Legislature(1993 - 1994)

02/18/1994 01:35 PM Senate HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
txt
    SENATE HEALTH, EDUCATION AND SOCIAL SERVICES COMMITTEE                     
                       February 18, 1994                                       
                           1:35 P.M.                                           
                                                                               
  MEMBERS PRESENT                                                              
                                                                               
 Senator Steve Rieger, Chairman                                                
 Senator Loren Leman                                                           
 Senator Jim Duncan                                                            
 Senator Johnny Ellis                                                          
 Senator Judy Salo                                                             
                                                                               
  MEMBERS ABSENT                                                               
                                                                               
 Senator Bert Sharp, Vice-Chairman                                             
 Senator Mike Miller                                                           
                                                                               
  COMMITTEE CALENDAR                                                           
                                                                               
 SENATE BILL NO. 270                                                           
 "An Act creating the Alaska Health Commission; relating to the                
 delivery, quality, access, and financing of health care; relating             
 to review and approval of rates and charges of health insurers;               
 relating to certain civil actions against health care providers and           
 health insurers; repealing Alaska Rule of Civil Procedure 72.1; and           
 providing for an effective date."                                             
                                                                               
 SENATE BILL NO. 284                                                           
 "An Act establishing the Alaska Health Insurance Corporation and              
 requiring licensed health care providers to comply with certain               
 statutes and regulations relating to the corporation; relating to             
 disability insurance claims processing and to approval of rates for           
 disability insurance, including health insurance; and providing for           
 an effective date."                                                           
                                                                               
  PREVIOUS SENATE COMMITTEE ACTION                                             
                                                                               
 SB 284 - See Health, Education & Social Services minutes dated                
          2/14/94.                                                             
                                                                               
 SB 270 - See Health, Education & Social Services minutes dated                
          2/9/94.                                                              
                                                                               
  WITNESS REGISTER                                                             
                                                                               
 Oliver Korshin                                                                
 1200 Airport Heights, #310                                                    
 Anchorage, AK 99508                                                           
    POSITION STATEMENT:   Supported SB 284.                                    
                                                                               
 Nancy Cornwell                                                                
 Anchorage, AK                                                                 
  POSITION STATEMENT:   Answered questions on SB 284.                          
                                                                               
 Steve Conn, Executive Director                                                
 Alaska Public Interest Research Group                                         
 P.O. Box 101093                                                               
 Anchorage, AK 99508                                                           
  POSITION STATEMENT:   Supported SB 284.                                      
                                                                               
 Sally Schliesmann                                                             
 2600 Denali, Suite 701                                                        
 Anchorage, AK 99503                                                           
  POSITION STATEMENT:   Supported SB 284.                                      
                                                                               
   Thelma Langdon, Chairman                                                    
 Health Committee                                                              
 Older Persons Action Group                                                    
  Anchorage, AK                                                                
  POSITION STATEMENT:   Supported SB 284 in general.                           
                                                                               
   Ron Mangelsdorf                                                             
 Christian Science                                                             
 P.O. Box 873452                                                               
 Wasilla, AK 99687                                                             
  POSITION STATEMENT:   Supported SB 284 with more work.                       
                                                                               
   Alice Holinger                                                              
 AK Physical Therapy Association                                               
 3761 Palmdale,                                                                
 Wasilla, AK 99645                                                             
  POSITION STATEMENT:   Supported SB 284 in general.                           
                                                                               
  Vera Gazaway, Executive Director                                             
 Older Persons Group                                                           
 325 E 3rd                                                                     
 Anchorage, AK                                                                 
  POSITION STATEMENT:   Supported SB 284 in general.                           
                                                                               
 Marie Darlin, President                                                       
 National Association of Retired Federal Employees For Alaska                  
 P.O. Box 21283                                                                
 Juneau, AK 99802                                                              
  POSITION STATEMENT:   Supported SB 284.                                      
                                                                               
 James Fisher                                                                  
 633 Harris St.                                                                
 Juneau, AK 99801                                                              
  POSITION STATEMENT:   Supported SB 284.                                      
                                                                               
 Wally Klingelhut                                                              
 Ketchikan, AK                                                                 
  POSITION STATEMENT:   Supported SB 284.                                      
                                                                               
 Marge Elliot                                                                  
 1831 Tongass                                                                  
 Ketchikan, AK 99901                                                           
  POSITION STATEMENT:   Supported SB 284.                                      
                                                                               
