                                               
larger  scope,  and how  far  to  expand  that definition.    She                                                               
offered that  it is a policy  call, and at this  time the sponsor                                                               
would  prefer  to  stay  within the  more  narrow  definition  of                                                               
terminal illness.                                                                                                               
                                                                                                                                
1:54:56 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE EASTMAN  acknowledged there are  several parallels                                                               
with this  bill and a  separate bill  making its way  through the                                                               
legislature in dealing  with assisted suicide.  Due  to the bills                                                               
being similar,  he asked the  sponsor's thoughts as  to inserting                                                               
language into the  bill to make clear that is  definitely not the                                                               
direction of this bill.                                                                                                         
                                                                                                                                
MS.  IVY advised  that it  is the  sponsor's position  that these                                                               
bills are different as to intent  because the issues are Right to                                                               
Die  and  Right   to  Try;  however,  the  sponsor   is  open  to                                                               
discussions regarding adding clarifying language.                                                                               
                                                                                                                                
1:55:52 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  LEDOUX noted  that  she was  late attending  this                                                               
hearing,  that  some  of  her questions  may  have  already  been                                                               
answered, and asked  the committee's indulgence.   She then asked                                                               
whether  there   had  been  any  organized   opposition  to  this                                                               
legislation, or  organized opposition  to similar bills  in other                                                               
states.                                                                                                                         
                                                                                                                                
MS. IVY answered, not to  her knowledge in Alaska, but nationally                                                               
there  had  been   concern  over  creating  false   hope.    Some                                                               
individuals, in response to that  concern have said, "It's better                                                               
to  have some  hope than  no hope  at all."   The  Alaska Medical                                                               
Board and  the Commission  on Aging  offered letters  of support,                                                               
and  as to  the national  support, she  said she  would defer  to                                                               
Starlee Coleman at the Goldwater Institute.                                                                                     
                                                                                                                                
1:56:47 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  LEDOUX  noted  that  either  Aetna  Insurance  or                                                               
Premera  Blue  Cross  Blue  Shield of  Alaska  had  suggested  an                                                               
amendment, and asked the sponsor's view of that amendment.                                                                      
                                                                                                                                
MS.  IVY pointed  to the  3/7/17 letter  from Premera  Blue Cross                                                               
Blue Shield of Alaska that  Representative Fansler had previously                                                               
inquired  about,  and  explained  that the  first  two  suggested                                                               
amendments  may   be  unnecessary  as  they   are  not  currently                                                               
requiring insurers  to cover investigational drugs  under federal                                                               
or  state statute.   The  third suggestion  could add  additional                                                               
protections  if  that   was  the  will  of   the  committee,  but                                                               
currently,  some of  these are  mandated by  the Affordable  Care                                                               
Act.   She advised that  in terms of  narrowing the scope  of the                                                               
definition  of terminal  illness,  the sponsor  does not  support                                                               
that suggestion.                                                                                                                
                                                                                                                                
[HB 43 was held over.]                                                                                                          
                                                                                                                                
           HB 108-FIDUCIARY ACCESS TO DIGITAL ASSETS                                                                        
                                                                                                                                
1:58:34 PM                                                                                                                    
                                                                                                                                
CHAIR CLAMAN announced  that the next order of  business would be                                                               
HOUSE BILL NO. 108, "An Act  adopting and relating to the Revised                                                               
Uniform  Fiduciary Access  to Digital  Assets  Act." [Before  the                                                               
committee was CSHB 108, Version U.]                                                                                             
                                                                                                                                
CHAIR CLAMAN advised that this is  the second hearing on the bill                                                               
and  being the  sponsor of  the bill,  passed the  gavel to  Vice                                                               
Chair Fansler for the duration of the hearing on HB 108.                                                                        
                                                                                                                                
[Chair Claman passed the gavel to Vice Chair Fansler.]                                                                          
                                                                                                                                
1:58:58 PM                                                                                                                    
                                                                                                                                
VICE CHAIR FANSLER advised that  committee members did not submit                                                               
amendments for  HB 108,  Version U, and  asked whether  there was                                                               
further discussion.                                                                                                             
                                                                                                                                
REPRESENTATIVE KOPP  asked whether  there had been  any organized                                                               
opposition to HB 108.                                                                                                           
                                                                                                                                
2:00:09 PM                                                                                                                    
                                                                                                                                
DEBORAH  BEHR, Member,  Alaska Uniform  Law Delegation,  answered                                                               
that  this legislation  has passed  in 24  states, pending  in 18                                                               
states, and  of those 18 states,  2 are on the  governors' desks.                                                               
She  offered  that there  had  been  no organized  opposition  on                                                               
Google or Facebook, the industry,  senior groups, or AARP Alaska,                                                               
and  that a  major  trust company  in Alaska  supports  it.   She                                                               
continued that  she was unaware  of anyone raising  any objection                                                               
to HB 108.                                                                                                                      
                                                                                                                                
VICE CHAIR  FANSLER asked  for final  comments from  the members,                                                               
and seeing none, he asked for a motion.                                                                                         
                                                                                                                                
2:01:09 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE KREISS-TOMKINS  moved to report CSHB  108, Version                                                               
30-LS0210/U,  out of  committee  with individual  recommendations                                                               
and the  accompanying fiscal  notes.   There being  no objection,                                                               
CSHB   108(JUD)  passed   from  the   House  Judiciary   Standing                                                               
Committee.                                                                                                                      
                                                                                                                                
[Vice Chair Fansler passed the gavel back to Chair Claman.]                                                                     
                                                                                                                                
         HB 42-FORFEITURE & SEIZURE: PROCEDURE; LIMITS                                                                      
                                                                                                                                
2:01:46 PM                                                                                                                    
                                                                                                                                
CHAIR CLAMAN announced  that the next order of  business would be                                                               
HOUSE  BILL NO.  42, "An  Act  relating to  seizure of  property;                                                               
relating to  forfeiture to the  state; relating to  criminal law;                                                               
amending Rules  3, 4, 11, 12,  16, 32, 32.2, 32.3,  39, 39.1, and                                                               
42, Alaska Rules of Criminal  Procedure, Rules 501, 801, and 803,                                                               
Alaska Rules  of Evidence,  and Rules 202,  209, and  217, Alaska                                                               
Rules  of Appellate  Procedure;  and providing  for an  effective                                                               
date."  [Before the committee was CSHB 42, Version U.]                                                                          
                                                                                                                                
CHAIR CLAMAN  advised as  follows: this is  the fifth  hearing on                                                               
this  bill; Amendments  1, 2,  and 3,  were adopted;  Amendment 4                                                               
failed; and  Amendments 5  - 7  were withdrawn.   Since  the last                                                               
hearing he worked with committee  members, the Department of Law,                                                               
and the  bill sponsor to  re-draft Amendment 4, which  was before                                                               
the committee as Amendment 8.                                                                                                   
                                                                                                                                
