Legislature(1995 - 1996)
04/18/1996 02:10 PM L&C
* first hearing in first committee of referral
= bill was previously heard/scheduled
= bill was previously heard/scheduled
HOUSE LABOR AND COMMERCE STANDING COMMITTEE April 18, 1996 2:10 p.m. MEMBERS PRESENT Representative Pete Kott, Chairman Representative Norman Rokeberg, Vice Chairman Representative Beverly Masek Representative Jerry Sanders Representative Brian Porter Representative Kim Elton Representative Gene Kubina MEMBERS ABSENT All members present COMMITTEE CALENDAR CS FOR SENATE BILL NO. 193(L&C) "An Act requiring insurance coverage for certain costs of birth; and providing for an effective date." - PASSED CSSB 193(L&C) OUT OF COMMITTEE HOUSE BILL NO. 345 "An Act relating to the procurement of investment and brokerage services by the Alaska State Pension Investment Board." - SCHEDULED BUT NOT HEARD HOUSE BILL NO. 549 "An Act relating to partnerships; and providing for an effective date." - SCHEDULED BUT NOT HEARD HOUSE BILL NO. 416 "An Act relating to fees or assessment of costs for certain services provided by state government, including hearing costs related to the real estate surety fund; fees for authorization to operate a postsecondary educational institution or for an agent's permit to perform services for a postsecondary educational institution; administrative fees for self-insurers in workers' compensation; business license fees; fees for activities related to coastal zone management, training relating to emergency management response, regulation of pesticides and broadcast chemicals, and subdivision plans for sewage waste disposal or treatment; and providing for an effective date." - SCHEDULED BUT NOT HEARD HOUSE BILL NO. 363 "An Act requiring banks to pay interest on money in reserve accounts held in connection with mortgage loans." - SCHEDULED BUT NOT HEARD HOUSE BILL NO. 518 "An Act exempting certain persons engaged in selling or servicing certain vehicles from overtime wage requirements." - SCHEDULED BUT NOT HEARD HOUSE BILL NO. 407 "An Act relating to discrimination by certain insurers against a person with a genetic defect." - SCHEDULED BUT NOT HEARD PREVIOUS ACTION BILL: SB 193 SHORT TITLE: MANDATORY INSURANCE FOR COSTS OF BIRTH SPONSOR(S): SENATOR(S) SALO, Donley, Ellis, Duncan, Kelly, Pearce, Zharoff; REPRESENTATIVE(S) Robinson, B.Davis, Finkelstein, G.Davis, Navarre, Elton JRN-DATE JRN-PG ACTION 12/29/95 2056 (S) PREFILE RELEASED - 12/29/95 01/08/96 2056 (S) READ THE FIRST TIME - REFERRAL(S) 01/08/96 2057 (S) LABOR & COMMERCE 01/16/96 2143 (S) COSPONSOR(S): DUNCAN 02/15/96 (S) L&C AT 1:30 PM BELTZ ROOM 211 02/15/96 (S) MINUTE(L&C) 02/21/96 2487 (S) L&C RPT CS 2DP 1NR SAME TITLE 02/21/96 2487 (S) ZERO FNS TO SB & CS (DCED, ADM, DHSS) 02/21/96 2487 (S) FIN REFERRAL ADDED 02/21/96 2498 (S) COSPONSOR: KELLY 02/27/96 (S) FIN AT 9:00 AM SENATE FINANCE 532 03/07/96 (S) FIN AT 9:00 AM SENATE FINANCE 532 03/07/96 (S) MINUTE(FIN) 03/12/96 (S) FIN AT 9:00 AM SENATE FINANCE 532 03/12/96 2707 (S) FIN RPT 5DP 2NR (L&C)CS 03/12/96 2707 (S) PREVIOUS ZERO FNS (DHSS, ADM) 03/12/96 2707 (S) ZERO FN (DCED) 03/12/96 2718 (S) COSPONSOR(S): PEARCE, ZHAROFF 03/13/96 (S) RLS AT 11:00 AM FAHRENKAMP RM 203 03/13/96 (S) MINUTE(RLS) 03/22/96 2834 (S) RULES TO CALENDAR 3/22/96 03/22/96 2840 (S) READ THE SECOND TIME 03/22/96 2840 (S) L&C CS ADOPTED UNAN CONSENT 03/22/96 2841 (S) ADVANCE TO THIRD RDG FLD Y8 N11 E1 03/22/96 2841 (S) THIRD READING 3/25 CALENDAR 03/25/96 2868 (S) READ THE THIRD TIME CSSB 193(L&C) 03/25/96 2868 (S) PASSED Y17 N3 03/25/96 2868 (S) EFFECTIVE DATE(S) SAME AS PASSAGE 03/25/96 2869 (S) Sharp NOTICE OF RECONSIDERATION 03/26/96 2911 (S) RECONSIDERATION NOT TAKEN UP 03/26/96 2912 (S) TRANSMITTED TO (H) 03/27/96 3386 (H) READ THE FIRST TIME - REFERRAL(S) 03/27/96 3386 (H) HES, L&C 03/28/96 3465 (H) CROSS SPONSOR(S): B.DAVIS 03/29/96 3495 (H) FIRST CROSS SPONSOR(S): ROBINSON 03/29/96 3495 (H) CROSS SPONSOR(S): FINKELSTEIN, G.DAVIS 04/01/96 3552 (H) CROSS SPONSOR(S): NAVARRE 04/11/96 (H) HES AT 2:00 PM CAPITOL 106 04/11/96 (H) MINUTE(HES) 04/12/96 3698 (H) HES RPT HCS(HES) NT 5DP 2NR 04/12/96 3698 (H) TITLE CHANGE AUTHORIZED BY HCR 34 04/12/96 3699 (H) DP: G.DAVIS, BUNDE, ROBINSON, TOOHEY 04/12/96 3699 (H) DP: BRICE 04/12/96 3699 (H) NR: ROKEBERG, VEZEY 04/12/96 3699 (H) 2 SEN ZERO FNS (DHSS, DCED) 2/21/96 04/12/96 3699 (H) SEN ZERO FN (ADM/ALL DEPTS) 2/21/96 04/17/96 (H) L&C AT 3:00 PM CAPITOL 17 04/17/96 3827 (H) CROSS SPONSOR(S): ELTON 04/18/96 (H) L&C AT 2:00 PM CAPITOL 17 WITNESS REGISTER SENATOR JUDY SALO Alaska State Legislature Capitol Building, Room 504 Juneau, Alaska 99801 Telephone: (907) 465-4940 POSITION STATEMENT: Gave sponsor statement for CSSB 193(L&C). BRUCE RICHARDS, Administrative Assistant to Senator Judy Salo Alaska State Legislature Capitol Building, Room 504 Juneau, Alaska 99801 