Legislature(1995 - 1996)

04/18/1996 02:10 PM L&C

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
txt
          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.                                                          
                                                                               

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