Legislature(2013 - 2014)Anch Temporary LIO
10/07/2014 01:00 PM House LABOR & COMMERCE
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| Audio | Topic |
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| Start | |
| Presentation: Patient Protection and Affordable Care Act | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
ALASKA STATE LEGISLATURE
HOUSE LABOR AND COMMERCE STANDING COMMITTEE
October 7, 2014
1:11 p.m.
MEMBERS PRESENT
Representative Kurt Olson, Chair
Representative Lora Reinbold, Vice Chair
Representative Mike Chenault
Representative Charisse Millett
Representative Dan Saddler
Representative Andy Josephson
Representative Craig Johnson
MEMBERS ABSENT
Representative Bob Herron
COMMITTEE CALENDAR
PRESENTATION: PATIENT PROTECTION AND AFFORDABLE CARE ACT
- HEARD
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
LORI WING-HEIER, Director
Division of Insurance
Department of Commerce, Community, and Economic Development
Juneau, Alaska
POSITION STATEMENT: Testified on the Patient Protection and
Affordable Care Act (ACA).
BECKY HULTBERG, President and CEO
Alaska State Hospital and Nursing Home Association (ASHNHA)
Juneau, Alaska
POSITION STATEMENT: Testified on the ACA.
SHEELA TALLMAN, Senior Manager, Legislative Policy
Premera Blue Cross
Seattle, Washington
POSITION STATEMENT: Testified on the ACA.
JASON GOOTEE, Regional Manager
Moda Health, Alaska
Palmer, Alaska
POSITION STATEMENT: Introduced his supervisor.
KRAIG ANDERSON, Senior Vice President and Chief Actuary
Moda Health
Portland, Oregon
POSITION STATEMENT: Testified on the ACA.
VINCE O'SHEA, Vice President
Pacific Seafood Processors Association (PSPA)
Juneau, Alaska
POSITION STATEMENT: Testified on the ACA.
BILL STREUR, Commissioner
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Testified on the ACA.
ACTION NARRATIVE
1:11:39 PM
CHAIR KURT OLSON called the House Labor and Commerce Standing
Committee meeting to order at 1:11 p.m. Representatives
Reinbold, Josephson, Saddler, Johnson, and Olson were present at
the call to order. Representative Sam Kito III was on line.
Representatives Millett and Chenault arrived as the meeting was
in progress.
^Presentation: Patient Protection and Affordable Care Act
PRESENTATION: Patient Protection and Affordable Care Act
1:12:30 PM
CHAIR OLSON announced that the only order of business would be a
discussion related to the federal Patient Protection and
Affordable Care Act (ACA) and the impact of rate increases.
When the ACA was rolled out, he said, people were told that if
they liked their doctors they could keep them and if people
liked their health care plans, they could keep them. The ACA
would also lower healthcare costs for families and for
businesses, he stated. He said if he was still in the insurance
business, "and I sold a product like that, I'd probably be in
jail for any number of violations of the insurance statutes."
He added that he is trying not to let his bias show.
1:14:37 PM
LORI WING-HEIER, Director, Division of Insurance (DOI),
Department of Commerce, Community, and Economic Development
(DCCED), said there have been many statements made about the
DOI. Its mission is to regulate the insurance industry to
protect Alaska consumers. She said that sometimes decisions
need to be made and issues need to be resolved that result in
"no clear winner" and that the division needs to make a decision
after reviewing hundreds of pages of data and holding countless
meetings to have a viable, financial, secure product for Alaska
consumers that is available today and tomorrow. Interestingly,
"sometimes our hands are tied [and] our creativity is stifled by
a statute or regulation or court decision that dictates how we
meet our mission." She noted that on March 23, 2010, President
Obama signed a sweeping piece of legislation called the Patient
Protection and Affordable Care Act (ACA) to provide affordable
healthcare insurance to those who were uninsured and to expand
certain benefits to those that were already insured.
1:18:36 PM
MS. WING-HEIER showed a timeline on slide 4 of her PowerPoint
presentation. In the fall of 2013, the insurance industry
canceled health insurance for five million Americans. She spoke
of shock and dismay, and it was unsettling for stakeholders and
for her division. Approximately 5,500 of the consumers were in
Alaska, she explained. These consumers were to go from a
noncompliant to a compliant plan, and people were shocked, she
said. In October, open enrollment began and there were problems
with the website, she reported, and repeated attempts to log in
caused distress. In November, people were notified that they
could keep their insurance for a year, through 2014, but that
delayed the individual enrollment. The "SHOP option" was also
delayed for one year [Small Business Health Options Program],
she stated. So the question given to the state was: Would you
allow your consumers to keep their current benefits for a year?
MS. WING-HEIER said that after some analysis, DOI issued
Bulletin 1309, and "it did not, per se, allow the transition,
but what it did allow was for the insurers to make a choice in
their business decisions to cancel and rewrite the current
insurance policies effective December 31 for a period of one
year." She said if a policy was to expire in April, it would
have been canceled on December 31, 2013, and would now expire
December 31, 2014, and it would continue to be a non-
grandfathered plan and out of the ACA. She said this was
distressing to consumers as they did not know if they were
supposed to enroll or not, and it created anxiety for the
insurers too as they had to adjust to the new plan. She said it
was upsetting for many. The progress was halted for the time
being, and the issues continued with the ACA website through the
spring of 2014, she explained. In March, President Obama
announced that those who like their insurance would be able to
keep it, and current plans, at the direction of the state, could
stay in place until October, 2016, she added. She noted that
two insurers, Premera and Moda, kept their plans in place. She
continued:
They were given notice, and, again, this is their
decision, if they keep those plans. The Division of
Insurance can only allow it; we cannot dictate it.
It's their business decision. Under Bulletin 1403
they received a notice that they had to make a
decision if they were going to continue the
noncompliant plans. We felt it was important to do so
because we realize the impact of the premiums in ACA
compliant plans, and we hope to delay it as long we
could for those that we could.
MS. WING-HEIER questioned if the division made the right
decision, but she feels that it did because it gave about 5,000
Alaskans the choice to stay out of the ACA compliant plans
unless they preferred them.
1:23:21 PM
MS. WING-HEIER noted that, in an attempt to keep costs to a
minimum for consumers, on June 2, the division petitioned Health
and Human Services to opt out of "SHOP" (for small business
owners) for one year. The ACA, she believes, allows for the
individual employee of small businesses to get a set amount of
money to go into the marketplace to buy his or her own plan.
She said she heard from several small business owners who did
not like that concept because of their concern with the
possibility of administering multiple plans in one small
business. So, the division did the petition and was granted the
authority to opt out of SHOP for one year.