Telephone: (907) 465-4940 POSITION STATEMENT: Answered questions relating to the difference between CSSB 193(L&C) and HCSCSHB 193(HES). LINNEA LAWERANCE, Registered Nurse Columbia Alaska Regional Hospital Address and Telephone Number Unavailable POSITION STATEMENT: Testified on SB 193. MIKE FORD, Attorney Division of Legal Services Legislative Affairs Agency 130 Seward Street, Suite 409 Juneau, Alaska 99801-2105 POSITION STATEMENT: Drafter of SB 193. ACTION NARRATIVE TAPE 96-37, SIDE A Number 001 The House Labor and Commerce Standing Committee was reconvened by Chairman Pete Kott at 2:10 p.m. Members present at the call to order were Representatives Porter, Masek, Sanders, Elton and Kott. Representative Rokeberg arrived at 2:14 p.m. and Representative Kubina arrived at 2:40 p.m. SB 193 - MANDATORY INSURANCE FOR COSTS OF BIRTH Number 060 CHAIRMAN PETE KOTT announced the first order of business would be CSSB 193(L&C), "An Act requiring insurance coverage for certain costs of birth; and providing for an effective date." Number 071 SENATOR JUDY SALO, Sponsor of SB 193, explained CSSB 193(L&C) passed the Senate by a vote 17 to 3. She said she introduced the bill as a result of a contact from a young mother in her district who had been required to leave the hospital prior to what she thought was a reasonable amount time for postnatal care. Senator Salo said she was surprised, following the contact from her constituent, how widespread that problem is not only in Alaska, but across the nation. She stated it is much more widespread across the nation and is more of an emerging problem in Alaska. Insurance companies, in an attempt to save money, are discharging mothers from the hospital or are only paying for postnatal coverage of up to 24 hours. Senator Salo said the frightening part about this trend is that in other states, that restriction has gotten to be even less. In some states it is 6 to 12 hours. In introducing SB 193, she wanted to make a reasonable attempt to stem that trend. In other states where this legislation has emerged, they have taken various approaches to it. She said she tried to take the least strong approach in not mandating 48 hours or 96 hours, but saying if it was deemed medically appropriate, that would be the amount of time that insurance companies, doing business in the state of Alaska, would have to provide. She said the amount of time is a recommendation from the American Academy of Obstetrics and Gynecology and the Pediatrics Organization - Nationwide. They think that is sort of a minimum safe time. Senator Salo explained that in some other states where they tried to deal with this problem, they also mandated follow-up care at home after the patient was discharged. Although there is follow-up care in certain communities in Alaska, she didn't really want to get into that given the diversity of the state and the ways in which health care is provided. She said the bill requires that insurance companies would offer 48 hours following a normal vaginal birth and 96 hours following a cesarian. She again pointed out that nothing mandates the patient to stay in the hospital that long. Senator Salo said she is trying to shift that decision back to the doctor and the patient or the health care provider and the patient. She noted it might also be a nurse practitioner or physician's assistant. In most cases, it is the doctor and the patient that should be making that decision. SENATOR SALO informed the committee that criticism of the bill has been very little. During two teleconferences on the bill, there has been only one person that testified against it. There has been testimony in favor of the bill from health care professionals, young mothers and people who are planning to have children in the future. She referred to the question "Should the legislature intervene in this type of situation?" Senator Salo said the answer to that is "Only where necessary." She pointed out this is a change to the insurance code and not a health care revision. There are 600 pages of statutes that governs the insurance industry in the state. Clearly, in the past, we've found public purpose in interfering and regulating insurance practices in Alaska. SENATOR SALO said she doesn't think she would be before the committee with SB 193 if the trend of the insurance companies hadn't gone in the direction of limiting care and lessening that amount time. It is a problem that has emerged as a result of insurance company practices and it compels the legislature to act to say "no" if they are going to do business in the state of Alaska. We're not going to risk jeopardizing new mothers and new babies. SENATOR SALO said in the House Health, Education and Social Services (HESS) Committee an amendment was added which is problematic to the bill and guts the intent. She said the committee didn't