Legislature(2007 - 2008)BUTROVICH 205

03/14/2008 01:30 PM Senate HEALTH, EDUCATION & SOCIAL SERVICES


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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
*+ SB 280 MEDICAID/ INS FOR CANCER CLINICAL TRIALS TELECONFERENCED
Heard & Held
*+ SB 288 PESTICIDES/BROADCAST CHEMICALS IN SCHOOLS TELECONFERENCED
<Bill Hearing Postponed>
*+ SJR 18 CHILD PRODUCT SAFETY TELECONFERENCED
Heard & Held
+ Bills Previously Heard/Scheduled TELECONFERENCED
+= SB 300 HEALTH CARE: PLAN/COMMISSION/FACILITIES TELECONFERENCED
Moved CSSB 300(HES) Out of Committee
                    ALASKA STATE LEGISLATURE                                                                                  
SENATE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE                                                               
                         March 14, 2008                                                                                         
                           1:35 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Senator Bettye Davis, Chair                                                                                                     
Senator Joe Thomas, Vice Chair                                                                                                  
Senator John Cowdery                                                                                                            
Senator Kim Elton                                                                                                               
Senator Fred Dyson                                                                                                              
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
All members present                                                                                                             
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                              
SENATE BILL NO. 300                                                                                                             
"An Act  establishing the Alaska  Health Care Commission  and the                                                               
Alaska health  care information office;  relating to  health care                                                               
planning and information; and providing for an effective date."                                                                 
     MOVED CSSB 300(HES) OUT OF COMMITTEE                                                                                       
                                                                                                                                
SENATE BILL NO. 280                                                                                                             
"An  Act  requiring health  care  insurers  to provide  insurance                                                               
coverage for  medical care received  by a patient  during certain                                                               
approved   clinical  trials   designed   to   test  and   improve                                                               
prevention,  diagnosis,  treatment,   or  palliation  of  cancer;                                                               
directing  the  Department  of  Health  and  Social  Services  to                                                               
provide Medicaid services to persons  who participate in clinical                                                               
trials; relating  to experimental  treatments; and  providing for                                                               
an effective date."                                                                                                             
     HEARD AND HELD                                                                                                             
                                                                                                                                
SENATE BILL NO. 288                                                                                                             
"An Act relating  to the procurement, use,  storage, and handling                                                               
of  pesticides and  broadcast chemicals;  and relating  to notice                                                               
and record keeping requirements pertaining to pesticides."                                                                      
     BILL POSTPONED TO 3/19/08                                                                                                  
                                                                                                                                
SENATE JOINT RESOLUTION NO. 18                                                                                                  
Requesting  the President  of  the United  States  to direct  the                                                               
United  States Consumer  Product  Safety Commission  to test  the                                                               
materials used  in children's toys and  other children's products                                                               
for toxicity and to make the results publicly available.                                                                        
     HEARD AND HELD                                                                                                             
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                              
BILL: SB 300                                                                                                                  
SHORT TITLE: HEALTH CARE: PLAN/COMMISSION/FACILITIES                                                                            
SPONSOR(s): HEALTH, EDUCATION & SOCIAL SERVICES                                                                                 
                                                                                                                                
03/06/08       (S)       READ THE FIRST TIME - REFERRALS                                                                        
03/06/08       (S)       HES, FIN                                                                                               
03/12/08       (S)       HES AT 5:00 PM BUTROVICH 205                                                                           
03/12/08       (S)       Heard & Held                                                                                           
03/12/08       (S)       MINUTE(HES)                                                                                            
03/14/08       (S)       HES AT 1:30 PM BUTROVICH 205                                                                           
                                                                                                                                
BILL: SB 280                                                                                                                  
SHORT TITLE: MEDICAID/ INS FOR CANCER CLINICAL TRIALS                                                                           
SPONSOR(s): SENATOR(s) DAVIS                                                                                                    
                                                                                                                                
02/19/08       (S)       READ THE FIRST TIME - REFERRALS                                                                        
02/19/08       (S)       HES, L&C, FIN                                                                                          
03/14/08       (S)       HES AT 1:30 PM BUTROVICH 205                                                                           
                                                                                                                                