 Janet Oates                                                                   
 Providence Hospital Employee                                                  
 9291 Hiland Road                                                              
 Eagle River, AK                                                               
  POSITION STATEMENT:   Urged compromise of SB 284 and SB 270.                 
                                                                               
 Daryl Nelson                                                                  
 Eagle River, AK                                                               
  POSITION STATEMENT:   Related relevant experiences.                          
                                                                               
 Bonnie Nelson                                                                 
 Eagle River, AK                                                               
  POSITION STATEMENT:   Reviewed SB 284 and SB 270.                            
                                                                               
 John Hanchett                                                                 
 P.O. Box 10041                                                                
 Fairbanks, AK 99710                                                           
  POSITION STATEMENT:   Opposed SB 284 and SB 270.                             
                                                                               
 David Busey                                                                   
 801 Lincoln                                                                   
 Sitka, AK 99835                                                               
  POSITION STATEMENT:   Reviewed SB 284.                                       
                                                                               
 Mike Lockwood                                                                 
 250 Hospital PL                                                               
 Soldotna, AK 99669                                                            
  POSITION STATEMENT:   Supported SB 284.                                      
                                                                               
 Barbara Wong                                                                  
 Souther AK Life Underwriters,                                                 
 National Association of Underwriters                                          
 10411 Lone Tree Drive                                                         
 Anchorage, AK 99516                                                           
  POSITION STATEMENT:   Reviewed SB 284.                                       
                                                                               
 Ed Burgan                                                                     
 Anchorage Chamber of Commerce                                                 
 9960 Lone Tree Drive                                                          
 Anchorage, AK 99516                                                           
  POSITION STATEMENT:   Read the Anchorage Chamber of Commerce's               
                      Resolution on Health Care Reform.                        
                                                                               
 Ken Taylor, Executive Director                                                
 Anchorage Community Mental Health Services                                    
 4020 Folker Street                                                            
 Anchorage, AK 99508                                                           
  POSITION STATEMENT:   Reviewed SB 284.                                       
                                                                               
 Vernon Marshall                                                               
 Anchorage, AK                                                                 
  POSITION STATEMENT:   Supported SB 284.                                      
                                                                               
 H. P. Gazaway                                                                 
 1521 W 14th Avenue                                                            
 Anchorage, AK 99501                                                           
  POSITION STATEMENT:   Encouraged formation of an Alaskan plan.               
                                                                               
 Joe Sonneman                                                                  
 324 Willoughby                                                                
 Juneau, AK 99801                                                              
  POSITION STATEMENT:   Reviewed SB 284 and SB 270.                            
                                                                               
 Ruth Callen                                                                   
 Chugiak Senior Center Resident                                                
 Eagle River, AK                                                               
  POSITION STATEMENT:   Noted the need for universal coverage.                 
                                                                               
 Jessie Yearsley                                                               
 Chugiak Senior Center Resident                                                
 Eagle River, AK                                                               
  POSITION STATEMENT:   Supported Ms. Callen's position.                       
                                                                               
 Ron Zoble                                                                     
 3431 Iliamna                                                                  
 Anchorage, AK                                                                 
  POSITION STATEMENT:   Reviewed SB 284.                                       
                                                                               
 Majorie Linder                                                                
 P.O. Box 230039                                                               
 Anchorage, AK 99523                                                           
  POSITION STATEMENT:   Reviewed health care crisis.                           
                                                                               
 Dennis DeGross                                                                
 AK Public Health Association                                                  
 2348 Leander Circle                                                           
 Anchorage, AK 99515                                                           
  POSITION STATEMENT:   Reviewed SB 284 and SB 270.                            
                                                                               
 Mary Ellen Gordian, Physician                                                 
 Anchorage Public Health Officer                                               
 9616 Newhaven                                                                 
 Anchorage, AK 99507                                                           
  POSITION STATEMENT:   Reviewed SB 284 and SB 270.                            
                                                                               
 Mano Frey, Executive President                                                
 AK AFL-CIO                                                                    
 2501 Commercial Drive                                                         
 Anchorage, AK 99501                                                           
  POSITION STATEMENT:   Supported SB 284.                                      
                                                                               
 Kay Lehdenperen                                                               
 Public Health Nurse                                                           
 P. O. Box 196650                                                              
 Anchorage, AK 99501                                                           
  POSITION STATEMENT:   Reviewed SB 284 and SB 270.                            
                                                                               
 Charles McKee                                                                 
 1508 W 43rd NO. 7                                                             
 Anchorage, AK 99504                                                           
  POSITION STATEMENT:   Opposed SB 270, reviewed SB 284.                       
                                                                               