think so at the time, but the legal opinion received since then leads her to believe that the original intent of the bill is much better served by the Senate Labor and Commerce version. Senator Salo encouraged the committee to adopt the Senate Labor and Commerce version of SB 197. Number 518 REPRESENTATIVE NORMAN ROKEBERG said he heard the bill in the House HESS Committee and said there was testimony from an insurance association, representing 95 insurance companies, who was against the bill. He asked if that was a fair statement on his part. SENATOR SALO said that is fair to say. She said she was referring to the people who testified via teleconference. There was testimony from Mr. Evans against the bill. Senator Salo noted the other insurance companies that practice in Alaska, who have representatives here, have not testified against the bill. They had some concerns which were addressed by amendments made in the Senate Labor and Commerce Committee. Number 600 REPRESENTATIVE ROKEBERG questioned the difference between the Senate Labor and Commerce version and the House HESS version of SB 193. CHAIRMAN KOTT explained line 6 was changed. SENATOR SALO informed the committee there are two changes. There is a change in the title and then on line 6 the word "offer" was changed. The intent of the person who offered the amendment was to say that if there is maternity coverage in an insurance plan, then this would apply. The legal opinion states that the effect is much different and it would allow insurance companies to offer this additional coverage or not allow it. She stated that isn't her intent. Her intent was to say, "You will do it." Senator Salo said there is a move more towards a menu plan for insurance in many places. If, for instance, an individual or a group chooses not to have maternity coverage offered for either themselves or for the group, then obviously the provisions would not apply. If you don't have maternity coverage, it is a mute point whether you've got 24 or 48 hours. Her intent is much better served by the Senate Labor and Commerce version. Number 918 REPRESENTATIVE BRIAN PORTER referred to the problem/problems that generated the need for the legislation and asked if mothers had to leave the hospital against their doctor's wishes. He also asked if they left because they couldn't afford to pay for the additional day. SENATOR SALO said probably both situations have existed. She said it depends on whether you're economically able to pick up that coverage for yourself. Apparently, the way it currently works is that if the doctor is willing to jump some hoops and state and prove some sort of medical necessity, you might be able to get additional coverage. She said in talking to several physicians, that is not such an easy thing to do. If you're bleeding or are still sedated, they probably could get the additional time. If it were a more normal situation where perhaps the delivery was a very long process and the mother is totally physically exhausted or is not ready to travel, the doctor probably wouldn't be able to get the additional stay preapproved. Senator Salo said one mother who called her was told by her insurance company, in the preauthorization phase, that she shouldn't come in until after midnight because they were only allowing one midnight. By going back to the 48 hours of coverage instead of 24 hours of coverage, there would be some leeway for a more reasonable practice. Senator Salo said she assumes that most mothers probably will still go home in about a day and a half, but by eliminating this kind of restriction we won't have ridiculous situations like people getting discharged at 3:00 a.m. because they had their baby at 3:00 a.m. and there is a 24-hour policy. Number 1022 BRUCE RICHARDS, Administrative Assistant to Senator Judy Salo, Alaska State Legislature, was next to come before the committee. He referred to the amendment made in the HESS Committee by Representative Bunde and said his example was, "If I'm a single man, I am not married and I don't plan on having any kids, why should I have to pay for this extended coverage?" In offering his amendment, Representative Bunde felt like he took care of that specific instance; however, the Division of Legal Services pointed out it would greatly affect group coverage. Mr. Richards said if he owned a company and provided benefits to his employees, the way the bill is currently worded the insurance company would have to offer him this extended coverage. He wouldn't have to accept it. Therefore, none of his employees will have any say as to whether or not they will receive that extended coverage. Mr. Richards said he would make that decision as their employer. REPRESENTATIVE ROKEBERG read from the opinion written by Mr. Ford, Division of Legal Services, "The option requiring the offer of insurance