Legislature(2011 - 2012)SENATE FINANCE 532

03/28/2011 09:00 AM FINANCE


Download Mp3. <- Right click and save file as

* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+= SB 102 AK AFFORDABLE HEATING PROGRAM PAYMENTS TELECONFERENCED
Moved SB 102 Out of Committee
+ SB 70 ALASKA HEALTH BENEFIT EXCHANGE TELECONFERENCED
Heard & Held
+ SB 87 GRANTS FOR SENIORS' MEDICAL CARE TELECONFERENCED
Heard & Held
+ Bills Previously Heard/Scheduled TELECONFERENCED
                 SENATE FINANCE COMMITTEE                                                                                       
                      March 28, 2011                                                                                            
                         9:02 a.m.                                                                                              
                                                                                                                                
                                                                                                                                
9:02:21 AM                                                                                                                    
                                                                                                                                
CALL TO ORDER                                                                                                                 
                                                                                                                                
Co-Chair Stedman called the Senate Finance Committee                                                                            
meeting to order at 9:02 a.m.                                                                                                   
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Senator Lyman Hoffman, Co-Chair                                                                                                 
Senator Bert Stedman, Co-Chair                                                                                                  
Senator Lesil McGuire, Vice-Chair                                                                                               
Senator Johnny Ellis                                                                                                            
Senator Dennis Egan                                                                                                             
Senator Donny Olson                                                                                                             
Senator Joe Thomas                                                                                                              
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
None                                                                                                                            
                                                                                                                                
ALSO PRESENT                                                                                                                  
                                                                                                                                
Senator Hollis  French; Andy Moderow, Staff,  Senator Hollis                                                                    
French;  John  Sherwood,  Department of  Health  and  Social                                                                    
Services; Denise  Daniello, Alaska Commission on  Aging; Bob                                                                    
Doll, Retired Public Employees of Alaska, Director;                                                                             
                                                                                                                                
PRESENT VIA TELECONFERENCE                                                                                                    
                                                                                                                                
Pat Luby, AARP; Mark Regan, Disability Law Center of                                                                            
Alaska, Anchorage;                                                                                                              
                                                                                                                                
SUMMARY                                                                                                                       
                                                                                                                                
SB 70     Alaska Health Benefit Exchange                                                                                        
                                                                                                                                
          SB 70 was HEARD and HELD in committee for further                                                                     
          consideration.                                                                                                        
                                                                                                                                
SB 87     Grants for Seniors' Medical Care                                                                                      
                                                                                                                                
          SB 87 was HEARD and HELD in committee for further                                                                     
          consideration.                                                                                                        
                                                                                                                                
SB 102    AK Affordable Heating Payment Program                                                                                 
                                                                                                                                
          SB 102 was REPORTED out of committee with a "do                                                                       
          pass" recommendation and with the accompanying                                                                        
          zero fiscal note.                                                                                                     
                                                                                                                                
9:02:44 AM                                                                                                                    
                                                                                                                                
SENATE BILL NO. 102                                                                                                           
                                                                                                                                
     "An Act relating to certain payments made under the                                                                        
     Alaska affordable heating program."                                                                                        
                                                                                                                                
9:03:27 AM                                                                                                                    
                                                                                                                                
Co-Chair Hoffman  stated that the legislation  amends a bill                                                                    
passed  in  the previous  session,  which  combines the  low                                                                    
income heating  and energy assistance  programs to  form the                                                                    
Affordable  Heating  Assistance   Program.  The  legislation                                                                    
would allow the department  to pro-rate the appropriation in                                                                    
times of low payments.                                                                                                          
                                                                                                                                
Co-Chair Stedman  stated that public testimony  was taken at                                                                    
a prior hearing,  and asked if there were  any concerns from                                                                    
committee members. There were no concerns by members.                                                                           
                                                                                                                                
9:04:03 AM                                                                                                                    
                                                                                                                                
Co-Chair Hoffman  MOVED to  report SB  102 out  of committee                                                                    
with individual recommendations  and the accompanying fiscal                                                                    
note. There being NO OBJECTION, it was so ordered.                                                                              
                                                                                                                                
SB  102 was  REPORTED  out  of committee  with  a "do  pass"                                                                    
recommendation and with the accompanying zero fiscal note.                                                                      
SENATE BILL NO. 70                                                                                                            
                                                                                                                                
     "An Act establishing the Alaska Health Benefit                                                                             
     Exchange; and providing for an effective date."                                                                            
                                                                                                                                
9:05:06 AM                                                                                                                    
                                                                                                                                
SENATOR  HOLLIS FRENCH,  SPONSOR, explained  that SB  70 was                                                                    
designed to set up a  health benefit exchange in Alaska. The                                                                    
legislation  would create  a website  that  would allow  the                                                                    
115,000 Alaskans  who do not  have health insurance  to make                                                                    
informed decisions  on health insurance when  the Affordable                                                                    
Care Act comes into effect in 2014.                                                                                             
                                                                                                                                
Senator  French  stated that  the  Affordable  Care Act  was                                                                    
designed to  bring an affordable health  insurance policy to                                                                    
the 40  million Americans who are  without health insurance.                                                                    
He stressed  that the  intent of the  program was  to foster                                                                    
competition,  and  to  subsidize  the choice  of  a  private                                                                    
insurance  policy.   He  stressed  that   competition  among                                                                    
insurance   companies,   might   foster  lower   prices   in                                                                    
traditional  capitalism. He  stated  that the  model of  the                                                                    
program  would be  constructed in  Alaska, by  Alaskans, for                                                                    
Alaskans.  He   explained  that  the  program   would  allow                                                                    
Alaskans to go to a website,  and analyze a policy that best                                                                    
meets  their needs.  Eligible individuals  could also  apply                                                                    
for  Denali  Kid Care  and  Medicaid  through the  site.  He                                                                    
acknowledged  that the  bill was  complicated and  long, but                                                                    
stressed that  it is essentially  a website run by  a board.                                                                    
The board would  have approximately 30 powers  and duties to                                                                    
implement.                                                                                                                      
                                                                                                                                
9:07:39 AM                                                                                                                    
                                                                                                                                
Senator  Ellis  noted  his dismay  when  the  administration                                                                    
chose to  miss the deadline  for application to  the federal                                                                    
government for the million dollars  being offered to states.                                                                    
He  observed that  some governors,  who opposed  health care                                                                    
reform,  took  the   money  to  set  up   their  own  health                                                                    
exchanges. He maintained that "the  last thing Alaskans want                                                                    
is for  the federal government  to impose a  health exchange                                                                    
on us  when we  can design  our own".  He wondered  if there                                                                    
would  be other  ramifications from  the missed  deadline in                                                                    
terms  of future  monies. Senator  French  thought that  the                                                                    
state would  miss out on  subsequent grants relating  to the                                                                    
health care  exchange as  a result of  having missed  out on                                                                    
the  initial  round  of grants.  He  emphasized  that  other                                                                    
states that  opposed the Affordable Care  Act took advantage                                                                    
of the initial grant.                                                                                                           
                                                                                                                                
