Legislature(1999 - 2000)

03/17/2000 03:25 PM L&C

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
          HOUSE LABOR AND COMMERCE STANDING COMMITTEE                                                                           
                         March 17, 2000                                                                                         
                           3:25 p.m.                                                                                            
MEMBERS PRESENT                                                                                                                 
Representative Norman Rokeberg, Chairman                                                                                        
Representative Andrew Halcro, Vice Chairman                                                                                     
Representative Lisa Murkowski                                                                                                   
Representative Tom Brice                                                                                                        
Representative Sharon Cissna                                                                                                    
MEMBERS ABSENT                                                                                                                  
Representative Jerry Sanders                                                                                                    
Representative John Harris                                                                                                      
COMMITTEE CALENDAR                                                                                                              
HOUSE BILL NO. 298                                                                                                              
"An Act requiring that health  care insurers provide coverage for                                                               
treatment of diabetes."                                                                                                         
     - HEARD AND HELD                                                                                                           
HOUSE BILL NO. 345                                                                                                              
"An Act relating to state employee health insurance."                                                                           
     - HEARD AND HELD                                                                                                           
HOUSE BILL NO. 416                                                                                                              
"An  Act  relating  to insurance  coverage  for  prostate  cancer                                                               
     - MOVED HB 416 OUT OF COMMITTEE                                                                                            
HOUSE BILL NO. 419                                                                                                              
"An Act relating  to the weekly rate of  compensation and minimum                                                               
and  maximum   compensation  rates  for   workers'  compensation;                                                               
specifying  components of  a  workers' compensation  reemployment                                                               
plan;  adjusting  workers'  compensation benefits  for  permanent                                                               
partial  impairment, for  reemployment plans,  for rehabilitation                                                               
benefits, for  widows, widowers,  and orphans, and  for funerals;                                                               
relating to  permanent total disability of  an employee receiving                                                               
rehabilitation benefits; relating to  calculation of gross weekly                                                               
earnings  for workers'  compensation  benefits  for seasonal  and                                                               
temporary workers and  for workers with overtime  or premium pay;                                                               
setting  time  limits for  requesting  a  hearing on  claims  for                                                               
workers'   compensation,    for   selecting    a   rehabilitation                                                               
specialist,  and  for  payment  of  medical  bills;  relating  to                                                               
termination and  to waiver of rehabilitation  benefits, obtaining                                                               
medical releases,  and resolving  discovery disputes  relating to                                                               
workers'  compensation;   setting  an  interest  rate   for  late                                                               
payments  of workers'  compensation; providing  for updating  the                                                               
workers' compensation medical fee  schedule; and providing for an                                                               
effective date."                                                                                                                
     - HEARD AND HELD                                                                                                           
PREVIOUS ACTION                                                                                                                 
BILL: HB 298                                                                                                                  
SHORT TITLE: REQUIRE HEALTH INS COVERAGE FOR DIABETES                                                                           
Jrn-Date    Jrn-Page           Action                                                                                           
 1/21/00      1961     (H)  READ THE FIRST TIME - REFERRALS                                                                     
 1/21/00      1961     (H)  HES, L&C, FIN                                                                                       
 1/24/00      1996     (H)  COSPONSOR(S): PHILLIPS                                                                              
 2/22/00               (H)  HES AT  3:00 PM CAPITOL 106                                                                         
 2/22/00               (H)  Moved CSHB 298(HES) Out of Committee                                                                
 2/22/00               (H)  MINUTE(HES)                                                                                         
 2/25/00      2315     (H)  COSPONSOR(S): CISSNA                                                                                
 2/28/00      2327     (H)  HES RPT CS(HES) 6DP 1DNP                                                                            
 2/28/00      2328     (H)  DP: GREEN, MORGAN, DYSON, WHITAKER,                                                                 
 2/28/00      2328     (H)  KEMPLEN, BRICE; DNP: COGHILL                                                                        
 2/28/00      2328     (H)  ZERO FISCAL NOTE (DCED)                                                                             
 2/28/00      2328     (H)  REFERRED TO LABOR & COMMERCE                                                                        
 3/17/00               (H)  L&C AT  3:15 PM CAPITOL 17                                                                          
BILL: HB 345                                                                                                                  
SHORT TITLE: STATE EMPLOYEE HEALTH INSURANCE                                                                                    
Jrn-Date    Jrn-Page           Action                                                                                           
 2/07/00      2118     (H)  READ THE FIRST TIME - REFERRALS                                                                     
 2/07/00      2118     (H)  L&C, STA, FIN                                                                                       
 2/07/00      2118     (H)  REFERRED TO LABOR & COMMERCE                                                                        
 3/17/00               (H)  L&C AT  3:15 PM CAPITOL 17                                                                          
BILL: HB 416                                                                                                                  
SHORT TITLE: PROSTATE CANCER SCREENING                                                                                          
Jrn-Date    Jrn-Page           Action                                                                                           
 2/16/00      2222     (H)  READ THE FIRST TIME - REFERRALS                                                                     
 2/16/00      2222     (H)  L&C, HES                                                                                            
 2/16/00      2222     (H)  REFERRED TO LABOR & COMMERCE                                                                        
 3/17/00               (H)  L&C AT  3:15 PM CAPITOL 17                                                                          
BILL: HB 419                                                                                                                  
SHORT TITLE: WORKERS' COMPENSATION                                                                                              
Jrn-Date    Jrn-Page           Action                                                                                           
 2/23/00      2279     (H)  READ THE FIRST TIME - REFERRALS                                                                     
 2/23/00      2279     (H)  L&C, JUD, FIN                                                                                       
 2/23/00      2279     (H)  REFERRED TO LABOR & COMMERCE                                                                        
 3/08/00               (H)  L&C AT  3:15 PM CAPITOL 17                                                                          
 3/08/00               (H)  Heard & Held                                                                                        
 3/08/00               (H)  MINUTE(L&C)                                                                                         
 3/17/00               (H)  L&C AT  3:15 PM CAPITOL 17                                                                          
WITNESS REGISTER                                                                                                                
REPRESENTATIVE LISA MURKOWSKI                                                                                                   
Alaska State Legislature                                                                                                        
Capitol Building, Room 406                                                                                                      
Juneau, Alaska  99801                                                                                                           
POSITION STATEMENT:  Testified as sponsor of HB 298.                                                                            
RICK MYSTROM, Mayor of Anchorage                                                                                                
2727 Iliamna Avenue                                                                                                             
Anchorage, Alaska 99517                                                                                                         
POSITION STATEMENT:  Testified in support of HB 298.                                                                            
MICHELLE CASSANO, Executive Director                                                                                            
American Diabetes Association                                                                                                   
801 West Fireweed Lane, Number 103                                                                                              
Anchorage, Alaska 99503                                                                                                         
POSITION STATEMENT:  Testified on HB 298.                                                                                       
DONALD NOVOTNEY                                                                                                                 
1120 Timberline Court                                                                                                           
Juneau, Alaska 99801                                                                                                            
POSITION STATEMENT:  Testified in support of HB 298.                                                                            
KATHY JACQUES, Registered Nurse                                                                                                 
     and Certified Diabetes Educator                                                                                            
3050 Lore Road, Number C3                                                                                                       
Anchorage, Alaska 99507                                                                                                         
POSITION STATEMENT:  Testified on HB 298.                                                                                       
JANEL WRIGHT                                                                                                                    
2945 Emery Street                                                                                                               
Anchorage, Alaska 99508                                                                                                         
POSITION STATEMENT:  Testified in support of HB 298.                                                                            
YOUNG SHIN, Registered Dietician                                                                                                
906 Clay Court                                                                                                                  
Anchorage, Alaska 99503                                                                                                         
POSITION STATEMENT:  Testified on HB 298.                                                                                       
JULIE BURNS                                                                                                                     
8800 Glacier Highway, Number 119                                                                                                
Juneau, Alaska 99801                                                                                                            
POSITION STATEMENT:  Testified on HB 298.                                                                                       
CHRIS HOLZWORTH                                                                                                                 
8800 Glacier Highway, Number 119                                                                                                
Juneau, Alaska 99801                                                                                                            
POSITION STATEMENT:  Testified on HB 298.                                                                                       
GORDON EVANS, Lobbyist for the                                                                                                  
   Health Insurance Association of America                                                                                      
211 Fourth Street, Suite 305                                                                                                    
Juneau, Alaska 99801                                                                                                            
POSITION STATEMENT:  Testified on HB 298 and offered amendment;                                                                 
testified on HB 416.                                                                                                            
BOB LOHR, Director                                                                                                              
Division of Insurance                                                                                                           
Department of Community and Economic Development                                                                                
P.O. Box 110805                                                                                                                 
Juneau, Alaska 99811-0805                                                                                                       
POSITION STATEMENT:  Testified on HB 298.                                                                                       
ALISON ELGEE, Commissioner                                                                                                      
Department of Administration                                                                                                    
P.O. Box 110200                                                                                                                 
Juneau, Alaska 99811-0200                                                                                                       
POSITION STATEMENT:  Testified on HB 345, Version G.                                                                            
DON ETHERIDGE, Lobbyist for                                                                                                     
   Alaska State AFL-CIO                                                                                                         
710 West Ninth Street                                                                                                           
Juneau, Alaska 99801                                                                                                            
POSITION STATEMENT:  Testified on HB 345, Version G.                                                                            
REPRESENTATIVE FRED DYSON                                                                                                       
Alaska State Legislature                                                                                                        
Capitol Building, Room 104                                                                                                      
Juneau, Alaska  99801                                                                                                           
POSITION STATEMENT:  Testified as sponsor of HB 416.                                                                            
MICHAEL H. MILLER                                                                                                               
6737 Gray Street                                                                                                                
Juneau, Alaska 99801                                                                                                            
POSITION STATEMENT:  Testified on HB 416.                                                                                       
SUSANNE OSBORN                                                                                                                
P.O. Box 878408                                                                                                                 
Wasilla, Alaska 99687                                                                                                           
POSITION STATEMENT:  Testified on HB 419.                                                                                       
ACTION NARRATIVE                                                                                                                
TAPE 00-29, SIDE A                                                                                                              
Number 0001                                                                                                                     
CHAIRMAN  NORMAN ROKEBERG  called  the House  Labor and  Commerce                                                               
Standing  Committee  meeting  to  order at  3:25  p.m.    Members                                                               
present  at  the call  to  order  were Representatives  Rokeberg,                                                               
Halcro,  Murkowski, Brice  and Cissna.   Representatives  Sanders                                                               
and Harris arrived as the meeting was in progress.                                                                              
HB 298-REQUIRE HEALTH INS COVERAGE FOR DIABETES                                                                               
CHAIRMAN ROKEBERG announced the first  order of business would be                                                               
HOUSE BILL NO.  298, "An Act requiring that  health care insurers                                                               
provide  coverage  for  treatment  of  diabetes."    [Before  the                                                               
committee was CSHB 298(HES)].                                                                                                   
Number 0143                                                                                                                     
REPRESENTATIVE  LISA MURKOWSKI  came  forward to  testify as  the                                                               
sponsor of HB 298.  She stated:                                                                                                 
     Thanks for  hearing HB  298.   It is  an Act  that will                                                                    
     require health  care insurers  to provide  coverage for                                                                    
     treatment   of   diabetes   and   this   includes   the                                                                    
     educational  component,  diabetes  equipment,  supplies                                                                    
     and, as I said, training and education.                                                                                    
     The issue of diabetes in the  state of Alaska is one of                                                                    
     some consequence.  There are  over 30,000 Alaskans that                                                                    
     have diabetes.   This is  one of those  just practical,                                                                    
     makes-good-sense issues  that if  you control  and work                                                                    
     with the disease, through  education and through proper                                                                    
     maintenance,  basically  you  can stave  off  the  ugly                                                                    
     side-effects, the  bad things that can  happen that are                                                                    
     associated with  diabetes such  as liver  disease, such                                                                    
     as  blindness, amputation.   Those  are the  real, very                                                                    
     costly, very difficult things  that are associated with                                                                    
     diabetes.   And,  as I  say, with  diabetes, if  one is                                                                    
     able  to, [you]  can  get yourself  into a  maintenance                                                                    
     situation  with   it,  you   can  lead   a  productive,                                                                    
     relatively  healthy  lifestyle   without  some  of  the                                                                    
     major,  major   complications  that  are   often  times                                                                    
     associated with it.                                                                                                        
     When  this  bill was  presented  in  the HESS  [Health,                                                                    
     Education  and  Social  Services]  Committee,  we  just                                                                    
     dealt  with the  mandate issue  head on,  and I'm  sure                                                                    
     that because this is the  Labor and Commerce Committee,                                                                    
     that's  going  to  be  the  issue here.    Why  are  we                                                                    
     mandating it?   Why  is it  necessary that  we mandate?                                                                    
     And the response  that I have to that  is sometimes you                                                                    
     just need a  little kick in the pants  to be encouraged                                                                    
     to do the right thing.                                                                                                     
     We, as a state, have chosen  to do the right thing when                                                                    
     it  comes  to  mammograms   for  women,  breast  cancer                                                                    
     screening, and  prostate screening.   We've got  a bill                                                                    
     on that  coming up  this afternoon.   It's  makes good,                                                                    
     sound,  fiscal  sense  to require  that  the  insurance                                                                    
     companies cover  it up front.   It may be one  of those                                                                    
     where the up-front  costs may be minimal,  but when you                                                                    
     look  at the  long-range aspects  of the  disease, it's                                                                    
     well worth the investment up front.                                                                                        
Number 0361                                                                                                                     
CHAIRMAN  ROKEBERG  commented  that  he and  the  committee  have                                                               
worked diligently  to try  and provide  the most  affordable, and                                                               
the best quality  health care and health insurance  in the state.                                                               
One  of the  biggest problems  in Alaska,  even though  there are                                                               
approximately 130 to  150 registered health insurers,  is this is                                                               
a market  where as few  as eight companies  actually participate.                                                               
He indicated there  is one company that has more  than 50 percent                                                               
of the  business in  Alaska.  In  addition, the  committee passed                                                               
legislation last  year to  mandate the  Division of  Insurance to                                                               
determine  the  number of  people  in  Alaska who  are  non-ERISA                                                               
[Employee Retirement Income Security Act] covered lives.                                                                        
CHAIRMAN ROKEBERG said that under  federal law, the ERISA pension                                                               
plan exempts  individuals who are  self-insured or  covered under                                                               
large  group   plans  from   regulation  by   state  governments.                                                               
Therefore,  they  are  exempt  from any  State  mandates  or  any                                                               
actions  of  the Legislature.    There  is an  estimated  155,000                                                               