1:24:22 PM
MS. WING-HEIER stated that people who had insurance on March 23,
2010, are grandfathered in and not subject to the majority of
the ACA, but they could benefit from the ACA program of insuring
their children up to the age of 26. The non-grandfathered (or
noncompliant) plans were purchased between March 23, 2010, and
January 1, 2014, she said, and they were to become compliant by
2014. Those were also the plans that the insurance companies
mailed out a notice of cancelation (but then reinstated) and can
be kept until October 1, 2016, if the insurer allows for it, she
explained. She said January 1, 2014, [begins the] compliance-
qualified health plans. "Those are the three buckets that we're
talking about," she added.
1:26:08 PM
REPRESENTATIVE SADDLER asked how many Alaskans have the non-
grandfathered plans.
MS. WING-HEIER said page 8 does not talk about the large
employers, "but it gives you an estimate of approximately 22,000
in the individual market in 2014." For the grandfathered
[plans], Premera had about 2,800 in individual markets and about
4,600 in the small groups. Moda does not have any grandfathered
plans. She said to look at her slide 9.
REPRESENTATIVE JOSEPHSON asked about slide 5. At the time of
the signing of the ACA, if someone had a policy it was
grandfathered, so they got to keep what they had.
MS. WING-HEIER agreed, but there were some modifications, such
as the children could remain on their parents' insurance until
the age of 26, as well as other benefits to those with
grandfathered plans, "but not the significant--the essential
health benefits and others that are in the ACA compliant plans."
She turned to slide 6 from 2012 and 2013, which shows all
insurers in Alaska, but it does not show the self-insured. She
said she has focused on Premera and Moda, because they are the
two insurers that "we have released the 2015 rates for and they
are the two insurers that offer products to Alaskan consumers on
the Federal Facilitated Marketplace." She noted that they had
about 75 percent of the market. In 2013, the numbers do not
change that much, she added. She turned to slide 8, "these are
all insurers--individual and small group in 2014." It includes
the grandfathered plans, non-grandfathered plans, and the ACA
compliant plans, but the numbers can change from day to day, she
noted. Slide 9 slices the numbers a little bit differently with
regard to what Premera and Moda have, as far as individual
markets, small group markets, grandfathered, non-grandfathered,
and ACA compliant, she explained.
1:31:25 PM
MS. WING-HEIER said her point is to show that if she added up
all of the numbers for all of the individuals that she has, and
if she added in the 6,000 that she thinks may be out there that
have yet to enroll, the sum is 28,828. Alaska is a small
market, and nothing about the ACA is going to change that. She
said Alaska has extremely high health care costs, and there is
not enough in the pool to spread the costs of the claims that
were seen in 2014 and prior years and make it affordable.
Looking at other states, the marketplace enrollment of ACA
qualified plans in 2014 was about 8 million nationwide, she
reported, and some states had a decrease in rates and others had
rates that did not go up. She said, "California enrolled 1.4
million; Idaho, 76; [and] Washington State, 163. Some states
had a little less than us. Hawaii, for one, had about 9,000.
South Dakota did not have many--about 13, and North Dakota, 10."
She added that those states have a lower cost of health care
and, perhaps, more access to some health care.
1:33:34 PM
MS. WING-HEIER presented a slide to show where Alaska falls with
enrollment [expectations], and it is "pretty much right on
target" for what CMS, Avalere, and what the Kaiser Family
Foundation shows us. Alaska is a little over 16,000 in all
markets for enrollment, she stated. No one knows exactly how
many uninsured there were in Alaska, but this is the closest
number she has. She said there has been a lot of discussion
over the federal exchange and the rate-review grants and why the
state made the decision that it did. Regarding the federal
exchange grants, the federal government awarded close to $4
billion to 49 states to study--and in some cases, design and
implement--a state-based exchange, and of those 49 states, 39
elected to participate in the federal exchange, "as Alaska did
from the beginning." Recent data shows that in addition to the
$4 billion from the federal government, there was close to $3.5
billion spent by the states themselves, she stated. In Hawaii,
the average cost per enrollee of their exchange is $23,899, and
for California it is $758. California has some of the highest
enrollment numbers of any state, she added.
1:34:15 PM
MS. WING-HEIER said Alaska is part of the FFM [Federally
Facilitated Marketplace], and the average cost is $12,890 per
enrollee. The lowest is Florida at $76 and North Dakota is
$7,089 per enrollee just to access the web site and process the
application, she said.
1:36:44 PM
REPRESENTATIVE JOSEPHSON noted that Ms. Wing-Heier said that the
State of Alaska spends over $10,000 and writes a check to
someone for each enrollee into the federal exchange.
MS. WING-HEIER said no. "We joined the federal exchange, the
federal government is spending $12,890 ... priced out over all
of the applicants or all the enrollees," and it is an average
for Alaska's share.
REPRESENTATIVE JOSEPHSON asked if that is the federal subsidy.
MS. WING-HEIER said no. "This is just the cost for you or I to
go to the website and enroll through healthcare.gov to obtain
insurance." She said she will find the source of that data for
him. She continued and said that several states started down
the path of the federal exchange grants, including Oklahoma,
Louisiana, Kansas, Maine, and Wisconsin, and they returned the
funding when they started to look at what the costs would be to
build a state-based exchange. She said the states of Oregon and
Nevada failed miserably. Oregon spent $350 million and Nevada
spent $75 million for their exchanges in 2014, and they are
joining the federal exchange in 2015. The costs are high, so
states are looking to partner with each other and searching for
a more economical way for people to access healthcare, she said.
With a small state like Alaska, there is no way to provide the
software and the commitment without the grant money running out,
leaving the state to deal with the financial burden.
1:39:12 PM
MS. WING-HEIER said she has heard about the Effective Rate
Review and what that means. Historically, the oversight of
insurance rates has been a state responsibility, and ACA
established a role for HHS [U.S. Department of Health and Human
Services] by requiring that the secretary establish a process
for the annual review of unreasonable rate increases in the
individual and small group market. [Alaska] rates were
submitted to HSS on September 4, and she said she had one
conversation with HSS and "they have yet to question the data
that was submitted to them or the need for the rate increase."
She said that HSS will also determine if a state has an
effective rate review, and she questioned what that is. She
showed a slide of the states that were granted an effective rate
review status, and "we, along with 45 other states, were
approved by HHS as an effective rate review." The process
entails very detailed information under federal and state
statutes, and "we try to point out the types of data that are
submitted to us and reviewed to determine if a rate is
justified," she explained. Much like the exchange, the federal
government released grants to fund states to become effective
rate review states, she added, and Alaska has been criticized
for not accepting [these grants]. She said, "Cycle I provided
$1 million to the states to help develop or enhance a rate
review process that we have already been certified as effective
rate review by HHS."