Senator  Ellis  reiterated  his concern  with  the  loss  of                                                                    
federal funds  and the  need to  address the  possibility of                                                                    
further loss of funding.                                                                                                        
                                                                                                                                
9:10:58 AM                                                                                                                    
                                                                                                                                
ANDY MODEROW, STAFF, SENATOR HOLLIS FRENCH, provided a                                                                          
sectional analysis of the legislation:                                                                                          
                                                                                                                                
   · Section   1   provides    intent   language   for   the                                                                    
     legislation.   It   highlights    the   importance   of                                                                    
     connecting  individuals   and  small   businesses  with                                                                    
     quality  health  insurance   policies,  to  reduce  the                                                                    
     number of uninsured Alaskans                                                                                               
                                                                                                                                
   · Section 2  of the  legislation, establishes  the Alaska                                                                    
     Health Benefit Exchange:                                                                                                   
                                                                                                                                
        o Section 21.54.200 sets up the health benefit                                                                          
          exchange  as a  public corporation  of the  state,                                                                    
         much like the permanent fund corporation.                                                                              
                                                                                                                                
        o Section 21.51.210 establishes the board, which                                                                        
          will  manage the  Alaska Health  Benefit Exchange.                                                                    
          The  board consists  of 8  members, with  7 voting                                                                    
          members.  The Commissioner  of  Health and  Social                                                                    
          Services,  or their  designee, will  serve on  the                                                                    
          committee  ex officio,  and  the  Director of  the                                                                    
          Division  of  Insurance  will  hold  a  non-voting                                                                    
          seat.                                                                                                                 
                                                                                                                                
   Mr. Moderow  clarified  that  the remaining  language  in                                                                    
   Section 2 sets out disclosure requirements, procedures in                                                                    
   case of  a vacancy,  and other  technical aspects  of the                                                                    
   board. In addition,  it authorizes the  board to  hire an                                                                    
   Executive  Director,  who  can  hire   staff  to  fulfill                                                                    
   obligations under the legislation.                                                                                           
                                                                                                                                
   Mr. Moderow outlined the provisions of Section 21.54.220,                                                                    
   contained in  Section 2,  which outlines  the powers  and                                                                    
   duties of the Alaska Health Benefit exchange:                                                                                
                                                                                                                                
   · Subsection  (a) (1)  outlines the  primary duty  of the                                                                    
     exchange, which is to facilitate  the purchase and sale                                                                    
     of qualified health plans.                                                                                                 
                                                                                                                                
   · Subsection  (a) (2)  and (a)  (12) establish  the Small                                                                    
     Business Health  Options Program  (SHOP), which  is the                                                                    
     small  business  equivalent  to  individuals  connected                                                                    
     through  the exchange.  Small businesses  pool together                                                                    
     to reduce variation  in premiums from year  to year and                                                                    
     to connect small businesses  with generous tax benefits                                                                    
     should they decide to provide health insurance.                                                                            
                                                                                                                                
   · Subsection  (a)  (3)  provides  for  a  telephone  call                                                                    
     center to assist individuals in  case they are not able                                                                    
     to access the internet portal.                                                                                             
                                                                                                                                
   · Subsection (a) (4)  establishes enrollment periods that                                                                    
     are  held   annually  to  facilitate   changing  health                                                                    
     insurance policies.  Enrollment periods  reduce adverse                                                                    
     selection, which occur when people  with high risk seek                                                                    
     generous  benefits at  times when  they  need them  and                                                                    
     chose  low risk  benefits when  the risks  are reduced.                                                                    
     This would allow  individuals to move from  one plan to                                                                    
     another  while  reducing   the  potential  for  adverse                                                                    
     selection.                                                                                                                 
                                                                                                                                
   · Subsection  (a) (5)  provides for  the  creation of  an                                                                    
     internet  marketplace   to  connect   individuals  with                                                                    
     health insurance coverage.                                                                                                 
                                                                                                                                
   · Subsection  (a)  (6)  provides  for  certification  and                                                                    
     decertification  of  health   plans  sold  through  the                                                                    
     exchange.                                                                                                                  
                                                                                                                                
   · Subsection (a)  (7) and (a)  (8) requires  the exchange                                                                    
     to  compare  health plans  on  metrics  of quality  and                                                                    
     price. He  observed that the Senate  and Labor Commerce                                                                    
     reviewed metrics used by other  states such as consumer                                                                    
     satisfaction,  types of  benefits, covered  procedures,                                                                    
     deductible  amounts,   and  etc…  All  easy   ways  for                                                                    
     consumers to make their decisions.                                                                                         
                                                                                                                                
Mr. Moderow did not discuss Subsection (a) (9). He went on                                                                      
to explain that:                                                                                                                
                                                                                                                                
   · Subsection (a) (10) requires  the exchange to determine                                                                    
     eligibility  for  state  or  local  medical  assistance                                                                    
     programs,  such  as  Medicaid and  Denali  KidCare.  If                                                                    
     qualified,   the   exchange   will  assist   with   the                                                                    
     enrollment process.                                                                                                        
                                                                                                                                
   · Subsection   (a)   (11)   establishes  a   tax   credit                                                                    
     calculator to help individuals know  the cost of health                                                                    
     coverage,  after federal  assistance  is applied.  This                                                                    
     allows   individuals  to   understand  their   eligible                                                                    
     benefits.                                                                                                                  
                                                                                                                                
   · Subsection (a) (13) requires that the exchange exempts                                                                     
     Alaskans   from  the   requirement  to   retain  health                                                                    
     insurance if  certain criteria is met.  Individuals can                                                                    
     apply  for exemptions  if an  insurance  policy is  not                                                                    
     affordable. He  observed that IHS recipients  can apply                                                                    
     for an exemption,  or they can chose  to participate at                                                                    
     a  generous  no cost  sharing  provisions  if they  are                                                                    
     under a certain income level.                                                                                              
                                                                                                                                
   · Subsection   (a)   (14)    shares   information   about                                                                    
     individuals   exempted   from  the   health   insurance                                                                    
     requirement.   Subsection    (a)   (14)    (B)   shares                                                                    
     information   about   employees  who   aren't   offered                                                                    
     affordable   health    coverage   through   employment.                                                                    
     Subsection  (a)  (14)   (C)  shares  information  about                                                                    
     employees who cease to have  employer coverage due to a                                                                    
     change in employment.                                                                                                      
                                                                                                                                
   · Subsection (a) (15) notifies an employer when an                                                                           
     employee   receives   premium   assistance   from   the                                                                    
     government, either  because the employer  doesn't offer                                                                    
     a plan,  or offers  a plan  which doesn't  meet minimum                                                                    
     standards.                                                                                                                 
                                                                                                                                
   · Subsection (a) (16) explicitly states that the                                                                             
     exchange   will   assist   consumers   by   determining                                                                    
     eligibility  for  premium   tax  credits,  reduced-cost                                                                    
    sharing, or exemptions from the insurance mandate.                                                                          
                                                                                                                                