 Barbara Huff Tucknass                                                         
 Teamsters Local 959,                                                          
 Anchorage Chamber of Commerce Member                                          
 P.O. Box 102092                                                               
 Anchorage, AK 99510                                                           
  POSITION STATEMENT:   Supported SB 284.                                      
                                                                               
 David Alexander                                                               
 Anchorage Pediatrician                                                        
 9601 Prospect Drive                                                           
 Anchorage, AK 99516                                                           
  POSITION STATEMENT:   Reviewed SB 284 and SB 270.                            
                                                                               
 Helen Beirne, Health Officer                                                  
 Health & Human Services, Municipality of Anchorage                            
 P.O. Box 196650                                                               
 Anchorage, AK 99519-6650                                                      
  POSITION STATEMENT:   Reviewed SB 284.                                       
                                                                               
                                                                               
  ACTION NARRATIVE                                                             
                                                                               
 TAPE 94-10, SIDE A                                                            
 Number 001                                                                    
 CHAIRMAN RIEGER called the Senate Health, Education and Social                
 Services (HESS) Committee to order at 1:35 p.m and announced  SB 284     4    
 (COMPREHENSIVE HEALTH INSURANCE ACT and  SB 270  (COMPREHENSIVE               
 HEALTH CARE) to be up for consideration.                                      
                                                                               
 OLIVER KORSHIN, Alaska State Medical Association, testified on                
 behalf of SB 284.  He said it was coherent and internally                     
 consistent.  It utilized an unusual market based single payer                 
 approach to achieve universal coverage for Alaskans.  It assures              
 high quality of services.  He believed that a single payer system             
 is the only one suited to Alaska's unusual patterns of seasonal and           
 part time employment.  He believed that the market based features             
 of this bill, such as the posting and publication of provider fees,           
 significant patient co-payments, and controlled utilization of cost           
 and volume by Alaska providers gives this plan a good chance of               
 succeeding.                                                                   
                                                                               
 Mr. Korshin said a very similar program exists in the state of                
 Maine which seems to be working.  He said the concept of public               
 ownership is why a government sponsored health care program may               
 work well in Alaska.  He said that the Anchorage Medical Society              
 voted by a margin of 2 to 1 to support this bill.                             
                                                                               
 Number 141                                                                    
                                                                               
 SENATOR LEMAN asked if Alaska does this ahead of the rest of the              
 United States, would others move here to take advantage of the                
 program.  MR. KORSHIN answered that his question depended on the              
 failure of the other states or the federal government to enact                
 universal coverage.  Alaska is still a cold and distant place and             
 there is also residency language in the bill.                                 
                                                                               
 Number 166                                                                    
                                                                               
 SENATOR SALO asked what residency requirements were in Hawaii for             
 participation in the program.  MR. KORSHIN said he wasn't familiar            
 with residency requirements in Hawaii.  She asked what our                    
 requirements were.                                                            
                                                                               
 NANCY CORNWELL, assisted in the work group that wrote the                     
 legislation, said that a definition of "residency" would be in the            
 section on definitions.  She said it is not as stringent as the one           
 required by the Permanent Fund Board, but more restrictive than               
 what is required by Medicaid.  SENATOR DUNCAN said the answer to              
 that question is on page 11, section 21.58.140 where there is                 
 direction to the corporation as to when the person would become               
 eligible.                                                                     
                                                                               
 STEVE CONN, Executive Director, Alaska Public Interest Research               
 Group, deferred much of the detailed testimony to Bonnie Nelson who           
 focused on consumer's rights within health care reforms.  He said             
 there are people who desperately need health care and don't want to           
 become welfare recipients.  He said quality health care is an                 
 inalienable right of all Alaskans.                                            
                                                                               
 Mr. Conn said that study after study shows that the single payer              
 system (in SB 284) is the cost efficient way to go.  They also                
 support the idea of cost control.  Consumers need SB 284, although            
 it needs more work.  They have real problems with the absence of              
 direct consumer control.                                                      
                                                                               
 Number 279                                                                    
                                                                               
 SALLY SCHLIESMANN, licensed psychologist and President, Alaska                
 Psychological Association, said she was here today to support                 
 putting psychological services into state health care reform.  She            
 supported SB 284, but her comments apply to any health care bill              
 being reviewed.  She said that many people drop out of therapy due            
 to financial struggles.  Mental health is an essential component of           
 total health care.                                                            
                                                                               