people who  are covered as  individuals or small-group  plans, or                                                               
under  non-ERISA  plans.   Approximately  24  percent  of  Alaska                                                               
residents would be affected by  any mandate.  Enforcing a mandate                                                               
could result in shifting costs  to individuals that are non-ERISA                                                               
covered.  He said  it is a matter of fairness and  cost.  He also                                                               
pointed  out  that  by  enacting   mandates,  states  may  create                                                               
barriers  for the  entry of  new insurance  companies to  provide                                                               
service in Alaska.   A cost-benefit analysis needs to  be done to                                                               
determine  whether or  not the  insurance  industry is  currently                                                               
providing this service and can do so in a cost-effective manner.                                                                
Number 0599                                                                                                                     
RICK MYSTROM,  Mayor of  Anchorage, testified  via teleconference                                                               
from Anchorage.  He stated:                                                                                                     
     I am a  Type I juvenile diabetic.  I  have had diabetes                                                                    
     now for 38 years and,  essentially, I think most of you                                                                    
     know,  it's  a  disease  in which  the  pancreas  stops                                                                    
     producing  insulin and,  therefore,  diabetics who  are                                                                    
     juvenile diabetics have to put  in their own insulin on                                                                    
     a daily basis,  sometimes two, three times a  day or be                                                                    
     on a pump like I do.                                                                                                       
     We have to continually try  to match the amount of food                                                                    
     we take in;  the different types of  food, whether it's                                                                    
     protein,  carbohydrates or  fats,  match the  calories,                                                                    
     and, therefore,  keep our blood sugar  at an acceptable                                                                    
     level...Now,  if  we are  unsuccessful  at  it, and  if                                                                    
     blood  sugars are  continually too  high, within  about                                                                    
     five  years or  so, some  very debilitating  issues can                                                                    
     come  about   especially  kidney   failure,  blindness,                                                                    
     circulatory  problems,  amputation  of legs  and  other                                                                    
     obviously debilitating results.                                                                                            
Number 0698                                                                                                                     
     On the other  hand, if your blood sugar is  too low, if                                                                    
     you fail  on the other  end and give yourself  too much                                                                    
     insulin, you'll  end up having seizures,  insulin shock                                                                    
     and other  things that can indeed  be life threatening.                                                                    
     During the  course of the  38 years I've  had diabetes,                                                                    
     I've probably  had five or  six or seven  seizures that                                                                    
     have resulted from  low blood sugar on that  end.  I've                                                                    
     been  very successful  with managing  my diabetes...I'm                                                                    
     55 years old  and have no [degenerative]  signs at all;                                                                    
     no  kidney problems,  no eye  problems, no  circulatory                                                                    
     problems at  all, and the  reason is because  I've been                                                                    
     able to do  it and manage it well with  my insulin pump                                                                    
     which  I've had  since 1981...and  by testing  my blood                                                                    
     about  10 times  a  day.   So,  I  have blood  testers,                                                                    
     Glucoscans in my case.  I  have one in each bathroom at                                                                    
     our house.   I have one  in my bathroom in  the office.                                                                    
     I have one  in a wallet that I keep  with me during the                                                                    
     course of the day.                                                                                                         
     Now, whenever  I'm traveling, I  have it so I  can test                                                                    
     it about  eight or 10  times a  day.  That's  more than                                                                    
     most  people  have, but...if  I  didn't  test my  blood                                                                    
     sugar,  and  these  are not  extraordinarily  expensive                                                                    
     items, but  they do cost  around $70, $80, $90,  $100 a                                                                    
     piece, and to  buy the test strips  is quite expensive,                                                                    
     and if  I didn't do that,  I would have spent  a lot of                                                                    
     time  at  the  hospital.   I  certainly  would  not  be                                                                    
     productive.  I may not be  healthy. I may not be alive.                                                                    
     For better or  worse, I wouldn't be  mayor of Anchorage                                                                    
     now.  There's  some of you who may cheer  that,  others                                                                    
     may not.                                                                                                                   
     In  all  seriousness,  if  you   can  keep  a  positive                                                                    
     attitude and  if you have  the tools to monitor  it and                                                                    
     keep  your blood  sugars  in control,  you  can live  a                                                                    
     healthy  lifestyle  and  ultimately  save  hundreds  of                                                                    
     thousands of  dollars, millions of dollars  in hospital                                                                    
     care in the long run, and  that really gives a person a                                                                    
     great  opportunity  for  a  good  lifestyle.    Without                                                                    
     insurance,  the management  of my  diabetes, as  I have                                                                    
     managed  it  over  the  past  20  or  30  years,  would                                                                    
     probably cost...$500 a  month or so just  to manage it,                                                                    
     not dealing  with any  negative consequences,  but just                                                                    
     to manage it.                                                                                                              
     That's  the kind  of money  that would  discourage most                                                                    
     people from  that good  education and  management care.                                                                    
     The insurance  that I've had  has kept me  healthy and,                                                                    
     quite frankly,  is probably going  to save my life.   I                                                                    
     really encourage this.   It can make  a huge difference                                                                    
     in  the  quality  of lives  of  diabetics  and  provide                                                                    
     healthy, productive people as  citizens of Alaska.  So,                                                                    
     I  would  really  encourage  it.    I  appreciate  your                                                                    
     initiative on this and certainly do support it.                                                                            
Number 0957                                                                                                                     
MICHELLE   CASSANO,   Executive   Director,   American   Diabetes                                                               
Association [ADA], came forward to testify on HB 298.  She said:                                                                
     Everyone on this committee has  been more than diligent                                                                    
     in  learning  what  diabetes   is,  the  statistics  of                                                                    
     diabetes,  the cost  of diabetes  and what  the savings                                                                    
     potentially can be for diabetes  by the passage of this                                                                    
     bill.   Today I'd  like to  be here  as a  resource for                                                                    
     this committee for questions [and]  just to make a very                                                                    
     few points as to  how important the education component                                                                    
     of this  bill is.   The cost  will vary  per individual                                                                    
     and we  at the ADA  feel there  is no need  to restrict                                                                    
     people from their education.                                                                                               
     There are standards  as to what they  have done studies                                                                    
     on   as to  how much  education will  help lead  to the                                                                    
     results of  studies such as the  Diabetes Complications                                                                    
     and Control  Trial [DCCT]  and the  UK Study  which has                                                                    
     shown that when  people are in good  control with self-                                                                    
     management,  they   stave  off  the   complications  of                                                                    
     stroke,   blindness,  amputations   and   such  by   an                                                                    
     aggregate  of  almost  58  percent  and  that's  not  a                                                                    
     percentage  of good  health care  that can  be ignored.                                                                    
     Diabetes,  for those  of  you  who do  not  know, is  a                                                                    
     disease  that has  no cure,  and people  who live  with                                                                    
     diabetes never get to take a day off.                                                                                      
     This is not  an unusual legislation.  As  of this week,                                                                    
     we  are   now  up  to   38  states  that   have  passed                                                                    
     legislation.    And  just  this   week,  the  state  of                                                                    
     Washington  repealed  the  sunset  clause  after  three                                                                    
     years unanimously  in both their House  and Senate with                                                                    
     no  opposition from  any industry.   This  is important                                                                    
     because very  few consumers actually get  the chance to                                                                    
     make a choice on what their coverage is.                                                                                   
     It's very often a human  resource issue, and so we have                                                                    
     done  studies and  have  gotten  some information  from                                                                    
     other  agencies like  American Association  of Diabetes                                                                    
     Educators,  the American  Dietetic  Association.   They                                                                    
     seem to think  there's less than a  1 percent aggregate                                                                    
     increase  in  insurance  premiums.   In  the  state  of                                                                    
     Maine, they  applied these standards to  their Medicare                                                                    
     population and the savings were  over $3,000 per person                                                                    
     in the  very first year.   So, when you get  beyond the                                                                    
     quality of  life which  is important to  all of  us who                                                                    
     help treat  people with diabetes,  there are  some real                                                                    
     economic standards that work in this field.                                                                                
Number 1130                                                                                                                     
REPRESENTATIVE MURKOWSKI  referred to Washington's repeal  of the                                                               
sunset  date  and  wondered  if there  are  any  statistics  with                                                               
respect  to   a  noticeable  increase  in   insurance  costs  and                                                               
MS.  CASSANO  replied  that  only   New  Hampshire  has  recently                                                               
commissioned a  study regarding this.   The savings have  been so                                                               
obvious  that there  have been  no requests  for studies  in this                                                               
field either by hospitals or the insurance industry.  She said:                                                                 
     In  terms of  Washington  State  statistics, we  pretty                                                                    
     much have what the  Milliman [& Robertson] study shows,                                                                    
     and  I  think  Shan  [Shan Han,  Legislative  Staff  to                                                                    
     Representative Murkowski] has a  study that was done by                                                                    
     Doctor  Robert  Mecklenberg,   who  actually  comes  to                                                                    
     Juneau  to conduct  an  endocrinology  clinic and  they                                                                    
     happen to  call theirs the Diabetes  Cost Reduction Act                                                                    
     for Washington,  but that  plan has  been in  place for                                                                    
     three years, it had a  sunset clause, they went back to                                                                    
     repeal it this year, and  it passed unanimously in both                                                                    
     houses and had no opposition.                                                                                              
Number 1200                                                                                                                     
CHAIRMAN ROKEBERG asked if Blue Cross of Alaska covers this.                                                                    
MS.  CASSANO replied  that  it is  pertinent  to each  individual                                                               
plan.   She said  the insurers  are not being  asked to  impose a                                                               
particular component  to a  plan to cover  items that  are deemed                                                               
necessary to  self-management of  care.   She anticipates  HB 298                                                               
would  affect  about 30  percent  of  insurance policies  because                                                               
state and  municipal policies  do cover  these items  quite well.                                                               
She commented:                                                                                                                  
     We often  see this kick  up with federal  employees the                                                                    
     first  of every  year.    They get  to  bid and  change                                                                    
     carriers  and,  inevitably,  a  carrier  who  may  have                                                                    
     covered something  one year, if  it's a new  person and                                                                    
     their plan, we'll have to  stomp our foot a little bit,                                                                    
     but  we  not  only  want good  insurance  coverage  for                                                                    
     today, but we  want good insurance and  good health for                                                                    
     Alaskans for the future.                                                                                                   
Number 1277                                                                                                                     
DONALD NOVOTNEY came forward to testify on HB 298.  He stated:                                                                  
     I am  a person with  diabetes.  I'm a  registered nurse                                                                    
     and  I'm chair-elect  for the  Alaska Affiliate  of the                                                                    
     American Diabetes  Association.   I sit on  the Pacific                                                                    
     Northwest Board  of the American  Diabetes Association.                                                                    
     Thank you,  Chairman, for allowing  me to speak.   I've                                                                    
     had diabetes  since 1979.   I  was discharged  from the                                                                    
     service because  they said I  wasn't fit for  duty, got                                                                    
     out, went to  school, and I've been  working since 1983                                                                    
     as a  registered nurse.   I've not  missed any  days of                                                                    
     work because  of my diabetes.   I keep it in  very good                                                                    
     control.   I  had a  nurse when  I first  was diagnosed                                                                    
     that spent time with me  and helped [me] to learn about                                                                    
     the disease  and to control  it.   And I thank  her for                                                                    
     that education she gave me.                                                                                                
     And "Intense Management"  by Harris (ph) in  1995, in a                                                                    
     published study  on health  insurance and  diabetes and                                                                    
     diabetes  in America,  found  intensive management  and                                                                    
     education  reduce the  cost of  diabetes care  and keep                                                                    
     workers  in the  workplace for  many more  years.   And                                                                    
     since  we  have  small  business in  Alaska,  I'm  also                                                                    
     concerned about  that.   If one  person is  sick, who's                                                                    
     coming in?  They're going  to call the boss, the owner.                                                                    
     They're going to come in and work.                                                                                         
     And people  with diabetes  don't want  to be  a burden.                                                                    
     They want  to get  out there  and work.   They  want to                                                                    
     benefit  our  society.   And  if  they don't  have  the                                                                    
     insurance, they're  going to be  a burden on  the State                                                                    
     of Alaska.   If you don't make enough  money, the state                                                                    
     covers it.   If  you're 65,  the state  covers it.   We                                                                    
     expect  the  same  from our  private  insurers  in  the                                                                    
CHAIRMAN ROKEBERG asked why the  state covers those over 65 years                                                               
of age.                                                                                                                         
MR. NOVOTNEY  explained that he  is referring to  Medicare, which                                                               
provides coverage for  those people 65 years and older.   He said                                                               
Medicaid also provides coverage for diabetes.                                                                                   
CHAIRMAN ROKEBERG asked, "So, Medicare does provide [coverage]?"                                                                
MR. NOVOTNEY  indicated that if  a person  is 65 years  or older,                                                               
then  Medicare   will  pay  for   insulin,  test   equipment  and                                                               
education.  They will also  pay for a continuous insulin infusion                                                               
pump which mimics the pancreas.                                                                                                 
CHAIRMAN ROKEBERG asked  if the insulin pump is the  type of item                                                               
Medicare would fully reimburse for.                                                                                             
MR.  NOVOTNEY  replied, "Usual,  customary,  and  that's what  we                                                               
would like from the private insurers."                                                                                          
Number 1452                                                                                                                     
KATHY JACQUES, Registered Nurse  and Certified Diabetes Educator,                                                               
testified via teleconference from Anchorage.  She said:                                                                         
     I want to  thank you, Mr. Chairman.  And  I'd also like                                                                    
     to  thank Representative  Murkowski  for sponsoring  HB                                                                    
     298.   I  am  a  registered nurse  and  I  have been  a                                                                    
     certified  diabetes   educator  for   14  years.     My                                                                    
     grandfather died  from complications  of diabetes.   My                                                                    
     mother  has   diabetes.     She  takes   three  insulin                                                                    
     injections  and four  to six  blood sugars  a day  and,                                                                    
     after 15  years and  a lot  of perseverance,  my mother                                                                    
     has  no  serious  complications  and  she  credits  the                                                                    
     education and support that I've been able to provide.                                                                      
     At  this time,  38 states  require health  insurance to                                                                    
     directly   reimburse   diabetes  out-patients'   health                                                                    
     management training.  Diabetes  is the leading cause of                                                                    
     kidney   failure,   blindness,   nerve   damage,   limb                                                                    
     amputation,  and diabetes  is also  a leading  cause of                                                                    
     heart disease  and stroke.   And when an  individual in                                                                    
     Alaska dies  from complications of diabetes,  the cause                                                                    
     of death is  usually listed as a fatal  heart attack or                                                                    
     stroke  or  kidney  failure  and,  therefore,  the  lay                                                                    
     population,  mostly,   misunderstands  the   impact  of                                                                    
     diabetes.   Our government  spends billions  of dollars                                                                    