   · Subsection (a) (17) establishes a framework for                                                                            
     Navigator Grants.  These grants can be  pursued by most                                                                    
     organizations  or  trade  groups for  the  purposes  of                                                                    
     helping  the  exchange  fulfill  its  goals.  Navigator                                                                    
     duties   include  enrollment   assistance,  information                                                                    
     sharing,  and assistance  with  dispute resolution.  He                                                                    
     observed  that  commercial  fishing  trade  groups  are                                                                    
     eligible  to be  navigators  to  help individuals  find                                                                    
     health coverage that meets their needs.                                                                                    
                                                                                                                                
   9:17:07 AM                                                                                                                 
                                                                                                                                
   Mr. Moderow continued with his presentation of the                                                                           
   sectional analysis:                                                                                                          
                                                                                                                                
   · Subsection (a) (18) requires the Division of Insurance                                                                     
     to  consider  the rate  of  premium  growth within  and                                                                    
     outside  the exchange,  in an  effort  to evaluate  the                                                                    
     effect  and benefit  of incorporating  larger employers                                                                    
     within the SHOP exchange.  Currently, employers with 50                                                                    
     or less  employees are eligible, but  the program could                                                                    
     be expanded in the future.                                                                                                 
                                                                                                                                
   · Subsection (a) (19) asks the Division of Insurance to                                                                      
     develop  policy and  procedures  that minimize  adverse                                                                    
     selection, both  inside the exchange and  between plans                                                                    
     sold within  and outside the exchange.  Nothing changes                                                                    
     the current insurance market place  as it exists today.                                                                    
     Plans can  still be purchased  and sold in  small group                                                                    
     markets  or  individual  markets  under  reform,  which                                                                    
     makes certain  the exchange  functions well  within the                                                                    
     existing market place.                                                                                                     
                                                                                                                                
   · Subsection (a) (20) requires the exchange to provide                                                                       
     credit for  any 'free choice voucher'  that an employer                                                                    
     provides  an  employee  for  the  purpose  of  covering                                                                    
     premium  costs.  These  set up  a  framework  where  an                                                                    
     employer  can  offer  to pay  $100  for  an  employee's                                                                    
     health coverage and  the employee can find  a plan that                                                                    
     meets their needs through the exchange.                                                                                    
                                                                                                                                
Mr. Moderow did not discuss Subsection (a) (21) or (a)                                                                          
(22).                                                                                                                           
                                                                                                                                
  · Subsection (a) (23) outlines accounting requirements.                                                                       
                                                                                                                                
   · Subsection (a) (24) requires an annual accounting                                                                          
     report   to  be   submitted   to   federal  and   state                                                                    
     stakeholders.                                                                                                              
                                                                                                                                
   · Subsection (a) (25) allows for cooperation with any                                                                        
     investigation or audit by the  Division of Insurance or                                                                    
     Secretary of Health and Human Services.                                                                                    
                                                                                                                                
   · Subsection (a) (26) allows a health insurer to offer a                                                                     
     limited  dental  plan as  part  of  a qualified  health                                                                    
     plan,  so   long  as  pediatric  dental   benefits  are                                                                    
     included.                                                                                                                  
                                                                                                                                
   · Subsection (a) (27) requires the  exchange to apply for                                                                    
     planning  and establishment  grants  for the  Exchange,                                                                    
     which addresses the question asked by Senator Ellis.                                                                       
                                                                                                                                
Mr.  Moderow  noted  that  grants of  $1  million  had  been                                                                    
awarded to  49 other  states dollars for  planning purposes.                                                                    
The  language in  Subsection (a)  (27) was  retained in  the                                                                    
legislation in case future openings exist.                                                                                      
                                                                                                                                
   · Subsection  (a)  (28)  requests that  the  Division  of                                                                    
     Insurance   offer   recommendations   about   potential                                                                    
     interstate  compacts that  would  permit  the sale  and                                                                    
     purchase of health insurance across state lines.                                                                           
                                                                                                                                
Mr. Moderow  acknowledged the small  pool of  individuals to                                                                    
insure in  Alaska. Buying and selling  health insurance over                                                                    
state lines has  been under discussion for a long  time as a                                                                    
way for the  free market to deal with rising  premiums and a                                                                    
means to  find low cost options.  Legislation would probably                                                                    
be required to enact any recommended compact.                                                                                   
                                                                                                                                
   · Subsection (a)  (29) requires  that the  Exchange board                                                                    
     establish a  plan of  operation, and  submit it  to the                                                                    
    director of the Division of Insurance for approval.                                                                         
                                                                                                                                
   · Subsection  (b)  (1),  page   9  line  30,  allows  the                                                                    
     exchange to  contract out some of  the responsibilities                                                                    
     outlined in the legislation.                                                                                               
                                                                                                                                
   · Subsection  (b)  (2)  allows   the  exchange  to  share                                                                    
     information with  federal and state  agencies, provided                                                                    
     that confidentiality protections  consistent with state                                                                    
     and federal laws are protected.                                                                                            
                                                                                                                                
   · Subsection  (b)  (3)  allows the  exchange  to  receive                                                                    
     grants  to  finance  operations,  and  requires  prompt                                                                    
     disclosure  of  any  financial  contributions,  whether                                                                    
     they   are   applied   for  or   received   to   ensure                                                                    
     transparency.                                                                                                              
                                                                                                                                
   · Subsection  (c)  prohibits  certain  expenses  to  keep                                                                    
     costs down for consumers.                                                                                                  
                                                                                                                                
   · Subsection (d)  ensures individuals won't  be penalized                                                                    
     if  they   change  coverage  because  they   are  newly                                                                    
     eligible for  that coverage,  or if  employer sponsored                                                                    
     coverage becomes affordable.                                                                                               
                                                                                                                                
9:21:23 AM                                                                                                                    
                                                                                                                                
Mr. Moderow continued to present the sectional analysis.                                                                        
He discussed Section 21.54.230 of the legislation, found in                                                                     
Section 2 beginning on page 10, line 22, which relates to                                                                       
health plan certification.                                                                                                      
                                                                                                                                
   · Subsection  (a) outlines  requirements  of a  qualified                                                                    
    health plan, and the insurers offering such plans.                                                                          
                                                                                                                                
   · Subsection (a)  (1) allows  flexibility for  an insurer                                                                    
     to  include or  not include  adult dental  benefits, so                                                                    
     long  as  one  supplemental  dental  plan  is  included                                                                    
     within the exchange.                                                                                                       
                                                                                                                                
   · Subsection  (a) (2)  requires  that  premium rates  and                                                                    
     plan language  are approved.  This minimizes  change to                                                                    
     our current market place. The  director of the Division                                                                    
     of Insurance  will still review  policies to  make sure                                                                    
     they line up with existing state law.                                                                                      
                                                                                                                                
   · Subsection  (a)  (3)  requires plans  to  meet  certain                                                                    
     quality guidelines  in terms of the  actuarial value to                                                                    
     a  consumer,  except  in instances  where  catastrophic                                                                    
     plans  are sufficient  to  protect  an individual  from                                                                    
     financial hardship.                                                                                                        
                                                                                                                                
   · Subsection (a)  (4) meets  cost sharing  and deductible                                                                    
     assistance requirements that protect consumers.                                                                            
                                                                                                                                