coverage instead of mandating the coverage effectively leaves the issue of coverage up to the insured. For group insurance policies the required offer may leave those individuals who receive health insurance by participation in a group policy without coverage." He asked if the point is that it might jeopardize insurance coverage. Representative Rokeberg said he isn't sure he understands Mr. Richard's objection to the last sentence. MR. RICHARDS said an example would be that the state of Alaska uses Aetna. The Department of Administration negotiates with Aetna for our health insurance. As an employee, he can certainly make recommendations to the state of Alaska as to what he would like to have covered, but they're not bound by anything he asks for as a benefit. Mr. Richards said he doesn't anticipate that the state of Alaska would not accept this coverage, as it was offered to them, but Senator Salo is concerned that other groups may not accept it and, therefore, their employees would not get the extended coverage. SENATOR SALO said she thinks that the amendment significantly weakened the bill. If you're going to offer maternity coverage, then you're going to offer it in this manner. She said she thinks the point that was being made by Representative Bunde might be better made in a separate bill that deals more with the menu plan insurance. Number 1185 REPRESENTATIVE KIM ELTON said if he owned a restaurant which employed 30 employees and he was buying group coverage for his employees, he would have the option of offering a maternity component of the group coverage, and under the terms of the Senate Labor and Commerce version, if he had maternity coverage that maternity coverage would come under the auspices of this bill. If he, as the employer - a white male, said "Maternity coverage is important, but I'm not sure that I want the extended coverage," then he would be able to pick a program that said, "I could offer maternity coverage but I do not want the extended coverage." Number 1248 REPRESENTATIVE ELTON made a motion to adopt CSSB 193(L&C), Version C. REPRESENTATIVE ROKEBERG objected. He said the House HESS version of the bill is in front of the committee members and that is the issue the committee is talking about. Representative Rokeberg informed the committee he is willing to debate the issue and try to come to a resolution. There is already a version of the bill approved by the House HESS Committee and he sees no reason to go with the other version. REPRESENTATIVE ELTON said the reason he is moving the Senate Labor and Commerce version of SB 193 is because he feels strongly that the version by the House HESS Committee has unintended consequences. One of those consequences is the title change which is going to complicate passage of the bill. He referred to the policy part of the bill and said he feels that if there is maternity coverage, he doesn't think we should be putting the mother, in this case, in the position of trying to decide whether or not their feeling of discomfort in leaving the hospital in a shortened period of time is a $250 discomfort or a $300 discomfort. That is the kind of decision that should be made between the patient and the health provider. The Senate Labor and Commerce Committee version of the bill allows that kind of a decision to be made between those two parties. Representative Elton referred to the unintended consequence of the House HESS version and said that it is probably realistic to say to him, if he is buying an individual policy, that he doesn't have to opt for maternity if he doesn't want to. Or if it is a policy that covers his wife and him, they would have an option to get maternity without the extended coverage. The consequence of the amendment that was added in the HESS Committee is that it allows him, as a potential employer, to say, "Now this kind of coverage isn't necessary for you," when the person thinks it is necessary. Number 1411 CHAIRMAN KOTT indicated he wouldn't object to Representative Elton's motion. He said there is a title change to the bill and it is his understanding that the committee that makes the title change should, at that point, forward the subsequent accompanying resolution that should follow the bill so that it is moved out of committee in conjunction with the bill. That has not been done. The title in the HESS version is wide open and he fears there may be some potential legislation that may be hung on the bill. REPRESENTATIVE PORTER said he agrees with the concern explained by the sponsor. One of the questions is, "Should government be involved in this thing at all?" He said he thinks that the options available in the HESS version provides what Representative Elton was talking about even more so than the other. The options available to people in the HESS version would allow for a person to say, "I