     on no-smoking programs,  cholesterol and blood pressure                                                                    
     lowering  programs, all  to reduce  the  risk of  blood                                                                    
     vessel  damage.   Diabetes management  and training  is                                                                    
     all about blood vessel preservation.                                                                                       
Number 1524                                                                                                                     
     No one  expects a person to  know how to build  a house                                                                    
     or use  a computer without  supplies and training.   We                                                                    
     must not  expect someone  who has  just been  told that                                                                    
     they have  diabetes to  be able  to control  it without                                                                    
     education and  supplies.  If diabetes  isn't controlled                                                                    
     and the  individual is  often labeled  non-compliant --                                                                    
     this usually happens  because a lack of  knowledge or a                                                                    
     lack  of understanding  --  does  this individual  know                                                                    
     that  all  types  of diabetes  are  serious?  Does  the                                                                    
     person know that they have  a lot of control over their                                                                    
     disease  or did  they watch  a loved  one die  young or                                                                    
     lose limb  after limb and  assume they best live  it up                                                                    
     now because the same fate awaits them?                                                                                     
     I have  seen hundreds  of people  with diabetes  in the                                                                    
     last 14  years.  A  person who  is told that  they have                                                                    
     diabetes can  make many different assumptions.   First,                                                                    
     the  person may  feel fine.   They  conclude that  they                                                                    
     must not  have the  serious kind  of diabetes,  not the                                                                    
     kind that their grandmother  had because she went blind                                                                    
     and  could no  longer live  at  home and  take care  of                                                                    
     Another  person  may think  that  they  don't have  the                                                                    
     serious kind that their next  door neighbor has because                                                                    
     he  takes insulin  and  his kidneys  have  failed.   Or                                                                    
     maybe  this person  is newly  diagnosed with  diabetes.                                                                    
     He feels  horrible for months  before the  diagnosis is                                                                    
     made.   Burning  pain in  his  legs so  severe that  he                                                                    
     can't sleep  at night  for weeks or  months.   Then the                                                                    
     doctor  puts him  on a  pill  for his  diabetes and  he                                                                    
     feels like a million bucks  within a few days or weeks.                                                                    
     He thinks he's  cured and all that's  needed to control                                                                    
     his diabetes is to take  his pill everyday.  The person                                                                    
     must  get training  in management  skills  in order  to                                                                    
     learn how to maintain diabetes  control for the rest of                                                                    
     his life.                                                                                                                  
Number 1610                                                                                                                     
     There have  been three major  studies completed  in the                                                                    
     1990s  that have  overwhelmingly  proven that  diabetes                                                                    
     can  and must  be controlled.   The  reduction and  the                                                                    
     occurrence and  severity of diabetes  complications was                                                                    
     dramatic  and it  was through  access  to supplies  and                                                                    
     education and  follow-up with their diabetes  team that                                                                    
     these thousands  of people were  able to  control their                                                                    
     diabetes over the 10 and 20-year studies.                                                                                  
     The  American  Diabetes   Association  has  established                                                                    
     quality standards of care and  education for all people                                                                    
     with diabetes...People  need to know how  to take their                                                                    
     medication   properly,  how   to  take   their  insulin                                                                    
     properly  and how  to  adjust the  insulin  on a  daily                                                                    
     base.   They need to  learn how to  prevent dangerously                                                                    
     low  blood sugar  spells,  how to  do  the blood  sugar                                                                    
     monitoring and  how to use that  information to control                                                                    
     their diabetes everyday.   Medical nutrition therapy is                                                                    
     also  crucial because  nutrition is  the foundation  of                                                                    
     blood sugar control.                                                                                                       
     We teach  foot exams  to prevent  amputation, pregnancy                                                                    
     and  pre-pregnancy recommendations.   If  a woman  with                                                                    
     diabetes   has  no   diabetic  complications   and  has                                                                    
     excellent  blood   sugar  control  at   conception  and                                                                    
     throughout  her  pregnancy,  she  can  have  a  healthy                                                                    
     pregnancy  and baby.   Often  our patients  arrive with                                                                    
     much  fear  and  anxiety.    It is  our  job  to  offer                                                                    
     (indisc.)  and current,  accurate  information.   Often                                                                    
     people  are  filled   with  misinformation  from  well-                                                                    
     meaning friends and relatives.                                                                                             
     I'd just like to say that  I think we should be able to                                                                    
     share  the  information  that  we  have  available  for                                                                    
     everybody with  diabetes, that  all people  should have                                                                    
     access and that  we can teach them to  live healthy and                                                                    
     live well  and that they  should not have  to sacrifice                                                                    
     the kind of  life that they want to  enjoy or sacrifice                                                                    
     good blood sugar control.                                                                                                  
Number 1714                                                                                                                     
JANEL WRIGHT testified via teleconference from Anchorage.  She                                                                  
     I am  one of  30,000 Alaskans  with diabetes,  and I've                                                                    
     had  Type I  insulin-dependent diabetes  for 25  years.                                                                    
     Thank   you  for   considering   this  very   important                                                                    
     legislation.   I  am here  today to  share my  personal                                                                    
     experience and  ask that each  of you  support diabetes                                                                    
     insurance reform in Alaska.                                                                                                
     The  importance of  this bill  is that  it will  ensure                                                                    
     that   Alaskans   have   access  to   the   medication,                                                                    
     equipment,  supplies and  education that  are necessary                                                                    
     to  treat  and control  diabetes.    With such  access,                                                                    
     diabetes can  be self-managed and the  complications of                                                                    
     diabetes very  minimized, consequently  reducing health                                                                    
     care costs.  To illustrate  the importance of access to                                                                    
     effective  treatment for  diabetes,  I'll  tell you  my                                                                    
     Before  obtaining insurance  that  covers  the cost  of                                                                    
     treatment  of diabetes,  my life  with diabetes  was an                                                                    
     absolute  nightmare.    I was  nearly  sent  home  from                                                                    
     college due  to uncontrolled  diabetes and  still bound                                                                    
     and determined  to get  my education,  after graduating                                                                    
     from  college, went  on to  law school.   While  at law                                                                    
     school, I could  not see the board and  requested to be                                                                    
     moved  to  the  front  of the  class  which  was  quite                                                                    
     unusual.   When that  didn't help,  I finally  went and                                                                    
     got glasses.   My  vision was  severely impaired.   Law                                                                    
     school was very  stressful and I did not  know from one                                                                    
     day to the  next what would happen with  my diabetes or                                                                    
     my blood  sugar.   The insurance plan  I was  under did                                                                    
     not  cover   the  cost  of  syringes,   of  blood  test                                                                    
     machines, test  strips or education.   It  covered only                                                                    
     the  costs  of  insulin.    Being  a  poor  law  school                                                                    
     student, I scraped together funds  to buy syringes so I                                                                    
     could  inject  the  insulin  upon  which  my  existence                                                                    
     depended.   The  cost  of a  blood  test machine,  test                                                                    
     strips  and  patient  education   were  not  within  my                                                                    
Number 1793                                                                                                                     
     I moved  to Alaska in  1988.   At that time,  I finally                                                                    
     had  insurance  coverage  that  funded  my  blood  test                                                                    
     machine,  test strips,  patient education  and it  also                                                                    
     covered  an insulin  pump and  supplies  that go  along                                                                    
     with the  pump.  There's  a test called  Hemoglobin A1C                                                                    
     [HgA1C] and the results of  this test show how well one                                                                    
     controls  their blood  sugar  over  the previous  three                                                                    
     months.    Ideally,  I  aim to  keep  my  blood  sugars                                                                    
     between  90 and  120.   My first  Hemoglobin A1C  after                                                                    
     coming to  Alaska was  8.5.  This  meant that  my blood                                                                    
     sugars were  usually 250 or  above.  Studies  have been                                                                    
     shown that when blood sugars  are this high, the costly                                                                    
     complications of  diabetes such  as impaired  vision or                                                                    
     blindness,  nerve damage,  kidney disease,  amputation,                                                                    
     heart  disease  and  stroke are  much  more  likely  to                                                                    
     Recently, at the beginning of  February, I received the                                                                    
     results of my  latest Hemoglobin A1C which  is now 5.4.                                                                    
     This means  that my blood  sugar average over  the past                                                                    
     three  months  was 94.    I  attribute this  to  having                                                                    
     insurance   coverage  that   allows  access   to  those                                                                    
     supplies  necessary  to  control  my diabetes.    I  no                                                                    
     longer  need  glasses.     With  improved  blood  sugar                                                                    
     control, my vision impairment is gone.                                                                                     
     Chairman  Rokeberg  asked  if   the  mandate  is  cost-                                                                    
     effective.   As you've  learned, 38 states  have passed                                                                    
     similar legislation and studies  from these states have                                                                    
     shown that  good blood  glucose control  resulting from                                                                    
     insurance  coverage  has reduced  hospitalizations  and                                                                    
     (indisc.) by 32 percent,  50 percent lower frequency in                                                                    
     emergency   room  visits   in   Maryland,  63   percent                                                                    
     reduction in emergency room visits  in Rhode Island and                                                                    
     a cost  savings of  approximately $917 per  patient per                                                                    
     year.  I  urge you to help Alaskans  with diabetes lead                                                                    
     healthier and more productive  lives by supporting this                                                                    
Number 1900                                                                                                                     
YOUNG  SHIN, Registered  Dietician, testified  via teleconference                                                               
from Anchorage.   She specializes  in diabetes education  and has                                                               
been involved  in this type of  education since the first  day of                                                               
her clinical practice.  She explained:                                                                                          
     Diabetes mellitus is a  costly and devastating disease.                                                                    
     Medical   nutrition   therapy,   the   cornerstone   of                                                                    
     treatment,  can  prevent  or   postpone  the  onset  or                                                                    
     decrease  the incidence  of costly  implications.   The                                                                    
     Diabetes  Control  and  Complications Trial,  known  as                                                                    
     DCCT, a  multi-center 10-year study of  Type I diabetes                                                                    
     mellitus,  demonstrated that  optimal glycemic  control                                                                    
     reduced  the  risk  of  diabetes  complications  by  60                                                                    
     percent.   Registered  Dietitians, key  members of  the                                                                    
     DCCT diabetes  management teams, were able  to identify                                                                    
     and promote  specific diet related  behavior associated                                                                    
     with improved glycemic control.                                                                                            
     Also,  there  was a  study  conducted  in 1994  by  the                                                                    
     International    Diabetes   Center    in   Minneapolis,                                                                    
     Minnesota for The  American Dietetic Association showed                                                                    
     that persons  with Type II diabetes  can better control                                                                    
     their  blood  glucose  levels, weight  and  cholesterol                                                                    
     with medical nutrition  therapy.  At all  phases of the                                                                    
     six-month study, medical  nutrition therapy provided by                                                                    
     a  Registered  Dietitian  resulted in  improvements  in                                                                    
     patient's  fasting plasma  glucose  [FPG] and  glycated                                                                    
     hemoglobin  A1C levels  compared to  the levels  at the                                                                    
     onset of the study.                                                                                                        
     Medical  nutrition therapy  is  a  cornerstone of  self                                                                    
     management   training   and    has   been   proven   to                                                                    
     significantly save  health care  costs by  reducing the                                                                    
     incidence  of complications  including lower  extremity                                                                    
     amputations, kidney  failure, blindness,  heart attacks                                                                    
     and frequent hospitalization.   An internal analysis of                                                                    
     nearly 2,400  cases studies  submitted by  The American                                                                    
     Dietetic Association  members shows that an  average of                                                                    
     more  than $9,000  per  case  can be  saved  in Type  I                                                                    
     diabetes   cases   with   intervention   and   diabetes                                                                    
     education,  as  well   as  medical  nutrition  therapy.                                                                    
     Intervention in  Type II diabetes cases  showed savings                                                                    
     of nearly $2,000 per case.                                                                                                 
     Medical nutrition  therapy plays  an important  role in                                                                    
     multi-disciplinary teams  helping people  with diabetes                                                                    
     self-manage  their disease  and  lead  a quality  life.                                                                    
     Quality,  comprehensive,  multi-disciplinary  education                                                                    
     in  the  early  stages   of  diabetes  is  a  necessary                                                                    
     investment  to prevent  costly  complications that  are                                                                    
     unavoidable     without  this  investment.     From  my                                                                    
     experience  with   many  who  do  not   have  insurance                                                                    
     coverage,  they  are  less  likely  to  come  back  for                                                                    
     further education  and follow-ups  and most of  them do                                                                    
     not succeed  in the long  run, but those who  have [an]                                                                    
     education   component   covered  by   their   insurance                                                                    
     companies  tend to  have  more  significant success  in                                                                    
     managing their diabetes.  Thank you for your time.                                                                         
Number 2024                                                                                                                     
CHAIRMAN  ROKEBERG asked  what the  normal cost  of the  diabetes                                                               
education program is.   He wondered if the  cost varies depending                                                               
on the individual.                                                                                                              
MS.  SHIN  said  the  cost  depends on  the  individual  and  the                                                               
facility attended.  Some individuals  may only require one or two                                                               
visits.   Other  individuals may  require more  education due  to                                                               
barriers such  as language  or ability  to learn.   There  are no                                                               
cases which show an abuse of  this education system.  The typical                                                               
cost per one-to-two-hour  session is $70 to $100.   The cost also                                                               
depends  on who  is  providing  the education,  whether  it is  a                                                               
Registered  Dietitian   or  a  Diabetes  Educator.     There  are                                                               
comprehensive, hospital-based programs  which meet the guidelines                                                               
set by  The American  Diabetes Association.   The cost  for these                                                               
programs varies.                                                                                                                
CHAIRMAN ROKEBERG  wondered how long a  typical education session                                                               
for a patient would last and how much the cost would be.                                                                        
MS. SHIN replied that the  education would require between six to                                                               
15 hours.   She reiterated the  cost would vary depending  on the                                                               
CHAIRMAN  ROKEBERG speculated  that  the cost  could be  anywhere                                                               
between $500 to $2,000 for education.                                                                                           
MS. SHIN agreed.                                                                                                                
Number 2144                                                                                                                     
JULIE BURNS came  forward to testify on HB 298.   She stated that                                                               
her 17-year-old  son has had  diabetes and was diagnosed  with it                                                               
six years  ago.  She  referred to Ms. Shin's  testimony regarding                                                               
education.  She added that  education is not necessarily required                                                               
every  year.   A diabetic  might meet  the maximum  for education                                                               
right away or may  go five or six years with only  an hour or two                                                               
of education every year.                                                                                                        