   · Subsection (a) (5) and (a)  (6) require that an insurer                                                                    
     in the  exchange offer plans that  meet certain quality                                                                    
     metrics,  and  that  they charge  the  same  rates  for                                                                    
     similar  policies  sold   inside  and  outside  in  the                                                                    
     traditional insurance market place.                                                                                        
                                                                                                                                
   · Subsection (a)  (7) requires the exchange  to determine                                                                    
     that making the plan  available through the exchange is                                                                    
     in the interest of employers and individuals.                                                                              
                                                                                                                                
   · Subsection  (b)  specifies   that  an  exchange  cannot                                                                    
     exclude a  plan because it is  fee-for-service, through                                                                    
     price controls,  or because a plan  pays for lifesaving                                                                    
     treatments.                                                                                                                
                                                                                                                                
   · Subsection (c) (1) requires an insurer to justify any                                                                      
     premium  increase  prior  to implementing  the  premium                                                                    
     increase. This  justification must  be shared  with the                                                                    
     public, and  the exchange  will consider  these premium                                                                    
     increases when determining whether to certify plans.                                                                       
                                                                                                                                
   · Subsection (c) (2) and (c) (3) requires insurers to                                                                        
     provide  the public  with  fiscal,  claim, rating,  and                                                                    
     enrollment  data,  in   instances  when  disclosure  is                                                                    
     consistent with  privacy laws. It requires  insurers to                                                                    
     release cost  data, including cost sharing  paid by the                                                                    
     consumer,  for  a  specific item  or  service  under  a                                                                    
     health  insurance policy.  This enables  individuals to                                                                    
     question how  a plan  would help them  historically, or                                                                    
     in the future.                                                                                                             
                                                                                                                                
   · Subsection (d) makes it clear that state insurance                                                                         
     laws  regarding   solvency  and  licensing   are  still                                                                    
     applicable  to  plans  within the  exchange,  and  that                                                                    
     insurers are treated equally.                                                                                              
                                                                                                                                
   · Subsection (e) relates to dental benefits under the                                                                        
     law, and the flexibility of  plans under reform in this                                                                    
     area.                                                                                                                      
                                                                                                                                
Mr. Moderow discussed Section 21.54.240,  found in Section 2                                                                    
on page 14,  which relates to exchange  funding. It requires                                                                    
the exchange to finance  itself after being established. The                                                                    
grants   available  to   the  state   were   only  for   the                                                                    
establishment  portion; afterwards  an  exchange  has to  be                                                                    
self-financing.  It  requires  this  funding  to  come  from                                                                    
insurers  who   offer  health  benefit  plans   through  the                                                                    
exchange. In  addition, the cost  of this financing  must be                                                                    
disclosed to the public on the exchange website.                                                                                
                                                                                                                                
Mr.  Moderow observed  that  Section  21.54.250, Section  2,                                                                    
page  14,   allows  the  exchange  board   and  Division  of                                                                    
Insurance to  adopt regulations to  fulfill the  purposes of                                                                    
the legislation.                                                                                                                
                                                                                                                                
Mr. Moderow  noted that Section  21.54.260, Section  2, page                                                                    
14, requires  insurers to honor state  health insurance laws                                                                    
as established;  and Section 21.54.270, Section  2, page 15,                                                                    
provides definitions of some terms used in this act.                                                                            
                                                                                                                                
Mr. Moderow  continued to outline  the final sections  of SB                                                                    
70:                                                                                                                             
                                                                                                                                
   · Section 3  adds employees of  the exchange to  the list                                                                    
     of partially exempt service.                                                                                               
                                                                                                                                
   · Section  4  defines  the   Executive  Director  of  the                                                                    
     exchange as a public official.                                                                                             
                                                                                                                                
   · Section  5  adds  the Alaska  Health  Benefit  Exchange                                                                    
     Board to the list of state commissions or boards.                                                                          
                                                                                                                                
   · Section  6 of  the  legislation, outlines  transitional                                                                    
     provisions relating to board terms.                                                                                        
                                                                                                                                
   · Section 7  gives the ability  to draft  regulations and                                                                    
     clarifies that regulations will not take effect until                                                                      
     the effective date of statutory changes.                                                                                   
                                                                                                                                
   · Sections 8 provides  for a July 1,  2011 effective date                                                                    
     for the exchange board, the duties of the board, and                                                                       
     the board's ability to make regulations.                                                                                   
                                                                                                                                
   · Section   9  makes   certain  transitional   provisions                                                                    
     effective immediately.                                                                                                     
                                                                                                                                
   · Section 10 makes the remainder  of the act effective on                                                                    
     July 1, 2012. This is when health plan certification                                                                       
     would begin under the legislation.                                                                                         
                                                                                                                                
9:26:17 AM                                                                                                                    
                                                                                                                                
Co-Chair  Stedman  asked  for   further  background  on  the                                                                    
legislation's  history.  Senator  French  explained  that  a                                                                    
federal  model  was  created in  Washington,  D.C.  to  help                                                                    
states with implementation. The idea  is to create a website                                                                    
where  consumers could  make a  complex financial  choice as                                                                    
simply  as   possible.  The   legislation  would   create  a                                                                    
framework shaped to Alaska.                                                                                                     
                                                                                                                                
9:27:27 AM                                                                                                                    
                                                                                                                                
Co-Chair Hoffman  wondered how natives who  are eligible for                                                                    
Alaska Native  Health Care would be  affected. He questioned                                                                    
if  they would  be able  to  participate in  the program  to                                                                    
obtain  additional  coverage.  Senator French  affirmed  and                                                                    
explained  that Indian  Health  Service (IHS)  beneficiaries                                                                    
would be given the option  of seeking additional coverage or                                                                    
maintaining their existing coverage.                                                                                            
                                                                                                                                
9:28:25 AM                                                                                                                    
                                                                                                                                
Co-Chair  Stedman  wondered  what was  necessary  under  the                                                                    
federal requirements  and what was optional.  Senator French                                                                    
emphasized that it was important  to remember that there are                                                                    
a  set of  federal guidelines  that must  be maintained.  He                                                                    
noted  that  there  would  be two  exchanges  if  the  state                                                                    
exchange  falls  too  far  outside  of  federal  guidelines.                                                                    
Consumers  must  have  a  place   where  they  can  make  an                                                                    
intelligent choice  at a minimum,  rating of  policies where                                                                    
consumers can look at how  many claims are denied, costs and                                                                    
benefits.                                                                                                                       
                                                                                                                                
Mr.  Moderow agreed  to  provide  more detailed  information                                                                    
regarding  federal regulations.  He  stressed  that the  tax                                                                    
benefits  would  only  be available  through  the  federally                                                                    
sanctioned exchange that meets federal guidelines.                                                                              
                                                                                                                                
9:30:29 AM                                                                                                                    
                                                                                                                                
Senator Olson  wondered if IHS  beneficiaries could  chose a                                                                    
different primary  insurance coverage  and retain  their IHS                                                                    
policy as  their secondary. Mr.  Moderow replied  that there                                                                    
was an  elimination of cost  sharing, and agreed  to provide                                                                    
more detailed information.                                                                                                      
                                                                                                                                
