Legislature(1995 - 1996)

04/30/1996 03:16 PM L&C

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
          HOUSE LABOR AND COMMERCE STANDING COMMITTEE                          
                         April 30, 1996                                        
                           3:16 p.m.                                           
 MEMBERS PRESENT                                                               
 Representative Pete Kott, Chairman                                            
 Representative Norman Rokeberg, Vice Chairman                                 
 Representative Beverly Masek                                                  
 Representative Brian Porter                                                   
 Representative Kim Elton                                                      
 Representative Gene Kubina                                                    
 MEMBERS ABSENT                                                                
 Representative Jerry Sanders                                                  
 COMMITTEE CALENDAR                                                            
 CS FOR SENATE BILL NO. 43(L&C)                                                
 "An Act relating to registration by the Board of Registration for             
 Architects, Engineers, and Land Surveyors; clarifying the meaning             
 of practicing or offering to practice architecture, engineering, or           
 land surveying; and amending the definition of `practice of land              
      - PASSED CSSB 43(L&C) OUT OF COMMITTEE                                   
 CS FOR SENATE BILL NO. 253(FIN)                                               
 "An Act relating to insurance coverage for costs of prostate cancer           
 or cervical cancer detection."                                                
      - PASSED CSSB 253(FIN) OUT OF COMMITTEE                                  
 (* First Public Hearing)                                                      
 PREVIOUS ACTION                                                               
 BILL:  SB 43                                                                
 SPONSOR(S): SENATOR(S) LEMAN                                                  
 JRN-DATE     JRN-PG                  ACTION                                   
 01/23/95        71    (S)   READ THE FIRST TIME - REFERRAL(S)                 
 01/23/95        71    (S)   L&C, FIN                                          
 03/07/95              (S)   L&C AT  1:30 PM FAHRENKAMP RM 203                 
 03/07/95              (S)   MINUTE(L&C)                                       
 02/20/96              (S)   L&C AT  1:30 PM FAHRENKAMP RM 203                 
 02/20/96              (S)   MINUTE(L&C)                                       
 02/27/96              (S)   L&C AT  1:30 PM FAHRENKAMP RM 203                 
 02/29/96              (S)   MINUTE(L&C)                                       
 03/12/96      2706    (S)   L&C RPT  CS  3DP 1NR      NEW TITLE               
 03/12/96      2706    (S)   ZERO FISCAL NOTE TO SB & CS (DCED)                
 04/22/96      3433    (S)   FIN REFERRAL WAIVED                               
 04/24/96              (S)   RLS AT 10:30 AM FAHRENKAMP RM 203                 
 04/24/96              (S)   MINUTE(RLS)                                       
 04/24/96      3490    (S)   RULES TO CALENDAR  4/24/96                        
 04/24/96      3520    (S)   READ THE SECOND TIME                              
 04/24/96      3520    (S)   L&C  CS ADOPTED UNAN CONSENT                      
 04/24/96      3521    (S)   ADVANCED TO THIRD READING UNAN CONSENT            
 04/24/96      3521    (S)   READ THE THIRD TIME  CSSB 43(L&C)                 
 04/24/96      3521    (S)   PASSED Y17 N3                                     
 04/24/96      3521    (S)   DUNCAN  NOTICE OF RECONSIDERATION                 
 04/25/96      3578    (S)   RECONSIDERATION NOT TAKEN UP                      
 04/25/96      3580    (S)   TRANSMITTED TO (H)                                
 04/26/96      4033    (H)   READ THE FIRST TIME - REFERRAL(S)                 
 04/26/96      4033    (H)   LABOR & COMMERCE, JUDICIARY                       
 04/30/96              (H)   L&C AT  3:00 PM CAPITOL 17                        
 BILL:  SB 253                                                               