1:41:31 PM
REPRESENTATIVE SADDLER asked if she is speaking of a review of
effective rates or is it the system that is effective.
MS. WING-HEIER said that the intent is to determine if "our rate
review process is effective and over any qualification that HHS
statutory obligation or any of their processes to determine the
rate to be charged to Alaska consumers."
1:42:17 PM
REPRESENTATIVE JOSEPHSON said Susan Johnson, U.S. Department of
Health and Human Services, gave him something that reads:
Although Alaska meets the effective rate review
standards, it does not go beyond the minimum standards
in terms of their rate review process and transparency
of rate review data. For example, Alaska does not
have public hearings on rates; they post minimal
information in a form inaccessible to consumers.
REPRESENTATIVE JOSEPHSON said that Ms. Johnson cites the Kaiser
Foundation who says that Alaska is one of the least transparent
states in terms of making rate review available. "Is it
possible that we're complying with this minimum standard but not
doing all that we could to help consumers?"
MS. WING-HEIER said, "No, sir, I believe we are going above the
standard." In Alaska the concern with the transparency is that
there is a statute that requires rates to be kept confidential
until the effective date. "I cannot, by statute, release the
rates until January 1." The statute was intended to keep
insurers from knowing what their competition was bidding to
enable fair competition, she said.
1:43:53 PM
MS. WING-HEIER said there was the $250 million over five years
awarded for effective rate review grants. "In Alaska, we felt
that there was adequate staffing; we thought we only qualified
and we believe we only qualified for Cycle I," she said, because
one of the criteria for Cycle II "is that you're trying to be an
effective rate review--we already achieved that status." There
are only eight healthcare insurers in Alaska, she explained, and
some states have 20 to 60 insurers, so it was not clear how
Alaska could spend a million dollars of federal money to enhance
a process that had been working for years, she stated. She
continued:
When we have taken criticism for the effective rate
review, we're taking it on the individual market,
because there are some significant rate increases--I
don't deny that; I can't, but no one talks about that
we use the same rate review, the same processes, for
the group market, and that the small group went down
17 percent on the average for Moda and a slight
increase of a little over 5 percent for Premera, and
it's the same process we use; the same type of data;
the same qualifiers.
1:45:25 PM
CHAIR OLSON recalled that Ms. Wing-Heier said that the top two
companies were writing 75 percent of the premiums.
MS. WING-HEIER said, yes, Premera and Moda. She continued and
said that the determination to accept funding under Cycle II was
that the state had to be working towards being an effective rate
review state, but Alaska had already qualified, so "we did not
qualify to receive Cycle II grants." She noted that there was
$159 million awarded, and $14 million was returned as the states
could not justify how to spend the money. Ms. Wing-Heier said
that the Division of Insurance does not set premium rates;
insurers file their rates and the division approves or
disapproves them, and rates are defined by statute and cannot be
excessive, based on historical data. The rates cannot be
inadequate, "we have to guarantee the solvency of the insurance
companies," she said, and they cannot unfairly discriminate or
be applied unfairly for similar risks, such as age, plan, or
tobacco use.
1:47:24 PM
MS. WING-HEIER noted that in 2014, when ACA came about, there
was speculation across the nation as to what the pool would look
like. She said there were assumptions that those who were most
in need of insurance would enroll the first year, and those who
are not in need of healthcare right now have yet to enroll. In
2014, there was significance loss. By reviewing the data, she
found that some of it is pent up demand and that there are some
very ill individuals who have needed healthcare. In certain
months, the division looks at loss ratios of the premiums coming
in over the claims going out. In some months the insurers were
paying out over $2.50 in claims for every $1.00 they were taking
in for premiums, and they cannot stay in business long paying
out that kind of money, she stated. She said that the ACA has
10 essential benefits, and those going forward in 2014 have the
benefits without any option "to roll in or roll out." Perhaps
someone does not want prescription or pediatric service, for
example, but the plan provides for them, she said.
1:49:46 PM
MS. WING-HEIER turned to the "medical loss ratio." She said
that this appears to be a good thing for consumers, "and perhaps
it is." In 2014, Premera issued checks back to consumers for
$2.6 million for their 2013 [indecipherable]. For all insurers,
the medical loss ratio is "if they, basically, guess wrong on
what they expect their claims were ... then the money is given
back to the consumers, which is a great thing on a good year."
She opined that it is unfortunate that the insurance companies
cannot keep the money to spread it out over the bad years. She
said if the companies guess too high on what their losses will
be, the money comes back to the consumers, but that does not
allow them to build up surplus money to pay future claims, and
that causes a rate increase. She turned to slide 25 dealing
with risk adjustment, risk corridor, and reinsurance, which are
part of the ACA, and the intent was to stabilize the market,
particularly for the first two years. The risk adjustment
transfers money amongst the insurers to adjust for the
possibility that some insurers may get more or less of their
proportionate share of costly enrollees, she said. She defined
reinsurance as insurance for the insurance companies. In 2014,
she said, "it attached to a claim at $45,000, but, I believe,
for the first $250,000 after that there was an 80 percent co-
insurance." She said it increases in 2015 and again in 2016,
and it is done in 2017. The risk corridor, she explained, is
much like the medical loss ratio, and it allows the government
to claw back some of the premiums if the expected losses are
lower than what the insurer predicted. The program will operate
for three years, and her concern is that last week the GAO
[federal Government Accountability Office] released a legal
opinion that the law was not funding for 2015 unless Congress
passes a clarification.
1:52:29 PM
REPRESENTATIVE SADDLER asked why it is only for three years.
1:52:53 PM
MS. WING-HEIER said that she has no clue, but she believes the
intent was for things to stabilize, and at some point we would
know exactly what was out there and the rates would be adequate
for the population served.
REPRESENTATIVE SADDLER asked if it was not to deal with the pent
up demand.
MS. WING-HEIER said it could have been to deal with the pent up
demand and to see what the pool would be. Everyone knew that
there were uninsured people and people needing healthcare, but
there was no way to quantify the number and the pool with regard
to healthcare costs.
CHAIR OLSON asked if it was written by the insurance companies.
MS. WING-HEIER said it was written into ACA. She continued. In
September 2014, Secretary Sylvia Burwell wrote that while
competition is working in the online marketplace, it may not
work as efficiently in a high-cost market with a small
population such as Alaska. That is the point Ms. Wing-Heier has
been trying to push since the onset of the ACA: the concerns of
a one-size-fits-all option to provide healthcare, without her
division being able to be creative or think outside the box,
which it is making it costly to consumers.