9:31:35 AM                                                                                                                    
                                                                                                                                
Senator  Olson wondered  if there  was  support from  health                                                                    
care   providers.    Mr.   Moderow   explained    that   IHS                                                                    
beneficiaries   can  take   advantage  of   eliminated  cost                                                                    
sharing. He thought  that IHS was the payer  of last resort.                                                                    
                                                                                                                                
Senator  Olson wondered  if there  was  support from  health                                                                    
care   providers.    Mr.   Moderow   explained    that   IHS                                                                    
beneficiaries   can  take   advantage  of   eliminated  cost                                                                    
sharing. He thought  that IHS was the payer  of last resort.                                                                    
                                                                                                                                
Senator Olson wondered if there  was support from healthcare                                                                    
providers. Mr. Moderow  noted a letterd of  support from the                                                                    
Small  Business Majority  and the  Anchorage Disability  Law                                                                    
Center.                                                                                                                         
                                                                                                                                
Senator  Olson  referred  to the  fiscal  note  and  ongoing                                                                    
costs. Mr.  Moderow noted the  department could  discuss the                                                                    
fiscal note.                                                                                                                    
                                                                                                                                
9:32:55 AM                                                                                                                    
                                                                                                                                
Senator  McGuire stressed  the  high  costs associated  with                                                                    
dental disease  and questioned if  dental care  was included                                                                    
in the  program. Mr. Moderow  replied that  pediatric dental                                                                    
programs were included in the  options. He agreed to provide                                                                    
a more detailed response.                                                                                                       
                                                                                                                                
9:34:29 AM                                                                                                                    
                                                                                                                                
Senator McGuire asked  if there is an  opt-out provision for                                                                    
Alaskans  that   don't  want  to  participate   based  on  a                                                                    
philosophical  right of  freedom to  choose. She  noted that                                                                    
mandatory  health  insurance  essentially exists  in  Alaska                                                                    
since emergency medical care is  not refused. "We will treat                                                                    
you at a  hospital; we are not  going to let you  die on the                                                                    
road; and  we will pay for  it as Alaskans." She  noted that                                                                    
one admission to an emergency room can cost $10 thousand.                                                                       
                                                                                                                                
Senator  French  explained that  the  bill  does not  exempt                                                                    
anyone based  on their  right to  choose to  participate. He                                                                    
acknowledged  that there  is  a free  rider  problem in  the                                                                    
state and  nation, where people  can seek free  medical care                                                                    
in  emergency rooms  that the  bill seeks  to end.  The bill                                                                    
seeks to get "every single  person paying something into the                                                                    
system  in exchange  for the  benefits they  receive through                                                                    
emergency rooms, or other places  they get, in essence, free                                                                    
medical  care." He  stressed that  it is  more efficient  to                                                                    
have a  health insurance  policy that allows  individuals to                                                                    
see  a primary  care physician  instead of  waiting until  a                                                                    
crisis  occurs that  requires an  emergency  room visit.  He                                                                    
maintained that as long as there  is a system that "will not                                                                    
let you die in the road; will  not let you sort of expire in                                                                    
the  gutter; that  is going  to  take you  to the  emergency                                                                    
room," everyone  should pay.  He maintained  the legislation                                                                    
errs on the side of health and wellbeing.                                                                                       
                                                                                                                                
9:38:04 AM                                                                                                                    
                                                                                                                                
Co-Chair Stedman  asked Senator  French to give  more detail                                                                    
on why the  exchange was structured as  a public corporation                                                                    
with   an  independent   legal  existence.   Senator  French                                                                    
explained  that the  exchange was  set  up with  independent                                                                    
bodies  to  operate  as  free   as  it  can  from  political                                                                    
influence, yet be  bound by the guidelines in  the bill. The                                                                    
exchange could be housed in the department as a division.                                                                       
                                                                                                                                
9:39:08 AM                                                                                                                    
                                                                                                                                
Co-Chair Hoffman referred to  discussions between the Senate                                                                    
Finance  co-chairs  and  the   Division  of  Insurance.  The                                                                    
division  expressed  concern that  Alaska  does  not have  a                                                                    
large  enough pool  to economically  administer an  exchange                                                                    
and alluded  to the  fact Alaska would  be better  served by                                                                    
joining another state such as  Washington State. He asked if                                                                    
the  sponsor considered  the  possibility  of a  multi-state                                                                    
exchange.  Senator  French   responded  that  a  multi-state                                                                    
exchange  was not  considered in  drafting the  legislation.                                                                    
However,  pooling in  respect to  buying across  state lines                                                                    
was addressed  in subsection 28, page  9. Insurance policies                                                                    
are largely a  creation of state law and  regulated by state                                                                    
regulators. A multi-state  pool would have to  be created to                                                                    
buy across state lines.                                                                                                         
                                                                                                                                
9:41:22 AM                                                                                                                    
                                                                                                                                
Co-Chair Hoffman  stressed that  perhaps a large  pool would                                                                    
lower administrative  costs. Co-Chair Stedman  observed that                                                                    
pooling with  smaller populated states  such as  Montana and                                                                    
Idaho were discussed.                                                                                                           
                                                                                                                                
9:41:50 AM                                                                                                                    
                                                                                                                                
Senator Thomas referred to education and prevention.                                                                            
                                                                                                                                
Senator French pointed to the intent language on page 1:                                                                        
                                                                                                                                
     (3) to provide consumer education and assist                                                                               
     individuals with access to programs, credits, and                                                                          
     cost-sharing reductions; and subsection (4) to reduce                                                                      
     the number of uninsured Alaskans by creating an                                                                            
    organized, transparent, and easy-to-navigate health                                                                         
    insurance marketplace that offers a choice of high                                                                          
     value health plans with low administrative costs for                                                                       
     individuals and employers;                                                                                                 
                                                                                                                                
Senator  French  acknowledged  that   there  are  no  health                                                                    
initiatives or  education programs. The ability  to obtain a                                                                    
check-up  is implicit.  He  maintained that  it  is easy  to                                                                    
forget  how daunting  it is  to those  without insurance  to                                                                    
have to pay  out of pocket for every cost.  He stressed that                                                                    
"lower  income folks  just don't  go see  a doctor  to their                                                                    
great detriment".                                                                                                               
                                                                                                                                
9:44:07 AM                                                                                                                    
                                                                                                                                
Senator  Thomas wondered  if the  board  could devise  plans                                                                    
that would  require annual physicals, which  could result in                                                                    
a savings in  terms of heart disease  and cancer prevention.                                                                    
Senator French observed that the  federal debate centered on                                                                    
the  role of  government in  people's lives.  He shared  the                                                                    
concerns about preventative care.  However, the laissez fare                                                                    
approach won.                                                                                                                   
                                                                                                                                
9:46:14 AM                                                                                                                    
                                                                                                                                
JOHN  SHERWOOD, DEPARTMENT  OF HEALTH  AND SOCIAL  SERVICES,                                                                    
noted  that  the  administration   believes  they  have  the                                                                    
authority to  begin the planning and  implementation process                                                                    
without  state legislation  and do  not support  SB 70.  The                                                                    
Department of  Health and Social Services  and Department of                                                                    
Commerce, Community and Economic  Development are working to                                                                    
analyze the  federal legislation  and requirements  to begin                                                                    
the implementation process.                                                                                                     
                                                                                                                                