 SPONSOR(S): SENATOR(S) DUNCAN, Ellis, Salo, Zharoff, Lincoln,                 
 Kelly; REPRESENTATIVE(S) Robinson, Kubina, Navarre                            
 JRN-DATE     JRN-PG                  ACTION                                   
 02/02/96      2279    (S)   READ THE FIRST TIME - REFERRAL(S)                 
 02/02/96      2280    (S)   L&C, FIN                                          
 02/05/96      2309    (S)   COSPONSOR(S):  ELLIS, SALO                        
 02/07/96      2330    (S)   COSPONSOR(S):  ZHAROFF                            
 03/07/96              (S)   L&C AT  1:30 PM FAHRENKAMP RM 203                 
 03/07/96              (S)   MINUTE(L&C)                                       
 03/12/96              (S)   MINUTE(L&C)                                       
 03/14/96      2736    (S)   L&C RPT  3DP 1NR                                  
 03/14/96      2736    (S)   ZERO FISCAL NOTES (DCED, ADM)                     
 03/28/96              (S)   FIN AT  8:30 AM SENATE FINANCE 532                
 03/28/96              (S)   MINUTE(FIN)                                       
 04/02/96              (S)   FIN AT  9:00 AM SENATE FINANCE 532                
 04/03/96              (S)   RLS AT  1:15 PM FAHRENKAMP RM 203                 
 04/03/96              (S)   MINUTE(RLS)                                       
 04/03/96      3042    (S)   FIN RPT  CS  7DP   NEW TITLE                      
 04/03/96      3042    (S)   ZERO FN TO CS (ADM)                               
 04/03/96      3042    (S)   PREVIOUS ZERO FN (DCED)                           
 04/10/96      3112    (S)   RULES TO CALENDAR  4/10/96                        
 04/10/96      3115    (S)   READ THE SECOND TIME                              
 04/10/96      3115    (S)   FIN  CS ADOPTED      Y18 N2                       
 04/10/96      3115    (S)   ADVANCE TO THIRD READING FLD Y14 N6               
 04/10/96      3136    (S)   COSPONSOR:  LINCOLN                               
 04/10/96      3116    (S)   THIRD READING 4/11 CALENDAR                       
 04/11/96      3167    (S)   READ THE THIRD TIME  CSSB 253(FIN)                
 04/11/96      3168    (S)   PASSED Y19 N1                                     
 04/11/96      3168    (S)   KELLY  NOTICE OF RECONSIDERATION                  
 04/12/96      3205    (S)   RECON TAKEN UP - IN THIRD READING                 
 04/12/96      3205    (S)   COSPONSOR(S): KELLY                               
 04/12/96      3206    (S)   PASSED ON RECONSIDERATION Y18 N1 E1               
 04/12/96      3220    (S)   TRANSMITTED TO (H)                                
 04/15/96      3733    (H)   READ THE FIRST TIME - REFERRAL(S)                 
 04/15/96      3733    (H)   L&C, STATE AFFAIRS                                
 04/15/96      3783    (H)   HES REFERRAL ADDED                                
 04/15/96      3785    (H)   CROSS SPONSOR(S): ROBINSON, KUBINA                
 04/22/96      3936    (H)   CROSS SPONSOR(S): NAVARRE                         
 04/23/96              (H)   HES AT  3:00 PM CAPITOL 106                       
 04/23/96              (H)   MINUTE(HES)                                       
 04/25/96              (H)   HES AT  3:00 PM CAPITOL 106                       
 04/25/96              (H)   MINUTE(HES)                                       
 04/26/96      4042    (H)   HES RPT HCS(HES) 2DP 1NR 2AM                      
 04/26/96      4042    (H)   DP: BUNDE, TOOHEY                                 
 04/26/96      4042    (H)   NR: G.DAVIS                                       
 04/26/96      4042    (H)   AM: BRICE, ROBINSON                               
 04/26/96      4043    (H)   SENATE ZERO FISCAL NOTES (DCED) 3/14/96           
 04/26/96      4043    (H)   SEN ZERO FNS (ADM/ALL DEPTS) 4/3/96               
 04/30/96              (H)   L&C AT  3:00 PM CAPITOL 17                        
 WITNESS REGISTER                                                              
 MARY VOLLENDORF, Administrative Assistant                                     
   to Senator Loren Leman                                                      
 Alaska State Legislature                                                      
 176 West Fourth, Suite 520                                                    
 Telephone:  (907) 258-8189                                                    
 POSITION STATEMENT:  Gave sponsor statement for CSSB 43(L&C).                 