 THELMA LANGDON, Older Persons Action Group, provided the Committee            
 with a copy of their position paper.  She said that overall SB 284            
 looked good.  The findings and purpose of the act are well stated.            
 She supported community and home based service to be available to             
 keep people in their homes and out of institutions as long as                 
 possible.  She asked how would Medicaid fit into a state plan.                
                                                                               
 Number 380                                                                    
                                                                               
 RON MANGELSDORF, Christian Science Church, suggested an amendment             
 to SB 284 which would expand the definition of health care provider           
 to include the term "sanitorium" as it is included in the                     
 definition of hospital in the federal Medicare law.  This includes            
 Christian Science Sanitoriums and their doctors.                              
                                                                               
 ALICE HOLINGER, Alaska Physical Therapy Association, recognized the           
 need for health care reform.  There are many people who have no               
 coverage, or not enough and people with pre-existing conditions.              
 She listed prevention, intervention, industrial health,                       
 osteoporosis, and arthritis intervention programs aimed at                    
 decreasing follow up in the elderly, cardiac and pulmonary                    
 rehabilitative programs, and prenatal and postnatal programs are              
 some of the critical areas.  She emphasized that the economies of             
 a small businesses should not be overburdened with the cost of                
 health care.  Ms. Holinger said the Physical Therapy Association,             
 in general, supports SB 284.                                                  
                                                                               
 Number 445                                                                    
                                                                               
 VERA GAZAWAY, Executive Director, Older Persons Action Group,                 
 endorsed Thelma Langdon's testimony.  She was pleased that public             
 health service has been threaded throughout.  This is a very                  
 important part of a universal health care system.  She said SB 284            
 incorporated the kind of care needed for the well to keep them well           
 while still caring for the ill.  She said they would put their                
 questions in writing and address them at a later date.                        
                                                                               
 SENATOR DUNCAN commented that the need for some long term care plan           
 with some deadlines was mentioned by a number of people.  He said             
 the legislature does require that it be designed and be in place by           
 January 1, 1997.                                                              
                                                                               
 SENATOR ELLIS asked if her membership planned to take a position on           
 health care reform?  MS. GAZAWAY said they endorse it                         
 wholeheartedly.                                                               
                                                                               
 MARIE DARLIN, State President, National Association of Retired                
 Federal Employees for Alaska, said she is concerned that Alaska               
 will not have a plan by January 1, 1998 when the federal employee             
 health benefits plan is supposed to end.  They, therefore, urged              
 the legislature to act on this bill, because it is the beginning of           
 what will definitely be needed.  One of the recommendations they              
 have is to provide long term care and health care facilities                  
 planning to meet current and future needs.  More community and                
 health services should be provided to allow retirees to remain in             
 their home as long as possible.                                               
                                                                               
 Number 513                                                                    
                                                                               
 JAMES FISHER, Juneau resident, said it is important for the                   
 maintenance of a rural community system to start on something of              
 the type that is outlined in SB 284.  It's a good start.  He                  
 urgently recommended speedy action.  He thought 4 referrals were              
 excessive considering the many, many years that have gone into the            
 study of this legislation.                                                    
                                                                               
 WALLY KLINGELHUT, Ketchikan, endorsed SB 284.  He said his wife is            
 diabetic, he is unemployed, and on COBRA.  The bill is $470 per               
 month.  Unemployment does not pay that much to keep the coverage.             
 He thought of starting a small business, but even the small                   
 business association will not take diabetics.  He said this bill is           
 a good start.                                                                 
                                                                               
 MARG ELLIOT, Ketchikan, said her husband is uninsurable because of            
 his health problems.  She is in the insurance industry and said               
 many people can't afford the coverage and they go without.  She               
 suggested setting up coverage in Alaska so that one didn't have to            
 go south for something worse than a hangnail.                                 
                                                                               
 Number 579                                                                    
                                                                               
 JANET OATES, Eagle River, works at Providence Hospital.  She said             
 she sat in on most of the compromise work group discussions.  She             
 said they supported SB 284.  Their concern is with the limited                
 scope of SB 270.  She thought a compromise could be worked out                
 between SB 270 and SB 284.  She said the single payer system was a            
 dramatic move, but most agree it makes the best sense for Alaska.             
                                                                               
                                                                               
 TAPE 94-10, SIDE B                                                            
 Number 588                                                                    
                                                                               