1:54:50 PM
REPRESENTATIVE JOSEPHSON asked what she meant by one size fits
all, and if that is the state perspective, not the consumer,
because consumers have some choices.
MS. WING-HEIER said the consumer can choose a gold, platinum,
silver, or a bronze plan, and the consumer can choose the
insurer. There are variations in the deductible "and such," but
the health benefits are one size fits all.
REPRESENTATIVE JOSEPHSON said that some states with small
populations, like Arkansas, saw a reduction of 2 percent and
Montana's increase was only 1.35 percent. "Are we just an
outlier?"
MS. WING-HEIER said part of the concern is the cost of
healthcare, which is one of the highest in the nation and higher
than healthcare in Arkansas. She said, "We're in a dilemma."
Alaska healthcare is one of the costliest in the nation. The
ACA has limited options for the products for the Alaska
consumers, she added. She said the underwriting has been
restrictive, and she has heard from people from all walks of
life that there is a problem with the ACA in Alaska
1:58:19 PM
MS. WING-HEIER said her mission is to protect Alaska consumers
and provide them with products that are financially secure and
to make sure the providers are stable and accountable. She
added that nothing in ACA is affordable, and the division is
doing everything in its power to make healthcare affordable.
1:59:01 PM
REPRESENTATIVE SADDLER turned to slide 27, and he asked if the
rates of increase are annual.
MS. WING-HEIER said the slide shows the average rates, filed by
the insurance companies, of individual states for the individual
market. It is the average rate of the individual markets, so it
is the expected change in healthcare expenses.
1:59:52 PM
CHAIR OLSON said the original numbers he saw for Alaska were
closer to 70 percent on certain types of groups.
MS. WING-HEIER said there was never a filing for a 70 percent
rate increase. When the division first met with Premera,
Premera indicated that it would be 70 percent, but because of
its relationship in the state, their financial solvency and
stability, "we could see that they could provide a product in
2015 [with] less than a 70 percent increase and still be around
in 2016." She said she does not know what Premera's testimony
will be, but its rates filed with the division show the
expectation of a $5 million loss next year.
REPRESENTATIVE SADDLER asked about the 2015 rates of plus 22
percent and plus 40 percent on slide 28.
MS. WING-HEIER said, "22 percent would the low end of one, to
the high end of the other, [and] all the plans in between."
2:02:22 PM
REPRESENTATIVE JOSEPHSON noted that Ms. Johnson said that the
state average premium increase was 17 percent between 2008 and
2011, so that is less than even our lower end, but Ms. Johnson
notes that Premera had the largest increase of 32 percent in
2008, which would be near the middle of those numbers. Although
none of this is good news, is it possible there could be some
leveling, he asked, and if it is wildly inconsistent.
MS. WING-HEIER said she hopes that there is some leveling and
that the rates stabilize in three to five years, but she does
not know if it will level out.
2:04:04 PM
REPRESENTATIVE SADDLER said he has an interest in the coverage
of young people with disabilities. He spoke of an exemption,
and he asked how many in Alaska do not have coverage of mental
healthcare services.
MS. WING-HEIER said she will get back to him on that.
BECKY HULTBERG, President and CEO, Alaska State Hospital and
Nursing Home Association (ASHNHA), said the members of ASHNHA
include hospitals and nursing homes across the state. As
healthcare providers, the members know the importance of
healthcare insurance, because an accident or unexpected
diagnosis can tilt someone's world, and for someone without
health insurance the consequences can be devastating. A
functioning private insurance market is critical to providing
Alaskans access to health insurance, she said. Not everyone
chooses to be employed, she explained, and private insurance is
a necessity, not a luxury, for those who are self-employed or
those with employers who do not offer health insurance. Having
a functioning private insurance market is essential to Alaska's
economy, she added.
MS. HULTBERG said, "We need entrepreneurs and we need risk
takers," but without affordable health insurance this may be too
much of a risk for people. Prior to the ACA, insurers could
deny coverage based on pre-existing conditions, and this
coverage is one of the most popular aspects of the ACA, she
explained. "We're not likely, nor should we, return to a time
where you could be denied coverage due to the genetic lottery or
unfortunate circumstances," she stated, but the provision has
changed the risk pool. She noted that in a small market, it is
hard to spread risk unless premiums increase. She spoke of
ASHNHA's concern about the premium increases in the private
market for 2015 and that the dialogue has not been as much about
finding solutions as it has been about pointing fingers. She
encouraged the state, the federal government, and private
insurers to sit down and discuss how to move this forward to a
sustainable future. The state needs to think big, she said.
Alaska is unique and here is an opportunity to demonstrate that
we can find unique solutions to our unique problems. She asked
the federal government to consider the flexibility and
innovation that may be necessary to meet the health insurance
needs of Alaskans. The problem is solvable if everyone works
together--it is a math equation, she said, and people need to
step out of their boxes and think differently.
2:07:40 PM
CHAIR OLSON said that when ACA was rolled out, one of the
appealing points was taking pressure off of the emergency rooms,
because primary care would no longer be dealt with in emergency
rooms. He asked if that impact is already occurring.
MS. HULTBERG said, "Not really." Medicaid expansion is what has
really changed that, so for states that have expanded Medicaid,
uncompensated care costs have gone down significantly. The
volume of new Alaska entrants to the exchange is not sufficient
enough to see any difference in the use of emergency rooms or
uncompensated care, she explained.
2:08:46 PM
REPRESENTATIVE REINBOLD asked her to describe the risk pool
Alaska had prior to the ACA.
MS. HULTBERG said she is not going to claim expertise on
insurance, but she believes that Alaska has had a high risk pool
through ACHIA (Alaska Comprehensive Health Insurance
Association), and some of the people who were in that high risk
pool have transferred to the individual market. It is a matter
of numbers. Alaska has a small pool, and in spreading risk over
a small pool "you can see these kinds of swings," she explained.
2:09:48 PM
REPRESENTATIVE MILLETT said she is confused by Ms. Hultberg's
testimony, and she asked if ASHNHA is in favor of Medicaid
expansion.
MS. HULTBERG said yes, but her point today is the concern about
the private insurance market and the importance in having it in
Alaska to provide access to insurance and for the health of
Alaska's economy. She added that ASHNHA is asking that
creativity and flexibility be brought to the table.
2:10:45 PM
REPRESENTATIVE JOSEPHSON asked about any linkage between the
states that have taken Medicaid expansion and cost increases.
MS. HULTBERG said she does not know, but the primary published
metric involves uncompensated care, and as uncompensated care
goes down, the financial performance and the ability of
healthcare providers to provide services is enhanced.