 KRISTINE PELLET, Student Intern                                               
   to Senator Jim Duncan                                                       
 Alaska State Legislature                                                      
 Capitol Building, Room 119                                                    
 Juneau, Alaska 99801                                                          
 Telephone:  (907) 465-4766                                                    
 POSITION STATEMENT:  Gave sponsor statement for CSSB 253(FIN).                
 GENE DAW, Volunteer                                                           
 American Association of Retired                                               
 People; Veterans of Foreign Wars                                              
 Box 20995                                                                     
 Juneau, Alaska 99801                                                          
 Telephone:  (907) 586-3816                                                    
 POSITION STATEMENT:  Urged passage of CSSB 253(Fin)                           
 SENATOR JIM DUNCAN                                                            
 Alaska State Legislature                                                      
 Capitol Building, Room 119                                                    
 Juneau, Alaska 99801                                                          
 Telephone:  (907) 465-4766                                                    
 POSITION STATEMENT:  Sponsor of SB 253.                                       
 BILL CHISHAM, State Employee                                                  
 6550 North Douglas                                                            
 Juneau, Alaska 99801                                                          
 Telephone:  (907) 586-8911                                                    
 POSITION STATEMENT:  Testified in support of CSSB 253(FIN).                   
 ACTION NARRATIVE                                                              
 TAPE 96-42, SIDE A                                                            
 Number 001                                                                    
 The House Labor and Commerce Standing Committee was called to order           
 by Chairman Pete Kott at 3:16 p.m..  Members present at the call to           
 order were Representatives Elton, Kubina, Rokeberg, Masek and Kott.           
 CSSB 43(L&C) - ARCHITECTS, ENGINEERS, LAND SURVEYORS                        
 CHAIRMAN PETE KOTT announced the first order of business would be             
 CSSB 43(L&C), "An Act relating to registration by the Board of                
 Registration for Architects, Engineers, and Land Surveyors;                   
 clarifying the meaning of practicing or offering to practice                  
 architecture, engineering, or land surveying; and amending the                
 definition of `practice of land surveying.'"                                  
 MARY VOLLENDORF, Administrative Assistant to Senator Loren Leman,             
 sponsor of the measure, testified via teleconference on behalf of             
 Senator Leman.  She said the bill is a architects, engineers and              
 land surveyors (AELS) cleanup bill.  Section 1 relates to the                 
 qualifications and (indisc.) territory (indisc.) or a foreign                 
 country.  They would have to have their application verified by the           
 board and then have their application reviewed and register in                
 accordance with regulations of the board.                                     
 MS. VOLLENDORF explained Section 2 relates to requiring status                
 registration.  On retiring from the practice of engineering, there            
 is a one-time fee and once the registrant is in good standing they            
 may apply for the conversion of a certificate of registration to a            
 retired status registration.  They will not be able to practice               
 architecture, engineering or land surveying, but may reapply for a            
 certificate of registration.                                                  
 MS. VOLLENDORF said Section 3 just adds the word "or."                        
 MS. VOLLENDORF explained in Section 4 a couple of technical words             
 were added for the (indisc.) of land surveying.                               
 Number 180                                                                    
 REPRESENTATIVE NORMAN ROKEBERG made a motion to move CSSB 43(L&C),            
 Version U, out of committee with individual recommendations and the           
 attached fiscal note.                                                         
 CHAIRMAN KOTT asked if there was anyone else wishing to testify.              