want two day coverage or I don't." They could then pay the cost of that. Under the Senate Labor and Commerce version, anybody who opts for a maternity package is going to pay the cost of the two day minimum. Representative Porter said he would rather go with having an option rather than going with it being mandatory. Number 1552 REPRESENTATIVE ELTON said because of pressures from insurance companies and cost containment he can envision a situation in which you would have the drive through delivery kind of system that could create significant end costs. If, for example, you are moving people out of the hospital too quickly, you may be creating costs down the road. When talking about cost containment, it is not all the front end costs, it is sometimes the back end costs that can add significantly to a problem. REPRESENTATIVE PORTER said the one day coverage does not in any way mean, from what his understanding is of the policies, that with any justification from a physician the time would be extended. It is in the case where a physician cannot come up any articulated reason that the 24-hour, if that is the policy they have, comes into play. If a physician releases someone in 24 hours that subsequently, because of an early release, caused additional problems then we can get into the tort reform debate. Representative Porter said this is a doctor, patient, facility, insurance company area that used the legislature to try to get a favored position. REPRESENTATIVE ROKEBERG said he is fortunate because he had the chance to hear substantial testimony in the House HESS Committee. He said he had some concerns about its impact on Medicaid and the medical assistance community. He pointed out there is a zero fiscal note from the department which he thinks is wishful thinking because he believes it is going to set patterns in practice in Alaska. He said he thinks the merit of the bill is justifiable. He stated concern about defensive medicine and the potential of litigation because it is easier for a physician to go ahead and authorize the extension if he is going to be practicing defensive medicine, therefore, use up resources. It is a subjective decision. Representative Rokeberg said the issue he is concerned with is the differential between the two versions and its impact on the costs, and so forth, on how the insurance policy is organized. Representative Rokeberg continued to discuss his feelings regarding the two different versions of the bill. Number 1815 REPRESENTATIVE PORTER questioned the differences in the titles of the two versions of the bill. SENATOR SALO said one says, "relating to" and the other says, "requiring." She referred to Representative Porter's concern regarding costs going up and said she has some data about what the average stay in Alaska is. It currently is 1.7 days for an uncomplicated vaginal delivery. It is 3.3 days for a cesarian. She said she doesn't think it has a fiscal impact because it is stemming a trend rather than significantly (indisc.). That is different than it was when Maryland passed its law because they were already well into these very shortened stays. Alaska is kind of on the edge of it in that it is just starting to happen. That is why there is a zero fiscal note for the state plan in which there is a significant number of people who are insured in the state. They don't think it will change current practice much under that plan, but some insurance companies have started to go in the direction of shortening that stay. She said she doesn't think you can say it will cause rates to go up, it might curtail savings that might be achieved this way in the future. Senator Salo said she isn't saying it might not have a fiscal impact; however, she isn't pushing so much for a longer stay in the hospital as a more reasonable way to deal with the hospital stay - to get away from the sit out in the parking lot and wait until midnight passes or to be discharged in the middle of the night. By going to the 48-hour time period, you get the kind of leeway to accommodate a more reasonable discharge procedure from the hospital. Senator Salo informed the committee that the other thing many of the health care providers have testified to, especially first time mothers, is that they benefit from some education relative to breast feeding, how to bathe it, how to take care of the umbilical cord, etc. They're not able to do that type of education with a mother that is still sedated who is exhausted within that first 24 hours, but given a little extra time that education is very valuable for both the mother and the baby. SENATOR SALO said she would reiterate that the House HESS Committee version is problematic for the reasons she already stated, but there might be a way to accommodate the concern without a title change and maybe just in the body of the bill. She