2:11:36 PM
REPRESENTATIVE REINBOLD asked why ASHNHA supports Medicaid
expansion and if the physicians are taking Medicaid.
MS. HULTBERG said that for many of ASHNHA's member facilities,
Medicaid expansion is a moral obligation. "We believe that
people have the right to healthcare," she stated. There is a
population of people with no way to purchase health insurance--
it is simply beyond their reach, she explained. She said that
the most fiscally responsible way to ensure healthcare coverage
for that population is through accessing federal funds.
Regarding the second questions, she noted that some of the
member hospitals employ physicians and some do not, so it really
depends on the facility.
2:12:28 PM
REPRESENTATIVE SADDLER asked Ms. Hultberg the basis for her
statement that people have a right to healthcare. "Is that the
state or federal constitutions, or any state law?"
MS. HULTBERG answered that this country has made the decision
with the Emergency Medical Treatment and Active Labor Act that
one of the things the people of the United States will provide
is emergency medical care regardless of a person's ability to
pay. The organization has many people with many different
opinions, but it is fair to say that many of the members do
believe that as a society, healthcare is one of those basic,
fundamental responsibilities.
REPRESENTATIVE SADDLER asked about the Emergency Medical
Treatment and Active Labor Act.
2:13:40 PM
REPRESENTATIVE MILLETT asked how many providers of ASHNHA are
accepting Medicaid at this point.
MS. HULTBERG said all of the hospitals take Medicaid, and she
assumes that the physicians who are employed by the hospitals
take Medicaid.
2:14:35 PM
REPRESENTATIVE REINBOLD spoke of government debt and questioned
this moral obligation [regarding providing healthcare to
others]. She said there are "families that want to be able to
support their own families--the people they've chosen." With
regard to spending federal dollars, there is a large debt to pay
back right now, so the "bottom line is why should people, when
we have such a high debt, be forced to pay more taxes in order
to take care of others when it's not a sustainable model?" She
asked where these federal dollars are going to come from.
MS. HULTBERG said these dollars will be spent regardless of
whether "the little bit that we would spend in Alaska on
Medicaid expansion is part of the equation or not." The funds
are already factored into those long-term projections, she
explained.
2:15:42 PM
SHEELA TALLMAN, Senior Manager, Legislative Policy, Premera Blue
Cross, said Premera provides coverage to over 100,000 Alaska
residents, and it offers coverage to individuals, small
employers, and large employers, as well as offering services to
the larger self-funded groups. She said that Premera received
approval for a 37.3 percent average rate increase for its
metallic Affordable Care Act compliant plan. The actual rate
increase that an individual might face will depend on age,
geography, and the plan selected, she noted. The plans are
offered both on and off of the exchange and will impact
approximately 7,000 members starting January, 2015, and
subsidies will help the lower income individuals. The 6,000
people on individual plans are members who will not be impacted,
she explained. Additionally, those who obtain coverage through
employer-sponsored plans are not impacted by the rate increase.
MS. TALLMAN said the individual market in Alaska has changed
significantly since the implementation of ACA; guaranteed access
means that all Alaskans have access to private healthcare
coverage regardless of health status. The high risk pool, or
ACHIA program, has decreased its enrollment by over half since
the beginning of this year, she said. Additionally, the federal
high risk pool, which ACHIA has administered, has also
[indiscernible], so those provided coverage to some very sick
individuals who could not obtain coverage in the private market.
MS. TALLMAN said the guaranteed access requirement coupled with
the small size of the Alaska market has resulted in an
unsustainable market. There are not enough healthy purchasers
in the individual market to offset the costs of members with
very high medical needs. She said that in 2014 there was a
significant influx of new enrollees with very high medical
costs. "We had more than $7 million in claims from just 33
members, and that is about a third of all the claims for all
7,000 members purchasing those metallic, individual plans," she
stated. On average, Premera is paying about $723 in claims per
month for members on this plan and receiving about $500 per
month in premiums. She said Premera expects to lose about $4
million in the market in 2014. The federal "Three Rs" or the
federal risk mitigation programs, were designed to minimize the
effects of adverse selection in the guaranteed access
environment. They are insufficient at the very high end of the
claims cost and will not be able to help spread the risk in a
market that is too small, she noted. Additionally, two of the
programs will sunset in 2016.
MS. TALLMAN stated that the key to addressing this situation is
to create a large enough pool to spread the costs of the members
with significant medical needs. Even if all of the individual
markets were in one pool and everyone purchased coverage, the
market in Alaska is still too small to adequately spread the
risk, she added. Premera suggested a policy option, which is
the implementation of a supplemental state-based free insurance
program, which would use the state's current high risk pool,
ACHIA, to spread the highest cost conditions across the entire
insured market, she said, which is how the high risk pool works
today. "We believe this will help stabilize the individual
market for all individual purchasers and create a more
competitive market without drastic swings and premiums." She
said Premera understands that the Division of Insurance is
evaluating this proposal and that this is a difficult situation,
especially for the impacted members, "so we are committed to
working with you and other stakeholders to create a sustainable
market in Alaska," she concluded.
2:20:20 PM
REPRESENTATIVE SADDLER asked about the supplemental insurance
program based on ACHIA.
MS. TALLMAN said it would be a state-based solution, and the
idea is to build it as a wrap-around to the federal re-insurance
program. An individual would sign up for coverage with any
health plan, obtaining all of the benefits and access to
providers, and on the back end--much like how the federal re-
insurance program works--is that once an individual hits a
certain amount of medical claims costs, then those claims would
be ceded to the high risk pool and spread across the entire
insured market through the existing assessments that ACHIA uses
today to spread the costs of the enrollees. She said there are
different ways of establishing a state-based re-insurance
program, like condition-based or a claims dollar amount, but the
essential concept is that certain claims costs would be spread
across the entire insured market.
REPRESENTATIVE SADDLER surmised that those higher costs would be
borne by the state.
MS. TALLMAN agreed. "Those costs would be spread just like how
ACHIA is funded today through an assessment of the entire
insured market; it would function the same way," she said.
REPRESENTATIVE SADDLER said that would be to the benefit of the
patient and the insurance companies, but the state would pay.
MS. TALLMAN said, "It would come at the cost of those purchasing
insurance, actually, because it is an assessment that's spread
across the entire insured market, so anybody that's in the
individual and group market would pay that assessment."
2:22:31 PM
REPRESENTATIVE JOSEPHSON said there is some dispute about how
many would be covered with Medicaid expansion; the low number is
around 9,000 and the high number is 41,000--a huge difference.
But if there were Medicaid expansion, he asked, "would any of
those dollars translate or effectuate themselves such that Moda
and Premera could meet this demand?" He referred to the $700 in
claims paid versus the $500 in premiums, and asked if Medicaid
would fix that difference by lowering the uncompensated care.