2:02:24 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  LEDOUX moved  to adopt  Amendment 8,  Version 30-                                                               
LS0193\U.12, Martin, 3/28/17, which read as follows:                                                                            
                                                                                                                                
     Page 7, line 5:                                                                                                            
          Delete all material and insert:                                                                                       
               "(4)  obtained the property                                                                                      
               (A) as a bona fide purchaser for fair market                                                                     
     value;                                                                                                                     
               (B) by inheritance before the date of the                                                                        
     offense resulting in forfeiture;                                                                                           
               (C) as a gift from a person other than the                                                                       
     defendant; or                                                                                                              
               (D) lawfully in a manner the court considers                                                                     
     just."                                                                                                                     
                                                                                                                                
CHAIR CLAMAN there being no objection, Amendment 8 was adopted.                                                                 
                                                                                                                                
2:02:45 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE EASTMAN commented that with  all of the changes to                                                               
this bill  he was  unsure it  accomplished everything  within the                                                               
original bill; however, he was  hopeful that with passage of this                                                               
bill "we can take a small step closer to where we want to be."                                                                  
                                                                                                                                
REPRESENTATIVE  KOPP  said  he appreciated  the  team  effort  in                                                               
moving  this   bill  forward.     Although,   it  may   not  have                                                               
accomplished  everything in  the bill,  he pointed  out that  not                                                               
everything intended  in the bill  was beneficial overall  to good                                                               
public policy.   Certainly,  he said,  the bill  sponsor's intent                                                               
was  to make  sure there  was due  process any  time there  was a                                                               
seizure of property and forfeiture,  and great strides were taken                                                               
in that direction.                                                                                                              
                                                                                                                                
2:04:16 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  FANSLER  moved to  report  CSHB  42, Version  30-                                                               
LS0193\U,  Martin,  3/20/17,  out of  committee  with  individual                                                               
recommendations and  the accompanying fiscal notes.   There being                                                               
no  objection,  amended  CSHB  42(JUD)   passed  from  the  House                                                               
Judiciary Standing Committee.                                                                                                   
                                                                                                                                
             HB 123-DISCLOSURE OF HEALTH CARE COSTS                                                                         
                                                                                                                                
2:04:48 PM                                                                                                                    
                                                                                                                                
CHAIR CLAMAN announced that the  final order of business would be                                                               
HOUSE  BILL NO.  123, "An  Act relating  to disclosure  of health                                                               
care  services  and  price  information;  and  providing  for  an                                                               
effective date." [Before the committee was CSHB 123, Version D.]                                                                
                                                                                                                                
2:05:27 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KREISS-TOMKINS  requested  that  Amendment  1  be                                                               
moved to the  bottom of the amendments stack  because he recently                                                               
received  "fresh data"  he would  like to  circulate amongst  the                                                               
committee members and the bill sponsor.                                                                                         
                                                                                                                                
2:05:48 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE REINBOLD  moved to adopt Amendment  2, Version 30-                                                               
LS0380\I.3, which read as follows:                                                                                              
                                                                                                                                
     Page 3, line 18, following "municipal,":                                                                                   
          Insert "federal,"                                                                                                     
                                                                                                                                
     Page 3, line 24:                                                                                                           
          Delete ""health care facility" does not include"                                                                      
                                                                                                                                
     Page 3, line 25, through page 4, line 3:                                                                                   
          Delete all material.                                                                                                  
                                                                                                                                
REPRESENTATIVE FANSLER objected.                                                                                                
                                                                                                                                
2:06:16 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  REINBOLD noted  that during  her discussion  with                                                               
the sponsor she mentioned this  amendment and the sponsor did not                                                               
offer  opposition.   This amendment,  she explained,  removes the                                                               
federal exemption and keeps everyone on the same page.                                                                          
                                                                                                                                
2:06:41 PM                                                                                                                    
                                                                                                                                
The committee took a brief at-ease.                                                                                             
                                                                                                                                
2:09:13 PM                                                                                                                    
                                                                                                                                
CHAIR CLAMAN  noted that the  initial question  of Representative                                                               
Reinbold  was  whether the  bill  sponsor  supported or  did  not                                                               
support Amendment 2.                                                                                                            
                                                                                                                                
2:09:51 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE IVY SPONHOLTZ, Alaska  State Legislature, said she                                                               
does not support  Amendment 2 because it is in  conflict with the                                                               
Supremacy Clause  of the United States  Constitution [Article VI,                                                               
Clause 2], which read as follows:                                                                                               
                                                                                                                                
     This Constitution,  and the laws  of the  United States                                                                    
     which  shall  be made  in  pursuance  thereof; and  all                                                                    
     treaties  made,  or  which shall  be  made,  under  the                                                                    
     authority of  the United States,  shall be  the supreme                                                                    
     law of  the land; and  the judges in every  state shall                                                                    
     be bound thereby, anything in  the Constitution or laws                                                                    
     of any State to the contrary notwithstanding.                                                                              
                                                                                                                                
REPRESENTATIVE  SPOHNHOLZ continued  that there  is not  a bright                                                               
line    separating   government    institutions   from    private                                                               
institutions in this bill, but  rather it separates out federally                                                               
funded organizations.   She opined it would put the  state in the                                                               
position of  defending costly lawsuits  which is not in  the best                                                               
interests of the state.                                                                                                         
                                                                                                                                
2:10:48 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE REINBOLD  said that  her impression,  during their                                                               
discussion on  this bill, was  that Representative  Spohnholz did                                                               
not have  any strong feelings one  way or another.   She stressed                                                               
that  federal dollars  are private  tax  dollars; therefore,  the                                                               
private  sector dollars  would fund  public facilities,  and this                                                               
amendment eliminates  exemptions for public facilities  funded by                                                               
private  dollars.   Also,  she  commented,  sometimes with  state                                                               
facilities there are matches, such  as Medicaid dollars, which is                                                               
also the  peoples' money.  She  opined that, at a  minimum, it is                                                               
only fair that public facilities be  on the same playing field as                                                               
the private sector.                                                                                                             
                                                                                                                                
2:12:12 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE LEDOUX  related that she understands  page 3, line                                                               
18, and inserting  federal, but she doesn't follow  when it comes                                                               
to [Section  1, AS 18.15.360(h)],  page 3, lines 24-25,  and page                                                               
4, lines 1-3, which read as follows:                                                                                            
                                                                                                                                
                    (A) the Alaska Pioneers' Home and the                                                                       
     Alaska  Veterans' Home  administered by  the department                                                                    
     under AS 47.55;                                                                                                            
                    (B) an assisted living home as defined                                                                      
     in AS 47.33.l990;                                                                                                          
                    (C) a nursing facility licensed by the                                                                      
     department to provide long-term care;                                                                                      
                    (D) a facility operated by an Alaska                                                                        
     tribal health organization; and                                                                                            
                    (E) a hospital operated by the United                                                                       
     States  Department of  Veterans Affairs  or the  United                                                                    
     States Department  of Defense,  or any  other federally                                                                    
     operated hospital or institution;                                                                                          
                                                                                                                                