Co-Chair  Stedman  observed  that the  commissioner  was  in                                                                    
Washington,  D.C. He  asked Mr.  Sherwood  to elaborate  and                                                                    
questioned how  the administration  would resolve  the issue                                                                    
that SB 70 attempts to address.                                                                                                 
                                                                                                                                
Mr.  Sherwood was  unable to  elaborate and  emphasized that                                                                    
the  department  was  still  in  the  planning  process.  He                                                                    
clarified that  the administration  was looking at  a multi-                                                                    
state  exchange.  The   federal  government  released  seven                                                                    
grants   to   early   adopters  (states   taking   different                                                                    
approaches to developing exchanges).  One of the grants went                                                                    
to  a consortium  of New  England states  for a  New England                                                                    
regional exchange.                                                                                                              
                                                                                                                                
9:50:34 AM                                                                                                                    
                                                                                                                                
Co-Chair  Stedman  asked  for guidance  on  the  legislative                                                                    
timeframe  and a  response to  Senator Ellis'  question. Mr.                                                                    
Sherwood  clarified that  the  federal legislation  requires                                                                    
that the  exchanges be operational  by January 1,  2014. The                                                                    
federal government will move in  to implement an exchange if                                                                    
it determines by January 1, 2013  that a state will not have                                                                    
a functioning exchange by that  date. The state will need to                                                                    
move forward by 2012.                                                                                                           
                                                                                                                                
9:51:29 AM                                                                                                                    
                                                                                                                                
Co-Chair Stedman  queried the denial  of the  million dollar                                                                    
grant.  Mr. Sherwood  acknowledged  that the  administration                                                                    
did not apply for the  grant, because the administration did                                                                    
not  want to  have federal  entanglement and  obligation. He                                                                    
acknowledged  that   most  of   the  development   money  is                                                                    
contingent on  having received the planning  money. He noted                                                                    
that federal policies can change.  The state is eligible for                                                                    
some funding  for related activities such  as developing the                                                                    
new required  Medicare coverage.  The exchange  would become                                                                    
self-funding once it is developed.                                                                                              
                                                                                                                                
9:53:12 AM                                                                                                                    
                                                                                                                                
Co-Chair  Hoffman  maintained  that  it is  a  major  public                                                                    
policy issue that is worthy  of a legislative discussion. He                                                                    
noted the lack  of legislative involvement and  asked if the                                                                    
intent  was to  avoid a  legislative decision.  Mr. Sherwood                                                                    
replied  that   the  administration  was  interested   in  a                                                                    
dialogue  about whether  the legislation  was needed  in the                                                                    
current  year.  Mr.  Sherwood  replied   that  there  was  a                                                                    
willingness to have a dialogue.                                                                                                 
                                                                                                                                
9:55:00 AM                                                                                                                    
                                                                                                                                
Senator  McGuire  understood  the  administration's  broader                                                                    
goal for rejecting the grant  money attached to the creation                                                                    
of universal  health care, but  questioned the  rejection of                                                                    
the $1  million that could  have been used for  planning and                                                                    
state control  of the exchange.  She queried  the rationale.                                                                    
Mr.  Sherwood  replied  that  the   money  was  rejected  to                                                                    
minimize federal  entanglement and avoid obligation  as part                                                                    
of an overall strategy.                                                                                                         
                                                                                                                                
9:56:50 AM                                                                                                                    
                                                                                                                                
Senator  McGuire stated  that she  wished that  the decision                                                                    
had  not been  made and  stressed  that "you  don't have  to                                                                    
throw the  baby out with  the bathwater". She felt  that the                                                                    
decision should  be made collectively with  the legislature.                                                                    
She referred to page 2,  which puts the commission selection                                                                    
in  the hands  of the  governor.  She pointed  out that  the                                                                    
commission  would  be  made up  of  Alaskan  small  business                                                                    
employers   and   health   care  insurance   companies   and                                                                    
emphasized  the uniqueness  of  Alaska.  She cautioned  that                                                                    
Alaska doesn't get  absorbed into bigger pools  that may not                                                                    
pay attention  to Alaska's  needs. She asked  if there  is a                                                                    
representative pointing  out the unique aspects  of diabetes                                                                    
or obesity  in Alaska and  wondered how Alaskan  health care                                                                    
needs are  being communicated in  the exchange  network. Mr.                                                                    
Sherwood clarified that Alaska was  not planning to join the                                                                    
New England exchange. He explained  that there are different                                                                    
models.  States  must  share  their  experience  with  other                                                                    
states as part of the  criteria for federal funds. Alaska is                                                                    
looking   at  different   models  including   a  multi-state                                                                    
exchange pool. He acknowledged the  task of keeping Alaska's                                                                    
unique  characteristics   in  mind   when  looking   at  the                                                                    
different models.                                                                                                               
                                                                                                                                
10:00:35 AM                                                                                                                   
                                                                                                                                
Senator  McGuire  referred  to her  experience  when  Alaska                                                                    
joined Washington  State's organ and tissue  donation model.                                                                    
Not  only did  Alaska loose  money, but  lives were  lost as                                                                    
well  when  Washingtonians  became  a  priority.  Washington                                                                    
medical departments and insurers  were in the driver's seat.                                                                    
She  expressed  concern  that Alaskans  could  suffer  in  a                                                                    
multi-state  exchange. Alaskans  should  come out  healthier                                                                    
from an exchange.                                                                                                               
                                                                                                                                
10:02:31 AM                                                                                                                   
                                                                                                                                
Senator  Thomas wondered  if there  were  statistics on  the                                                                    
cost  to those  that can  pay from  uncollectible or  unpaid                                                                    
medical  bills  from those  that  cannot  pay. Mr.  Sherwood                                                                    
replied  that he  did not  know, but  stated that  there was                                                                    
some data on uncompensated care for hospitals.                                                                                  
                                                                                                                                
Co-Chair  Stedman  requested   more  data  on  uncollectible                                                                    
hospital debt  being absorbed into the  system. Mr. Sherwood                                                                    
indicated he would provide that information.                                                                                    
                                                                                                                                
10:03:46 AM                                                                                                                   
                                                                                                                                
Co-Chair Stedman  addressed the four proposed  fiscal notes:                                                                    
$3  million GF  from  the Department  of Administration  for                                                                    
band  width, hardware  and software  and maintenance  of the                                                                    
system;  $1,662,100  GF  from the  Department  of  Commerce,                                                                    
Community and  Economic Development for 12  new positions to                                                                    
manage the  program, as  well as  board costs  and supplies;                                                                    
$230.2  thousand GF  and  $230.2  thousand matching  federal                                                                    
funds from the Department of  Health and Social Services for                                                                    
five new analyst positions; and  a zero fiscal note from the                                                                    
Division of insurance.                                                                                                          
                                                                                                                                