 Hearing none, he stated the motion is to move CSSB 43(L&C) from               
 committee with individual recommendations with the accompanying               
 zero fiscal note.  He asked if there was an objection.  Hearing               
 none, CSSB 43(L&C) was moved out of the House Labor and Commerce              
 Number 230                                                                    
 CHAIRMAN KOTT announced the committee would hear CSSB 253(FIN),               
 "An Act relating to insurance coverage for costs of prostate cancer           
 or cervical cancer detection."                                                
 Number 230                                                                    
 KRISTINE PELLET, Student Intern to Senator Jim Duncan, came forward           
 to explain CSSB 253(FIN).  She read her statement into the record:            
 "Thank you for scheduling Senate Bill 253, `An Act relating to                
 insurance coverage for costs of prostate cancer or cervical cancer            
 detection.'  Prostate cancer accounts for 36 percent of all male              
 cancers and is the second leading cause of death in men, after lung           
 cancer, as reported by the National Cancer Institute.  Although               
 often presumed to develop slowly, nearly two-thirds of new prostate           
 cancer cases has spread beyond the prostate gland by the time of              
 "In addition to coverage for screening of prostate cancer, Senate             
 Bill 253 would require screening of cervical cancer screening.                
 Cervical cancer accounts for about 16 percent of all cancers in               
 women, is estimated that nearly half of the approximately 15,000              
 women who are diagnosed annually with the condition never underwent           
 early screening procedures.                                                   
 "Senate Bill 253 makes health issues a priority.  I recommend that            
 the committee consider this Senate Finance Committee's version of             
 Senate Bill 253.  This version retains the mandatory aspect that I            
 had originally intended with the bill.  I would welcome your                  
 support in requiring that insurance companies cover the cost of               
 prostate and cervical cancer testing."                                        
 Number 356                                                                    
 REPRESENTATIVE ROKEBERG asked Ms. Pellet to point out the                     
 difference in wordage between the two bills.                                  
 REPRESENTATIVE BEVERLY MASEK referred to the page 2, line 1 of the            
 House Health, Education and Social Services (HESS) Committee's                
 version of the bill it stated the bill says, "required to be                  
 offered".  The Senate Finance Committee's version of the bill says,           
 "required by this section".                                                   
 CHAIRMAN KOTT indicated there isn't a title change.  He noted the             
 committee is working on Version G.                                            
 Number 467                                                                    
 REPRESENTATIVE GENE KUBINA moved to adopt CSSB 253(FIN), Version F.           
 REPRESENTATIVE ROKEBERG objected.  He said, "We did have a work               
 session on this and related matters.  I think there was a                     
 substantial amount of confusion, particularly after we received the           
 testimony in this committee on Senate Bill, I believe, 193 which              
 was Senator Salo's bill on child care extension of birthing periods           
 under insurance and frankly, Mr. Chairman, I was a little                     
 disappointed because I think that this committee was somewhat                 
 misled, not intentionally of course, but by the testimony received            
 from leg counsel when this issue was brought before us the last               
 time on another bill, which is very similar - it's the very same              
 type of language, and a distinction made between what was mandated            
 in the insurance coverage and what could be offered.  And this is             
 this is a concern I have that is a distinction and I would caution            
 the members of the committee that what I thought it was the                   
 intention as brought forward by legislative counsel at our last               
 meeting on that bill is not the nature of the beast as we assumed.            
 We thought that the ability of an insurer -- of an insured, that is           
 the consumer, was best maintained or would be maintained by the               
 original language and in this case the Finance language supported             
 by the sponsor and that option really isn't there is my                       
 understanding.  Lets see if I can think this through here.  The               
 problem and the real distinction becomes between the - a group plan           
 and the individual plan.  And right now if the sponsor's preferred            
 version - it is my understanding that this would be mandated by all           
 coverage and there would be no optional provision on the part of              
 the consumer to take it or leave it, and correct me if I'm wrong              
 here on that.  Because a lot of the testimony on these bills we've            
 had has been from the group side, for example, AETNA was (indisc.)            
 and so forth.  And my concern, frankly is for the people that are             
 individually purchasing insurance, not group plans and that have              
 all the economic power and abilities to come down.  And the                   
 thinking being that this - any types of well treatments like this             
 that are mandated under a policy will have the ultimate impact of             
 increasing the amount of premium that the insured would have to               
 pay.  So I think the desire of the HESS Committee and so forth was            
 to allow a matter of choice on the part of the insured and not to             
 mandate the coverage and that was really the - kind of a                      
 philosophical issue and somebody correct me if I'm not telling this           
 right.  I'd just like to make sure the committee is getting the               
 whole story.  I'm not sure I'm doing a good enough job to explain             
 it.  I was thoroughly confused along with you the other day, Mr.              
