Legislature(1999 - 2000)
03/17/2000 03:25 PM House L&C
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* 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
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
screening."
- 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
premiums.
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
state.
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
herself.
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
stated:
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
story.
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
budget.
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
occur.
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
legislation.
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
facility.
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
them.
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
back.
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
received.
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
school.
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
introduced.
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
said:
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
said:
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
from.
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
insurance.
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
web-site."
MR. EVANS referred to testimony that no other states have caps
on their mandates. He clarified that three other states do have
caps.
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
away.
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
predicted.
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
project.
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
maintained.
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
costs.
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
commented:
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
California.
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
insulin.
CHAIRMAN ROKEBERG asked if insurance companies charge extra
premiums for people with the pre-existing conditions of
diabetes.
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
explained:
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
issue.
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
committee.
Number 0039
REPRESENTATIVE MURKOWSKI stated she is against Amendment 2. She
commented:
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
addressed.
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
298.
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
coverage...
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
representative.
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
insurance."
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
necessary.
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
contribute.
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
program.
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
protection.
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,
sir."
CHAIRMAN ROKEBERG asked why the state does not enter into
managed-care contracts on the PPO with health care providers in
Alaska.
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
cancer.
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
[test].
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
victims.
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
taking.
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
stated:
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
misfortune.
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.
ADJOURNMENT
CHAIRMAN ROKEBERG adjourned the House Labor and Commerce
Standing Committee meeting at 6:07 p.m.
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