REPRESENTATIVE LEDOUX  asked how  a nursing facility  licensed by                                                               
the department to provide long-term care would be federal.                                                                      
                                                                                                                                
2:12:59 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SPOHNHOLZ   answered  "that   it  is   not,"  and                                                               
clarified that  she was  speaking to the  first section  of which                                                               
inserts  "federal."   The  second section  would  delete out  the                                                               
Pioneers'  Homes, Veterans'  Homes,  assisted  living homes,  and                                                               
nursing facilities,  in particular.   She said  she chose  not to                                                               
include  those  facilities  because   everyone  living  in  those                                                               
facilities knew exactly  what their stay would cost,  no one goes                                                               
into  a long  term care  facility or  the Pioneers'  Home without                                                               
knowing the  exact daily  cost.  Therefore,  having it  posted on                                                               
the wall  was not  additional information.   In  the case  of the                                                               
tribal  health organizations  and  subparagraph (E),  it was  her                                                               
understanding that  the tribal health organizations  were largely                                                               
federally funded, and she actually  received verbal feedback that                                                               
a lawsuit would  probably ensue because it viewed  itself as part                                                               
of a  federal entity.   She said  she chose not  to take  that on                                                               
because her primary  focus was on the  individual marketplace and                                                               
having the most opportunity to make a big difference.                                                                           
                                                                                                                                
2:15:04 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE LEDOUX referred to  a nursing facility licensed by                                                               
the department  to provide long  term care, and opined  that with                                                               
some  of these  facilities possibly  basic "stuff"  was provided,                                                               
but there's  the "other stuff"  that's provided upon  request for                                                               
necessity.    She   said  she  was  thinking  of   her  folks  in                                                               
California, when  her father broke  his hip  he went into  a long                                                               
term  care facility  and was  billed for  specific services.   It                                                               
wasn't just that he had to pay  "X" amount of dollars in order to                                                               
enter the  place, and  she asked  how the  facilities are  run in                                                               
Alaska.                                                                                                                         
                                                                                                                                
REPRESENTATIVE SPOHNHOLZ  opined that  the facilities tend  to be                                                               
that the patient pays for the  level of care they need, there may                                                               
be  some individual  distinctions, but  the pricing  tends to  be                                                               
based on the level of care  for the patient.  She explained there                                                               
are  different  pricings  for  different   levels  of  care,  and                                                               
generally speaking,  the patient knows  the cost, and  their bill                                                               
doesn't  change dramatically  from one  month to  another, unless                                                               
there was a major medical event.   She explained that she was not                                                               
discussing that level  of care, but rather care  such as, routine                                                               
and/or elective  care when going  to the traditional  health care                                                               
provider.   It  was her  intent, she  said, to  focus in  on that                                                               
routine and/or elective  care, of which makes up the  bulk of the                                                               
particular kind of marketplace this bill could influence.                                                                       
                                                                                                                                
2:18:06 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KOPP referred  to Amendment  2 and  inserting the                                                               
word "federal,"  and noted that  any person or  provider eligible                                                               
under  the federally  funded Indian  Health Service  program does                                                               
not   compete  in   the  marketplace   with   respect  to   price                                                               
transparency.   Also,  with respect  to the  word "federal,"  how                                                               
would this  impact military  hospitals, such  as the  hospital on                                                               
Joint  Base Elmendorf-Richardson  (JBER).   He  said  he was  not                                                               
familiar with how  TRICARE works currently, and  opined that with                                                               
the intent  being marketplace transparency  he was unsure  how it                                                               
aligned with a military hospital posting a price disclosure.                                                                    
                                                                                                                                
2:19:26 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SPOHNHOLZ  remarked that they were  discussing two                                                               
distinct   elements  when   talking  about   this  one   specific                                                               
population served  through TRICARE, the Veterans  Affairs, or the                                                               
United States  Department of Defense (DoD)  delivered health care                                                               
services.   In  the case  of the  federal facilities  operated on                                                               
bases, or just  outside of the military bases in  the case of the                                                               
Department of  Veterans Affairs,  those are  excluded on  page 4,                                                               
lines 1-3, [subparagraph (E)], which read as follows:                                                                           
                                                                                                                                
          (E) a hospital operated by the United States                                                                          
     Department  of Veterans  Affairs or  the United  States                                                                    
     Department of Defense, or  any other federally operated                                                                    
     hospital or institution;                                                                                                   
                                                                                                                                
REPRESENTATIVE SPOHNHOLZ  pointed out that those  were treated as                                                               
separate  because they  are federal  institutions.   Although, in                                                               
the event a veteran with  TRICARE received approval for some sort                                                               
of  care outside  of the  military system  and visited  a private                                                               
provider in  the marketplace, the  veteran should be able  to see                                                               
that  information.    TRICARE  can be  used  within  the  private                                                               
market,    with   some    restrictions   outside    of   military                                                               
installations, but she said she did not know all of the details.                                                                
                                                                                                                                
2:20:51 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE KOPP referred  to Amendment 2, page  1, lines 4-5,                                                               
deleting  subparagraphs  (D) and  (E),  and  asked whether  there                                                               
would be a problem leaving subparagraphs (A), (B), and (C).                                                                     
                                                                                                                                
REPRESENTATIVE  SPOHNHOLZ  advised  that  the way  the  bill  was                                                               
drafted was actually the inverse because ...                                                                                    
                                                                                                                                
REPRESENTATIVE  KOPP   clarified  that  he  asked   the  question                                                               
backwards.                                                                                                                      
                                                                                                                                
REPRESENTATIVE  SPOHNHOLZ responded  that she  did not  object to                                                               
his suggestion,  although she did  not believe anyone  moves into                                                               
an assisted living  home without first receiving  the exact cost,                                                               
how they are  charged for services, and how the  services will be                                                               
paid.   Therefore, she  remarked, the  need for  transparency was                                                               
not the same when compared to  the needs at the Pioneers' Home or                                                               
an assisted  living home, and  walking into an emergency  room at                                                               
the hospital and  considering an MRI, or to the  local doctor for                                                               
additional bloodwork.                                                                                                           
                                                                                                                                
2:23:01 PM                                                                                                                    
                                                                                                                                
CHAIR  CLAMAN explained  that when  his family  had to  determine                                                               
which  assisted living  community center  would be  best for  his                                                               
parents,  his  siblings  talked to  approximately  four  and  six                                                               
different assisted living centers, and  they knew the exact price                                                               
for each center.                                                                                                                
                                                                                                                                