 MS. OATES emphasized the urgency to act.  She explained the vicious           
 cycle of health care.   She stated that SB 284 could serve as a               
 catalyst toward the development of a unique health system in the              
 entire country.  She acknowledged the need to have consumer input             
 when the benefit package is developed.  She urged beginning soon              
 with the framework that SB 284 sets up.                                       
                                                                               
 DARYL NELSON, disabled citizen, expressed the need to have choices            
 for consumers.  He related some of his own experiences with the               
 health care system and health insurance.                                      
                                                                               
 BONNIE NELSON, consumer advocate, stated that the committee could             
 refer to her position paper.  She noted that Commissioner Usera had           
 mentioned that the Governor and his Administration believed that              
 quality and affordable health care was an inalienable right;                  
 however, she did not find such sentiment in SB 270.  She expressed            
 the need for a benefit package.                                               
                                                                               
 Ms. Nelson was concerned with the pre-existing condition clause due           
 to the discrimination and inequality it creates.  She noted that              
 New York was the only state that had abolished the pre-existing               
 condition clause.  She related her personal situation when                    
 explaining that employers should not be punished if they hire                 
 someone with a pre-existing condition or a disabled individual.               
                                                                               
 Ms. Nelson pointed out that consumer involvement should be utilized           
 in whatever infrastructure.  She asserted that whichever bill                 
 passes should realize and encourage having individuals with good              
 mediation skills.  She stated that everyone will have to sacrifice            
 and pay.  She explained different cost control methods that she               
 believed were unfair to the people whom health care reform is                 
 attempting to address.  She suggested having a comprehensive                  
 package like Governor Hickel's $5 payment.  She discussed the need            
 for price control, but not to cap control or limit services.  She             
 asserted that what is best for the consumer should be done.                   
                                                                               
 Number 468                                                                    
                                                                               
 JOHN HANCHETT, insurance agent, opposed both SB 270 and SB 284.  He           
 explained that cost factors need to be addressed before setting up            
 a state entity.  He does not see how the cost of health care                  
 insurance can be decreased when including every needed area and               
 uninsurables.                                                                 
                                                                               
 SENATOR ELLIS asked for which insurance companies Mr. Hanchett                
 writes policies.  JOHN HANCHETT stated that he was an independent             
 agent in Fairbanks working with Blue Cross of Washington, Alaska              
 Principle Mutual, Golden Rule, Washington National, and various               
 smaller companies.                                                            
                                                                               
 DAVID BUSEY, private citizen and consumer, testifying from Sitka              
 stated that SB 284 is a good bill.  He commended the required                 
 public involvement process of SB 284.  He explained that the                  
 corporation was a good foundation representing all Alaskans while             
 being somewhat removed from the political arena.  He recommended              
 that the terms be extended to seven years rather than four years.             
 He noted that removal from the corporation should be difficult and            
 with proven reasons.  Removal should be in the same manner as the             
 appointment to the corporation, by action of the Governor and the             
 legislature.  He expressed the need to have compromise seeking                
 individuals, not political right thinkers as members of the                   
 corporation.  He stated that the Tort Reform must occur                       
 concurrently with this legislation so that the insurers and                   
 providers can be protected as well.                                           
                                                                               
 MIKE LOCKWOOD, Executive Director of Central Peninsula General                
 Hospital, member of the work group and Co-Chair of the Physician              
 Hospital, supported SB 284.  He agreed with the comments of Dr.               
 Korshin and Janet Oates.  Originally he opposed the single payer              
 system; however, after being involved in the health reform process            
 he now believes that the market based single payer system is the              
 only system appropriate for Alaska.  SB 284 will decrease                     
 administrative costs and unnecessary utilization while increasing             
 access to sick care, preventive care, and public health services.             
                                                                               
 SENATOR SALO thanked Mr. Lockwood for his work on the health reform           
 and enlightenment on the single payer system.                                 
                                                                               
 Number 354                                                                    
                                                                               
 BARBARA WONG, health insurance agent, member of the Southern Alaska           
 Life Underwriters and National Association of Underwriters, stated            
 that she would address SB 284.  She questioned if there is research           
 proving people are not receiving care.  She pointed out that there            
 is a significant difference between care and coverage and should be           
 addressed.  She expressed concern that the solution is greater than           
 the problem.  She did acknowledge that there is a problem with                
 coverage for a portion of the population.  She questioned whether             
 the Alaska Health Insurance Corporation would be able to provide              
 coverage at a more reasonable price.                                          
                                                                               