noted she hasn't had a chance to look at that. Senator Salo said she did accommodate the concerns that were expressed by Blue Cross and AETNA in the Senate Labor and Commerce Committee version. One concern was that frequently, an insurance company will have an arrangement with the hospital for a lump sum kind of payment. So they'll say, "O.K., we reimbursed $3,700 for deliveries and you guys figure out the rest of it." They wanted to make sure that this bill didn't interfere with having that kind of arrangement and it doesn't. A clause was added saying we have no intention to interfere with that. Senator Salo said the other change was making sure it was made clear that this is not a mandatory stay. It would be upon the consent of the health care provider and the patient. You can go home an hour after delivery if you're ready to do that. Number 2025 CHAIRMAN KOTT pointed out there is a motion before the committee to adopt the Senate Labor and Commerce version of SB 193. He noted the drafter of the memorandum, Mike Ford, is on his way to the meeting to clarify the language. REPRESENTATIVE ROKEBERG asked Chairman Kott if the bill could be held temporarily until Mr. Ford arrives. Number 2040 REPRESENTATIVE ELTON withdrew his motion. CHAIRMAN KOTT said the committee would take testimony while awaiting the arrival of Mr. Ford. Number 2067 LINNEA LAWERANCE, Registered Nurse, Columbia Alaska Regional Hospital, testified via teleconference on behalf of herself. She said she is a nurse in the mother/baby unit and takes care of mothers and babies after delivery. Ms. Lawerance said at Columbia Regional Hospital, their policy is that a mother who has a normal vaginal delivery has as much time as their insurance will allow. She noted they don't discharge patients at 3:00 a.m. If a woman delivers at 3:00 a.m., she has actually until midnight the next day. She doesn't have to actually leave at 3:00 a.m. Ms. Lawerance explained she has heard that other hospitals have that immediate 24-hour policy due to constraints for rooms, etc. She explained about two weeks ago a woman had delivered her first baby and the woman and her husband had a lot of questions. They said, "Lets see what we can do to try and get the insurance companies to have another day for her to stay." The woman delivered about 9:00 p.m. the day before. Ms. Lawerance explained the woman was physically fine, but she had to get all of her teaching done so that she could go home. The woman would have benefitted in having some extra time to have help with breast feeding and her care. Ms. Lawrence said if they can't find anything physically wrong, they have to tell these people they have to leave and that is hard to do. Number 2189 CHAIRMAN KOTT said there are no further witnesses. He called an at ease at 2:47 p.m. to await the arrival of Mr. Ford. Chairman Kott called the meeting back to order at 2:50 p.m. CHAIRMAN KOTT asked Mr. Ford to explain his memorandum. Number 2213 MIKE FORD, Attorney, Division of Legal Services, Legislative Affairs Agency, explained under the House HESS Committee version there will be perhaps those insurers who choose not to elect this coverage, for example, the state of Alaska could elect not to take this coverage under the language. None of the participants get a choice as to whether they pick that particular element of coverage. So in that situation, you wouldn't have coverage. If you intend to allow that kind of latitude, that is the language you would want. REPRESENTATIVE PORTER asked if technically what he is saying is that it would leave them without the mandatory coverage. MR. FORD said that is correct. The question is, "Where do you impose the mandate?" Do you simply require the insurers to offer the coverage or do you require the insurers to include that coverage whenever they provide this type of health insurance. An example of where we do mandate coverage, in the sense that the insurer is required to include that, is mammograms. He said there are provisions where we simply say they have to offer the coverage. You don't have to take it, but it has to be offered. Typically, those are cases where we've had trouble in getting insurers to even offer the coverage. Automobile insurance is like that. Number 2296 SENATOR SALO referred to the change made in the House HESS Committee and the legal opinion is difficult to interpret in terms of what it does mean. She said what she gets out of it is that it becomes a very optional thing and the bill really has very little impact if insurance companies have a choice of offering this coverage because they certainly have that choice today. So the bill would have little or no effect on anything under the HESS version. MR. FORD explained there is a distinction in kinds of insurance. He said when he uses the example of automobile insurance, normally you don't