MS. TALLMAN answered that would require some additional
analysis, but she said she is addressing the individual market
today, and those eligible for Medicaid expansion can go into the
individual market to get coverage and get subsidies, but they
are eligible for separate programs, so she is not sure what
impact Medicaid expansion would be on the private market.
REPRESENTATIVE JOSEPHSON asked about the rates that are set by
Premera and Moda, which may be based partly on the income of the
two main Alaska hospitals. "Would it seem logical to you that
if, according to the high end, there was $1.1 billion of revenue
that came in covering 41,000 people, that that would trickle
down and benefit some of the people in the individual market by
suppressing inflation?"
MS. TALLMAN said she understands his point, but it would still
be difficult to answer without doing additional analyses.
2:25:02 PM
REPRESENTATIVE JOHNSON asked if the $4 million was across all
business lines or just across those 7,000 outside of the plan.
"Is that your total loss for the state, or is that just within
those individual plans?"
MS. TALLMAN said the loss is just for that individual market.
Premera just evaluates based on each segment, looking at the
individual block and other components separately.
REPRESENTATIVE JOHNSON said, "We're looking at the state as a
whole, and the state pays an awful lot of insurance being self-
insured, and we provide a certain margin in that, so I would be
curious to know across your total lines if that $4 million holds
true or if we're really not that bad of a market to be in."
2:26:11 PM
CHAIR OLSON asked if there any other states that are doing the
supplemental rate insurance.
MS. TALLMAN said Oregon has passed a law that would establish
their supplemental state re-insurance program, and a couple
other states might be looking into it.
CHAIR OLSON asked if it is a violation of ACA to have a cap on
benefits. He spoke of totally debilitating long-term cancer
with drugs costing $70,000 a month, "but it wouldn't be capped
under ACA, is that correct?"
MS. TALLMAN said yes, so under a supplemental program, the
member would still receive all of those benefits without any cap
or limits, "it's just on the back end with how the claims costs
are being spread. You would set some sort of attachment and
build parameters to help spread the risk of the claims cost on
the back end."
CHAIR OLSON asked if it would be optional or mandatory to
participate.
MS. TALLMAN said it would depend on how it is designed, but it
could be permissible for any insurer to participate.
CHAIR OLSON asked who pays for it.
MS. TALLMAN reiterated that it would be based on how the current
high risk pool works today, which is funded through an
assessment on the entire insured market. The idea would be to
not increase the assessment going forward, but there are
different ways of designing it, she explained.
2:28:52 PM
CHAIR OLSON asked what the assessment has been.
MS. TALLMAN said she believes that it has fluctuated over the
past few years, but the average is between $8 million to $10
million annually. From Premera's perspective, the assessment
has ranged from about $8 to $10 per member per month.
REPRESENTATIVE SADDLER asked how the projections of the costs to
private insurers of no longer having exclusions of pre-existing
conditions compare to actual costs of the past year.
MS. TALLMAN said, "If we're paying $723 in claims per member per
month compared to $540 in premiums in 2013, and probably prior
years it's been much closer to the premium amount that we've
been collecting."
REPRESENTATIVE SADDLER asked about the projections.
MS. TALLMAN said she does not know, but Premera anticipated a
lot more people and potentially healthier people purchasing in
the pool overall, and so it has set the rates in 2014 based on
that. "Now we're looking at rates based on the actual experience
that we're seeing."
2:30:23 PM
JASON GOOTEE, Regional Manager, Moda Health, Alaska, said his
supervisor flew to Juneau specifically for this hearing.
KRAIG ANDERSON, Senior Vice President and Chief Actuary, Moda
Health, said Moda Health was known as ODS Health Plans Inc. and
was a Delta Dental Plan in 1955. It is the only "Delta Dental"
that does medical insurance, he noted. In the mid-2000s, Moda
took over marketing rights for Delta Dental in Alaska, and
between 2005 and 2007, "we rolled out individual and group
dental and medical products in Alaska." Moda established an
office in Anchorage in 2005, which serves as a sales office and
account services, and in 2013, ODS rebranded to Moda. With the
passage of health reform in 2010, there were significant market
reforms, and perhaps the most significant was the impact to the
individual market by the requirement of guaranteed issue and the
exclusion of health statement underwriting. Prior to 2014, in
order to get individual coverage in Alaska, a person had to go
to an insurance company, fill out an application with health
statement information, and the insurance company could either
accept or decline him or her for that coverage. Another option,
he said, was that the insurance company could actually rate up
the policy depending on a person's health condition (but that
was not a practice of Moda). "So that was the environment
before healthcare reform," he stated, and that was why the
private individual market was healthier than average and had
lower costs.
CHAIR OLSON asked about lifestyle choices, like smoking.
MR. ANDERSON said those people were not declined by Moda, but
they may have had higher premiums.
2:35:26 PM
MR. ANDERSON said in June, 2012, a company called Lewis and
Ellis did an actuarial analysis of the exchange and it factored
in the impacts that healthcare would have on Alaska. The report
had some interesting insights that relate to the individual
market, he stated. It noted three factors of health reform that
would increase rates in the individual market: eliminating age
bans; health status and guaranteed issue restrictions; and
minimum benefit coverage. However, he said, the primary factor
is the health status and guaranteed issue restriction. He
explained that the primary goal of health reform was the
expansion of coverage to the uninsured, and that was to be done
through the exchanges. The federal government set up a program
to allow for subsidized premiums for people who earn up to 400
percent of the poverty level as long as they purchased a policy
on an exchange.
MR. ANDERSON said that Lewis and Ellis estimated that the
average cost of those who are currently uninsured is
approximately 36% higher than the existing population in the
private individual market. He reiterated that the private
individual market, which was health statement underwritten and
healthier on average, and the study "looked at the uninsured
people that are out there in Alaska and estimated they would be
36 percent higher in costs, and those are the people that
they're trying to move in to the market." Although Lewis and
Ellis said that the average cost was 36 percent higher, they did
not know how many of the uninsured would actually go into the
private market even with the subsidies, he added. In 2013, the
uninsured population in Alaska was estimated to be about
138,000. The study estimated that 54,000 of these uninsured
would move into the private market, but only 16,000 people ended
up being on the exchange--a very small slice of a very large
pie. He said that that this small group of people who actually
picked up policies in the exchanges are the ones with the
highest healthcare costs.
2:39:00 PM
REPRESENTATIVE JOSEPHSON said the director talked about maybe
finding 6,000 more [people to get policies in the exchanges].