 CHAIRMAN KOTT said as it was explained by leg counsel or the legal            
 folks it was his understanding that what was being addressed was              
 what was heard in a subsequent hearing, the work session.  He said            
 it is basically a policy call - one of requiring or one as                    
 requiring to offer.  If it is required to be offered under the                
 group plan, the employer is, in fact, going to make the choice for            
 the employee.  Chairman Kott said his opinion under the group                 
 policy plan is he would much rather see the employee have the say             
 so in having it required.  He said he can understand Representative           
 Rokeberg's concern with the individual policy.  Chairman Kott                 
 suggested the committee hear from someone who represents the                  
 Number 800                                                                    
 REPRESENTATIVE KUBINA explained he has a little bit of first hand             
 knowledge of this and that is why he feels so strongly that it be             
 a required thing in the policies.  He said with his and his wife's            
 insurance through the school district, it was not in the policy.              
 He asked Chairman Kott if this is the appropriate time to debate              
 the bill.                                                                     
 CHAIRMAN KOTT suggested he withdraw his motion for the purpose of             
 taking testimony.                                                             
 REPRESENTATIVE KUBINA withdrew his motion.                                    
 Number 849                                                                    
 GENE DAW, Volunteer, representing American Association of Retired             
 People and the Veterans of Foreign Wars, came before the committee            
 to address SB 253.  He said the organizations he represents thinks            
 the bill is good for all Alaskans.  Mr. Daw indicated this is the             
 fifth time he has testified on the bill.  He referred to prostate             
 cancer and indicated he has had the screening test three times.               
 His doctor told him that this test is one of the quickest ways for            
 detecting prostate cancer.  This type of cancer spreads very fast             
 so the sooner you catch it, the better chance you have of stopping            
 it.  Once it spreads, it is hard to do anything about it.  Mr. Daw            
 said insurance people gave testimony at some of the other hearings            
 on the measure where they said that this test is an experimental              
 test.  It is not an experimental test, it is a well established               
 test and most doctors use it.  It should be provided for by                   
 insurance companies to encourage people to have this test.  He                
 explained if the screen tests aren't paid for by an insurance                 
 company, it would be easy for someone to say, "Well, maybe I'll               
 have it next year or the year after."  Mr. Daw noted he is a                  
 disabled veteran and he is lucky the Veterans Administration pays             
 for his medical expenses.  He stated that the prostate and the                
 cervical cancer tests are good.  Prostate cancer is the second                
 largest killer of men in America.  He urged passage of CSSB                   
 Number 1138                                                                   
 SENATOR JIM DUNCAN urged the committee to pass CSSB 253(FIN) out of           
 committee.  He added he believes it is very important to include              
 the word "provide" in the legislation instead of "offer."  If you             
 say "offer," it does nothing more than what is the present status             
 quo because they can currently offer.  Senator Duncan said several            
 years ago, there was similar legislation passed relating to                   
 mammograms and it has been very successful and is a very good                 
 preventive health care step, not only for breast cancer but for               
 prostate and cervical cancer.                                                 
 REPRESENTATIVE ROKEBERG recalled reading an article which indicated           
 that the PSA test had about a 30 or 35 percent efficacy.  There was           
 also another article which pointed out that there was a new test              
 coming.  He referred to subsection (e) on page 2 which said, "In              
 this section, `prostate cancer screening tests' includes a prostate           
 antigen blood test or another test that is equivalent or better in            
 cancer detection," and questioned if this would include another               
 SENATOR DUNCAN indicated that if there is another test that comes             
 along that has better and more accurate findings and results than             
 the PSA test, then it should be provided.  He said the PSA test may           
 not always be accurate, but the medical providers he has talked to            
 indicated that the test is very helpful and is one they recommend             
 be done.                                                                      
 REPRESENTATIVE ROKEBERG said he believes there is some controversy            
 about "experimental nature" of this.  So if there is a new better             
 version, he would presume unless it has significantly higher                  
 positive rates, it could be categorized as experimental also.                 