CHAIRMAN  ROKEBERG asked,  "Why  would you  do  that, changes  in                                                               
technology or health, or what?"                                                                                                 
MS.  BURNS  said, "Definitely,  change  in  technology.   They're                                                               
getting better  all the time.  ... As  time goes by,  you change,                                                               
your  body  changes  and  how  you use  your  insulin...."    She                                                               
indicated she has been lucky  enough to have health insurance for                                                               
her son.   She said  most insurers do  not have a  problem paying                                                               
for  insulin  because it  is  an  absolute  necessity.   She  has                                                               
encountered  problems obtaining  coverage  for all  of the  other                                                               
accessories.  She stated:                                                                                                       
     The test  strips, ... those  are like 75  cents apiece,                                                                    
     and you  can either test once  or twice a day  or seven                                                                    
     or  eight times  a day,  depending on  what you're  at.                                                                    
     And  the  more  you  test, then  obviously  the  better                                                                    
     control   that   you're    in   [of]   your   diabetes.                                                                    
     Syringes,... a  lot of times  they're covered,  but you                                                                    
     pay  for them  in advance  and  then you  send all  the                                                                    
     information into your health  insurance which is mounds                                                                    
     and mounds  and mounds  of paperwork.   Then  you might                                                                    
     get  reimbursed or  they might  think  that, you  know,                                                                    
     from  the  last time  you  sent  in for  reimbursement,                                                                    
     you've  used  too  many  insulin  strips  or  too  many                                                                    
     syringes  and they'll  only pay  you back  for part  of                                                                    
     In fact [in] December,  Christopher, my 17-year-old, he                                                                    
     just got a  new insulin pump, and so  when were getting                                                                    
     that, I  went out  and I  got him a  bunch of  new test                                                                    
     strips, you know,  got him set up on  his supplies, and                                                                    
     I spent $140 just before  Christmas.  Just on Monday, I                                                                    
     received a check from my  insurance company for $70....                                                                    
     That's half  of what I  paid....  I'm  not complaining,                                                                    
     but  I'm lucky  in that  aspect:   I did  get something                                                                    
     But the  hard part of  that ... is  that I have  a ten-                                                                    
     year-old daughter and, of  course, everybody's tight on                                                                    
     money,  especially if  you're a  single parent.  ... My                                                                    
     daughter she's  been really good about  things, but you                                                                    
     have to  kind of  sit back  and look  at her  and laugh                                                                    
     because,  you know,  you say,  "Money's tight,  money's                                                                    
     tight.  You can't have this.   No, you can't have a new                                                                    
     bike.   No, you  can't go  to the  movies."   And, but,                                                                    
     yet, at the exact same  moment or five minutes [later],                                                                    
     you're  writing  a  check  out  for  $150  for  insulin                                                                    
     supplies. ...                                                                                                              
     You and  I understand that  there's nothing you  can do                                                                    
     about it, you have to do  that, but to a four- or five-                                                                    
     or six-year old that just wants  to go to the movies or                                                                    
     just wants a  new bike, "My big  brother's getting, not                                                                    
     only is he getting to do  the same things I am, but mom                                                                    
     just spent  $150 on him  and I didn't get  anything out                                                                    
     of this."   Granted,  she understands now,  but several                                                                    
     years ago  she didn't.   And  I think  that's something                                                                    
     that  a lot  of people  don't  think about.   It's  the                                                                    
     money  out of  the pocket  that's constant.   It  never                                                                    
     goes away.                                                                                                                 
MS.  BURNS continued,  saying her  son  is getting  to the  point                                                               
where he is  going to have to  worry about what kind of  a job he                                                               
gets in  order to have  insurance.  She  stressed that he  has to                                                               
pick his  profession based  on the  amount of  insurance offered.                                                               
She   pointed out that  small businesses  many times do  not have                                                               
good  enough insurance  coverage.   She does  not think  a person                                                               
should pay  for everything he  needs for his diabetes  because it                                                               
is something that he  has to live with.  She it  would be nice to                                                               
have  someone  to  help  and  someone to  provide  him  with  the                                                               
necessary  education.   She sees  a difference  in her  son since                                                               
Christmas.  His  moods have changed and his blood  sugar is under                                                               
better control.  She attributes much  of this to the education he                                                               
Number 2398                                                                                                                     
REPRESENTATIVE  HALCRO  said  he   thinks  Ms.  Burns'  testimony                                                               
highlights the difficult position of  dealing with these types of                                                               
health  mandates.   He referred  to  her comment  that her  son's                                                               
employment will  be dictated  by the type  of health  coverage he                                                               
can  obtain.   This  might automatically  eliminate some  options                                                               
with  small businesses.   He  said this  is really  a problem  in                                                               
Alaska because  86 percent  of the  businesses are  classified as                                                               
small businesses with of 20 or fewer employees.  He stated:                                                                     
     We  have heard  some very  positive statistics  earlier                                                                    
     about how this has actually  helped save costs which is                                                                    
     very  positive, but  I think  you,  in your  testimony,                                                                    
     highlight  the problem  that we  have  when we  address                                                                    
     these   things  about   mandating  specific   coverages                                                                    
     through   health  policies   because   you  have   some                                                                    
     employers  that   are  really  struggling   to  provide                                                                    
     coverage  for  their  employees  and  you  get  into  a                                                                    
     situation  of making  exceptions for  one or  the other                                                                    
     and  then  pretty soon  at  the  end  of the  day,  the                                                                    
     employer can't  afford any  coverage, can't  afford the                                                                    
     premiums, and so  they in turn drop  their coverage and                                                                    
     aren't able to provide coverage.                                                                                           
MS. BURNS agreed.   She reiterated that education  saves way more                                                               
money than  any increase  in insurance would  ever come  close to                                                               
doing.  She spent several days  on the telephone when getting her                                                               
son's insulin pump set up.   [Some testimony was not included due                                                               
to tape change.]                                                                                                                
TAPE 00-29, SIDE B                                                                                                              
MS. BURNS  said she had  spent an  outrageous amount of  time and                                                               
effort dealing  with the insurance  company to get an  "okay" for                                                               
her son's insulin  pump.  She noted the insulin  pump has already                                                               
made a  huge difference in his  life.  She cannot  articulate how                                                               
much time and  effort they have spent  so that he can  go on with                                                               
his life.   She said he needs  to be able to lead  a normal life.                                                               
Diabetes has not stopped him from  doing anything, but it has put                                                               
a damper on  things because of the lack of  education, as well as                                                               
the financial  burden.   She pointed out  that insurers  will pay                                                               
for  her son's  education,  but education  is  something that  is                                                               
necessary for  others involved.   She said,  "I need to  have the                                                               
education  because I  need  to know  how  to cook  for  him.   My                                                               
daughter, she needs  to have the education. ...   What happens if                                                               
she comes home  from school and he's passed out  from a low blood                                                               
sugar?  She has to know what to do."                                                                                            
Number 0069                                                                                                                     
CHRIS HOLZWORTH came forward to testify on HB 298.  He developed                                                                
diabetes  about  six  years  ago.   He  slept  constantly,  drank                                                               
copious amounts of fluids and lost  almost 25 pounds in two days.                                                               
He has  spent easily three  to four  weeks in the  emergency room                                                               
over the  past seven years.   Two years ago, he  spent three days                                                               
in the  hospital as  a result  of dehydration from  the flu.   He                                                               
pointed out there are many  complications with diabetes.  Part of                                                               
the problem he attributes to lack of education.                                                                                 
MR. HOLZWORTH explained  that he was with his father  when he was                                                               
first diagnosed  with diabetes.   His father was in  the military                                                               
at the  time, and the military  was helpful and provided  both he                                                               
and his  father with  the necessary  education.   His mom  was in                                                               
Alaska during  that time and  had to  pay for her  own education.                                                               
He initially  had six  hours of education  which he  indicated is                                                               
not enough to  know how to begin  to live with diabetes.   He has                                                               
spent  much of  his own  time learning  about diabetes.   He  has                                                               
written many  reports for school  on diabetes.   He does  this to                                                               
better his own life and help inform other people.                                                                               
MR. HOLZWORTH  said when  he was  first diagnosed  with diabetes,                                                               
his hemoglobin A1C  level was over 17.  Last  year, his level was                                                               
13.9  and six  months ago  it  was 10.9.    With the  use of  his                                                               
insulin pump, his blood sugar has  been lower and he has not been                                                               
as sick.   He misses a  significant amount of school  every year.                                                               
He missed  an average of  30 days of  school last semester.   The                                                               
year  before, he  missed approximately  50  days of  school.   He                                                               
thinks HB 298  would be very helpful for himself,  his family and                                                               
his friends, in terms of education.                                                                                             
CHAIRMAN ROKEBERG asked if Mr. Holzworth plays any sports.                                                                      
MR. HOLZWORTH replied that he  played basketball as a freshmen in                                                               
high school.   Currently, he  is participating in  weight lifting                                                               
and basketball.                                                                                                                 
Number 0187                                                                                                                     
REPRESENTATIVE  HALCRO wondered  how he  manages his  diabetes at                                                               
MR.  HOLZWORTH explained  that he  has spoken  with his  teachers                                                               
about his diabetes.  He tests his own blood sugar during class.                                                                 
Number 0230                                                                                                                     
GORDON EVANS,  Lobbyist for the  Health Insurance  Association of                                                               
America (HIAA),  came forward to  testify on  HB 298.   He stated                                                               
that HIAA  is opposed  to mandates  because they  generally raise                                                               
insurance premiums  whether they are  one percent or  10 percent.                                                               
Mandates also cause  an increase in the number of  people who are                                                               
not insured because employers end  up dropping insurance coverage                                                               
on that basis.  He has looked  over the amendments to HB 298 that                                                               
Representative Murkowski is proposing to  offer.  He believes the                                                               
amendments strengthen the bill somewhat.                                                                                        
MR. EVANS indicated that the proponents  of HB 298 point out that                                                               
over 36,000 Alaskans  are affected by diabetes.   The accuracy of                                                               
this figure  is not being questioned.   However, it is  not known                                                               
how many of that number actually  would be affected by passage of                                                               
HB 298 because many may already  be covered by health plans or by                                                               
other  coverage that  this particular  mandate  would not  affect                                                               
such as  self-insured employers or  others covered by ERISA.   In                                                               
Alaska, that  includes, besides the  military, the  Native health                                                               
services,  and other  governmental  agencies, large  self-insured                                                               
employers such  as Safeway/Carrs,  BP/Amoco, the  Municipality of                                                               
Anchorage and other major oil companies.                                                                                        
MR. EVANS said even though HB  298 calls for a mandated coverage,                                                               
HIAA would  not oppose  this particular  legislation if  it would                                                               
provide  for  a temporary  cap  on  how  much  will be  paid  for                                                               
coverage   of   the   outpatient  self-management   training   or                                                               
education.  He heard the  testimony today about the importance of                                                               
education and also referred to  the testimony regarding the state                                                               
of Washington  eliminating their cap.   He is not sure  he agrees                                                               
with how  this was done.   He  thinks insurance in  Washington is                                                               
very different  than that in Alaska  and should not be  used as a                                                               
comparison of what is best for  Alaska.  In that vein, HIAA urges                                                               
the committee to consider an amendment to HB 298 which reads:                                                                   
     Page 2, line 1, insert new subsection (b) to read:                                                                         
      (b)  The amount of coverage for the cost of diabetes                                                                      
      outpatient self-management training or education is                                                                       
     limited to $1,000.00 per year.                                                                                             
     Re-letter following subsection                                                                                             
     Page 2, line 6, add new Sec. 2 to read:                                                                                    
     * Sec. 2. AS 21.42.390(b) is repealed January 1, 2004.                                                                     
MR. EVANS explained that the  amendment would place a $1,000 cap,                                                               
per person, per year, on  coverage for outpatient self-management                                                               
training or education for three  full insurance years; after that                                                               
time period,  the cap would  be repealed.   That would  give both                                                               
the health insurance industry and  proponents of this legislation                                                               
ample  time to  review actual  costs of  such coverage  over that                                                               
period  and  determine  whether the  cap  should  be  reinstated,                                                               
either in a higher or lower amount, or permanently removed.                                                                     
CHAIRMAN ROKEBERG  wondered, "Doesn't your  amendment permanently                                                               
repeal it?"                                                                                                                     
MR. EVANS responded no.  He  clarified that it does, but the idea                                                               
is that it  would then come back before the  legislature in order                                                               
to ask that it be reinstituted.                                                                                                 
CHAIRMAN ROKEBERG said, "It's a de facto sunset."                                                                               
MR. EVANS  said that is  correct.   He reiterated that  HIAA does                                                               
not  have  a  problem  with the  amendments  that  Representative                                                               
Murkowski will be proposing.                                                                                                    
CHAIRMAN  ROKEBERG  asked,  "Do  her  amendments  please  you  or                                                               
displease you, or are you neutral?"                                                                                             
MR. EVANS replied  that HIAA is neutral.  He  stated, "It's still                                                               
a  mandated  bill,  and  because  it is  a  mandate,  I  have  to                                                               
officially be against  the bill because of that.   But at least I                                                               
think that our amendment would soften the blow, so to speak."                                                                   
CHAIRMAN ROKEBERG wondered how much it would soften the blow.                                                                   
Number 0478                                                                                                                     
MR. EVANS  said if  the cost of  diabetes education  runs between                                                               
$500 and  $2,000, then a $1,000  cap would cover the  majority of                                                               
people who need  it.  He did not understand  Ms. Burns' testimony                                                               
about whether the  education cost is meant to  cover every member                                                               
in a family or  just the person with diabetes.   It sounds to him                                                               
that in some circumstances the  entire family should be educated.                                                               
He is not sure how insurance companies would cover that.                                                                        
Number 0513                                                                                                                     
MS. CASSANO  commented that it  is her experience  that hospital-                                                               
based programs or physician office-based  programs put the charge                                                               
in  for the  client.   She does  not know  of any  hospital-based                                                               
program in  Alaska that  does not  openly invite  family members,                                                               
friends and support members at no charge.                                                                                       
CHAIRMAN  ROKEBERG  said,   "Presumably,  your  amendment's  okay                                                               
because it'd be for the  covered life and, therefore, extended to                                                               
the family members of the covered life."                                                                                        
MR. EVANS replied yes.                                                                                                          
MS. CASSANO said  she is not aware of any  other mandate that has                                                               
a  capping  requirement.    She  would not  like  to  see  a  cap                                                               
MR. EVANS pointed out that mental health does have a cap.                                                                       
REPRESENTATIVE HALCRO  stated that it  appears to him  that self-                                                               
management training  and education is  one of the  most important                                                               
components in  treating and keeping  diabetes under control.   He                                                               
     Why don't we  reverse this a little  bit, your proposed                                                                    
     amendment?   Why  don't  we not  put a  cap  and put  a                                                                    