MR. ANDERSON said the Lewis and Ellis report was done in 2012,
so it gave a very preliminary estimate of possibly 54,000 people
moving into the market. He said he thinks 22,000 is a more
current estimate of the number of people expected to move into
the exchange market.
CHAIR OLSON stated that of the 138,000, there is probably a
significant portion that are already covered, and he spoke of
Native Alaskans.
MR. ANDERSON said that is possible.
CHAIR OLSON suggested that Native Alaskans and young males are
not signing up as projected. Young males think they are "bomb
proof," he explained. Many of his daughters' friends do not
have insurance but could; "a lot of them work on the North Slope
or have the income..."
MR. ANDERSON agreed; many of the uninsured are young and
healthy.
2:41:54 PM
REPRESENTATIVE MILLETT asked if he included people who had
health benefits under the Indian Health Service as uninsured.
MR. ANDERSON said he did not know.
2:42:27 PM
REPRESENTATIVE REINBOLD asked who commissioned the Lewis and
Ellis study.
MR. ANDERSON said he cannot recall who commissioned it.
REPRESENTATIVE REINBOLD said that a very valid source told her
that 26,000 of these people were working age, childless adults
who had the ability to work.
MR. ANDERSON said, "When I hear the term childless adult, what
comes to mind to me are those who would have fallen in the gap
of Medicaid expansion. That's what's coming to mind for me."
REPRESENTATIVE REINBOLD said the "26,000 people were adults that
were completely capable of working, did not get Medicaid because
they didn't have children, but it was this uncovered population,
speaking of possibly these young men that are running around,
you know, that feel like they're invincible. So, I just want
you to address that." These are people who are not interested
in taking out a plan at this time, she added.
MR. ANDERSON said he believes they would be included if they are
not receiving insurance coverage. The 26,000 childless adults
who do not have coverage would be within the 138,000 number that
he referenced earlier.
2:44:53 PM
MR. ANDERSON noted the additional complication when, in 2013,
people were allowed to keep the coverage that they had. But
that population who extended their health plans from 2013 to
2014 tended to be healthier and did not enter the ACA risk pool
either. So these combined factors have resulted in a higher
than average risk profile for the ACA than what was predicted,
he stated. Insurance companies have to price its products to
the average market risk, and he said the Wakely Consulting
[Group] provides that information to Moda and other insurance
companies. Based on their information, Moda found that the
average morbidity of the entire Alaska marketplace was 26
percent higher than what was in Moda's own pool of people, he
noted, and this was the main contributing factor to Moda's rate
increase.
MR. ANDERSON stated that without insurance companies
participating in the exchanges, it would not work. There is no
mandate for the insurance companies to join, and going into
2014, there were a number of national carriers who "sat it out
in some markets." In Alaska, for the exchange to stay
competitive there needs to be more than one option, "and for us
to remain an option, we had to raise our rates going into 2015."
He said Moda has looked at 2014 financial modeling and it
indicates a loss. A big source of the loss is the transfer
payment, he said, which is one of the Three Rs (or a risk
adjustment component), where Moda will be making a payment to
other insurance carriers because Moda has better than average
risk in its population.
2:49:22 PM
MR. ANDERSON explained that there are three risk mitigation
programs as mentioned earlier: reinsurance, risk adjustment, and
risk corridors. The risk adjustment program is permanent, and
it transfers money between insurance companies to average out
the risk. It is designed so that insurance companies do not try
to manipulate their risk pools. The average risk of the market
is much higher than Moda's market, so Moda will have a transfer
payment at the end of the year, he clarified. It is a zero-sum
game, however, because there is no funding source for risk
adjustment outside of the premium that is collected by the
market--it is just moving that premium between carriers and it
is done on a retrospective basis, he added.
2:50:58 PM
REPRESENTATIVE REINBOLD asked if the projected loss has to do
with risk or does it also have to do with an increase in the
number of Moda employees, bonuses, salaries, or capital
improvements.
MR. ANDERSON said it is primarily a loss due to risk--"there are
no expenses of the nature you mentioned that are in excess of
what was planned."
REPRESENTATIVE REINBOLD asked if he was anticipating any
decrease in reimbursements. [Mr. Anderson answered no.]
2:52:18 PM
REPRESENTATIVE JOSEPHSON asked if Moda believes it will capture
more enrollees because the penalties on tax returns are going to
escalate and because the [ACA] website is working better.
Nationally there has been an increase of 10 million [enrollees],
and he asked if any study suggests that there will be
improvement in small states like Alaska.
MR. ANDERSON said he believes that the 8 million to 10 million
represents only private insurance and does not include Medicaid
expansion. His question is really the heart of the matter and
the concern that Moda has. "We would anticipate more of the
insured," he said. He said there were difficulties in getting
people enrolled in time and there should be more enrollment.
The concern is that with insurance companies raising their rates
as much as they have, on average, there may be people dropping
coverage.
REPRESENTATIVE JOSEPHSON asked, "Why is Moda's low-end
anticipated increase 22 percent and Premera's high end 40
percent?"
MR. ANDERSON said he does not know how the two ended up with
different increases; this process is confidential so he does not
know what other carriers are doing in the marketplace.
2:55:02 PM
MR. ANDERSON stated that MODA is committed to the individual
market in Alaska, but he is concerned that the increases
necessitated by the worsening risk pool will make it more
difficult for those who are uninsured to purchase policies and
for those who are currently insured, to maintain those policies.
The intent is to work with the Division of Insurance to come up
with ideas and to provide assistance to ensure the long-term
viability of the individual market, he concluded.
2:55:58 PM
REPRESENTATIVE SADDLER asked what Moda is working on with the
Division of Insurance.
MR. ANDERSON said he has not had those discussions yet. In
Oregon, there is a technical advisory group, which is hosted by
the insurance division and brings in the carriers to work
together on issues like this. One issue is the supplemental re-
insurance program, and it is already in place. Ideas may result
in legislation that the technical group can help draft, he said.
Secondly, the pool can be expanded by putting in all the people
who are in the individual market and potentially expand the pool
to those that are uninsured who may qualify for significant
subsidies so that they do not have a lot of out-of-pocket
expense to get insurance, he stated. There are a number of
Alaskans in the uninsured population, and maybe Alaska could
look at merging the individual and small group markets at some
point.
REPRESENTATIVE SADDLER noted that Ms. Hultberg said this is a
math problem, so [indiscernible].
2:58:41 PM
CHAIR OLSON asked if Premera and Moda can talk without having
the Division of Insurance in the room.
MR. ANDERSON said Moda does meet with other insurance companies
but is bound by restrictions on what can be discussed. "In
concept we could talk about a program as long as it wasn't
related to how rates were developed."