2:23:54 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  EASTMAN  referred  to  federal  jurisdiction  and                                                               
opined that it made sense  for the Department of Veterans Affairs                                                               
to determine  what goes on in  its facilities, and to  keep those                                                               
standards  consistent state-to-state.   Which,  he commented,  is                                                               
different from the federal medical  facilities not competing with                                                               
the private sector in the  marketplace because they absolutely do                                                               
compete in this  state.  For example, he said,  the Alaska Native                                                               
Medical Center  (ANMC) provides treatment for  federally eligible                                                               
beneficiaries and  also any  number of different  people.   It is                                                               
the  only  hospital  in  Anchorage  with  the  ability  to  serve                                                               
multiple  trauma cases  simultaneously, and  it can  compete with                                                               
other aspects  of the  private sector.   He offered  concern with                                                               
the  idea that  transparency was  needed for  all of  the various                                                               
facilities  covered  under  this bill  because  transparency  was                                                               
already working well,  such as with a senior center.   He said he                                                               
hoped for  consistency and equity in  applying these requirements                                                               
to  everyone  in   Alaska,  and  if  the   legislature  made  the                                                               
requirement to post  prices, that requirement should  be made for                                                               
everyone  regardless of  the facility.    In the  event the  word                                                               
"federal" was  not inserted at line  18, he said, there  would be                                                               
no need  for any of  the federal references in  subparagraphs (D)                                                               
or (E.                                                                                                                          
                                                                                                                                
2:31:21 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  FANSLER related  that he  could see  a difference                                                               
between subparagraphs (A),  (B), and (C), and what  this bill was                                                               
attempting to provide in that he  could not walk into an assisted                                                               
living facility and have his  broken arm examined unless he lived                                                               
there.  The  bill encourages transparency in the  situation of an                                                               
elective  surgery and  the patient  would know  where they  would                                                               
want to go based on that  transparency.  As for subparagraphs (D)                                                               
and (C), he could see  their complete difference, obviously, with                                                               
the  Supremacy Clause.   Perhaps,  he suggested,  when facilities                                                               
are required  to post  fees, if  the federal  facilities suddenly                                                               
were no  longer taking in the  patients they once did  because it                                                               
didn't have that  transparency, he pointed out,  that chances are                                                               
that the  free market  would pull them  into the  transparency on                                                               
its own.                                                                                                                        
                                                                                                                                
2:33:10 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE REINBOLD offered  that she was open  to a friendly                                                               
amendment, but in  reviewing the Supremacy Clause  she would like                                                               
the  Department  of  Law  to  weigh in.    She  opined  that  the                                                               
Supremacy Clause had  nothing to do with this and  that it was an                                                               
overuse of  that clause.  However,  she said she would  go to the                                                               
United States  Constitution, Amendment  IX and  X, which  read as                                                               
follows:                                                                                                                        
                                                                                                                                
     Amendment IX                                                                                                               
                                                                                                                                
     The  enumeration   in  the  Constitution,   of  certain                                                                    
     rights,  shall not  be construed  to deny  or disparage                                                                    
     others retained by the people.                                                                                             
                                                                                                                                
     Amendment X                                                                                                                
                                                                                                                                
     The powers  not delegated to  the United States  by the                                                                    
     Constitution, nor  prohibited by it to  the states, are                                                                    
     reserved to the states respectively, or to the people.                                                                     
                                                                                                                                
REPRESENTATIVE  REINBOLD  asked  whether  it  was  the  sponsor's                                                               
intention that the private sector  be required to publically post                                                               
their CPT codes and fees,  while the public sector, using private                                                               
sector dollars,  would not  be required to  post those  codes and                                                               
fees.                                                                                                                           
                                                                                                                                
2:34:23 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SPOHNHOLZ  pointed out  that page 3,  lines 18-24,                                                               
read as follows:                                                                                                                
                                                                                                                                
                         (2) "health care facility" means                                                                       
     private,  municipal,  or  state  hospital,  psychiatric                                                                    
     hospital,  independent   diagnostic  testing  facility,                                                                    
     residential psychiatric treatment center ...                                                                               
                                                                                                                                
REPRESENTATIVE  SPOHNHOLZ  continued  that  it is  a  long  list,                                                               
several of which  include public entities.  She  pointed out that                                                               
she had said  several times that the distinction  was not between                                                               
public and  private institutions.   She reiterated that  the only                                                               
entities carved  out, specifically  due to the  Supremacy Clause,                                                               
are  federal  in nature,  and  she  stressed  that was  the  only                                                               
distinction.                                                                                                                    
                                                                                                                                
REPRESENTATIVE REINBOLD  asked that  the Department of  Law weigh                                                               
in on the  Supremacy Clause because she believed it  was a misuse                                                               
of the Supremacy Clause.                                                                                                        
                                                                                                                                
2:35:09 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE LEDOUX pointed out that  she did not pretend to be                                                               
an expert  in the Supremacy Clause,  but there is a  long line of                                                               
judicial precedent stating that the  state can't make the federal                                                               
government do  things.  For  example, she said, the  state cannot                                                               
tax the  federal government, and  while the states do  not always                                                               
have to adhere to what the  federal government tells them what to                                                               
do, the state cannot make the federal government do things.                                                                     
                                                                                                                                
2:35:53 PM                                                                                                                    
                                                                                                                                
CHAIR   CLAMAN  commented   that   he   completely  agrees   with                                                               
Representative  LeDoux  about the  Supremacy  Clause,  and as  he                                                               
offered during  the last  hearing, he intends  to move  this bill                                                               
out of committee today.  He  pointed out that the question of the                                                               
Supremacy Clause  came up  during the last  hearing on  this bill                                                               
and  Representative  Reinbold could  have  followed  up with  the                                                               
Department  of Law  or Legislative  Legal  and Research  Services                                                               
before  today.   He  stated  that there  was  no  reason to  call                                                               
Legislative  Legal  and  Research Services  during  this  hearing                                                               
because  the courts  have consistently  ruled,  again and  again,                                                               
exactly as Representative LeDoux described.                                                                                     
                                                                                                                                
REPRESENTATIVE  REINBOLD  argued that  it  is  important for  the                                                               
Department of Law  or Legislative Legal and  Research Services to                                                               
weigh  in on  the Supremacy  Clause, and  the committee  needs to                                                               
discuss the Constitution of the  United States, Amendments IX and                                                               
X.  She then described herself  as a federalist "and I do believe                                                               
that the --  the rights that are not  absolutely specifically ...                                                               
and I  see nothing  in the  constitution that  says that  -- that                                                               
they  can't, you  know, post,  or they  shouldn't be  transparent                                                               
with --  with public  dollars.  It  just -- it  just seems  to me                                                               
outlandish to be using that Supremacy  Clause in this case."  She                                                               
said the  committee needs  [this bill]  to be  on a  fair playing                                                               
field.                                                                                                                          
                                                                                                                                