     sunset clause  and we can  revisit it in three  or four                                                                    
     years and if,  at that point in time,  we have realized                                                                    
     savings,  that's  great.   If  it  has caused  to  have                                                                    
     negative  ripples throughout  the  insurance world,  we                                                                    
     can  address it  at that  time,  but it  sounds to  me,                                                                    
     given  prior   testimony  and  statistics   from  other                                                                    
     states, that  it's sometimes revenue  neutral.   In one                                                                    
     case,  Vermont, I  believe,  the  state actually  saved                                                                    
     money.   So,  would  you be  acceptable  to simply  not                                                                    
     having a cap, but just  revisiting the idea in three or                                                                    
     four years and seeing how it shakes out?                                                                                   
Number 0621                                                                                                                     
MR.  EVANS  asked  if  Representative  Halcro  was  referring  to                                                               
putting the repealer on the entire bill and eliminating the cap.                                                                
REPRESENTATIVE HALCRO said yes.                                                                                                 
MR. EVANS commented that seems all  right to him, but he needs to                                                               
check with HIAA.                                                                                                                
CHAIRMAN  ROKEBERG said  he thinks  one  of the  concerns is  the                                                               
potential for abusing this particular  situation because it would                                                               
involve  discretionary use  by an  individual or  family members.                                                               
The course or type of training might also be longer or shorter.                                                                 
MR.  EVANS  stated  that  Representative  Murkowski's  amendments                                                               
would require  that education be  prescribed by a physician.   He                                                               
     Leaving it wide open, one  of the problems that I could                                                                    
     foresee  is  the  cost  of  the  pumps,  for  instance.                                                                    
     There's not  just one pump at  one price.  You  can get                                                                    
     from the  Chevrolet to the  Cadillac version of  them I                                                                    
     understand,  and so  is there  going to  be a  limit on                                                                    
     something like that?                                                                                                       
Number 0695                                                                                                                     
REPRESENTATIVE  HALCRO explained  that the  cap only  pertains to                                                               
self-management training and education.  He stated:                                                                             
     I don't  believe that somebody  is going to go  out and                                                                    
     load up  on education because they  don't have anything                                                                    
     to  do.   As we  heard testimony  from Christopher,  it                                                                    
     sounds to me like he takes  it upon himself to do a lot                                                                    
     of research  himself through his school  work, but, you                                                                    
     know,  in another  point,  Ms.  Cassano was  absolutely                                                                    
     right.      I   had   the  opportunity   to,   at   the                                                                    
     recommendation of  my doctor, in January  before I came                                                                    
     down here to  visit a nutritionist, and I  went with my                                                                    
     fiancé and they  charged just me, and  they didn't have                                                                    
     any problem with  people sitting in....   I think that,                                                                    
     obviously,  we, as  opposed to  other mandates  that we                                                                    
     have seen in this committee,  or at least my brief time                                                                    
     here,  this is  one that  actually has  some statistics                                                                    
     that  prove   that  this  kind  of   an  investment  or                                                                    
     mandating this  kind of  coverage actually  saves money                                                                    
     down  the road.   I  certainly, myself,  ... would  not                                                                    
     support  a  cap,  because  I  think  the  training  and                                                                    
     education is the foundation to treating this disease.                                                                      
MR. EVANS referred to the statistics discussed.  He said he has                                                                 
asked HIAA for some confirmation of those statistics, but they                                                                  
have not been able to provide them.  He said:                                                                                   
     The lady  that I  report to  in Washington,  D.C., also                                                                    
     covers  the states  of Vermont  and New  Hampshire, and                                                                    
     she says that those statistics  were news to her.  Now,                                                                    
     I  don't know  whether they,  and I  specifically asked                                                                    
     her  for  the  diabetes  statistics,  and  so  I  can't                                                                    
     respond to  those.  I  can't say that they're  not true                                                                    
     or not.   And, as I indicated in  a previous committee,                                                                    
     it's always  easy to say  that statistics show  this or                                                                    
     that. ... I can't respond to that.                                                                                         
Number 0814                                                                                                                     
CHAIRMAN ROKEBERG wondered,  "Well, Mr. Evans, on  that point, if                                                               
in fact  the mandate of  this type  of coverage on  the insurance                                                               
industry  save  the  insurance  industry  money,  your  insurance                                                               
industry would probably know about it, wouldn't they?"                                                                          
MR. EVANS said he hopes so.                                                                                                     
REPRESENTATIVE CISSNA asked if some of the insurance companies                                                                  
cover supplies.                                                                                                                 
MR. EVANS said he is sure that some do cover supplies.                                                                          
REPRESENTATIVE  CISSNA expressed  curiosity  about the  different                                                               
types of insulin pumps and  wondered where that information comes                                                               
MR. EVANS indicated  he has been informed that  there are several                                                               
different types of  pumps.  He does not know  personally what the                                                               
different types are.                                                                                                            
REPRESENTATIVE CISSNA asked Ms. Cassano to address her question.                                                                
Number 0909                                                                                                                     
MS.  CASSANO  said  she believes  three  main  companies  produce                                                               
pumps.  She thinks there is  a standard pump that is approved the                                                               
federal Food and Drug Administration.  She stated:                                                                              
     I  think information  that would  be beneficial  to the                                                                    
     committee is - if I had  Janel White here, who wears an                                                                    
     insulin  pump,  she's  a woman  who  has  diabetes,  of                                                                    
     child-bearing age.  By being  in good control with this                                                                    
     insulin pump,  she's 85 percent  less likely,  when she                                                                    
     has  her child,  for that  child  to go  to a  neonatal                                                                    
     intensive  care.   If she  was taking  multiple insulin                                                                    
     injections every  day, it would almost  be assured that                                                                    
     upon  delivery,   that  child  would  go   to  neonatal                                                                    
     intensive care.                                                                                                            
REPRESENTATIVE CISSNA wondered  if that cost would  be covered by                                                               
MS.  CASSANO  affirmed  it  would  be.    The  cost  of  neonatal                                                               
intensive  care is  approximately  $1,500 to  $2,000 dollars  per                                                               
day.  Medicaid will pay for an  insulin pump for a woman of child                                                               
bearing  age who  has diabetes  because the  initial $3,000  pre-                                                               
pregnancy  investment  will save  money.    She added,  "All  the                                                               
different states'  bills and  the supporting  interest is  on our                                                               
MR. EVANS  referred to testimony  that no other states  have caps                                                               
on their mandates.  He clarified  that three other states do have                                                               
REPRESENTATIVE CISSNA stated:                                                                                                   
     I guess  my point  is that  it sounds  like, in  a way,                                                                    
     that  there's not  -  if, in  fact,  you have  spin-off                                                                    
     costs  from progressing  problems  - there  would be  a                                                                    
     social component too;  we would start picking  up, as a                                                                    
     society,  some of  the costs  for  diabetes that's  not                                                                    
     carefully managed.                                                                                                         
MR.  EVANS said,  "The  fewer  insured people  there  are in  the                                                               
state, those costs are going to be higher for them."                                                                            
CHAIRMAN  ROKEBERG  said   the  issue  is  whether   there  is  a                                                               
willingness to put  the increased costs on the 25  percent of the                                                               
people who will be paying the tab.                                                                                              
Number 1065                                                                                                                     
REPRESENTATIVE  MURKOWSKI  referred to  the  sunset  issue.   She                                                               
wondered if the long-term, positive  effects will be noticed in a                                                               
three-year  time  period.   She  is  curious  about  Washington's                                                               
sunset clause.  She said:                                                                                                       
     If it's  something like health care  costs where you're                                                                    
     going  to notice  your savings  not  in the  immediate,                                                                    
     short term,  but what is  a reasonable long term?   I'm                                                                    
     not suggesting that I'm totally  opposed to caps or I'm                                                                    
     totally opposed to a sunset,  but I'm suggesting to you                                                                    
     that both would have to be reasonable and realistic.                                                                       
MR. EVANS  stated that  HIAA's idea  of the cap  is to  provide a                                                               
handle on what the costs  are immediately for diabetes education.                                                               
He  does not  know if  there  is any  way to  determine what  the                                                               
eventual savings will be.  He said it is unpredictable.                                                                         
REPRESENTATIVE HALCRO wondered if HIAA  has any statistics on the                                                               
number of insureds who had to  drop coverage because of a mandate                                                               
on diabetes.                                                                                                                    
MR. EVANS said he was not aware of any statistics.                                                                              
REPRESENTATIVE CISSNA commented:                                                                                                
     Excuse me,  Mr. Evans,  but I believe  you said  it was                                                                    
     unpredictable.   And actually, having  had a  member of                                                                    
     my family  with diabetes,  it can  become progressively                                                                    
     worse   and   worse,   unmanaged.      So,   it   isn't                                                                    
     unpredictable in one sense.   It's very predictable and                                                                    
     it can get  worse.  It's not like  it accidentally goes                                                                    
MR. EVANS said that is not what  he meant.  He thinks it is clear                                                               
to everyone  that if  you do  not treat  diabetes, there  will be                                                               
disastrous  results.    He  clarified that  the  cost  cannot  be                                                               
CHAIRMAN ROKEBERG  said that  is the  point, even  though studies                                                               
have shown  a substantial savings.   Those studies do  not relate                                                               
to a  discrete group of  insurers.   The studies are  broader and                                                               
relate to several different areas.                                                                                              
Number 1256                                                                                                                     
BOB  LOHR,   Director,  Division  of  Insurance,   Department  of                                                               
Community and Economic  Development, testified via teleconference                                                               
from Anchorage.  He explained  the Division has traditionally had                                                               
concerns regarding mandated benefits  and the possible impacts on                                                               
rates and the availability of coverage.  He stated:                                                                             
     The study that we've  seen most recently, however, from                                                                    
     the  U.S. General  Accounting Office  on the  potential                                                                    
     impact   of   mandate    benefits   on   coverage,   is                                                                    
     inconclusive.   It  does not  reach  a firm  conclusion                                                                    
     that  there is  a  negative impact  on availability  of                                                                    
     coverage.   Each  potential mandate  is,  of course,  a                                                                    
     judgment call  for the Legislature  or the  governor to                                                                    
     make, but  this one certainly  has the weight of  a lot                                                                    
     of evidence in  support of it.  It  does (indisc.) that                                                                    
     there  are   potential  savings  available   given  the                                                                    
     widespread availability of  coverage under this mandate                                                                    
     in  other  states.    I think  the  indication  was  38                                                                    
     states.     The  division  believes  that   this  is  a                                                                    
     worthwhile subject for (indisc.) a possible mandate.                                                                       
REPRESENTATIVE  HALCRO asked  how  this relates  with respect  to                                                               
possible savings to other proposed mandates.                                                                                    
MR. LOHR replied that they need  to be analyzed on a case-by-case                                                               
basis.   He said it  is hard to  argue against prevention  in any                                                               
case.  He  thinks if the costs of prevention  become in excess of                                                               
any kind  of discounted cash-flow  analysis or  discounted future                                                               
benefit-cost analysis, then  you would have to take  a hard look.                                                               
It appears  to him to  be a  case-by-case assessment of  what the                                                               
cost-savings  benefits  of prevention  would  be.   The  division                                                               
would be  willing to participate  in an effort to  document those                                                               
in  this case.   He  believes  doing this  would play  a role  in                                                               
implementation  as  opposed  to  some  kind  of  a  demonstration                                                               
CHAIRMAN ROKEBERG closed public testimony on HB 298.                                                                            
Number 1518                                                                                                                     
REPRESENTATIVE MURKOWSKI made  a motion to adopt  Amendment 1 [to                                                               
CSHB 298(HES)], which read [typographical errors corrected]:                                                                    
     Page 1, line 1, following "that":                                                                                        
     Insert "certain"                                                                                                           
     Page 1, line 6, following "plan":                                                                                          
     Insert "that includes coverage for pharmacy services"                                                                      
     Page 1, line 8, following "supplies"                                                                                       
     Delete ","                                                                                                                 
     Insert "."                                                                                                                 
     Page 1, line 8, before "outpatient"                                                                                        
     Insert "For all health insurance plans, such coverage                                                                      
     shall include"                                                                                                             
     Page 1, line 8, following "and":                                                                                           
     Insert "medical"                                                                                                           
     Page 1, line 9:                                                                                                            
     Delete "recommended"                                                                                                       
     Insert "prescribed"                                                                                                        
     Page 1, line 12, following "of":                                                                                           
     Insert "medical"                                                                                                           
REPRESENTATIVE HALCRO objected for the purposes of discussion.                                                                  
Number 1556                                                                                                                     
REPRESENTATIVE  MURKOWSKI explained  that the  amendment tightens                                                               
up the language.   The language changes were  recommended by Blue                                                               
Cross.    The  amendment  requires  that  diabetes  treatment  be                                                               
prescribed by a health care  provider.  With respect to nutrition                                                               
therapy, the  amendment clarifies that medical  nutrition therapy                                                               
is  being  referred to.    It  also  provides that  the  existing                                                               
insurance plan must include coverage for pharmacy services.                                                                     
CHAIRMAN  ROKEBERG asked  if  the objection  to  Amendment 1  was                                                               
REPRESENTATIVE HALCRO replied no.                                                                                               
CHAIRMAN  ROKEBERG stated  that Amendment  1 was  adopted without                                                               
objection.   He  indicated  the amendment  offered  by Mr.  Evans                                                               
would be marked  Amendment 2.  He made a  motion for the adoption                                                               
of Amendment 2.                                                                                                                 
REPRESENTATIVE BRICE objected.                                                                                                  
CHAIRMAN ROKEBERG explained that Amendment  2 places a $1,000 cap                                                               
on diabetes training and education.  He said:                                                                                   
     I think  that the indications about  cost savings here,                                                                    
     while  clearly are  true in  a broader  sense, I  don't                                                                    
     think they've been  sufficiently demonstrated to myself                                                                    
     empirically in  the Alaska setting  for our  24 percent                                                                    
     of cost-shift payers.  That's my problem.                                                                                  
REPRESENTATIVE  BRICE  indicated  that  it has  not  been  proven                                                               
either.   He  appreciates the  intent  of the  amendment, but  he                                                               
feels it  hampers access to  care for the most  complicated cases                                                               
of diabetes.  He said:                                                                                                          
     And  if what  we're  trying  to do  is  help the  least                                                                    
     complicated  at the  expense of  the most  complicated,                                                                    
     then I  think we need  to really  step back and  take a                                                                    
     look  at what  we're doing  with this  amendment.   So,                                                                    
     that's  what we're  doing.   The easier  the case,  the                                                                    
     cheaper the  cost of education.   The  more complicated                                                                    
     the  case, ...  the more  expensive it's  going to  be.                                                                    
