Legislature(1995 - 1996)
05/02/1996 08:05 AM House STA
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
HOUSE STATE AFFAIRS STANDING COMMITTEE
May 2, 1996
8:05 a.m.
MEMBERS PRESENT
Representative Jeannette James, Chair
Representative Scott Ogan, Vice Chair
Representative Joe Green
Representative Ivan Ivan
Representative Brian Porter
Representative Caren Robinson
Representative Ed Willis
MEMBERS ABSENT
All members were present.
COMMITTEE CALENDAR
CS FOR SENATE BILL NO. 253(FIN)
"An Act relating to insurance coverage for costs of prostate cancer
or cervical cancer detection."
- PASSED OUT OF COMMITTEE
PREVIOUS ACTION
BILL: SB 253
SHORT TITLE: INS. FOR PROSTATE & CERVICAL CANCER TESTS
SPONSOR(S): SENATOR(S) DUNCAN, Ellis, Salo, Zharoff, Lincoln,
Kelly; REPRESENTATIVE(S) Robinson, Kubina, Navarre, Rokeberg
JRN-DATE JRN-DATE ACTION
02/02/96 2279 (S) READ THE FIRST TIME - REFERRAL(S)
02/02/96 2280 (S) L&C, FIN
02/05/96 2309 (S) COSPONSOR(S): ELLIS, SALO
02/07/96 2330 (S) COSPONSOR(S): ZHAROFF
03/07/96 (S) L&C AT 1:30 PM FAHRENKAMP RM 203
03/07/96 (S) MINUTE(L&C)
03/12/96 (S) MINUTE(L&C)
03/14/96 2736 (S) L&C RPT 3DP 1NR
03/14/96 2736 (S) ZERO FISCAL NOTES (DCED, ADM)
03/28/96 (S) FIN AT 8:30 AM SENATE FINANCE 532
04/02/96 (S) FIN AT 9:00 AM SENATE FINANCE 532
04/03/96 (S) RLS AT 1:15 PM FAHRENKAMP RM 203
04/03/96 3042 (S) FIN RPT CS 7DP NEW TITLE
04/03/96 3042 (S) ZERO FN TO CS (ADM)
04/03/96 3042 (S) PREVIOUS ZERO FN (DCED)
04/10/96 3112 (S) RULES TO CALENDAR 4/10/96
04/10/96 3115 (S) READ THE SECOND TIME
04/10/96 3115 (S) FIN CS ADOPTED Y18 N2
04/10/96 3115 (S) ADVANCE TO THIRD READING FLD Y14 N6
04/10/96 3136 (S) COSPONSOR: LINCOLN
04/10/96 3116 (S) THIRD READING 4/11 CALENDAR
04/11/96 3167 (S) READ THE THIRD TIME CSSB 253(FIN)
04/11/96 3168 (S) PASSED Y19 N1
04/11/96 3168 (S) KELLY NOTICE OF RECONSIDERATION
04/12/96 3205 (S) RECON TAKEN UP - IN THIRD READING
04/12/96 3205 (S) COSPONSOR(S): KELLY
04/12/96 3206 (S) PASSED ON RECONSIDERATION Y18 N1 E1
04/12/96 3220 (S) TRANSMITTED TO (H)
04/15/96 3733 (H) READ THE FIRST TIME - REFERRAL(S)
04/15/96 3733 (H) L&C, STATE AFFAIRS
04/15/96 3783 (H) HES REFERRAL ADDED
04/15/96 3785 (H) CROSS SPONSOR(S): ROBINSON, KUBINA
04/22/96 3936 (H) CROSS SPONSOR(S): NAVARRE
04/23/96 (H) HES AT 3:00 PM CAPITOL 106
04/23/96 (H) MINUTE(HES)
04/25/96 (H) HES AT 3:00 PM CAPITOL 106
04/26/96 (H) MINUTE(HES)
04/26/96 4042 (H) HES RPT HCS(HES) 2DP 1NR 2AM
04/26/96 4042 (H) DP: BUNDE, TOOHEY
04/26/96 4042 (H) NR: G.DAVIS
04/26/96 4042 (H) AM: BRICE, ROBINSON
04/26/96 4043 (H) SENATE ZERO FISCAL NOTES (DCED)
3/14/96
04/26/96 4043 (H) SEN ZERO FNS (ADM/ALL DEPTS) 4/3/96
04/30/96 (H) L&C AT 3:00 PM CAPITOL 17
04/30/96 (H) MINUTE(L&C)
04/30/96 4168 (H) L&C RPT 2DP 4NR
04/30/96 4168 (H) DP: KUBINA, ELTON
04/30/96 4168 (H) NR: ROKEBERG, MASEK, PORTER, KOTT
04/30/96 4168 (H) SEN ZERO FN (ADM/ALL DEPTS) 4/3/96
04/30/96 4168 (H) SEN ZERO FN (DCED) 3/14/96
04/30/96 4180 (H) CROSS SPONSOR(S): ROKEBERG
05/02/96 (H) STA AT 8:00 AM CAPITOL 102
WITNESS REGISTER
JIM DUNCAN, Senator
Alaska State Legislature