 Ms. Wong expressed concerns with SB 284:  It does not offer a plan            
 or an estimate for funding the insurance corporation, and the                 
 corporation does not require anything beyond public opinion input             
 with the Governor appointed and Legislature approved members.  She            
 noted that the individual risk pool without application of the pre-           
 existing condition clause is now in place and available to Alaskans           
 denied insurance coverage.  She stated that in her opinion, the               
 rates of the pool are reasonable.  She pointed out that the Small             
 Reform and Reinsurance Program should allow guarantee issue and               
 coverage for employees of small corporations without application of           
 the pre-existing condition clause.  Those rates appear reasonable.            
 She suggested reviewing how those systems may work before revamping           
 the system to a single payer system.  She stated that the terms               
 market based and single payer are a conflict in terms.  She did not           
 understand where the market base would be in a single payer system.           
 She suggested considering the Anchorage Chamber of Commerce                   
 Resolution on Health Care Reform before passing this bill.                    
 SENATOR DUNCAN stated that one of the basic principles of SB 284              
 was universal coverage not just universal access.  He agreed with             
 Ms. Wong's assessment that access is available to everyone at some            
 point.  He explained that the level of access is the problem.                 
 Those who do not have insurance coverage have access; but at the              
 most expensive level, the critical care level.  He noted that often           
 the results are uncompensated care which creates cost shifting                
 which in turn results in higher costs to those who are insured and            
 increases the number of uninsured people.  It is a vicious cycle.             
 Only through the universal coverage of SB 284 does the inflationary           
 spiral and the vicious cycle end.                                             
                                                                               
 BARBARA WONG stated that now and under SB 284 everyone is paying              
 for the care, so it does not seem to be less.  She reiterated that            
 the solution is greater than the problem.                                     
                                                                               
 SENATOR ELLIS asked if Ms. Wong had read the final report of the              
 Health Resources and Access Task Force.  MS. WONG said she had read           
 SB 284.  SENATOR ELLIS encouraged Ms. Wong and others involved in             
 this debate to review the Health Resources and Access Task Force              
 which includes the number of uninsured Alaskans.                              
                                                                               
 Number 239                                                                    
                                                                               
 ED BURGAN, representing the Anchorage Chamber of Commerce, read the           
 Anchorage Chamber of Commerce's Resolution on Health Care Reform.             
 The Resolution listed thirteen items that they urged the                      
 Legislators and the Governor to address.  The Resolution also                 
 stated that town meetings should be held on any proposed changes              
 before voting on reform.  The final statement of the Resolution               
 acknowledged the need to review and make some changes with the                
 health care system, but it discouraged tearing it down.                       
                                                                               
 SENATOR DUNCAN asked if the Anchorage Chamber of Commerce supported           
 universal coverage.  MR. BURGAN said yes.  SENATOR DUNCAN asked if            
 businesses in Anchorage have seen increases in premiums over the              
 years or a decline in the benefits the businesses can offer.  MR.             
 BURGAN said yes.  SENATOR DUNCAN asked if health care costs were a            
 major portion, an increasing portion, of the businesses' budgets.             
 MR. BURGAN stated that health care costs are a big cost, but it is            
 not a major cost.                                                             
                                                                               
 KEN TAYLOR, Executive Director of Anchorage Community Mental Health           
 Services, stated that the business operation has seen approximately           
 a 30 percent increase in health costs annually.  He referred to an            
 article on the editorial page of the Anchorage Times.  He gave              
 statistics that pointed out that the poor in Alaska are not covered           
 by Medicaid.  He asserted that whether one believes there is a                
 health care crisis or not depends on the situation; are you in the            
 health system or not.  He agreed that Alaska has a very high                  
 quality health care system; however, he believed that if one is not           
 in the system, individuals without money or resources, there is no            
 access for these people.                                                      
                                                                               
 Mr. Taylor referred to Elizabeth McNeil's article in the Metro.  He    He   
 urged doing effective mental health treatment with respect to                 
 offsets.  He stated that the Anchorage Community Mental Health                
 governing board and management supported universal coverage and               
 inclusion of behavioral health in that coverage.  Furthermore, he             
 supported certain facets of SB 284.  He stated that they opposed              
 the lack of attention to mental health.                                       
                                                                               