purchase group automobile insurance. You purchase individual and you go in and pick and choose. He said there are statutory minimums that you have to meet and you can't go below that, but you can add to it. He referred to the health insurance area and said the fact is that most people participate in some kind of group coverage. The percentage of the market that is an individual policy issue to someone who walks into an insurance company is relatively small. So the effect of going to an offer of coverage as opposed to mandated coverage is to leave it to the mechanism of the group insured process as opposed to making sure it is a part of all health insurance policies whether they're an individual group, HMOs, whoever they are. Number 2373 SENATOR SALO referred to the mammogram example and said we decided that was an important enough state policy to say mammograms must be included in insurance policies that are offer. She indicated SB 193 is similar in saying that we believe, as a state policy, the care of infants and new mothers is important enough to be included in insurance policies offered in the state. Number 2392 REPRESENTATIVE PORTER explained it has finally struck him as to what the real difference is between the two bills. Both of them say that -- offered in the state. The House HESS Committee version requires insurance companies to offer that coverage. Currently, they don't have to offer it. They can say, "We'll cover your first 24 hours and that's all we're going to cover." He said they don't do that, but technically they could. We're saying, in the House HESS Committee version, "Absolutely you will offer 48-hour coverage without a medical requirement." In the Senate Labor and Commerce Committee version we're saying that we will mandate that you will provide. SENATOR SALO referred to the Senate Labor and Commerce version of the bill, Section 1, it says an insurer who provides coverage for the costs of child birth shall also provide coverage. She said, "So if an insurer does not provide coverage for the costs of child birth, obviously this doesn't apply and nothing in this bill mandates that the costs of child birth be covered in the insurance plan." REPRESENTATIVE ROKEBERG asked if that is what the C Version does. CHAIRMAN KOTT indicated that is correct. MR. FORD said if the policy did not provide coverage for costs of child birth, then you wouldn't fall under this provision. [END OF TAPE] TAPE 96-37, SIDE B Number 001 REPRESENTATIVE KUBINA said, "....ensure that people have enough time in the hospital. I'm sure you've all heard of reports of people who have left the hospital the first day, since this became an issue, and a problem arose very quickly with a child especially, and the child has died after being home less than 24 hours and stuff. I don't know why we're, other than the mandated part, I'm not sure why we're arguing so much. My understanding is the insurance companies aren't really up in arms about this or anything and why don't we do it and let this go forward. We're making a policy decision." CHAIRMAN KOTT said evidentially there is a few out there that are opposed to the bill REPRESENTATIVE KUBINA asked if they have come forward and testified today. CHAIRMAN KOTT said they haven't come forward today. Number 048 REPRESENTATIVE ELTON said he would like to point out that the differences are not all that great. The Senate Labor and Commerce Committee version does provide that nothing in this section is construed to require hospitalization. We're not changing anything unless the mother and the medical provider feel that it is necessary. Representative Elton again moved to adopt the Senate Labor and Commerce Committee version, CSSB 193(L&C). CHAIRMAN KOTT asked if there was objection. Hearing none, CSSB 193(L&C) was before the committee. Number 095 REPRESENTATIVE ROKEBERG said, "Mr. Chairman, let me just clarify what happened here. In the HESS Committee I don't think we had the understanding of the language that was before them of the terms of the optional nature of the offering of any maternity coverage and that was really the crux of the issue. That was the confusion. And clearly, without Mr. Ford's great help here, I appreciate that because I am satisfied now with the explanation. But I think we can all admit that there was a legitimate question there and that was the issue and I'm happy that we have that resolved, Mr. Chairman." Number 118 REPRESENTATIVE ROKEBERG made a motion to pass CSSB 193(L&C), Version C, out of the House Labor and Commerce Committee with individual recommendations and the accompanying zero fiscal note. CHAIRMAN KOTT asked if there was an objection. Hearing none, CSSB 193(L&C) was moved out of the House Labor and Commerce Committee. ADJOURNMENT CHAIRMAN KOTT adjourned the House Labor and Commerce Committee meeting at 3:00 p.m.