BILL: SJR 18                                                                                                                  
SHORT TITLE: CHILD PRODUCT SAFETY                                                                                               
SPONSOR(s): SENATOR(s) WIELECHOWSKI                                                                                             
                                                                                                                                
02/19/08       (S)       READ THE FIRST TIME - REFERRALS                                                                        
02/19/08       (S)       HES, L&C                                                                                               
03/14/08       (S)       HES AT 1:30 PM BUTROVICH 205                                                                           
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
TOM OBERMEYER                                                                                                                   
Staff to Chair Davis                                                                                                            
Alaska State Capitol                                                                                                            
Juneau, AK                                                                                                                      
POSITION STATEMENT: Read the sponsor statement for CSSB 280.                                                                  
                                                                                                                                
DR. JEANNE ANDERSON, Medical Oncologist                                                                                         
Anchorage, AK,                                                                                                                  
POSITION STATEMENT: Supported CSSB 280.                                                                                       
                                                                                                                                
DR. ALAN LICHTER, CEO                                                                                                           
American Society of Clinical Oncology (ASCO)                                                                                    
POSITION STATEMENT: Supported CSSB 280.                                                                                       
                                                                                                                                
DR. STEPHEN COMPTON, Clinical Cardiologist                                                                                      
Alaska Heart Institute (AHI)                                                                                                    
POSITION STATEMENT: Supported CSSB 280.                                                                                       
                                                                                                                                
DENNIS BAILEY                                                                                                                   
Legislative Legal and Research Services Division                                                                                
Legislative Affairs Agency                                                                                                      
Juneau, AK                                                                                                                      
POSITION STATEMENT: Answered questions about CSSB 280.                                                                        
                                                                                                                                
DEBORAH APPERSON, representing herself                                                                                          
Anchorage, AK,                                                                                                                  
POSITION STATEMENT: Supported CSSB 280.                                                                                       
                                                                                                                                
KRISTA RANGISCH, representing herself                                                                                           
Anchorage, AK                                                                                                                   
POSITION STATEMENT: Supported CSSB 280.                                                                                       
                                                                                                                                
DR. MARY STEWART, Oncologist                                                                                                    
Anchorage, AK                                                                                                                   
POSITION STATEMENT:                                                                                                           
                                                                                                                                
EMILY NENON, Alaska Government Relations Director                                                                               
American Cancer Society                                                                                                         
Anchorage, AK                                                                                                                   
POSITION STATEMENT:                                                                                                           
                                                                                                                                
CLAIRE WADDOUP, representing herself                                                                                            
Anchorage, AK                                                                                                                   
POSITION STATEMENT:                                                                                                           
                                                                                                                                
LINDA HALL, Director                                                                                                            
Division of Insurance                                                                                                           
Anchorage, AK                                                                                                                   
POSITION STATEMENT: Offered to work with the committee on some                                                                
verbiage.                                                                                                                       
                                                                                                                                
DR. LARRY WICKERHAM, Associate Chairman                                                                                         
National Surgical Adjuvant Breast and Bowel Project (NSABP)                                                                     
Address not provided                                                                                                            
POSITION STATEMENT: Supported CSSB 280.                                                                                       
                                                                                                                                
BEVERLY K. WOOLEY, representing herself                                                                                         
Director, Alaska Division of Public Health                                                                                      
Anchorage, AK                                                                                                                   
POSITION STATEMENT: Supported CSSB 280.                                                                                       
                                                                                                                                
SENATOR BILL WIELECHOWSKI                                                                                                       
Alaska State Legislature                                                                                                        
Juneau, AK                                                                                                                      
POSITION STATEMENT: Introduced SJR 18.                                                                                        
                                                                                                                                
KRISTIN RYAN, Director                                                                                                          
Division of Environmental Health                                                                                                
Department of Environmental Conservation                                                                                        
POSITION STATEMENT: Supported SJR 18.                                                                                         
                                                                                                                                