 Number 064                                                                    
                                                                               
 VERNON MARSHALL said that Alaskans will benefit by establishing a             
 universal health care plan prior to the adoption of a national                
 plan.  He pointed out that the National Education Association of              
 Alaska (NEA-AK) is committed to a comprehensive health care single            
 payer system guaranteeing universal access regardless of pre-                 
 existing conditions or economic circumstances.  He explained that             
 the plan needed to address problems unique to Alaska, such as                 
 health care delivery systems, transportation, and provider                    
 incentives to locate in areas not served or under served.  He                 
 stated that any plan should support and include collective                    
 bargaining, simplification of forms, and reducing unnecessary                 
 paperwork.  He also noted that controlling health care costs                  
 through reduction of administrative costs and increased budget                
 discipline on health care providers and insurance companies should            
 be included in any plan.  The plan must also contain preventive               
 care.  He noted that in order to achieve the National Education's             
 Goal that all children will start school ready to learn, health               
 care must be universally available.  NEA-AK supports SB 284.                  
                                                                               
 TAPE 94-11, SIDE A                                                            
 Number 002                                                                    
                                                                               
 H. P. GAZAWAY stated that Alaska has the most costly and the                  
 poorest coverage of health insurance of any other nation.  He                 
 encouraged forming an Alaskan plan because if another plan passes             
 it will not fit the needs of Alaska.                                          
                                                                               
 JOE SONNEMAN, a Doctor of Government and lawyer, informed the                 
 committee that he had campaigned for a single payer Canadian style            
 system in the 1992 Senate race.  He explained that the Canadian               
 style system allows the individual to choose their own physician.             
 The physicians remain in private practice, but are paid government            
 rates negotiated between the government and the medical societies.            
 The government pays the physicians from a combination of federal              
 and provincial, state, income and other taxes.  He noted that this            
 system leads to early treatments because individuals are willing to           
 go to physicians since they do not pay directly.  This system also            
 leads to a more caring attitude of health care providers who are no           
 longer concerned with making personal fortunes.                               
                                                                               
 Mr. Sonneman noted that both SB 284 and SB 270 set up some sort of            
 entity and as previous hearings have expressed they partially                 
 intend to avoid government; the avoidance of government would be a            
 serious mistake.  He explained Alaska's history of public control             
 over governmental functions.  Both bills try to avoid this public             
 control which would be a serious flaw.  He noted that problems in             
 our current system are present in SB 284:  maintaining control by             
 the providers and maintaining a market based system.  He stated               
 that SB 284 will not fix the current system.  He suggested that               
 income taxes, as in the Canadian system, would be a way of ensuring           
 that those who are able to pay higher payments will do so.                    
                                                                               
 RUTH CALLEN, resident of Chugiak Senior Center, related her own               
 experience to illustrate the need for universal coverage.                     
                                                                               
 JESSIE YEARSLEY, resident of Chugiak Senior Center, supported Ms.             
 Callen's testimony and noted that many residents of the center only           
 have Medicare and need help.                                                  
                                                                               
 Number 145                                                                    
                                                                               
 RON ZOBLE, testifying from Anchorage, explained that when he was an           
 Assistant Attorney General advising the Division of Insurance and             
 later when he dealt with Insurance and Anti-Trust matters the                 
 crisis in health care insurance system became obvious.  He said               
 that universal coverage was long overdue.  He expressed his                   
 surprise that there is no control over health care rates.  There              
 should be some control over these rates.  He noted that SB 284 does           
 include some cost controls.  He emphasized that the current system            
 does not bring security to the individual.                                    
                                                                               
 Mr. Zoble stated that there was more bureaucracy in the present               
 system than could be in the proposed system.  He related personal             
 experiences illustrating the present health care insurance system's           
 bureaucracy and its cost.  He said that the free market does not              
 work well with health care insurance.  There are very few forms of            
 insurance where true competition occurs in the state of Alaska.               
 Most often health insurance companies in Alaska are based elsewhere           
 and they want to insure those who will not get sick.  He stated               
 that self intervention into a pure free market is necessary.  He              
 expressed his disappointment with the pre-existing condition issue            
 and the fact that other countries offer better health care than the           
 U.S. even without health insurance.  He suggested that the Senate             
 give universal coverage or repeal their legislative health                    
 coverage.  He said that it was time to act.                                   
                                                                               
 MARJORIE LINDER pointed out that this health care crisis could                
 happen to anyone.  She related her personal experience with what              
 she called "gotcha clauses" and suggested changing from premiums              
 to taxes.  She implied that this would alleviate the employers'               
 budget and therefore, employees should ask for a raise.                       
                                                                               