2:38:27 PM                                                                                                                    
                                                                                                                                
A  roll  call  vote  was  taken.    Representatives  Eastman  and                                                               
Reinbold   voted    in   favor    of   adopting    Amendment   2.                                                               
Representatives  Fansler,   Kopp,  Kreiss-Tomkins,   LeDoux,  and                                                               
Claman voted  against it.   Therefore, Amendment  2 failed  to be                                                               
adopted by a vote of 2-5.                                                                                                       
                                                                                                                                
2:39:07 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE REINBOLD  moved to adopt Amendment  3, Version 30-                                                               
LS0380\I.4, which read as follows:                                                                                              
                                                                                                                                
     Page 1, line 1, following "information;":                                                                                
          Insert "relating to health care insurers;"                                                                          
                                                                                                                                
     Page 2, line 1, following "AS 18.23.400":                                                                              
          Insert "and AS 21.96.125"                                                                                         
                                                                                                                                
     Page 4, following line 21:                                                                                                 
     Insert a new bill section to read:                                                                                         
        "*  Sec. 3.  AS 21.96  is amended  by  adding a  new                                                                  
     section to read:                                                                                                           
          Sec. 21.96.125. Disclosure of health care                                                                           
     services   and  price   information   by  health   care                                                                  
     insurers. (a) A health care insurer shall annually                                                                       
               (1)  compile a list describing, by procedure                                                                     
     code, including  a brief description in  plain language                                                                    
     that  an  individual  with   no  medical  training  can                                                                    
     understand,  the 50  most common  health care  services                                                                    
     covered by  the insurer in  this state in  the previous                                                                    
     calendar year  and the  total cost  to the  insurer for                                                                    
     each of those health care services during that period;                                                                     
               (2)  publish and update the list on the                                                                          
     insurer's  Internet website  by  January 31 each  year;                                                                    
     and                                                                                                                        
               (3)  submit the list by January 31 each year                                                                     
     to  the Department  of Health  and Social  Services for                                                                    
     entry in the database under AS 18.15.360(a).                                                                               
          (b)  The Department of Commerce, Community, and                                                                       
     Economic  Development   may  adopt   regulations  under                                                                    
     AS 44.62  (Administrative Procedure  Act) to  implement                                                                    
     this section.                                                                                                              
          (c)  A health care insurer that fails to comply                                                                       
     with the requirements  of this section is  liable for a                                                                    
     civil  penalty. The  Department  of  Health and  Social                                                                    
     Services may  impose a civil  penalty of not  more than                                                                    
     $150 for  each day  after March 31  that a  health care                                                                    
     insurer  fails  to  provide  and  post  information  as                                                                    
     required under  (a) of this section.  The total penalty                                                                    
     may not  exceed $2,500.  A person penalized  under this                                                                    
     subsection is  entitled to a  hearing conducted  by the                                                                    
     office of administrative hearings under AS 44.64.                                                                          
          (d)  In this section,                                                                                                 
               (1)  "health care insurer" has the meaning                                                                       
     given in AS 21.54.500;                                                                                                     
               (2)  "health care service" has the meaning                                                                       
     given in AS 18.23.400;                                                                                                     
               (3)  "insured" means an individual covered                                                                       
     by a health care insurance policy."                                                                                        
                                                                                                                                
     Renumber the following bill section accordingly.                                                                           
                                                                                                                                
REPRESENTATIVE FANSLER objected                                                                                                 
                                                                                                                                
2:39:25 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE REINBOLD  explained that  Amendment 3,  requires a                                                               
posting of the prices paid by the insurance companies.                                                                          
                                                                                                                                
2:39:52 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SPOHNHOLZ  offered that while she  appreciates the                                                               
intent  of   expanding  price  transparency,   unfortunately,  in                                                               
looking at  Amendment 3, she could  not support it at  this time.                                                               
She noted that lines 15-16 ask  for the total cost to the insurer                                                               
for each  of those health  care services during that  period, and                                                               
she was  unsure what that  meant because  there are a  variety of                                                               
definitions  of health  care  costs  are out  there.   She  asked                                                               
whether  Amendment 3  referenced  the total  amount they've  paid                                                               
out,  in  which  case  that  would  be  getting  into  a  totally                                                               
different issue than under HB  123, because it is about informing                                                               
consumer price transparency.   She noted that it  could also mean                                                               
what the  insurers are  paying to  different providers,  and that                                                               
would  vary depending  upon  whether or  not  that providers  was                                                               
within  a  preferred provider  network  or  out of  the  provider                                                               
network.    She  related  that  a   lot  of  time  was  spent  in                                                               
determining  how   to  have   a  clean,   clear  bill   that  was                                                               
understandable  by the  end  user, and  Amendment  3 muddies  the                                                               
water.                                                                                                                          
                                                                                                                                
2:41:20 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  LEDOUX asked  Representative Reinbold  to explain                                                               
Amendment 3 because  she was unsure whether the  amendment was so                                                               
doctors  could see  what the  insurance companies  were going  to                                                               
pay,  or  whether  the  consumer would  see  what  the  insurance                                                               
company pays.                                                                                                                   
                                                                                                                                
REPRESENTATIVE REINBOLD  explained that  doctors will  post their                                                               
rack rate  fee, the CPT  codes, except doctors  receive different                                                               
reimbursements  from  insurers  for   their  different  types  of                                                               
insurance  patients.   Unfortunately,  she  said, patient's  will                                                               
"freak out"  over the  posted charge,  not understanding  that is                                                               
not the amount the doctor  is actually reimbursed, and it becomes                                                               
more complicated under managed care.   For example, while working                                                               
in  a doctor's  business office  in  Texas, the  office was  only                                                               
allowed  to charge  $400  and the  rack rate  fee  may have  been                                                               
$10,000 because  it had  negotiated a low  price.   The amendment                                                               
allows that  the reimbursable price  the insurance  companies pay                                                               
be transparent, she said.                                                                                                       
                                                                                                                                
2:43:50 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE LEDOUX  offered that while she  was sympathetic to                                                               
what this amendment was trying to  do, but was complicated in its                                                               
manner  because around  here  things  are sometimes  accomplished                                                               
through baby steps.  She remarked  that she will not support this                                                               
amendment  because, in  the context  of this  bill, it  would not                                                               
work.                                                                                                                           
                                                                                                                                
2:44:51 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE EASTMAN  referred to page  2, line 3,  wherein the                                                               
fine appears to  have tripled and asked why it  went from $50 per                                                               
day to $150 per day.                                                                                                            
                                                                                                                                
REPRESENTATIVE  REINBOLD noted  that she  had not  requested that                                                               
language and asked that the drafter explain the difference.                                                                     
                                                                                                                                
2:45:28 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   SPOHNHOLZ  pointed   out  that   this  amendment                                                               
requires  the health  care insurer  to post  information allowing                                                               
patients to  see what the  insurer would charge for  the service.                                                               
In that manner,  a person would have to review  the doctor's rack                                                               
rates and then  review their insurer's website  to determine what                                                               
the insurer would  pay.  Essentially, she related,  her source at                                                               
the Department of Health and  Social Services advised that an all                                                               
payor claims  database would be  required to mesh  this amendment                                                               
with the bill.                                                                                                                  
                                                                                                                                