10:04:35 AM                                                                                                                   
                                                                                                                                
PAT LUBY,  AARP (via  teleconference), testified  in support                                                                    
of SB  70. He  emphasized that  the federal  government will                                                                    
impose  an exchange  if the  state does  not create  one. He                                                                    
maintained  that  an exchange  is  the  easiest way  for  an                                                                    
individual  or small  business to  find adequate  affordable                                                                    
health  coverage. Two-thirds  of America's  small businesses                                                                    
offered some  form of health  insurance, but had to  rely on                                                                    
brokers for advice  on the best coverage at  the least cost.                                                                    
Web based  exchanges make  it easier  for the  individual or                                                                    
small business  to compare coverage  and cost as well  as to                                                                    
find out  what subsidies might  be available. He  noted that                                                                    
Medicare Part D allows  clients to choose their prescription                                                                    
drug coverage by going on  line, typing in their medications                                                                    
and finding out what the best policy and cost is for each.                                                                      
                                                                                                                                
Mr. Luby  referred to recent  conversations with  the Alaska                                                                    
Association of Insurance Underwriters  (AAIU) and noted that                                                                    
AAIU cautioned  against looking  to multi-state  pooling due                                                                    
to the high health care costs in Alaska.                                                                                        
                                                                                                                                
Mr.  Luby noted  that AARP  supports SB  70 and  believes it                                                                    
will  help all  Alaskans to  find the  best coverage  at the                                                                    
lowest cost;  and will be  Alaskan designed and  not imposed                                                                    
by the federal government.                                                                                                      
                                                                                                                                
10:06:45 AM                                                                                                                   
                                                                                                                                
MARK  REGAN,  LEGAL  DIRECTOR,   DISABILITY  LAW  CENTER  OF                                                                    
ALASKA,   ANCHORAGE  (via   teleconference),  testified   in                                                                    
support of  SB 70.  He emphasized  that the  exchange system                                                                    
puts people  with disabilities into  the pool  with everyone                                                                    
else and  includes federal safeguards to  insure that people                                                                    
with  disabilities  are   not  charged  excessive  premiums.                                                                    
Overall  costs   could  be  reduced  since   everyone  would                                                                    
participate. He noted that most  people that want to opt out                                                                    
would  do so  not  to  evoke their  rights  to freedom,  but                                                                    
because they  think participation  will cost them  money. He                                                                    
emphasized  that social  security  and Medicare  Part A  are                                                                    
mandatory  programs and  that  exchanges  would help  people                                                                    
establish  their exemptions  due to  the lack  of affordable                                                                    
coverage or other reasons, without penalty.                                                                                     
                                                                                                                                
Mr.  Regan did  not  believe the  state  could establish  an                                                                    
exchange   without   detailed  legislation.   The   proposed                                                                    
legislation  is  an  adaptation  of  the  model  legislation                                                                    
proposed   by   the   National  Association   of   Insurance                                                                    
Commissioners.  States have  the  ability to  setup how  the                                                                    
exchange  is managed  and operated.  He stressed  that while                                                                    
the exchange's function is laid  out in federal legislation,                                                                    
there  will need  to be  additional  state legislation  that                                                                    
lays out  what the exchange does  and there is room  for the                                                                    
legislature and administration to dialog.                                                                                       
                                                                                                                                
10:12:20 AM                                                                                                                   
                                                                                                                                
Senator  Olson  wondered  why the  private  sector  had  not                                                                    
stepped up to develop  the exchange. Senator French observed                                                                    
that  insurance  companies  are   not  interested  in  being                                                                    
compared to other  companies; a consumer group  is needed to                                                                    
put companies' side-by-side for comparison.                                                                                     
                                                                                                                                
SB  70  was   HEARD  and  HELD  in   committee  for  further                                                                    
consideration.                                                                                                                  
                                                                                                                                
SENATE BILL NO. 87                                                                                                            
                                                                                                                                
     "An  Act establishing  a program  in the  Department of                                                                    
     Commerce,  Community,  and   Economic  Development  for                                                                    
     payment of grants to health  care providers for care of                                                                    
     patients who are 65 years of age or older."                                                                                
                                                                                                                                
10:14:03 AM                                                                                                                   
                                                                                                                                
Senator French,  Sponsor, explained the bill.  He maintained                                                                    
that Alaska's Medicare system is not working well.                                                                              
                                                                                                                                
     Too  many seniors  cannot find  a primary  care doctor.                                                                    
     Physicians who  do accept Medicare patients  are losing                                                                    
     money with  each visit, as  the cost of  providing care                                                                    
     exceeds the federal reimbursement rate.                                                                                    
                                                                                                                                
     We  can't  wait  for  the  federal  government  to  fix                                                                    
     Medicare;  instead,   we  need   to  act   today.  This                                                                    
     legislation  will immediately  improve seniors'  access                                                                    
     to primary care services in Alaska.                                                                                        
                                                                                                                                
     The  bill  establishes a  grant  fund  for health  care                                                                    
     providers serving Alaskans who  are sixty-five years of                                                                    
     age  or  over.  The  grants will  be  paid  to  medical                                                                    
     providers   that  increase   primary  care   access  to                                                                    
     Alaska's   seniors.  All   health   care  providers   -                                                                    
     including   physicians,    nurse   practitioners,   and                                                                    
     physician assistants - would be eligible for grants.                                                                       
                                                                                                                                
     Access  to  primary care,  as  you  know Mr.  Chariman,                                                                    
     improves  health outcomes  and  reduces medical  costs.                                                                    
     Instead of waiting for small  ailments to become major,                                                                    
     primary  care  prevents expensive  medical  treatments.                                                                    
     Instead of  requiring an emergency room  visit, primary                                                                    
     care keeps our seniors healthy.                                                                                            
                                                                                                                                
Senator French  observed that a  new Medicare  clinic opened                                                                    
in Alaska.  The clinic hopes  to serve five to  six thousand                                                                    
citizens,  which  is only  half  of  the 13,000  seniors  on                                                                    
Medicare  in  Anchorage that  do  not  have a  primary  care                                                                    
provider. While the Medicare clinic  is a good step forward,                                                                    
Senator  French did  not  feel that  one  solution could  be                                                                    
relied on to solve the  entire problem. He observed that the                                                                    
Institute of  Social and Economic Research  (ISER) estimates                                                                    
that Alaska  will have  86,000 non-native  Alaskans eligible                                                                    
for Medicare by 2020.                                                                                                           
                                                                                                                                
Senator French  estimated that the supplemental  cost of one                                                                    
primary care visit for those  that don't have a primary care                                                                    
doctor would cost  the state $1.2 million.  He stressed that                                                                    
costs  would  be  reduced  by the  coverage  of  nurses  and                                                                    
physician assistants.                                                                                                           
                                                                                                                                
10:17:51 AM                                                                                                                   
                                                                                                                                
In response to  a question by Senator  Olson, Senator French                                                                    
clarified  that  the Medicare  clinic  was  put together  by                                                                    
Providence Hospital.                                                                                                            
                                                                                                                                
Senator  Olson wondered  if there  were provisions  to cover                                                                    
dental   costs.  Mr.   Moderow   agreed   to  provide   that                                                                    
information.                                                                                                                    
                                                                                                                                