 Number 1274                                                                   
 SENATOR DUNCAN said he isn't sure that providers nor would he say             
 that PSA is experimental.  It has been used.  He said he would say            
 that the accuracy rate is not 100 percent, but it is a good test              
 for early detection of prostate cancer and it has been very                   
 successful.  Surely, it is better to have the test than not to have           
 it.  Even if there is a misleading result, it is better to have it            
 than not to have it.                                                          
 REPRESENTATIVE ROKEBERG said there was testimony in other hearings            
 where some insurers call it experimental.                                     
 SENATOR DUNCAN referred to subsection (e) and said it was written             
 with providers and others involved.  Clearly, he believes that                
 indicates that prostate antigen blood tests or another test if one            
 is developed that is equivalent or better would be included.  If a            
 better test comes along he doesn't say that it should not be                  
 REPRESENTATIVE ROKEBERG said, "However this bill comes out, I'm               
 gunna be supporting I want you to know."                                      
 SENATOR DUNCAN said he hopes that he will support it with the word            
 "provide," because if it is supported with "may offer," nothing               
 changes.  What they'll do is give a laundry list of coverages that            
 people may select, there will be a long list and you'll have to               
 read through and select it and most people won't do that.                     
 Number 1394                                                                   
 BILL CHISHAM, State Employee, came before the committee to testify            
 in support of the bill.   He said he has a background in insurance            
 law.  He said he is in favor of the specific words, "will provide,"           
 and nothing that gives them an opportunity to make it optional.               
 Mr. Chisham said in 1992 and 1993, his physician recommended this             
 test on his annual physical.  So he had it and AETNA paid for it.             
 The following year he had the test and AETNA said they wouldn't pay           
 for it.  He called and questioned why and they said, "Well, we                
 apparently made a mistake in paying for last year."  Mr. Chisham              
 said since then, he has been paying for it.  It runs between $70              
 and $75.  He said he personally feels it is a good test to take as            
 a backup, particularly to the other tests, and to some extent                 
 somewhat more comfortable to take.  Mr. Chisham continued to                  
 explain the process of the test and said he will continue to have             
 the test whether AETNA will pay for it or not.  He urged that the             
 legislation move forward.  He noted he prefers the original                   
 version, but if that isn't possible, he would prefer a version that           
 does make this specifically required by the insurance carrier.                
 REPRESENTATIVE ROKEBERG asked if the proper way to do the test is             
 to have both the digital and the PSA test together because of the             
 higher level of accuracy.                                                     
 MR. CHISHAM said he can't speak as a doctor, but as an individual             
 if there was a choice of one or the other, he would pick the PSA              
 test first.  If possible, he would prefer to have both.                       
 Number 1614                                                                   
 REPRESENTATIVE ELTON noted it is his understanding that if the test           
 is flawed, it gives false positives, not false negatives.  Having             
 a PSA test originally doesn't preclude the backup test if you get             
 a false negative.                                                             
 Number 1614                                                                   
 MR. DAW said he would like to note that his doctor has told him the           
 PSA screening test is 95 percent positive and if there is any type            
 of infection or prostate cancer, 95 percent of the time they'll               
 detect it.  He explained he would rather have the PSA test.                   
 REPRESENTATIVE ROKEBERG said, for the record, that he saw a Larry             
 King show with Michael Milken (Sp.?) who was underwriting a major             
 genetic study of prostate cancer and Mr. Milken, General                      
 Swartzkoph, Lynn Donson and Jack Kemp were also on the show.  They            
 all had false negative PSA tests and without the digital and follow           
 up, they would have not been diagnosed timely.                                
 CHAIRMAN KOTT asked if there was anybody else wishing to testify.             
 there being none, he close the public hearing.                                