2:46:49 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE REINBOLD advised that  her intention is to include                                                               
insurers  because  the third  party  insurance  company pays  the                                                               
bills.  She  commented that the amendment is fair  if the goal is                                                               
to get true transparency and make this a consumer friendly bill.                                                                
                                                                                                                                
2:48:26 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE EASTMAN  commented that Amendments 1  and 3 appear                                                               
to  be  going  in  the same  direction,  yet  applying  different                                                               
language to get there.                                                                                                          
                                                                                                                                
CHAIR CLAMAN interjected that Amendment  1 has nothing to do with                                                               
information  from  insurance carriers,  and  Amendment  3 is  all                                                               
about information from  insurance carriers.  He  pointed out that                                                               
Representative Eastman  cannot claim they address  the same issue                                                               
as they are completely different.                                                                                               
                                                                                                                                
REPRESENTATIVE EASTMAN  opined that  they do, and  that obtaining                                                               
information from insurers  appears to be a  fairly important part                                                               
of  this whole  equation.    He related  that  when  he visits  a                                                               
doctor's office,  that office queries  his insurance  company for                                                               
information  and relays  that information  to him.   He  said, "I                                                               
work  with them  on whether  or not  I'm gonna  actually contract                                                               
with  them  for  the  services."   His  concern  with  the  bill,                                                               
unamended, is  that it  runs into the  "bridge too  far problem."                                                               
He explained that  there was an idea to go  straight from Britain                                                               
to  Berlin, during  World  War  II, by  way  of several  bridges.                                                               
Unfortunately, the forces  were unable to reach  the last bridge,                                                               
and; therefore, the  whole idea and effort  crumbled because they                                                               
never  got there.   He  related that  if the  legislature doesn't                                                               
actually  get  to  the  point of  an  Alaska  resident  receiving                                                               
helpful information, then it appears like  a lot of effort and it                                                               
doesn't get the legislature where it needs to be.                                                                               
                                                                                                                                
2:50:50 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   KOPP  suggested   that  this   amendment  raises                                                               
questions  in that  the health  care insurance  market negotiates                                                               
rates  for procedures  individually with  health care  facilities                                                               
and  employers.    Certainly,   he  commented,  those  rates  are                                                               
different  depending  upon  volume,  how  well  the  health  care                                                               
program  is managed,  history with  the  insurer, and  a host  of                                                               
issues.  He suggested getting  an insurance expert online and ask                                                               
whether  the legislature  can do  this because  it will  get into                                                               
market  proprietary  information   between  insurance  companies.                                                               
Also, he said,  possibly the committee would  be interfering with                                                               
insurers as  to the  market by requiring  them to  disclose their                                                               
negotiated rates  for a  whole host of  entities, such  as health                                                               
care facilities or employers.                                                                                                   
                                                                                                                                
2:52:24 PM                                                                                                                    
                                                                                                                                
CHAIR CLAMAN commented that the  House Health and Social Services                                                               
Standing Committee  heard this bill  and the  insurance companies                                                               
said  little, but  they did  say there  were significant  privacy                                                               
issues   between   commercial    relationships,   the   insurance                                                               
companies, and their insured.                                                                                                   
                                                                                                                                
He commented  that he  recognizes the  sponsor's intent  for more                                                               
transparency as  to health  care costs  and insurance  costs, and                                                               
rather than try  to globally fix everything,  the sponsor prefers                                                               
to  take baby  steps toward  improved transparency.   He  related                                                               
that the [amendment] requires Premera,  Blue Cross Blue Shield of                                                               
Alaska to voice how  much it paid in the state  last year for all                                                               
of the  completed blood counts, and  to give a total  number.  He                                                               
suggested  this  amendment  asks  that, instead  of  letting  the                                                               
consumer know the  average price for a complete  blood count paid                                                               
by insurance  company "X," it  would provide the total  number of                                                               
the many hundreds  of thousands of people  they provide insurance                                                               
for, and the consumer would not be helped.                                                                                      
                                                                                                                                
CHAIR CLAMAN  advised that  Ms. Glover  was online  regarding the                                                               
$150 penalty.   He said he believes the committee  could agree to                                                               
change the figure  to $50 consistent with the bill,  and treat it                                                               
as an informal amendment.                                                                                                       
                                                                                                                                
2:55:50 PM                                                                                                                    
                                                                                                                                
CHAIR CLAMAN  asked the committee to  agree that on page  2, line                                                               
3, delete  "$150" and  insert "$50."   There being  no objection,                                                               
the informal amendment was adopted.                                                                                             
                                                                                                                                
2:56:28 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE REINBOLD  opined that Chair Claman  said something                                                               
about  insurance   companies  not   wanting  to   disclose  their                                                               
information due to it being  proprietary information, even though                                                               
a lot  of doctors  don't want  to do that  either due  to sticker                                                               
shock.  She commented that people  believe the rate posted is the                                                               
amount the doctor  receives and it turns the  patient against the                                                               
doctor.  Unfortunately, she said,  the patient doesn't know their                                                               
doctor has  far more specialties,  went through 10-20  more years                                                               
of schooling with  loans, or that the doctor may  take a Medicare                                                               
patient  and only  receive 10  percent of  the rack  rate posted.                                                               
She  argued that  if the  legislature doesn't  require government                                                               
facilities  to meet  the same  standards as  the private  sector,                                                               
they don't have to comply.   The fact that these doctors may post                                                               
a $500 fee,  they may only receive $50 for  their service because                                                               
the  insurance  company  negotiated  a deal  where  it  racks  in                                                               
hundreds of  millions of  dollars and  takes no  risk.   Yet, she                                                               
pointed out, it  is the doctors seeing the  patients, the doctors                                                               
have the insurance, the doctors have  to deal with the follow up,                                                               
and  now the  insurance  companies "get  scot-free  clean."   She                                                               
stressed that it  would be completely misguided  if the insurance                                                               
companies were not included in this bill.                                                                                       
                                                                                                                                
2:58:59 PM                                                                                                                    
                                                                                                                                
A roll call  vote was taken.   Representatives Eastman, Reinbold,                                                               
Kopp voted  in favor  of adopting  Amendment 3.   Representatives                                                               
LeDoux,  Fansler, Kreiss-Tomkins,  and Claman  voted against  it.                                                               
Therefore, Amendment 3 failed to be adopted by a vote of 3-4.                                                                   
                                                                                                                                
2:59:31 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE REINBOLD  moved to adopt Amendment  4, Version 30-                                                               
LS0380\I.5, which read as follows:                                                                                              
                                                                                                                                
     Page 2, line 11, following "charged":                                                                                      
          Insert "and the amount the provider actually                                                                          
     received"                                                                                                                  
                                                                                                                                