10:18:24 AM                                                                                                                   
                                                                                                                                
Senator  Olson  stressed  concern with  high  pharmaceutical                                                                    
costs. Senator French observed that  Medicare Part D and the                                                                    
Affordable Care  Act shrunk the "donut  whole" that affected                                                                    
so   many   seniors  that   had   to   pick  up   costs   of                                                                    
pharmaceuticals.   The   legislation   primarily   addresses                                                                    
primary care; pharmacy costs are not addressed.                                                                                 
                                                                                                                                
10:19:23 AM                                                                                                                   
                                                                                                                                
Co-Chair Stedman  wondered if there  were some areas  of the                                                                    
state that  are underserved. Senator French  stated that the                                                                    
south central region held the biggest issue.                                                                                    
                                                                                                                                
10:20:43 AM                                                                                                                   
                                                                                                                                
JOHN  SHERWOOD, DEPARTMENT  OF HEALTH  AND SOCIAL  SERVICES,                                                                    
stated  that the  responsibility of  the program  would fall                                                                    
under  the Department  of Commerce,  Community and  Economic                                                                    
Development.  Federal  legislation   allowing  state  grants                                                                    
without  Medicare  payment   issues  precludes  the  state's                                                                    
Medicare  agency  from  operating  the  grant  program.  The                                                                    
Department  of  Health  and Social  Services  is  the  state                                                                    
agency.                                                                                                                         
                                                                                                                                
Co-Chair    Stedman   queried    the    position   of    the                                                                    
administration.    Mr.    Sherwood    replied    that    the                                                                    
administration had not taken a position.                                                                                        
                                                                                                                                
10:22:04 AM                                                                                                                   
                                                                                                                                
Co-Chair Stedman  highlighted the  fiscal note:  $234,100 GF                                                                    
from  the Department  of  Commerce,  Community and  Economic                                                                    
Development for  two new positions and  supplies. The fiscal                                                                    
note does  not make  assumptions on  the possible  number of                                                                    
grants or provide grant funding.                                                                                                
                                                                                                                                
10:22:38 AM                                                                                                                   
                                                                                                                                
PAT LUBY,  AARP (via  teleconference), testified  in support                                                                    
of SB  87. The legislation  would enable a grant  program to                                                                    
help  providers that  see a  significant number  of Medicare                                                                    
patients.  He  pointed  to access  problems  faced  by  many                                                                    
Medicare  patients, primarily  in urban  areas. He  stressed                                                                    
that  older Alaskans  will leave  the state  if they  cannot                                                                    
find a health provider.                                                                                                         
                                                                                                                                
10:23:37 AM                                                                                                                   
                                                                                                                                
DENISE  DANIELLO, EXECUTIVE  DIRECTOR, ALASKA  COMMISSION ON                                                                    
AGING, spoke in  support of SB 87. Alaska  continues to lead                                                                    
all  states  with  the  growth  of  its  senior  population.                                                                    
Currently, there are 53,200 Alaskans  age 65 or older. Older                                                                    
Alaskans,  growing   in  number   and  living   longer,  are                                                                    
experiencing chronic medical  health conditions and physical                                                                    
disabilities. Alaska  is, at the  same time,  experiencing a                                                                    
shortage  of  primary  care   providers.  In  recent  years,                                                                    
seniors have  been unable to  access primary health  care as                                                                    
doctors  refuse  them  due  to  low  Medicare  reimbursement                                                                    
rates. A  statewide survey by  the Commission found  that 16                                                                    
percent of  respondents had difficulty finding  a doctor. In                                                                    
2005,  a similar  survey found  that 24  percent of  seniors                                                                    
experienced  a  health care  problem.  Today  31 percent  of                                                                    
seniors experience a health care problem.                                                                                       
                                                                                                                                
10:26:23 AM                                                                                                                   
                                                                                                                                
BOB  DOLL, PRESIDENT,  RETIRED PUBLIC  EMPLOYEES OF  ALASKA,                                                                    
testified  in support  of  SB 87.  Medicare  appears as  the                                                                    
state  sanctioned method  for providing  post-retirement age                                                                    
medical coverage  that was part of  employment for retirees.                                                                    
He  observed that  the retirees  look to  the plan  creators                                                                    
(legislature)  for remedy  to problems.  He maintained  that                                                                    
that SB  87 provides a  remedy and acknowledged the  work of                                                                    
the    Alaskan    congressional   delegation    in    making                                                                    
supplementary  payments  to  Medicare  providers  legal.  He                                                                    
maintained that  thousands of  Alaskan seniors  pass through                                                                    
the  Medicare window  every  year and  some  will find  that                                                                    
their health care is jeopardized.                                                                                               
                                                                                                                                
10:27:55 AM                                                                                                                   
                                                                                                                                
Co-Chair Hoffman  wondered why there  was a proposal  to set                                                                    
up  the  program   without  recommendations  for  individual                                                                    
grants.   Senator   French   replied  that   there   was   a                                                                    
recommendation  of $1.2  million,  which  would satisfy  the                                                                    
problem for a year.                                                                                                             
                                                                                                                                
10:28:46 AM                                                                                                                   
                                                                                                                                
SB  87  was   HEARD  and  HELD  in   committee  for  further                                                                    
consideration.                                                                                                                  
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
10:29:18 AM                                                                                                                   
                                                                                                                                
The meeting was adjourned at 10:29 AM.                                                                                          
                                                                                                                                
                                                                                                                                

Document Name Date/Time Subjects
SB 87 - 2010 Letter to Governor.pdf SFIN 3/28/2011 9:00:00 AM
SB 87
SB 87 Sponsor Statement.PDF SFIN 3/28/2011 9:00:00 AM
SL&C 3/1/2011 2:00:00 PM
SB 87
SB 87 - Letter of Support AARP.pdf SFIN 3/28/2011 9:00:00 AM
SB 87
SB 87 - Explanation of Changes.pdf SFIN 3/28/2011 9:00:00 AM
SB 87
SB 87 - Letter of Support ACoA.pdf SFIN 3/28/2011 9:00:00 AM
SB 87
SB 87 - ISER Medicare Report.pdf SFIN 3/28/2011 9:00:00 AM
SB 87
SB 70 - ADN Article.pdf SFIN 3/28/2011 9:00:00 AM
SB 70
SB 70 - Explanation of Changes.pdf SFIN 3/28/2011 9:00:00 AM
SB 70
SB 70 - Houston Chronicle Article.pdf SFIN 3/28/2011 9:00:00 AM
SB 70
SB 70 - Letters Of Support.pdf SFIN 3/28/2011 9:00:00 AM
SB 70
SB 70 - NCSL Article.pdf SFIN 3/28/2011 9:00:00 AM
SB 70
SB 70 - Sectional.pdf SFIN 3/28/2011 9:00:00 AM
SB 70
SB 102 Sponsor Statement.docx SFIN 3/28/2011 9:00:00 AM
SB 102
SB 70 Sen. French Response to Questions 040111.pdf SFIN 3/28/2011 9:00:00 AM
SB 70
SB 87 Sen. French Response to Questions 040111.pdf SFIN 3/28/2011 9:00:00 AM
SB 87