     That, and  they're the ones  who run the  highest risk,                                                                    
     Mr. Chair,  for the medical complications  that will be                                                                    
     covered.  So, I think,  basically, what we end up doing                                                                    
     in  the  long  run,  by  (indisc.)  the  education,  is                                                                    
     establishing  a  system  for  failure  and  for  higher                                                                    
REPRESENTATIVE  HALCRO  agreed  with Representative  Brice.    He                                                               
referred  to  Ms.  Shin's testimony  that  education  could  cost                                                               
between  $500  to  $2,000  and  could be  a  one-time  hit.    He                                                               
     If  you're  over  $1,000,  and it's  more  or  less  an                                                                    
     arbitrary  figure, especially  when you  consider that,                                                                    
     as  I   said  earlier,  self-management   training  and                                                                    
     education is  one of the  most important  components of                                                                    
     mandating this coverage.                                                                                                   
REPRESENTATIVE HALCRO  moved to  adopt an amendment  to Amendment                                                               
2, "to  delete page 2, line  1, and all of  the referenced change                                                               
there."   He added, "Simply  leave page 2,  line 6, which  is the                                                               
repealer in January 1, 2004."                                                                                                   
Number 1900                                                                                                                     
REPRESENTATIVE  CISSNA  indicated  she  had a  problem  with  the                                                               
sunset date.   She also  had a problem  with the cap  on diabetes                                                               
training and education.  It  is her experience that diabetics are                                                               
autonomous  types of  people  who take  the  initiative to  self-                                                               
management.  She said:                                                                                                          
     I mean, just  this population doesn't seem to  me to be                                                                    
     the  type that  are going  to  be jacking  up the  cost                                                                    
     because they want.  It's  only going to be because they                                                                    
     need to...I think putting an  arbitrary number, when in                                                                    
     fact the industry doesn't seem  to have numbers that we                                                                    
     know of.                                                                                                                   
CHAIRMAN  ROKEBERG  asked Ms.  Cassano  what  she believes  is  a                                                               
typical estimate for annual costs.                                                                                              
MS. CASSANO  stated that a  person newly diagnosed  with diabetes                                                               
would need  approximately 12 to  15 hours of education  through a                                                               
recognized program.   In addition,  an hour with an  educator and                                                               
an hour  with a dietician  are possibly  needed.  In  some cases,                                                               
this is not enough because people  are so overwhelmed.  She would                                                               
hate to  see HB 298  inflation-proofed.   She said many  of these                                                               
benefits are being  offered with no reimbursement  to health care                                                               
professionals, which  makes the  industry to enter  into diabetes                                                               
care as  a business.   She said  $1,000 might be  sufficient, but                                                               
she is not sure.  Some  of the group classes offered at hospitals                                                               
range from $125 to $200 for a certain number of sessions.                                                                       
Number 2106                                                                                                                     
CHAIRMAN  ROKEBERG  commented that  he  wants  to know  what  the                                                               
overall typical cost is, not just for education.                                                                                
MS.  CASSANO  answered that  the  typical  cost of  medicine  and                                                               
maintenance   for  a   diabetic  without   an  insulin   pump  is                                                               
approximately $2,100 annually.                                                                                                  
CHAIRMAN ROKEBERG wondered if that includes insulin.                                                                            
MS. CASSANO replied that it includes insulin but not education.                                                                 
CHAIRMAN ROKEBERG asked, "Does that work in Alaska?"                                                                            
MS.  CASSANO noted  that insulin  is  cheaper in  Alaska than  in                                                               
CHAIRMAN ROKEBERG wondered  if the range with  education would be                                                               
between $2,700 to $5,000.                                                                                                       
MS. CASSANO stated that it depends on the individual.                                                                           
CHAIRMAN ROKEBERG  said he thinks  it is important  to understand                                                               
what the amendment does.                                                                                                        
MS. CASSANO said:                                                                                                               
     Costs  are fairly  consistent in  New Hampshire,  and I                                                                    
     pay my  mother's pharmaceutical bills in  New Hampshire                                                                    
     because she was a  non-working woman without insurance,                                                                    
     and  my cost  was  over  $300 a  month,  and she  takes                                                                    
CHAIRMAN  ROKEBERG  asked  if insurance  companies  charge  extra                                                               
premiums  for   people  with   the  pre-existing   conditions  of                                                               
MS. CASSANO said she does not know.                                                                                             
CHAIRMAN ROKEBERG asked if these people get turned down.                                                                        
MS. CASSANO affirmed this.  She said that is why they worked on                                                                 
the comprehensive insurance pool a number of years ago.  She                                                                    
     There has  been some  federal legislation that  in some                                                                    
     instances where  once someone is  in an  insurance pool                                                                    
     of  some sort  and  they change  employment, that  they                                                                    
     cannot     be     dropped...due     to     pre-existing                                                                    
     conditions...Nobody  has  ever  lost  a job  due  to  a                                                                    
     diagnosis  of breast  cancer or  prostate cancer.   The                                                                    
     amount of public  misperception about diabetes, there's                                                                    
     still  a  considerable  amount of  discrimination  that                                                                    
     goes along.   So, when Representative  Cissna says, you                                                                    
     know,  people  who  have  diabetes   tend  to  be  very                                                                    
     introspective     and     they     take     care     of                                                                    
     themselves...that's  because  they have  had  difficult                                                                    
     times at schools.                                                                                                          
CHAIRMAN ROKEBERG reiterated that the question is the cost                                                                      
TAPE 00-30, SIDE A                                                                                                              
REPRESENTATIVE HALCRO made a motion to remove his amendment to                                                                  
Amendment 2.                                                                                                                    
CHAIRMAN ROKEBERG stated that Amendment 2 was before the                                                                        
Number 0039                                                                                                                     
REPRESENTATIVE MURKOWSKI stated she is against Amendment 2.  She                                                                
     I  think  we need  to  recognize  that  this is  not  a                                                                    
     situation where, on  the first of every  year, a person                                                                    
     with  diabetes goes  in for  an annual  check and  then                                                                    
     you're  done and  over  with and  that  it's an  annual                                                                    
     educational process  as was  indicated.   There's highs                                                                    
     and lows  in a  person's diabetes.   There's  highs and                                                                    
     lows.  There's  changes in the technology.   It's not a                                                                    
     constant so just  to say that it's $1,000  per year and                                                                    
     if you  don't spend  any this  year, you've  blown your                                                                    
     $1,000...I think  what needs  to be recognized  is that                                                                    
     the only  way we're going  to recognize a  cost benefit                                                                    
     with the  diabetes issue, is  if education  is promoted                                                                    
     and  the way  that  you  promote it  is  you allow  the                                                                    
     person  who has  diabetes  to take  what  is needed  in                                                                    
     terms of education.                                                                                                        
CHAIRMAN ROKEBERG indicated his preference to hold over HB 298.                                                                 
REPRESENTATIVE  BRICE said  he  thinks Amendment  2  needs to  be                                                               
disposed of.                                                                                                                    
CHAIRMAN ROKEBERG  clarified that he believes  Amendment 2 should                                                               
be withdrawn and HB 298 held over.                                                                                              
REPRESENTATIVE  BRICE expressed  that  he would  like  to make  a                                                               
motion on HB 298 and believes  good testimony has been heard.  He                                                               
thinks  the  labor and  commerce  aspects  of  HB 298  have  been                                                               
adequately explored.                                                                                                            
CHAIRMAN ROKEBERG  pointed out  that he would  like to  have some                                                               
time to make sure the  industry and cost aspects are thoughtfully                                                               
REPRESENTATIVE BRICE said he understands.  He said:                                                                             
     But the questions you were  asking and have been asking                                                                    
     very  vigilantly for  the past  four  years, some  very                                                                    
     important  questions, have  not been  answered in  four                                                                    
     years.   Hopefully the department  in the  future might                                                                    
     be able to  come up with the specific  questions on how                                                                    
     mandates impact  coverage.  I  think the  bottom public                                                                    
     policy  that we  must make,  and we  can make  with the                                                                    
     information presented,  is whether or not  coverage for                                                                    
     diabetes  is an  important  issue for  insurance to  be                                                                    
     involved in.                                                                                                               
REPRESENTATIVE MURKOWSKI stated:                                                                                                
     Mr. Chairman,  just to let  you know, you've  asked for                                                                    
     some additional  time to kind  of look at  the numbers,                                                                    
     if you will.   And when we heard this  bill in the HESS                                                                    
     [Health, Education and  Social Services] Committee, ...                                                                    
     we did  not move  to schedule this  immediately because                                                                    
     we  wanted to  make  sure that  the  players that  were                                                                    
     involved had an  opportunity to get the  numbers to get                                                                    
     the information  and the discussions  that we  had had,                                                                    
     the  only real  ones in  opposition to  this have  been                                                                    
     from Mr.  Evan's clients.   It has  been kind of  a cap                                                                    
     figure that's  been pulled out  of the air.   There are                                                                    
     three other states which, in fact,  do have caps.  As I                                                                    
     understand,  there's  really  not  a lot  of  rhyme  or                                                                    
     reason as to  how that cap has come  about and nobody's                                                                    
     clearly established  that those caps are  proving to be                                                                    
     effective.  So, I  question what additional information                                                                    
     we'll be able to get between now and Monday.                                                                               
CHAIRMAN  ROKEBERG asked,  "Representative Murkowski,  did I  ask                                                               
you to do something?"                                                                                                           
REPRESENTATIVE MURKOWSKI  replied, "You  did."   She said  he had                                                               
asked for things in writing.                                                                                                    
CHAIRMAN ROKEBERG  explained to the  committee that he  had asked                                                               
Representative  Murkowski to  check  with the  top  six to  eight                                                               
insurance companies  that write  approximately 85 percent  of the                                                               
policies in Alaska  and to find out what their  position is on HB                                                               
REPRESENTATIVE MURKOWSKI  explained that Amendment 1  is a direct                                                               
result of the communication with those insurance companies.                                                                     
Number 0513                                                                                                                     
REPRESENTATIVE HALCRO stated:                                                                                                   
     This is  the second  committee of  referral and,  as we                                                                    
     have  seen in  this committee  and I've  seen in  other                                                                    
     committees, when there's  been associations or affected                                                                    
     industries that  have been opposed  to a bill  or cried                                                                    
     about potential  negative impacts, they have  been very                                                                    
     present, not  just in the first  committee of referral,                                                                    
     but  all the  way down  the line.   If  this is  one of                                                                    
     those  things where,  you know,  let sleeping  dogs lie                                                                    
     and they haven't come to  the table with any complaints                                                                    
     other than Mr. Evans, who does  a fine job, you know, I                                                                    
     would  say,   obviously,  they're  probably   taking  a                                                                    
     neutral  position  because  I   would  bet  dollars  to                                                                    
     doughnuts that  if this  had a  negative impact  on the                                                                    
     bottom line,  they'd be sitting  at this  table telling                                                                    
     us  that  they're  going  to lose  X  amount  of  their                                                                    
CHAIRMAN  ROKEBERG  interjected.   He  clarified  that there  are                                                               
eight  insurers in  Alaska,  but  the problem  is  there are  not                                                               
enough health  insurers underwriting health insurance  in Alaska.                                                               
He said, "You don't get it."                                                                                                    
REPRESENTATIVE HALCRO said  he does get it.  He  thinks if it was                                                               
of  great interest  to these  insurers,  they would  have sent  a                                                               
CHAIRMAN ROKEBERG indicated HB 298 would be held over.                                                                          
HB 345-STATE EMPLOYEE HEALTH INSURANCE                                                                                        
CHAIRMAN ROKEBERG announced  the next order of  business would be                                                               
HOUSE BILL  NO. 345,  "An Act relating  to state  employee health                                                               
CHAIRMAN ROKEBERG  commented that  this bill was  introduced more                                                               
or less  as an  informational piece of  legislation to  bring the                                                               
topic before the public.  He  had no intention of moving the bill                                                               
that day.  The intention of the  bill is to make the public aware                                                               
that the Administration  has made a policy to  involve the rights                                                               
to health insurance  to the various bargaining units.   He is not                                                               
certain of the  impacts, but he thinks some  public discussion is                                                               
CHAIRMAN ROKEBERG said  he is concerned that the  breaking up the                                                               
size  of  the pool  will  have  a  negative impact  on  actuarial                                                               
benefit costs  to the remaining members  of the pool.   There are                                                               
also other  problems with 2,000  to 3,000 uncovered  employees in                                                               
the  state that  are not  represented  by bargaining  units.   He                                                               
believes there  might some benefit  to breaking down the  size of                                                               
the pool.   The  proposed committee substitute  (CS) for  HB 345,                                                               
Version G,  points out in  section 4 that  there is no  effect on                                                               
the  current  contracts.   The  proposed  CS indicates  that  the                                                               
Department of  Administration keep self-insured pool  as large as                                                               
possible  to lower  the costs,  maintain  those bargaining  units                                                               
that have independence  now, and pay their portion  of the Alaska                                                               
Comprehensive Health Insurance Association [ACHIA].                                                                             
Number 1024                                                                                                                     
REPRESENTATIVE  HALCRO made  a motion  to adopt  as a  work draft                                                               
Version G of  HB 345 [1-LS1364\G, Cramer, 3/17/00].   There being                                                               
no objection, Version G was adopted.                                                                                            
Number 1056                                                                                                                     
ALISON  ELGEE, Commissioner,  Department of  Administration, came                                                               
forward to  testify on HB  345, Version G.   She stated  that the                                                               
department understands what  the chairman is attempting  to do in                                                               
terms  of  spreading   the  cost  of  the  ACHIA   pool  to  more                                                               
participants.    However, the  department  is  opposed to  asking                                                               
state  employees to  participate in  ACHIA in  the present  self-                                                               
insured environment.                                                                                                            
MS. ELGEE explained that self-insured  programs are not presently                                                               
subject to ACHIA participation.   In effect, the bill taxes state                                                               
employees  because,  under  the collective  bargaining  agreement                                                               
currently,  the financial  participation has  been capped  on the                                                               
side of the State.  Anything  the department does to increase the                                                               
cost  of the  health insurance  program is  being borne  by state                                                               
employees who pay the difference out  of pocket.  It is estimated                                                               
that  the cost  of  returning the  state  participation in  ACHIA                                                               
would be about $500,000 per  year, which amounts to approximately                                                               
$50  paid  per   employee  in  addition  to   what  they  already                                                               
MS. ELGEE said state employees  contribute a wide range of things                                                               
under the existing contracts.  Many  people pay close to $200 per                                                               
month for  their health insurance  coverage.  As  an alternative,                                                               
the  department suggests  direct appropriation  to subsidize  the                                                               
MS. ELGEE turned  attention to Section 3 of Version  G.  She said                                                               
she  interpreted   the  original   proposal  differently.     The                                                               
department  is not  particularly concerned  about the  a perfect-                                                               
sized pool  for its  self-insured environment.   This  is because                                                               
there is a range of options  available in terms of protecting the                                                               
state from undue  risk.  There are two extremes:   the completely                                                               
self-insured environment or a totally  insured product that would                                                               