     Page 2, line 16, following "charged":                                                                                      
          Insert "and the amount the provider actually                                                                          
     received"                                                                                                                  
                                                                                                                                
REPRESENTATIVE FANSLER objected.                                                                                                
                                                                                                                                
2:59:35 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  REINBOLD referred  to  her  comments regarding  a                                                               
posted  fee of  $500,  and  explained that  the  doctor may  only                                                               
receive  $50  or  write  off  the entire  fee,  and  Amendment  4                                                               
requires  "the amount  the  provider  actually received"  because                                                               
that information  is important for  the patients.   Some patients                                                               
may believe their doctors are  millionaires, not knowing they may                                                               
have extensive education loans, and  insurance costs to pay.  She                                                               
related    that   the    insurance   companies    treat   doctors                                                               
"horrendously," the sticker shock can  be high, and the amendment                                                               
requires  the amount  the providers  actually received  for their                                                               
services to be posted.                                                                                                          
                                                                                                                                
3:00:52 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  EASTMAN  commented  that Amendment  4  moves  the                                                               
committee closer to actual transparency  by requiring all doctors                                                               
to post the actual amount  they receive from the insurer, thereby                                                               
allowing an even playing field.                                                                                                 
                                                                                                                                
3:02:34 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  LEDOUX  said she  was  sympathetic  to what  this                                                               
amendment  was trying  to do,  but  if the  committee was  really                                                               
concerned  about  the  impact  on the  private  sector,  she  was                                                               
hesitant to ask doctors to  post the amount they actually receive                                                               
from  insurers,  Medicaid,  Medicare,  or  workers'  compensation                                                               
insurance.   In  response  to  Representative Eastman's  argument                                                               
that  doctors certainly  have the  opportunity  to explain  their                                                               
rack  rates during  the  patient's visit,  she  pointed out  that                                                               
there is nothing in the  bill prohibiting physicians from posting                                                               
all of those rates.                                                                                                             
                                                                                                                                
3:03:59 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KREISS-TOMKINS noted  that  Amendments  3 and  4,                                                               
appear  to  approach  health care  price  transparency  from  the                                                               
insurance side of the equation,  as opposed to the provider side,                                                               
and  agreed  that  it  was  important  to  approach  it  in  both                                                               
directions.    Amendment  4  is elegant  in  its  simplicity,  he                                                               
described,   but  the   element  he   struggles  with   was  what                                                               
Represented  LeDoux pointed  out,  that  different insurers  have                                                               
different rates and no one has  any idea how much anything costs.                                                               
He  commented  that he  was  unsure  this  bill was  the  correct                                                               
vehicle because  it was more of  a provider based bill.   He then                                                               
read the language  in the amendment "and the  amount the provider                                                               
actually  received," and  asked how  Representative Reinbold  saw                                                               
that being implemented and practiced.                                                                                           
                                                                                                                                
REPRESENTATIVE  REINBOLD responded  that if  this was  a provider                                                               
based bill,  because most providers  hate this bill, and  it will                                                               
make patients "freak  out" at the sticker shock.   In response to                                                               
Representative LeDoux  comment that nothing prohibits  the doctor                                                               
from discussing their  rates, she answered that  some doctors may                                                               
not want to  tell their patients they receive $50  for a Medicare                                                               
patient, $55  for a veteran, and  $200 for a lawyer.   She opined                                                               
that doctors want to discuss  the patient's medical and emotional                                                               
issues, and  not get  into this  "price fixing,  this anti-trust,                                                               
this movement  toward --  I think  this is  a much  bigger issue,                                                               
like with stark laws and anti-trust  laws, and all sorts of other                                                               
things."   She said she  believes that even with  this amendment,                                                               
"it's none of our business."                                                                                                    
                                                                                                                                
3:07:52 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE EASTMAN  surmised that, currently the  bill states                                                               
the discounted price  charged, and this amendment  would then add                                                               
the amount  the provider  received, and  commented that  he hoped                                                               
the   committee   was  not   worried   about   having  too   much                                                               
transparency.  There  is a medical facility in  his district with                                                               
a history of "being on the  high side," but with that information                                                               
available it would  give patients the opportunity to  ask why the                                                               
prices are  high.  He described  the bill as helpful  in starting                                                               
conversations so that 10 years  from now the population would not                                                               
be looking at the same problem.                                                                                                 
                                                                                                                                
3:09:41 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KOPP commented  that  a couple  of  years ago  he                                                               
threw his lower  back out, and the chiropractor  advised it would                                                               
be $80 if he self-paid, or  $260 would be billed to the insurance                                                               
company.  He commented that Amendment  4 gets right at this issue                                                               
because if  the committee was  really looking at  transparency in                                                               
the marketplace, at  some point it must be recognized  there is a                                                               
business   relationship,  which   is  not   inherently  evil   or                                                               
nefarious,   with   third   party  payor   insurance   companies.                                                               
Currently, patients  are not directly  paying physicians,  and if                                                               
the goal  is transparency  without including  the insurer  in any                                                               
manner,  it does  make  it  harder to  get  there, he  commented.                                                               
While realizing  Amendment 4  was problematic,  he said  he would                                                               
support the amendment.                                                                                                          
                                                                                                                                
REPRESENTATIVE  REINBOLD  commented  that she  would  stick  with                                                               
Representative Kopp's good comments.                                                                                            
                                                                                                                                
3:11:40 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE FANSLER maintained his objection.                                                                                
                                                                                                                                
3:11:47 PM                                                                                                                    
                                                                                                                                
A roll call  vote was taken.   Representatives Eastman, Reinbold,                                                               
and   Kopp   voted   in   favor    of   adopting   Amendment   4.                                                               
Representatives  Kreiss-Tomkins,  LeDoux,   Fansler,  and  Claman                                                               
voted against  it.  Therefore,  Amendment 4 failed to  be adopted                                                               
by a vote of 3-4.                                                                                                               
                                                                                                                                
3:12:46 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE KREISS-TOMKINS  withdrew Amendment 1,  labeled 30-                                                               
LS0380\I.2 [prior to offering a motion to adopt the amendment].                                                                 
                                                                                                                                