State Capitol Building, Room 119
Juneau, Alaska 99801
Telephone: (907) 465-4766
POSITION STATEMENT: Sponsor of SB 253; urged passage of
CSSB253(FIN) version.
EUGENE DAU
Capital City Task Force
American Association of Retired Persons
and Member, Veterans of Foreign Wars
P.O. Box 20995
Juneau, Alaska 99802
Telephone: (907) 586-3816
POSITION STATEMENT: Supported SB 253.
ACTION NARRATIVE
TAPE 96-65, SIDE A
Number 0015
CHAIR JEANNETTE JAMES called the House State Affairs Committee
meeting to order at 8:05 a.m. and noted there was a quorum.
Members present at the call to order were Representatives James,
Ivan, Porter, Robinson and Willis. Representatives Green and Ogan
joined the meeting at 8:16 a.m. and 8:19 a.m., respectively.
SB 253 - INS. FOR PROSTATE & CERVICAL CANCER TESTS
CHAIR JAMES brought SB 253 before the committee and called on
Senator Duncan to present the bill.
Number 0032
SENATOR JIM DUNCAN, sponsor of SB 253, said it basically required
that insurance policies cover both Prostate Specific Antigen (PSA)
tests and cervical cancer detection. According to the National
Cancer Institute, prostate cancer accounts for 36 percent of all
male cancers and is the second leading cause of cancer death in
men. Senator Duncan said an estimated 40,000 men in the United
States would die from prostate cancer this year.
SENATOR DUNCAN explained that although prostate cancer was often
presumed to develop slowly, nearly two-thirds of new cases had
spread beyond the prostate gland by the time of diagnosis.
SENATOR DUNCAN said SB 253 was amended in the Senate Finance
Committee to require coverage of screening for cervical cancer,
which accounts for 16 percent of all cancers in women. "It is
estimated that nearly half of the approximately 15,700 women who
are diagnosed annually with the condition never underwent early
screening procedures which could have led to highly successful
treatment," he stated.
Number 0154
SENATOR DUNCAN believed SB 253 made preventive health care a
priority. He noted that committee packets contained letters of
support from providers who worked in the field; information from
the National Cancer Institute, including their recommendation of a
PSA test for men over age 50 or in a high-risk group; and a
recommendation for cervical cancer screening.
SENATOR DUNCAN acknowledged there was debate over whether the tests
were always accurate. "In fact, the providers indicate ... there
are times that they may have a false reading," he stated. "But
it's better to have that false reading and further examination than
to not detect cancer early at all."
Number 0259
SENATOR DUNCAN pointed out there was a zero fiscal note and said,
"There's not expected to be ... any premium increase as a result of
coverage of these two tests. The one thing that the fiscal notes
do not show, however, is the long-term savings. It's clear that
when you have a preventive health care measure in place, when you
require preventive health care tests and you have early detection
of a disease, that the cost savings in the long term are great.