 Number 1715                                                                   
 REPRESENTATIVE KUBINA moved that the committee adopt CSSB 253(FIN),           
 Version F.                                                                    
 REPRESENTATIVE ROKEBERG objected.                                             
 REPRESENTATIVE KUBINA informed the committee that his wife, through           
 their school district insurance policy, would not cover this.  At             
 one time when his wife went to get a check up, the insurance                  
 company wouldn't cover the test under their insurance so they                 
 decided to pay for it themselves.  Some cervical cancer was                   
 discovered.  Representative Kubina said the district has now                  
 negotiated for the cervical test so that if a doctor required it,             
 they would pay for it.  He noted that was something they had to               
 negotiate outside of the policy.  Our dental health insurance is              
 all preventive, but the health insurance isn't preventive at all.             
 Representative Kubina said he has been told that this isn't a big             
 cost factor to insurance companies - yes, the cost will get passed            
 on, but there are major insurance companies that are not objecting            
 to this.                                                                      
 Number 1818                                                                   
 REPRESENTATIVE PORTER said you could come up with a good reason for           
 adding a whole bunch of tests to the bill.  The point is when a               
 insurance company offers coverage, they cost it out with specific             
 testing and coverage in mind and that's what they're covering.  If            
 new tests come along or the individual policy holder did not opt              
 for a certain kind of coverage, that isn't provided.                          
 Representative Porter said philosophically, he is opposed to                  
 mandating these kinds of things.  The section in (e) that has been            
 added to take care of developing expertise in these kinds of areas            
 might have an effect of not being negligible cost even to the group           
 policies.  As it stands, it has an effect on individual policies,             
 but not knowing what it is that this better detection test involves           
 or how much it's going to cost, we could be setting up a scenario             
 that could run into a whole lot of money.  He said he would support           
 the G version of the bill.                                                    
 Number 1915                                                                   
 CHAIRMAN KOTT said he has had some discussion with some of the                
 major insurance carriers in the state and they are comfortable with           
 Version F, which is the Senate Finance Committee's version.  The              
 small amount of money that these tests costs is clearly a minor               
 amount compared to not discovering the cancer at a later stage                
 which would then entail some exorbitant costs that will have to be            
 paid for by the insurance company.  He said he thinks they are                
 willing to prevent or to detect early on any types of cancer which            
 would reduce some of the expenses from their behalf.  Chairman Kott           
 said he will support the Senate version of the bill.  He noted he             
 is philosophically opposed to mandating coverage in most cases and            
 that's basically what the insurance company said, but in this                 
 particular case they were willing to make some concession.  He said           
 he believes they're looking out for their long-term interest.                 
 Number  1987                                                                  
 REPRESENTATIVE ELTON said indicated that substituting Version G for           
 Version F essentially does nothing.  He said he would encourage the           
 committee to move Version F.                                                  
 REPRESENTATIVE ROKEBERG said Representative Elton indicated that              
 Version G would have no value at all.  He said it seems to him that           
 by mandating the offer of coverage, it institutes a line item on a            
 menu - it's a menu type selection, whereas today he isn't aware               
 that a consumer coming in to buy an individual policy would be                
 offered this coverage at all.  Therefore, Version G would mandate             
 that they be offered coverage.                                                
 Number 2092                                                                   
 SENATOR DUNCAN said he concurs with Representative Elton.  He said            
 he believes if the committee adopts the House HESS Committee                  
 version, you really are doing nothing because insurance companies             
 can now offer a coverage for PSA or can offer coverage for a pap              
 smear.  So really the committee would be doing nothing but saying,            
 "You must offer it."  That doesn't mean that it will be provided or           
 that anyone will select it.  The problem would be that most people            
 when they get their insurance probably aren't going to spend a lot            
 of time going through the long laundry list of options available to           
 then and, therefore, in many cases wouldn't select it.  Senator               
 Duncan said if you are going to use the words "must offer," you               
 really are not solving or addressing the problem.  He said when it            
 was mandated that mammograms be covered, there wasn't a great jump            
 in health care premiums.  So there wouldn't be a great jump in                
 health care premiums because of this.  Unfortunately, the fiscal              
 notes can't reflect what the true savings are.  We don't know, but            
 we do know that preventive health care saves money.  To spend $75             
 on a PSA test may save many months in the hospital later on because           
 you have cancer and many other expensive procedures.                          