REPRESENTATIVE  KREISS-TOMKINS  commented  that  after  reviewing                                                               
actual CPT  codes in  a facility  realized that  many of  the CPT                                                               
codes are diagnostic  and testing in nature and that  none of the                                                               
"meat and  potatoes" procedures the  committee was  interested in                                                               
actually made the  top 50 CPT codes.  After  reviewing a workers'                                                               
compensation medical fee schedule which  included all of the meat                                                               
and potatoes  procedures, such  as MRIs,  X-rays, stitches  for a                                                               
laceration, he  drafted an amendment  to maintain  the simplicity                                                               
of the  bill and integrates all  of that information   The Alaska                                                               
State  Hospital and  Nursing Association  (ASHNA) worked  closely                                                               
with  his  office to  provide  a  list  of  the top  10  grossing                                                               
procedures at a  sample facility, and from  a different facility,                                                               
and there  was 100  percent overlap between  the top  10 grossing                                                               
procedures and  the top  50 most  common procedures.   Therefore,                                                               
Amendment  1 is  redundant; however,  he opined,  the way  to get                                                               
there is using NTCI data  which comes from workers' compensation.                                                               
It listed  the 10  top grossing  procedures within  different AMA                                                               
service categories,  and the four largest  AMA service categories                                                               
in health care include: surgery at  31 percent of all health care                                                               
costs;   physical  medicine   at  29   percent;  evaluation   and                                                               
management at  16 percent;  and radiology at  13 percent.   Those                                                               
four AMA service  areas account for the  preponderance of medical                                                               
costs.  He summarized  that today is not the day,  but he felt it                                                               
was important to  put on the record that possibly  there is a way                                                               
to get  at the meat  and potatoes procedures while  still working                                                               
within the parameters of the simplicity in this legislation.                                                                    
                                                                                                                                
3:15:59 PM                                                                                                                    
                                                                                                                                
CHAIR CLAMAN advised that the  bill was back before the committee                                                               
with no  amendments attached, and  asked for further  comments or                                                               
discussion.                                                                                                                     
                                                                                                                                
3:16:12 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  EASTMAN said  that Representative  Kreiss-Tomkins                                                               
solution was not  before the committee, and he  could not support                                                               
the bill.   In determining  how to get from  "where we are"  to a                                                               
more transparent  system and possibly more  economical pricing in                                                               
dealing with  the cost  of delivering health  care, he  said this                                                               
bill  "gets us  somewhere" but  was unsure  whether it  moves the                                                               
state closer  to where it  wants to  be and was  possibly pulling                                                               
the committee  farther away.   The  bill imposes  more government                                                               
regulations,  institutes  the  threat  of fines  on  health  care                                                               
facilities,  and the  problem of  the disparity  between what  is                                                               
expected  of the  state's facilities  and  state departments  and                                                               
what is  being asked  of the private  sector hasn't  been solved.                                                               
For example,  the sponsor  made an  effective date  of HB  123 at                                                               
January 1, and on that  date the requirements would be instituted                                                               
for health  care facilities  with total  penalties not  to exceed                                                               
$2,500, but the  fiscal note has a department that  will not have                                                               
the regulations in place for it  to uphold its end of the bargain                                                               
until July 1, 2019.  He said he will vote against the bill.                                                                     
                                                                                                                                
3:19:44 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE REINBOLD  offered that the  bill is coming  from a                                                               
"fabulous place," but her philosophy  is that this will have some                                                               
negative  unintended  consequences   in  patients  against  their                                                               
doctors due to fees.  She  described it as a double standard when                                                               
asking the private  sector to post fees  without requiring public                                                               
facilities to  also post fees,  and that  the is being  missed if                                                               
the bill doesn't  include insurance companies, which  are the key                                                               
third  party payor,  as part  of this  government solution.   She                                                               
referred to the  Constitution of the State of  Alaska, Article 1,                                                               
Section 22,  and commented, "It  is the legislature's job  to not                                                               
infringe  on privacy  of our  citizens" and  this may  be on  the                                                               
verge of that infringement.                                                                                                     
                                                                                                                                
3:23:22 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE FANSLER  moved to  report CSHB  123(HSSS), Version                                                               
30-LS0380\I,  out of  committee  with individual  recommendations                                                               
and the accompanying fiscal notes.                                                                                              
                                                                                                                                
REPRESENTATIVE EASTMAN objected.                                                                                                
                                                                                                                                
3:23:35 PM                                                                                                                    
                                                                                                                                
A  roll  call vote  was  taken.   Representatives  Kopp,  Kreiss-                                                               
Tomkins, LeDoux, Fansler, and Claman  voted in favor of CSHB 123.                                                               
Representatives   Eastman   and   Reinbold  voted   against   it.                                                               
Therefore, CSHB 123(HSS) was reported  out of the House Judiciary                                                               
Standing Committee by a vote of 5-2.                                                                                            
                                                                                                                                
3:25:02 PM                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no  further business before the  committee, the House                                                               
Judiciary Standing Committee meeting was adjourned at 3:25 p.m.                                                                 

Document Name Date/Time Subjects
HB043 ver D 3.14.17.PDF HJUD 3/29/2017 1:00:00 PM
HJUD 4/3/2017 1:00:00 PM
HB 43
HB043 Sponsor Statement 3.14.17.pdf HJUD 3/29/2017 1:00:00 PM
HB 43
HB043 Sectional Analysis ver D 3.14.17.pdf HJUD 3/29/2017 1:00:00 PM
HJUD 4/3/2017 1:00:00 PM
HB 43
HB043 Supporting Document-Legislative Map 3.14.17.pdf HJUD 3/29/2017 1:00:00 PM
HB 43
HB043 Supporting Document-FDA Drug Review Process 3.14.17.pdf HJUD 3/29/2017 1:00:00 PM
HB 43
HB043 Supporting Document-Goldwater Institute Fact Sheet 3.14.17.pdf HJUD 3/29/2017 1:00:00 PM
HB 43
HB043 Supporting Document-Goldwater Institute Patient Stories 3.14.17.pdf HJUD 3/29/2017 1:00:00 PM
HB 43
HB043 Supporting Document-Clinical Trials in Alaska 3.14.17.pdf HJUD 3/29/2017 1:00:00 PM
HB 43
HB043 Supporting Document-Letters and Emails of Support 3.14.17.pdf HJUD 3/29/2017 1:00:00 PM
HB 43
HB043 Additional Document-Letter from Premera 3.27.17.pdf HJUD 3/29/2017 1:00:00 PM
HB 43
HB43 Additional Document-Powerpoint Presentation 3.27.17.pdf HJUD 3/29/2017 1:00:00 PM
HB 43
HB043 Powerpoint Presentation with Video.pptx HJUD 3/29/2017 1:00:00 PM
HB 43
HB043 Fiscal Note DCCED-CBPL 3.14.17.pdf HJUD 3/29/2017 1:00:00 PM
HB 43
HB042 Amendment #8 3.28.17.pdf HJUD 3/29/2017 1:00:00 PM
HB 42
HB042 Amendments #1-8 3.28.17.pdf HJUD 3/29/2017 1:00:00 PM
HB 42
HB042 Amendments #1-8 - HJUD Final Votes 3.29.17.pdf HJUD 3/29/2017 1:00:00 PM
HB 42
HB123 Amendments #1-4 3.28.17.pdf HJUD 3/29/2017 1:00:00 PM
HB 123
HB123 Amendments #1-4 - HJUD Final Votes 3.29.17.pdf HJUD 3/29/2017 1:00:00 PM
HB 123