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