2:59:45 PM
VINCE O'SHEA, Vice President, Pacific Seafood Processors
Association (PSPA), said PSPA is a trade association with nine
members companies that operate in Alaska, and seven of those
operate shore-based plants, buying and processing fish. The
companies employ tens of thousands of people and provide markets
to Alaska fishermen. Because of ACA, insurance expenses are
rising. He reminded the committee that the members of PSPA "are
not price makers in the markets that we sell to." He said that
70 percent of Alaska seafood goes into the global market, and
PSPA produces less than one percent of the supply. "So for us
to go to our customers and say our expenses have gone up, simply
means they will go to somebody else that will meet the price
that they're willing to offer." He said that includes factory
trawlers, which are not covered by the same rules that PSPA
operates under. If labor costs go up, his members must look at
new ways to reduce costs, and that will include a reduction in
employees through automation and through exporting work
overseas. He noted that Alaska is already sending $1.4 billion
a year worth of seafood to China, South Korea, and Southeast
Asia, which then gets shipped to other markets including the
United States. He said PSPA members want their workers to have
health insurance, "but we also need, at the end of the day, to
be able to produce fish at a price that we're able to sell for
more than what it costs us to produce the fish."
REPRESENTATIVE SADDLER surmised that Mr. O'Shea's message is
that there is a national desire to provide health insurance, but
it might be pricing your products out of the market.
MR. O'SHEA said health insurance alone will not put his members
out of the market, but it will add to the burden of competing on
the global market.
3:04:24 PM
REPRESENTATIVE MILLETT asked about insurance for seasonal
workers.
MR. O'SHEA said it depends on the company, but under the ACA
there will be standards, and some of their workers are
benefitting from the program. He said there will be winners and
losers. At least one of the companies in PSPA is covered by a
union contract, so that goes into the equation, he added.
3:05:48 PM
BILL STREUR, Commissioner, Alaska Department of Health and
Social Services (DHSS), noted that the committee heard a lot of
numbers, which seem to be getting a little mixed up. He said
that the figure for the number of uninsured, 134,000, is very
close to DHSS's estimate "of about 143,000 at the outside." He
added that 41,000 is very close to the total number of eligible
people under Medicaid expansion, and DHSS has been using the
figure of 9,000 people who would be in the gap--those who would
be in need of either chronic or acute medical care (but it is a
difficult number to estimate). A consulting firm estimated
Alaska's Medicaid expansion to be 44,000, and of those, about
19,000 would be in the gap population, he stated. "Those are
the folks that are under 100 percent of poverty level, largely
childless adults, [and] not necessarily healthy. I want to
clarify that because that 9,000 number that we were talking
about is folks that may have an acute or chronic medical
condition that prevents them from being able to work." He said
that is where there has been difficulty in looking at that gap
population to see what the healthcare needs would be. He
offered to create a table that includes the figures that were
spoken about today.
REPRESENTATIVE MILLETT asked how many people qualify for Indian
Health Services out of the 143,000 uninsured people.
COMMISSIONER STREUR said he does not have that number today, but
"for some reason 40 percent of that sticks in my mind." That
would be the percentage of those covered under the Indian Health
Services, he clarified.
REPRESENTATIVE MILLETT asked, "Between the 44,000 and the 9,000
that we're talking about that are uninsured ... have any of
those been identified as being covered under Indian Health
Services or are they just eligible for Medicaid expansion,
whether or not they qualify for the benefits under Indian Health
Services?"
COMMISSIONER STREUR said the 44,000 includes tribal members who
would be eligible [for Medicaid expansion], and the 9,000 leaves
out tribal members--"We're talking about folks who we believe
have extremely limited access to healthcare."
REPRESENTATIVE MILLETT asked if the state is doing anything to
identify those people who are covered by Indian Health Services,
and getting them in contact with those benefits.
COMMISSIONER STREUR said DHSS and the Indian Health Service are
working on that. In the Medicaid population alone, "we have to
do a better job of ensuring that Indian Health Service members
are receiving services within the IHS system." He added that
about 40 percent of the total expenses "we" pay in Medicaid for
tribal members is delivered in the IHS system and 60 percent is
going outside the tribal system.
REPRESENTATIVE SADDLER asked about the progress of the Medicaid
Reform Advisory Group.
COMMISSIONER STREUR said the meeting in October may be the last
one before giving recommendations to the governor and
legislature. He added that he believes the report is due in
November.
3:12:21 PM
REPRESENTATIVE REINBOLD asked how the healthcare providers are
doing in the marketplace.
COMMISSIONER STREUR said the United States has the highest
healthcare costs in the world, and Alaska is one of the states
with the highest healthcare costs in the country, so "I believe
that the providers are doing well." All of the hospitals
participate in Medicaid and nearly all of the physicians do.
"We have incredible access, but we also pay 140 percent of
Medicare," he said. Most states pay about 70 percent of
Medicare, "so we're paying about double," he added.
REPRESENTATIVE REINBOLD asked if there are enough providers.
COMMISSIONER STREUR said he cannot answer that with any kind of
authority. He noted that there are challenges with access to
care, and that may be in regards to medical specialties, like
finding a dermatologist in Southeast Alaska, but because of the
innovations of the tribal partners, the development of the
clinics in the rural areas, and the sophistication of the tribal
health centers in rural Alaska, "we do have incredible access
for the amount of road systems we have in this state."
REPRESENTATIVE REINBOLD asked if Commissioner Streur anticipates
a shortage of providers because of the Affordable Care Act.
COMMISSIONER STREUR said he cannot answer that; however, he
believes that with additional Alaskans getting insured, there
will be a greater need for care.
3:16:15 PM
CHAIR OLSON noted that tomorrow there will be public testimony.
He said he had invited Senators Begich and Murkowski today, but
they did not attend.
3:17:14 PM
ADJOURNMENT
There being no further business before the committee, the House
Labor and Commerce Standing Committee meeting was adjourned at
3:17 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| Labor and Commerce 10-7-2014 Div of Insurance Presentation ACA.pdf |
HL&C 10/7/2014 1:00:00 PM |
Affordable Care Act |
| Labor and Commerce 10-7-2014 Press Release Premera 9-5-2014.pdf |
HL&C 10/7/2014 1:00:00 PM |
Affordable Care Act |
| Additional Supplemental bulletins and letters for the Labor Commerce hearing on October 7 2014.pdf |
HL&C 10/7/2014 1:00:00 PM |
Affordable Care Act |
| Written Testimony by Kraig Anderson-Moda to HL&C Committee 10-7-2014.pdf |
HL&C 10/7/2014 1:00:00 PM |
Affordable Care Act |