 Number 2187                                                                   
 REPRESENTATIVE KUBINA said in his school district the people                  
 covered doesn't receive a list.  The school district actually                 
 determines what coverage they are going to accept.  He said he                
 thinks why the insurance companies would be supportive of this is             
 because they probably understand the benefit of it.  When employers           
 come to negotiate the package that they're going to get, they want            
 the cheapest one they can get, so it could fall off the list.  If             
 it is required the insurance company can't say, "Well, it's off the           
 REPRESENTATIVE ELTON suggesting defining the wording "to offer."              
 To use the wording "to offer" doesn't mean it will come up on the             
 REPRESENTATIVE ROKEBERG explained it says "shall offer."                      
 REPRESENTATIVE ELTON said that doesn't mean it has to be on a menu            
 list.  It just means that if they're asked, they have to offer it.            
 He said he doesn't believe that "to offer" means that it is going             
 to be one of the lists of options.  He said he thinks that it means           
 if somebody asks for it, they're going to have to offer it.                   
 REPRESENTATIVE ROKEBERG said it doesn't say that to him.  From his            
 perspective, everybody seems to be talking about the group plans,             
 fiscal notes, etc.  He said he happens to represent small business            
 people in this state and nobody talks about the person who goes in            
 for an individual policy and those are the people he is concerned             
 about.  They will directly pay that policy increase.  He said he is           
 all for this particular bill and the concept of it, but he wants to           
 be able to make sure it is a matter of choice for those people who            
 do make those choices when they go as consumers to buy that policy.           
 Representative Rokeberg said his understanding of the cervical                
 cancer/pap smear test, because it is an annual test, it is                    
 recommended by all gynecologists to be done yearly from an early              
 age in the 20s for all female patients, where the PSA tests are for           
 men over 50.                                                                  
 Number 2337                                                                   
 CHAIRMAN KOTT noted when he was in the military, his wife had                 
 annual physicals in the doctor's offices on military instillation.            
 She could have rejected it, but as part of the physical they                  
 require her to have a pap smear.  Obviously, there is a reason                
 behind that.  They are trying to look at it from a long-term                  
 perspective, if they catch it early, you pay it now or pay later.             
 Chairman Kott said he understands Representative Rokeberg's concern           
 over the small group type employers, but from the insurance                   
 perspective they could offer it and you could reject it.                      
 REPRESENTATIVE ROKEBERG said he would point out that after                    
 mammograms were mandated, some insurers did provide that as                   
 required by statute but they put caps and limits on the coverage.             
 REPRESENTATIVE ELTON said if you have an individual policy and it             
 is mandated, you're saving costs down the road too.  Maybe it has             
 a negative effect on the premium over time.  He said he can't prove           
 that will happen, but he certainly thinks that there is a cost                
 savings down the road.                                                        
 TAPE 96-42, SIDE B                                                            
 Number 001                                                                    
 CHAIRMAN KOTT called for a roll call vote.  Representatives Masek,            
 Kubina, Elton and Kott voted in favor of the adoption CSSB                    
 253(FIN), Version F.  Representatives Porter and Rokeberg voted               
 against the adoption CSSB 253(FIN), Version F.  So CSSB 253(FIN),             
 Version F was adopted.                                                        
 Number 020                                                                    
 REPRESENTATIVE ELTON made a motion to pass CSSB 253(FIN), Version             
 F, out of committee with individual recommendations and the                   
 accompanying fiscal notes.                                                    
 CHAIRMAN KOTT asked if there was an objection.  Hearing none, CSSB            
 253(FIN) moved out of the House Labor and Commerce Committee.                 
 There being no further business to come before the House Labor and            
 Commerce Committee, CHAIRMAN KOTT adjourned the meeting at 4:06               

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