be bought  on behalf of  employees.  There  are a variety  of in-                                                               
between  options with  regard to  buying  stop-loss coverage  for                                                               
Number 1229                                                                                                                     
CHAIRMAN ROKEBERG  asked when  the last  payment was  made before                                                               
the state became self-insured.                                                                                                  
MS.  ELGEE  replied  that  the  state  began  the  self-insurance                                                               
program in July of 1997.  Prior  to that, the state picked up the                                                               
entire the  cost of  health insurance for  state employees.   The                                                               
implications of  their participation  in ACHIA  were not  felt by                                                               
the employees, but were borne by the state.                                                                                     
CHAIRMAN ROKEBERG said he thinks Ms. Elgee is probably right.                                                                   
Number 1314                                                                                                                     
DON ETHERIDGE,  Lobbyist for Alaska  State AFL-CIO,  came forward                                                               
to testify  on HB 345, Version  G.  He pointed  out the effective                                                               
date [July  1, 1999] is the  main problem.  The  AFL-CIO has many                                                               
tentative contracts that  are up for ratification right  now.  He                                                               
does  not know  if any  of them  have this  option included.   He                                                               
thinks this  would be  shooting down  the negotiations  that have                                                               
just  been concluded.   In  response to  a comment  from Chairman                                                               
Rokeberg, he clarified  that he does not know  what the contracts                                                               
that have been negotiated say.   He indicated he has heard rumors                                                               
that there is  a possibility that some of the  contracts have the                                                               
option of  doing this.  He  knows the effective date  would shoot                                                               
down any of the negotiated contracts.                                                                                           
CHAIRMAN ROKEBERG agreed with that analysis.                                                                                    
MR. ETHERIDGE said ways of  curtailing health costs for the state                                                               
and for the  membership are being looked into.   The formation of                                                               
health care coalitions  are being investigated.   This would help                                                               
reduce costs.   Non-covered employees would not  be left hanging.                                                               
There is  a provision that  is being  looked at that  would bring                                                               
these  people under  the coalition.    The main  objective is  to                                                               
reduce costs  in order to  maintain the current  benefits without                                                               
lowering the benefits or raising prices.                                                                                        
REPRESENTATIVE HALCRO referred to  Ms. Elgee's testimony that the                                                               
additional cost  to each  employee would  be $50  per month.   He                                                               
asked Mr. Etheridge if he has done any research on that.                                                                        
MR. ETHERIDGE replied no.                                                                                                       
CHAIRMAN  ROKEBERG   wondered,  "If   the  AFL-CIO   health  care                                                               
coalitions  are  able to  get  lower  costs  and save  the  state                                                               
employees, isn't  that because they have  PPO [preferred provider                                                               
organization] type or managed care type contracts?"                                                                             
MR. ETHERIDGE  responded, "That is  what we presently  have, yes,                                                               
CHAIRMAN  ROKEBERG  asked  why  the state  does  not  enter  into                                                               
managed-care contracts on  the PPO with health  care providers in                                                               
MR.  ETHERIDGE  replied,  "Politics."   After  Chairman  Rokeberg                                                               
asked him to elaborate, he stated:                                                                                              
     If the doctor  in your neighborhood is left  out of it,                                                                    
     and it's a state contract  that's out there, he's going                                                                    
     to be  over there beating  on your door,  screaming and                                                                    
     hollering that "Hey,  I want to be part of  this."  You                                                                    
     tell  him,  "Well, lower  your  prices  to meet  what's                                                                    
     going on."  And he says,  "Well, I can't do that."  Are                                                                    
     you going  to be the  one coming back to  the committee                                                                    
     saying, "Well,  he's out" just  because he's one  of my                                                                    
     constituents?  ... And  that's  a lot  of  what it  is.                                                                    
     With the  labor coalition, we  can do that,  because we                                                                    
     don't have  to worry about the  political ramifications                                                                    
     if we say no.                                                                                                              
CHAIRMAN ROKEBERG asked:                                                                                                        
     So, if  we change  this bill and  said the  state shall                                                                    
     enter   into   preferred  provider   agreements   where                                                                    
     feasible,  that  tertiary  care hospitals,  that  would                                                                    
     probably lower  the costs up here,  because that's what                                                                    
     you guys do.                                                                                                               
MR. ETHERIDGE said that is correct.                                                                                             
CHAIRMAN ROKEBERG indicated HB 345 would be held over.                                                                          
HB 416-PROSTATE CANCER SCREENING                                                                                              
CHAIRMAN ROKEBERG announced  the next order of  business would be                                                               
HOUSE BILL  NO. 416, "An  Act relating to insurance  coverage for                                                               
prostate cancer screening."                                                                                                     
Number 1564                                                                                                                     
REPRESENTATIVE  FRED   DYSON,  Alaska  State   Legislature,  came                                                               
forward  to  testify as  the  sponsor  of HB  416.    He said  he                                                               
believes  the  medical  community  and  insurance  companies  are                                                               
realizing that  lives can be  saved and  costs can be  reduced if                                                               
men are  screened for prostate cancer  sooner.  He had  agreed to                                                               
bring this  bill forward partly  in response to Mike  Miller, who                                                               
is a four-year survivor of prostate  cancer.  The bill lowers the                                                               
age  at   which  prostate  cancer  screening   is  reimbursed  by                                                               
insurance companies.                                                                                                            
CHAIRMAN ROKEBERG  asked if Representative  Dyson knows  the cost                                                               
impacts  of  the  bill.    In  addition,  he  wondered  what  the                                                               
insurance industry thinks of the bill.                                                                                          
REPRESENTATIVE  DYSON said  a representative  from the  insurance                                                               
industry here would be able to answer those questions.                                                                          
Number 1680                                                                                                                     
MICHAEL H. MILLER came forward to testify on HB 416.  He stated:                                                                
     Mr. Chairman, I'd like to  thank you and members of the                                                                    
     committee for  allowing me to  come forth.  My  name is                                                                    
     Michael  H.  Miller....   I  am  an  advanced  prostate                                                                    
     cancer patient  and a prostate  cancer advocate....   I                                                                    
     became  a  four-year  survivor of  prostate  cancer  on                                                                    
     January  17, 2000.   At  the  time of  my diagnosis  in                                                                    
     1996,  I  was given  17  to  35  months  to live.    An                                                                    
     aggressive clinical trial program  has enabled me to be                                                                    
     here today to urge your support for HB 416.                                                                                
     In 1996, the legislature passed  SB 253 - which was the                                                                    
     fourth state to mandate  prostate cancer screening, and                                                                    
     today there are 22 states  that have mandated bills - a                                                                    
     bill  requiring insurers  to cover  the cost  of annual                                                                    
     prostate cancer  screening for men  50 years  or older.                                                                    
     HB  416   would  amend  that  law   by  requiring  this                                                                    
     screening be covered  at age 40, and at age  35 for men                                                                    
     at high risk of contracting  this disease.  "High risk"                                                                    
     is defined in  the bill as a person who  is an African-                                                                    
     American  or  who  has a  family  history  of  prostate                                                                    
     According  to the  American Cancer  Society, this  year                                                                    
     1.2  million Americans  will contract  cancer.   That's                                                                    
     every 25 seconds somebody is  diagnosed with cancer and                                                                    
     552,000  will die  of the  disease, which  is every  56                                                                    
     seconds.   In our  state, an estimated  1,500 Alaskans,                                                                    
     or  four a  day, will  contract cancer  this year,  200                                                                    
     more people  on an annual  basis than three  years ago.                                                                    
     An  estimated  700 Alaskans  will  die  of cancer  this                                                                    
     year,  2 per  day, or  58 per  month.   Prostate cancer                                                                    
     accounts  for  29  percent   of  all  the  male-related                                                                    
     cancers  and 11  percent  of  cancer-related deaths  in                                                                    
     men.  This  year, approximately 715 men  in Alaska will                                                                    
     be  diagnosed  with  cancer,  nearly  one-quarter  with                                                                    
     prostate cancer.   Of the  estimated 354 men  that will                                                                    
     die of cancer  this year in Alaska,  about five percent                                                                    
     will die  from prostate  cancer.   African-American men                                                                    
     have  a  32 percent  higher  risk  of contracting  this                                                                    
     disease than  others.  They  have the  highest incident                                                                    
     rate in the world.                                                                                                         
Number 1812                                                                                                                     
     In    1979,    Dr.    Gerald    Murphy,    a    Seattle                                                                    
     oncology/urologist,  developed  the  Prostate  Specific                                                                    
     Blood  Antigen [PSA]  test  to  help diagnose  prostate                                                                    
     cancer...The test  became available  to all  doctors in                                                                    
     1990.   A decade old, this  test has led to  a decrease                                                                    
     in the prostate cancer mortality  rate.  In 1976, there                                                                    
     was a 30  percent mortality rate for  men with prostate                                                                    
     cancer.   In 2000, that  mortality rate is  expected to                                                                    
     drop  to 17.7  percent, due  in large  part to  the PSA                                                                    
     Today,  more and  more young  men  are being  diagnosed                                                                    
     with  prostate  cancer.    According  to  the  American                                                                    
     Cancer Society,  209,900 men in the  United States were                                                                    
     diagnosed  with prostate  cancer  in  1997, and  41,800                                                                    
     died of  the disease.  About  23 percent or 47,  600 of                                                                    
     those  diagnosed that  year were  under age  65.   As a                                                                    
     patient who  was diagnosed with prostate  cancer at age                                                                    
     43, I know  that prostate cancer in men  under 65 tends                                                                    
     to  be more  aggressive  in nature.   Early  detection,                                                                    
     especially for men  who are high risk, is  the best way                                                                    
     to  save lives.    I  have a  vested  interest in  this                                                                    
     legislation because my two sons  have up to six times a                                                                    
     higher risk  of contracting  prostate cancer  because I                                                                    
     have the disease.                                                                                                          
     Located in  your packet is  a page  listing statistical                                                                    
     information from the 1999  Alaska Cancer Registry which                                                                    
     is the third  page in, if you could go  to that at this                                                                    
     time, and also shows  the 2000 American Cancer Society-                                                                    
     Cancer  Facts  and   Figures  indicating  the  prostate                                                                    
     cancer risk by age groupings.   Statistics for 1999 and                                                                    
     2000  show that  one in  10,000 a  man is  predicted to                                                                    
     contract  prostate  cancer before  age  40.   In  1999,                                                                    
     statistics for  the 40 to 59  age group show one  in 57                                                                    
     will contract the disease.   The 2000 statistics show a                                                                    
     greater occurrence in  this age group, with  one in 53.                                                                    
     Four  years ago  the statistics  in  the 40  to 59  age                                                                    
     group  were one  in 59.   If  this trend  continues, in                                                                    
     2008,  [men] in  this age  group  will have  one in  35                                                                    
     chance of contracting prostate cancer.                                                                                     
     With an  aging Baby Boomer  society, more and  more men                                                                    
     will be  diagnosed with prostate  cancer.  It  would be                                                                    
     prudent  for  the State  of  Alaska  and the  insurance                                                                    
     industry to  make an investment in  preventative health                                                                    
     care  maintenance  for  men  starting  prostate  cancer                                                                    
     screening at the  age of 35 for those at  high risk and                                                                    
     age 40 for  others.  HB 416 will help  men be diagnosed                                                                    
     at a younger age, saving both lives and money.                                                                             
     I  do  have  an  attached   page  that  gives  you  the                                                                    
     associated  medical costs  estimate  [included in  bill                                                                    
     packet]  which will  show that  of the  nearly 700  men                                                                    
     that were diagnosed, and 72  over a four-year period of                                                                    
     time, that's  175 men per  year.   And 18 men  per year                                                                    
     pass away from this disease.   That leaves 628 men, and                                                                    
     over a four-year period of  time, the cost is $5,024,00                                                                    
     or $1.26 million  per year.  Then there's  292 men that                                                                    
     are in  the 40 to  64 category which accounts  for $2.3                                                                    
     million or $584,000 per year.   There are between 40 to                                                                    
     50, which  we're addressing in  this amendment,  24 men                                                                    
     per year  times four  that's 768, 000  or 192,  000 per                                                                    
     year.    If this  expenditure  continues,  by the  year                                                                    
     2008, it will be $1.5 million.                                                                                             
Number 2007                                                                                                                     
     The 1999  Alaska Cancer Registry report  show that only                                                                    
     two  men aged  40 to  44 were  diagnosed with  prostate                                                                    
     cancer in  Alaska in 1996, and  10 in the 45  to 49 age                                                                    
     group  which   is  in  the   fourth  page   marked  Age                                                                    
     Distribution of Invasive  Cancers.  I was  one of those                                                                    
     two  men in  1996.   At age  43, I  was diagnosed  with                                                                    
     advanced prostate  cancer.   If the  PSA test  had been                                                                    
     made available to  me at age 40, I  would probably been                                                                    
     diagnosed  with  early  stage prostate  cancer  and  my                                                                    
     disease might not have spread.                                                                                             
     Prostate cancer  has left me  unable to work.   I, like                                                                    
     many cancer  survivors, [am] receiving  Social Security                                                                    
     Disability  Income  and  State  Disability  Retirement.                                                                    
     The  average  cost  for prostate  cancer  treatment  is                                                                    
     $6,000 to  $10,000 annually.   My expenses  are running                                                                    
     $12,000  to  $15,000  annually   and  that's  just  for                                                                    
     medication.   It is cost  effective to catch  and treat                                                                    
     this disease  early on, rather  than pay  for long-term                                                                    
     cost of  treatment at an estimated  $48,690 per person.                                                                    
     If  you  turn to  the  first    page of  the  reference                                                                    
     material  there's a  Pay Now  or Pay  Later chart  that                                                                    
     will show  you in the  second left-hand column  that at                                                                    
     age 35  to 65 if you  eat ten slices of  low fat cheese                                                                    
     pizza  per  week,  the tomato  sauce  contains  cancer-                                                                    
     fighting lycopene,  which is  a high  anti-oxidant, the                                                                    
     cost will only  be $18,720.  I've stated  before if you                                                                    
     have prostate cancer it will cost $48,690.                                                                                 
     HB  416   should  not   cause  insurance   premiums  to                                                                    
     increase.  Although  insurers generally oppose mandate,                                                                    
     when   SB   253   was  passed   in   1996,   an   Aetna                                                                    
     representative  testified that  Aetna would  not oppose                                                                    
     this bill if  the Legislature felt the  benefits of the                                                                    
     screening would outweigh  the small costs.   He said an                                                                    
     argument  can  be  made  that  early  detection  should                                                                    
     result  in  more  efficient  treatment  and  ultimately                                                                    
     avoid high catastrophic treatment costs.                                                                                   
Number 2102                                                                                                                     
     Men  dying  of  prostate   cancer  are  leaving  behind                                                                    
     spouses, children and many  family members and friends.                                                                    
     I have a friend  of mine that I lost at  the age of 41,                                                                    
     Mark (indisc.),  with advanced prostate cancer,  and he                                                                    
     left behind a  10-year old daughter, a  14-year old son                                                                    
     and a  16-year old son.   When  I was lobbying  back in                                                                    
     Washington, D.C.  last year with  100 other  men, there                                                                    
     was  little   Sebastian  Hanson  (ph)   of  Scottsdale,                                                                    
     Arizona and his mother, Lisa  Hanson (ph).  He lost his                                                                    