They're hard to quantify, so ... they're not on a fiscal note. But
if you have early detection and catch a disease early, the costs
are much less than if you let the disease get well-underway and
then have to do some major surgery or major treatment, which is
very expensive."
Number 0315
SENATOR DUNCAN expressed that even more important than overall cost
savings was the savings of life. "Early detection, of course,
means that many people can be cured, and, therefore, many lives
saved," he stated. "So, I think it's a very important piece of
legislation."
SENATOR DUNCAN urged committee members to pass out CSSB 253(FIN),
the version passed out of the Senate and the House Labor and
Commerce Committee. "That's the bill that very clearly says that
the insurance policy shall provide for a PSA test and shall provide
for a cervical cancer screening," he explained. "It's important,
I think, to have that provision there, to make it clear that those
insurance policies will provide those preventive tests and not just
offer them. If we're to just ... ask insurance companies to offer
them, we're really doing nothing, because right now, insurance
companies can offer [them]."
Number 0410
SENATOR DUNCAN related that four years earlier, legislation had
passed in Alaska requiring that mammograms be covered by insurance
companies. "And that's being done," he said. "There was no
appreciable increase, or any increase that we could detect, in
health care premiums because of that requirement. ... But
undoubtedly, and again, that's difficult to quantify, there has
been a lot of costs saved because of early detection, and a lot of
lives saved. So, I think it's very important to look at these two
tests in the same regard."
SENATOR DUNCAN noted there were related articles in the committee
packets, including one from the Juneau Empire. There was also a
quote from a lobbyist for a major insurance company in Alaska,
indicating the company believed covering preventive health care was
the right thing to do, because in the long run, it saved money and
lives.
Number 0517
EUGENE DAU, Capital City Task Force, American Association of
Retired Persons (AARP) and Member, Veterans of Foreign Wars (VFW),
believed SB 253 was extremely important. Most men do not talk
about prostate cancer, even with their doctors, he stated, despite
the high death rate. Early screening was needed because prostate
cancer, when not caught in the early stages, spread fast. His own
doctor claimed the PSA test was 95 percent accurate. His doctor
had told him the test could reveal other problems with the
prostate, unrelated to cancer, as well.
MR. DAU said the PSA test was simple and not painful. "I think by
passing this bill, it would make people more aware of these two
tests, and especially the prostate cancer part," he said. "I think
if the bill passed in the original version, the Senate version
where insurance companies pay for these tests, it would encourage
people to take the test." He believed the bill would benefit all
Alaskans.
Number 0827
CHAIR JAMES noted someone was present from the Division of
Retirement and Benefits to answer questions. She asked if anyone
else wished to testify. Chair James referred to Senator Duncan's
suggestion that the committee accept the Senate Finance Committee
version of the bill, and asked: "When it says `shall provide
coverage', how does that make people do it? Because just having
the coverage there does not necessarily get people in to take the
test." She asked if Senator Duncan was expecting insurance
companies to do something beyond paying for the tests when
requested.
Number 0893
SENATOR DUNCAN replied he did not expect insurance companies to
force people to go to the doctor for tests. "But it would be a
covered item on your insurance policy, on every insurance policy
that's sold in this state, if you meet the qualifications or the
requirements that are under this legislation: age 50 or older if
you're a man, or if you're in a high-risk category, or age 18 and
older if you're a woman," he stated. Senator Duncan believed that
knowing it was covered, and knowing the seriousness of the
illnesses, people would request the tests, allowing early
detection.
Number 0947
CHAIR JAMES commented that under some dental plans, people who did
not get their teeth checked regularly did not receive the same kind
of coverage as those who did. "And that was what I was wondering,
if that was what you're expecting this to do," she said.
SENATOR DUNCAN replied that was not the intent.
Number 0962
REPRESENTATIVE CAREN ROBINSON suggested the outcome would be more
education, with people realizing it was important to take the
tests. She believed it was similar to what took place when the
legislature did the same thing with mammograms. "I think it
started the education, out in both the public and the media, and
people started doing what they should be doing," she stated.