Susan Ely, Legislative and Communications Manager                                                                               
Alaska Conservation Alliance (ACA)                                                                                              
Anchorage, AK                                                                                                                   
POSITION STATEMENT: Supported SJR 18.                                                                                         
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
CHAIR  BETTYE  DAVIS  called the  Senate  Health,  Education  and                                                             
Social Services  Standing Committee  meeting to order  at 1:35:20                                                             
PM. Present at the call to  order were Senators John Cowdery, Kim                                                             
Elton, Fred Dyson, Joe Thomas and Chair Bettye Davis.                                                                           
                                                                                                                                
         SB 300-HEALTH CARE: PLAN/COMMISSION/FACILITIES                                                                     
                                                                                                                                
1:35:53 PM                                                                                                                    
CHAIR DAVIS announced  consideration of SB 300. She  said she had                                                               
changed  the  bill  so  that   the  department  rather  than  the                                                               
commission  would  be  responsible  for hiring  a  contractor  to                                                               
perform  the CON  study  and  asked if  anyone  on the  committee                                                               
wanted to comment.                                                                                                              
                                                                                                                                
SENATOR ELTON said he was prepared for a motion.                                                                                
                                                                                                                                
SENATOR DYSON said  he was a little uncomfortable  that they were                                                               
ducking the  CON issue;  it needed to  be addressed.  He believed                                                               
the rest of the bill had value  and needed to be done, but wished                                                               
they had  time to  work through  this issue.  He said  that, even                                                               
with Chair Davis' change, it  was still possible that the results                                                               
could be  "stacked," and asked  if she had considered  having the                                                               
department  submit a  short list  of 2  or 3  contractors to  the                                                               
legislature for a final decision.                                                                                               
                                                                                                                                
CHAIR DAVIS  said she had not,  but they could look  at that when                                                               
it got to Finance.                                                                                                              
                                                                                                                                
SENATOR DYSON said Finance was so  backed up that he doubted much                                                               
of that kind of  work was going to get done.  He pointed out that                                                               
Chair Davis  had enough votes to  pass this out and  he would not                                                               
strenuously object.                                                                                                             
                                                                                                                                
CHAIR  DAVIS said  she would  like to  have Senator  Dyson's vote                                                               
too, and  she wanted to  hear from  Senator Elton on  the matter.                                                               
She asked Senator  Elton if the current version of  the bill gave                                                               
him more confidence than the previous one had.                                                                                  
                                                                                                                                
SENATOR ELTON thanked her for asking.  He was not sure they would                                                               
ever  get to  his comfort  level or  Senator Dyson's;  they might                                                               
just have  to assume good behavior  was going to happen.  He said                                                               
he was prepared to go with her solution.                                                                                        
                                                                                                                                
1:40:00 PM                                                                                                                    
SENATOR COWDERY moved to adopt  the proposed committee substitute                                                               
CSSB 300, labeled 25-LS1, Version  \C, as the working document of                                                               
the committee. There being no objection, the motion carried.                                                                    
                                                                                                                                
SENATOR DYSON  said he would  have more comfort with  moving this                                                               
bill today  if she would commit  to move the Governor's  bill out                                                               
in the next week.                                                                                                               
                                                                                                                                
CHAIR  DAVIS said  the bill  would be  moved, but  she could  not                                                               
commit to  a specific time  frame as there  was still work  to be                                                               
done on it.                                                                                                                     
                                                                                                                                
SENATOR DYSON said  he trusted her to do that,  but didn't always                                                               
trust  the  process and  was  worried  it  might die  because  of                                                               
timing.                                                                                                                         
                                                                                                                                
SENATOR COWDERY  moved to report  SB 300 from the  committee with                                                               
individual recommendations and attached fiscal note(s).                                                                         
                                                                                                                                
1:42:07 PM                                                                                                                    
SENATOR DYSON objected.                                                                                                         
                                                                                                                                
A  roll call  was  taken. Senators  Cowdery,  Elton, Thomas,  and                                                               
Davis  voted  yea and  Senator  Dyson  voted nay.  Therefore  the                                                               
motion passed 4:1 and CSSB 300(HES) moved from committee.                                                                       
Senators  Dyson,  Elton  and  Thomas left  to  attend  a  Finance                                                               
meeting.                                                                                                                        
                                                                                                                                