     father at  five months...  And we're not  talking about                                                                    
     statistics  or numbers.   We're  talking about  a young                                                                    
     man  like Sebastian  Hanson (ph)  that never  ever will                                                                    
     know what  his father  stood for.   At five  months old                                                                    
     you  cannot comprehend  that, and,  my feeling,  that's                                                                    
     what we're talking about.                                                                                                  
     While we have  made great strides in  the United States                                                                    
     in cancer  treatment research, too  many men  are still                                                                    
     being lost  at too young  an age.   Over the  last four                                                                    
     years,   approximately  700   Alaska   men  have   been                                                                    
     diagnosed  with prostate  cancer.   Many of  their sons                                                                    
     will also  contract this  disease.   Let's give  men an                                                                    
     opportunity to be  diagnosed at an earlier  age.  Those                                                                    
     with  a  five-year  survival rate  from  this  disease,                                                                    
     which means  that men that  were diagnosed in  1995 and                                                                    
     now it's the year 2000,  have a 100 percent chance they                                                                    
     will die  of another cause.   I would like to  leave my                                                                    
     two the best possible gift,  an opportunity for them to                                                                    
     be  screened for  prostate cancer  at  an earlier  age,                                                                    
     because  the  odds  are that  they  will  contract  the                                                                    
     disease at a younger age.                                                                                                  
     If you  notice at the  addendum, the cost to  the State                                                                    
     right now, at the bottom  of the first page, FY99 State                                                                    
     of  Alaska Disability  Retirement expenditure  amounted                                                                    
     to  $7.2  million  from  PERS.     In  FY90,  the  PERS                                                                    
     disability  retirement  expenditure was  $2.8  million.                                                                    
     And  that  does  not  count  the  teachers'  retirement                                                                    
     system  nor the  self insured  individually or  private                                                                    
     sector.   With  the teachers'  retirement, I  think the                                                                    
     figure  goes up  from $2.8  [million] in  FY90 to  $5.1                                                                    
     million.   And  that  $7.2 million  figure now  becomes                                                                    
     $11.1 million.   I urge your support of HB  416 for the                                                                    
     future health  and well being of  all Alaskan families.                                                                    
     Thank you for your time.                                                                                                   
CHAIRMAN ROKEBERG asked if the amount Mr. Miller referred to                                                                    
with respect to the PERS disability retirement expenditure was                                                                  
the  total  amount of  disability  payments  for prostate  cancer                                                               
MR. MILLER  replied no.   He  clarified that  it was  for overall                                                               
disability retirement.  He said:                                                                                                
     The point that  I'm trying to make is that  if you have                                                                    
     more and more prostate  cancer patients, we're going to                                                                    
     add  to this  debt.   Cancer  has a  $107 billion  debt                                                                    
     annually in  the United States;  $35 billion  in direct                                                                    
     medical costs,  $11 billion  in job  loss productivity.                                                                    
     I am  part of  that $11  billion.   And $59  billion in                                                                    
     premature  debts and  people that  are going  to go  on                                                                    
     some sort  of assistance because they've  lost a family                                                                    
     member, you're going  to have a spin-off of  that.  So,                                                                    
     I guess what I'm saying is  that, if the State does not                                                                    
     take  the  responsibility,  then the  State  disability                                                                    
     retirement costs are going to even climb higher.                                                                           
CHAIRMAN ROKEBERG  wondered if these are  the disability payments                                                               
the state is paying out now.                                                                                                    
MR. MILLER responded yes.   He explained that his Social Security                                                               
disability and  state disability  have been nearly  $219,000 over                                                               
the last four years.                                                                                                            
Number 2308                                                                                                                     
REPRESENTATIVE MURKOWSKI referred to  the material Mr. Miller had                                                               
provided to  the committee.   She  said it  appears there  is not                                                               
unanimity   within   the    medical   community   regarding   the                                                               
recommendations for  prostate cancer screening.   She pointed out                                                               
a  comment  stating that  the  American  Cancer Society  promoted                                                               
prostate  cancer  screening,  but have  recently  lessened  their                                                               
support and their  position now is to promote  patient choice and                                                               
access to screening.   Another article suggests  screening at age                                                               
45 unless you are at risk.  It  does not appear to her that there                                                               
is agreement  with respect to  the age at which  screening should                                                               
begin.   She wondered if  Alaska is  taking the lead  in lowering                                                               
the age  and if  this also  the direction  that other  states are                                                               
MR. MILLER replied:                                                                                                             
     If you go to the third  page, I can answer part of that                                                                    
     in the  numbers and the fact  that, if you look  at the                                                                    
     top, it  was put out  by the Alaska Cancer  Registry in                                                                    
     the 40 to  59 [years of age] column, it  was one in 57,                                                                    
     and I  made reference that  in 1996  it was one  in 59.                                                                    
     The Cancer Facts  and Figures, put out  by the American                                                                    
     Cancer  Society,  shows that  it's  one  in 53.    I've                                                                    
     directly spoken  with and I  have worked with  Dr. Judd                                                                    
     Mau  (ph)  who  is  the  Director  at  the  Center  for                                                                    
     Prostate  Disease  Research,  and he  e-mailed  me  and                                                                    
     explained that  they just completed a  Army, Navy serum                                                                    
     repository research,  and their age reference,  that in                                                                    
     this study that they are  looking at, is between 20 and                                                                    
     45 years of age, so that  way they can tell the doctors                                                                    
     where  that upper  limit will  be  in a  young man  and                                                                    
     where the lower limit will be  in a young man.  I think                                                                    
     it's just going to be a matter of time.                                                                                    
     The  position  that  the American  Cancer  Society  has                                                                    
     taken,  it has  put  a  tailspin ...  not  only in  the                                                                    
     medical  community,  but  in  the  survivor  community.                                                                    
     There are 1,300 Man-to-Man  chapters that are sponsored                                                                    
     by  the American  Cancer Society.    When the  American                                                                    
     Cancer  Society took  the  stance  that they  presently                                                                    
     have  taken compared  to two  years ago,  they've heard                                                                    
     from all  1,300 chapters and  all of those  men opposed                                                                    
     their decision making on taking that stance.                                                                               
REPRESENTATIVE MURKOWSKI asked why the American Cancer Society                                                                  
(indisc. - coughing).                                                                                                           
Number 2454                                                                                                                     
MR. MILLER  said his  belief is that  the guideline  the American                                                               
Cancer Society has adopted was made  up in 1997 and had just come                                                               
out  in 1999.   He  thinks there  might be  various reasons,  but                                                               
cannot  pinpoint  exactly  what  it  is  ...[some  testimony  not                                                               
recorded because of tape change.]                                                                                               
TAPE 00-30, SIDE B                                                                                                              
MR. MILLER continued:                                                                                                           
     ... [Tom  Bruckman (ph)]  from the  American Foundation                                                                    
     for  Urologic Disease.   He  says  it's going  to be  a                                                                    
     matter of time whether it's going  to be a one in 35 or                                                                    
     a one in  40. ... He said, "You know,  I really have to                                                                    
     applaud what you're doing."   And he said this will set                                                                    
     the  ...  standard for  the  rest  of the  country,  to                                                                    
     answer your  other question, that Alaska  will take the                                                                    
     lead in this.                                                                                                              
REPRESENTATIVE MURKOWSKI  referred to Mr. Miller's  summary sheet                                                               
of  the prostate  cancer laws  throughout the  states.   She said                                                               
there  is a  list of  states that  mandate screening  and various                                                               
other alternatives  the states  do.   She asked  if the  ages are                                                               
similar to what Alaska has now.                                                                                                 
MR. MILLER  said the ages are  similar, starting at 40  for those                                                               
at high risk and  50 for others.  As time goes  on, more and more                                                               
younger men  will develop prostate  cancer.  He pointed  out that                                                               
his  sons will  have a  six times  greater chance  of contracting                                                               
prostate  cancer.   He  commented that  the  lesions of  prostate                                                               
cancer  start at  puberty.   Three  to four  years ago,  9 to  11                                                               
million  men in  the country  were walking  around with  prostate                                                               
cancer, and the number is increasing.   He stressed that the face                                                               
of prostate  cancer is  ever-changing.  It  is difficult  for the                                                               
medical  community to  keep up  with these  changes.   Four years                                                               
ago, there  was a  belief that  diet may play  a factor,  but now                                                               
they know  that diet is  a factor.  He  is simply trying  to help                                                               
the State of Alaska save some money.                                                                                            
CHAIRMAN ROKEBERG asked, "Mr. Miller,  on your cost estimates,...                                                               
just to make  sure I understand this now,  that your survivorship                                                               
would need  treatment at $8,000 a  year, is that how  you come up                                                               
to that dollar amount?"                                                                                                         
MR. MILLER answered,  "Between six to ten, and  the average would                                                               
be ... $8,000."                                                                                                                 
CHAIRMAN ROKEBERG  wondered whether that  is if a  man contracted                                                               
the disease and did not have early intervention.                                                                                
MR. MILLER  replied that  this is  an average cost  of a  Stage C                                                               
cancer.  Stage D might cost a  little more.  At early stages, the                                                               
cost of a radical prostectomy is $20,000.                                                                                       
CHAIRMAN ROKEBERG asked if that would be a one-time shot.                                                                       
MR.  MILLER responded  yes.   He referred  to a  note from  Diane                                                               
Lemmon (ph), who is the head  researcher with Dr. Bruce Lowe (ph)                                                               
at Oregon Health Sciences University.   It stated that 95 percent                                                               
of  the  men  diagnosed  with  prostate  cancer  have  a  radical                                                               
prostectomy.   The  percentage of  men who  stay continent  after                                                               
this procedure  is now at 96  percent.  Today, 90  percent of the                                                               
surgeons  who perform  this procedure  have  patients who  remain                                                               
continent,  but impotence  varies from  man to  man.   This is  a                                                               
process  a man  has  to  go through  to  decide  which course  of                                                               
treatment is best.   He does not  believe he would be  here if he                                                               
had not done an aggressive treatment program.                                                                                   
CHAIRMAN ROKEBERG  said he appreciates Mr.  Miller's inclusion of                                                               
an addendum to his testimony.                                                                                                   
MR. MILLER indicated he had called  around and found out the cost                                                               
of a PSA  in different places in  the state.  A  PSA in Anchorage                                                               
costs $42.50.  In  Juneau the cost varies from $63  to $106.  The                                                               
average  cost  is  estimated  to   be  $60.    Between  July  and                                                               
September,  there were  nearly 1,000  men  screened for  prostate                                                               
cancer.    He commented  that  90  percent  of the  time,  benign                                                               
prostatic hyperplasia [BPH] occurs.                                                                                             
CHAIRMAN ROKEBERG said  this is a pretty clear-cut  case based on                                                               
the facts.   From  the statistics Mr.  Miller provided,  he noted                                                               
that there is public policy  and cost-benefit ratio effectiveness                                                               
in doing prostate cancer screening.                                                                                             
Number 0368                                                                                                                     
GORDON  EVANS, Health  Insurance Association  of America  [HIAA],                                                               
came forward  to testify  on HB  416.  He  indicated HIAA  has no                                                               
objection to the bill and does endorse it.                                                                                      
Number 0410                                                                                                                     
REPRESENTATIVE  HALCRO made  a motion  to  move [HB  416] out  of                                                               
committee with  individual recommendations  and the  attached two                                                               
zero fiscal  notes.  There being  no objection, HB 416  moved out                                                               
of the House Labor and Commerce Standing Committee.                                                                             
HB 419-WORKERS' COMPENSATION                                                                                                  
CHAIRMAN ROKEBERG announced  the next order of  business would be                                                               
HOUSE  BILL NO.  419,  "An Act  relating to  the  weekly rate  of                                                               
compensation  and  minimum  and maximum  compensation  rates  for                                                               
workers'  compensation;  specifying   components  of  a  workers'                                                               
compensation reemployment  plan; adjusting  workers' compensation                                                               
benefits  for  permanent  partial  impairment,  for  reemployment                                                               
plans,  for rehabilitation  benefits, for  widows, widowers,  and                                                               
orphans,   and  for   funerals;  relating   to  permanent   total                                                               
disability  of  an  employee receiving  rehabilitation  benefits;                                                               
relating  to calculation  of gross  weekly earnings  for workers'                                                               
compensation benefits for seasonal  and temporary workers and for                                                               
workers with  overtime or  premium pay;  setting time  limits for                                                               
requesting  a hearing  on claims  for workers'  compensation, for                                                               
selecting  a  rehabilitation  specialist,   and  for  payment  of                                                               
medical  bills;   relating  to  termination  and   to  waiver  of                                                               
rehabilitation   benefits,   obtaining  medical   releases,   and                                                               
resolving discovery  disputes relating to  workers' compensation;                                                               
setting  an   interest  rate  for   late  payments   of  workers'                                                               
compensation;  providing for  updating the  workers' compensation                                                               
medical fee schedule; and providing for an effective date."                                                                     
Number 0492                                                                                                                     
SUSANNE OSBORN  testified via teleconference  from Wasilla.   She                                                               
     I'm   a   state    worker   currently   on   [workers']                                                                    
     compensation.  I  am receiving no benefits.   I haven't                                                                    
     received any  benefits since November.   I'm  having to                                                                    
     start sell my belongings in  order to survive.  I think                                                                    
     that  this  bill  is  not  going  to  help  anybody  on                                                                    
     workmen's comp[ensation] and I am totally against it.                                                                      
CHAIRMAN  ROKEBERG  asked  Mr.  Osborn if  she  has  applied  for                                                               
workers' compensation.                                                                                                          
MS. OSBORN  answered that she  applied for  workers' compensation                                                               
and was on it until November.  She  was told she could go back to                                                               
work, but  her doctor advised  otherwise.   She was off  work for                                                               
another two weeks  without benefits.  She was then  ordered to go                                                               
back to work in December or  lose her job, even though her doctor                                                               
had written  indicating she  had post-traumatic  stress syndrome.                                                               
She returned to work January 3  and was asked if she was mentally                                                               
and physically able  to work.  It was indicated  that she was too                                                               
much of  a liability,  and she  was asked her  to leave  her job.                                                               
She left her job and currently has no benefits.                                                                                 
CHAIRMAN  ROKEBERG  said he  was  distressed  to hear  about  her                                                               
MS. OSBORN  said she, too,  is sorry.   She pointed out  that she                                                               
has suffered personal  trauma from this experience.   She depends                                                               
on friends  for food and has  overdue bills.  She  commented that                                                               
HB 419 is not going to help her at all.                                                                                         
CHAIRMAN  ROKEBERG replied,  "Well it  is intended  to raise  the                                                               
benefits to those beneficiaries that are receiving ..."                                                                         
MS. OSBORN said,  "Yeah, well, I'm not receiving  anything.  They                                                               
don't even want to talk to me right now."                                                                                       
CHAIRMAN   ROKEBERG   noted   that  the   Anchorage   Legislative                                                               
Information Office was no longer  connected.  He indicated HB 419                                                               
would be held over.                                                                                                             
CHAIRMAN  ROKEBERG   adjourned  the  House  Labor   and  Commerce                                                               
Standing Committee meeting at 6:07 p.m.                                                                                         

Document Name Date/Time Subjects