CHAIR JAMES noted that Representatives Green and Ogan had joined
the meeting.
Number 0994
REPRESENTATIVE BRIAN PORTER indicated he would vote against the
bill, as he philosophically did not believe in this form of
providing medicine. "I think preventative medicine is so
beneficial that its efficacy should be apparent to even insurance
companies," he stated. However, he believed requiring it would
raise costs for individuals maintaining insurance. He said he
would support the other version, which required that it be offered.
CHAIR JAMES agreed, saying it was for an even more imbedded
philosophical reason. She suggested this moved further into social
engineering, where people did not have to make choices. She
preferred that people be responsible for their own lives. She
suggested coverage would make no difference for those who seldom
went to the doctor, because the deductible would not be met.
However, she thought it should be offered. "I understand the
interest of it," she said. "I'm not totally convinced that there
will not be an increase over the long term ... because I'm not
convinced that because we make them provide the coverage, that the
actual thing is going to be happening that much more."
Number 1148
REPRESENTATIVE SCOTT OGAN apologized for his late arrival and asked
for clarification about projected costs.
SENATOR DUNCAN referred to the fiscal notes and said he believed a
PSA test was about $75, not a major cost but one that was
prohibitive to many individuals. There was no appreciable
projection of increase in premiums, if any, he said. He emphasized
that long-term savings, due to early detection, were not included
in the fiscal note because that could not be quantified. "So, the
fiscal note shows zero," he said. "I believe in the long term,
it's a cost savings."
Number 1235
CHAIR JAMES emphasized that she supported preventive measures, not
only in medicine. However, she also strongly supported the concept
of people taking responsibility for their lives. She noted that
PSA screenings were $30 at the health fair, an amount that she did
not believe would prohibit people from taking the test if they
wanted preventive medicine for themselves. Chair James agreed the
bill would probably not have a big cost impact and would probably
save some lives. "But the biggest objection I have to it is that
it takes away individual responsibility and puts the responsibility
somewhere else," she said.
Number 1287
REPRESENTATIVE JOE GREEN apologized for being late and explained he
and Representative Ogan had been in another meeting. He asked if
these tests would be part of a general physical. He said some
health policies covered physicals, whereas others did not, unless
they were associated with diagnosis of an ailment.
SENATOR DUNCAN explained that under SB 253, every insurance policy
sold in the state would cover a PSA test for men who meet the
criteria in the legislation. Men would qualify at age 50, because
that was the age at which prostate cancer became a problem. If
they were in a high-risk group, they would qualify at age 40.
Women over the age of 18 would qualify. This was true whether the
insurance covered a physical exam or not.
Number 1383
REPRESENTATIVE GREEN questioned when a person would take this test.
SENATOR DUNCAN indicated people should get physicals and suggested
men should be screened for prostate cancer when they reached age
50. He pointed out an article in the packet about a local man, in
a high-risk category, who got a serious case of prostate cancer in
his 40s. He apologized for not providing a further article in the
packet and said, "The insurance industry, you don't see them here
at the table today opposing this. Some insurance companies might
say it increased costs. But the major insurers recognized
otherwise. Blue Cross and Aetna have both indicated that they are
not opposing this. In fact, one of the lobbyists clearly said that
they support preventive measures such as Pap tests and prostate
tests, and that they believe preventive health care is the right
direction." He suggested that the insurance company recognized
that in the long-run, preventive health care probably reduced their
costs.
Number 1515
REPRESENTATIVE GREEN said he understood the blood test was
effective and considerably cheaper than the old-fashioned test.
SENATOR DUNCAN said when he had the blood test, he thought it was
around $75.
REPRESENTATIVE GREEN indicated although he thought it was a good
idea, he was a little concerned it was getting into social
engineering. "If I elect to be dumb enough not to get those tests,
then that's my prerogative," he said.