 Number 266                                                                    
                                                                               
 DENNIS DEGROSS, representing the Alaska Public Health Association,            
 stated that SB 284 is a much better alternative than SB 270.  He              
 believes that health care in Alaska is at a crisis.  He emphasized            
 that insurance companies are only interested in maintaining the               
 status quo.  He was surprised with the Anchorage Chamber of                   
 Commerce's stance toward health care reform.  He explained that               
 health care must be moved out of the business community due to its            
 limitations on employers and employees.                                       
                                                                               
 MARY ELLEN GORDIAN, Physician and Public Health Officer for the               
 City of Anchorage, thanked the committee for their time and effort            
 with the health care.  She noted that Ms. Wong had stated the                 
 essence of the problem:  people do have access to care but they do            
 not have coverage.  She explained that the current health care                
 system does not benefit society because it does not make people               
 productive.  She expressed the need to have a system that allows              
 individuals to receive needed care so that they can be productive             
 members of society not just living members.  She stated that SB 284           
 is a comprehensive and innovative approach to health care reform.             
 She pointed out what she felt were important elements of SB 284:              
 universal coverage, board representing the people, market based               
 single payer system, and cost containment.  She mentioned that                
 SB 270 seems to lack cost containment.                                        
                                                                               
 Number 354                                                                    
                                                                               
 MANO FREY, Executive President of the Alaska AFL-CIO, stated                  
 support for SB 284.  He reiterated the belief that there is a                 
 crisis in health care.  He opposed waiting for a federal plan to be           
 imposed upon Alaska.  He stated that SB 284 should be used as a               
 starting point from which a comprehensive package could be                    
 developed.  He urged the legislature to approve SB 284.                       
                                                                               
 KAY LEHDENPEREN, a public health nurse, appreciated all the work of           
 the health reform committee.  She noted that SB 284 emphasizes                
 public health and a consumer partnership which SB 270 does not seem           
 to address.  She commended the senators involved who had shown                
 vision and care for Alaskans.                                                 
                                                                               
 CHARLES MCKEE opposed SB 270.  He referred to page 17 line 23 of SB
 284 as a point of concern.  He explained that the insurance                   
 companies do not seem to be interested in public involvement.  He             
 asked if the insurance companies do not want SB 284, how can we               
 have FDIC.  He questioned the guarantee fund of insurance                     
 companies.                                                                    
                                                                               
 Number 468                                                                    
                                                                               
 BARBARA HUFF TUCKNASS, representing the Teamsters Local 959 and               
 members of the Anchorage Chamber of Commerce, noted the struggle              
 through their own health welfare trust with increasing health care            
 costs.  She stated support for comprehensive health care reform and           
 a market driven single payer system.  SB 284 will address current             
 rising costs and provide needed health care coverage for the                  
 uninsured for which covered individuals pay.  She urged passage of            
 SB 284.                                                                       
                                                                               
 DAVID ALEXANDER, Anchorage pediatrician and Alaska Medical                    
 Association on CHIPRA and member of the joint action health group,            
 stated that he was pleased with the base SB 284 provides.  He                 
 expressed concern with the funding, the benefit package, the Tort             
 Reform, and specific cost containment issues.  He preferred SB 284            
 over SB 270.  He cited the Governor appointed members as the                  
 problem of SB 270 whereas SB 284 identifies members as individuals            
 interested and experts in the medical field.                                  
                                                                               
 Mr. Alexander referred to page 12 line 19 of SB 284 when                      
 recommending changing the language to avoid the trigger word                  
 problem.  He suggested using the language on page 10 Section C. of            
 the February 8, 1994 report of the Health System Reform Work Group.           
 He expressed concern that the corporation being subject to                    
 appropriation on page 13 line 5 of SB 284 would be a problem.  He             
 stated that the implementation of dates for development of the                
 uniform claims form could be done quicker than projected.  He noted           
 that there was no implementation date for the benefit package and             
 recommended providing a date.                                                 
                                                                               
 HELEN BEIRNE, Director of Health and Human Services for the                   
 Municipality of Anchorage, commented that SB 284 was a good                   
 comprehensive bill.  She identified the following as areas that               
 should be maintained in SB 284:  a seven member corporation,                  
 upgrading the data system, comprehensive health care plan,                    
 preventive care, long term care, and good time frames.                        
                                                                               
 Number 562                                                                    
                                                                               
 CHAIRMAN RIEGER noted that SB 284 and SB 270 would be before the              
 committee again.  He thanked everyone for participating in the                
 teleconference.                                                               
                                                                               
 There being no further business before the committee, the meeting             
 was adjourned at 3:50 p.m.                                                    
                                                                               
                                                                               

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