Number 1592
REPRESENTATIVE ROBINSON said once a woman was in a high-risk
category and supposed to get a certain number of mammograms, they
could become very costly. "And they didn't used to be paid for,"
she said. "As a matter of fact, once you're in the high-risk,
quite often they want you to get it every six months. And all this
is saying, just like when you get a throat culture and you send it
into your insurance company and it comes back and they have agreed
to pay for it, it's just saying this is a coverage that's going to
be paid for." Representative Robinson indicated she knew of many
women who were required by their doctors to get mammograms, and yet
it had not been paid for. "And this is just bringing, in my
opinion, equity into the other areas that are serious cancers, and
primarily for men," she concluded.
REPRESENTATIVE GREEN commented that somebody had to pay for it and
this seemed more a socialist approach than a free-enterprise
approach.
Number 1664
CHAIR JAMES stated, "I do believe with ... preventive medicine,
that there will be a savings over the long haul. And ... I don't
believe that we ought to be here legislating that the insurance
companies cover these. I think the insurance companies, looking
for long-term savings, ought to be doing this on their own."
Number 1691
SENATOR DUNCAN replied, "I didn't want to mislead you to believe
that Aetna, and other insurance companies, always cover PSA tests.
They don't. There are many times when men have had a PSA test and
they have denied payment on it. Even though they believe it's the
right thing to do, ... they are not covering it unless we tell them
to cover it. And, therefore, it's discouraging people from getting
those tests."
SENATOR DUNCAN explained the bill got started after a local man in
a high-risk category was turned down by Aetna for a PSA test. He
said that was one example, of many, where insurance companies did
not cover tests they were not required to cover. Senator Duncan
disagreed that it smacked of socialism, as someone was paying for
the premiums. Nor did he believe premiums would rise. "But I
think the bottom line, most important consideration here, is ...
the cost savings over the long term, the fact that you will detect
cancer early, you'll avoid many major surgical procedures and long-
term cancer treatment, and you're going to save lives," he stated.
Number 1813
CHAIR JAMES commented, "It is not fair for someone who didn't have
a preventive test taken to say they didn't do it because nobody was
going to pay for it."
REPRESENTATIVE OGAN said although he concurred in philosophy with
his Republican colleagues, his father had died of prostate cancer
at 52 years of age and he himself was high-risk. "I think I'm
going to have to come down on the side of supporting this," he
said. Representative Ogan doubted that many people even knew the
blood tests were available. While he agreed about personal
responsibility, he supported moving the bill from committee and
felt it was worthy of a floor debate.
Number 1888
REPRESENTATIVE GREEN said his concern stemmed from a recent
diagnosis that he was a borderline diabetic. He asked: "What is
to prevent me from introducing a bill next year that says that all
diabetics get the test kit....?" He asserted a number of tests
could be added into health insurance. Representative Green
acknowledged that perhaps socialism was the wrong term. However,
he felt all were being forced to take care of the high-risk groups.
CHAIR JAMES cited an example from her childhood and reiterated her
beliefs in preventive medicine and individual responsibility.
Number 2109
REPRESENTATIVE ED WILLIS said, "[On] this one, I've got to come
down on the side that prevention can save lives and it can save
money." He indicated that a physical exam, which had identified a
problem early on, had saved his life on two occasions.
CHAIR JAMES agreed and said the only issue is who pays.
Number 2170
REPRESENTATIVE ROBINSON made a motion that CSSB 253(FIN), version
F, move from committee with attached zero fiscal notes and
individual recommendations.
CHAIR JAMES noted the motion and asked if there was an objection.
There being no objection, SB 253 moved from committee.
Number 2250
CHAIR JAMES informed committee members of plans to put SB 280 into
subcommittee for the summer, with public hearings. She asked
anyone who wanted to be part of that to let her know.
REPRESENTATIVE GREEN asked if Chair James would be notifying
members.
CHAIR JAMES agreed she would and said they would try to have
hearings on it this summer.
REPRESENTATIVE GREEN asked if hearings would be on teleconference.
CHAIR JAMES indicated they would try to do so.
ADJOURNMENT
There being no further business to conduct, CHAIR JAMES adjourned
the House State Affairs Standing Committee meeting at 8:47 a.m.
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