        SB 280-MEDICAID/ INS FOR CANCER CLINICAL TRIALS                                                                     
                                                                                                                                
CHAIR DAVIS announced consideration of SB 280.                                                                                  
                                                                                                                                
1:45:02 PM                                                                                                                    
TOM OBERMEYER, Staff to Chair Davis, read the sponsor statement                                                                 
as follows:                                                                                                                     
                                                                                                                                
     This is an Act requiring health care insurers to provide                                                                   
     insurance coverage for medical care received by a patient                                                                  
     during certain approved clinical trials designed to test                                                                   
     and improve prevention, diagnosis, treatment, or palliation                                                                
     of cancer; directing the Department of Health and Social                                                                   
     Services to  provide Medicaid  services to  persons who                                                                    
     participate in clinical trials; relating to experimental                                                                   
     procedures; and providing for an effective date.                                                                           
                                                                                                                                
     Clinical trials are research studies that test how well new                                                                
     medical approaches work in patients. Each study  answers                                                                   
     scientific questions and tries  to find  better ways to                                                                    
     prevent, screen for, diagnose, or treat disease. Patients                                                                  
     who take part in cancer clinical trials have an opportunity                                                                
     to contribute to the  knowledge of, and progress against                                                                   
     cancer. They also receive state-of-the art treatment from                                                                  
     experts in the field. The  National Cancer Institute, as                                                                   
     part of the  U.S. National Institutes of Health, reports                                                                   
     6,000 cancer trials in the United States at any one time.                                                                  
     They include trials in  prevention, screening, diagnosis,                                                                  
     treatment, quality-of-life, and genetic studies.                                                                           
                                                                                                                                
     SB 280 removes important barriers to the participation of                                                                  
     patients in cancer clinical trials in Alaska. It requires                                                                  
     that  all health care  plans, including Medicaid, cover                                                                    
     routine patient care costs for patients enrolled in all                                                                    
     phases of clinical trials, including prevention, detection,                                                                
     treatment, and  palliation (supportive care) of  cancer.                                                                   
     Currently Alaska health plans  can exclude coverage for                                                                    
     routine patient-care costs while a patient with cancer is                                                                  
     enrolled in a  clinical trial. Providers of health care                                                                    
     plans often conclude that money is saved by excluding care                                                                 
     while patients participate in clinical trials. But these                                                                   
     patients, if not enrolled in clinical trials, will continue                                                                
     to receive conventional therapy at  roughly the same or                                                                    
     slightly increased costs in the short-run.                                                                                 
                                                                                                                                
     Studies have shown that only 2-3 percent of eligible adult                                                                 
     patients enroll in  clinical trials with a  6.5  percent                                                                   
     increase in costs for clinical trial participants compared                                                                 
     to   nonparticipants. (National   Conference  of  State                                                                    
     Legislatures      ncsl.org/programs/health/clinicaltrials,                                                                 
     accessed 2/27/08) Without in-state facilities and support                                                                  
     of clinical trials participants in Alaska currently have to                                                                
     travel out of state, increasing the cost of non-emergency                                                                  
     transportation which is about 3 percent of total Medicaid                                                                  
     costs.                                                                                                                     
                                                                                                                                
     In FY  2007 an  estimated 4,600 patients received cancer                                                                   
     treatments through Alaska's Medicaid program at a cost of                                                                  
     $21.5 million. The  average payment per beneficiary was                                                                    
     about $4,675. The federal government reimburses the state                                                                  
     at  about 50 percent  of the  total costs. Based  on an                                                                    
     estimated 2.5 percent participation rate per above, about                                                                  
     115 patients are expected to participate in clinical trials                                                                
     each year. A 6.5 percent increase for 115 persons would add                                                                
     $35.00 per year to  Medicaid for cancer treatments. Non-                                                                   
     emergency transportation costs for  the same  group are                                                                    
     estimated to add another $15.00 per year. The fiscal note                                                                  
     adds  an estimated  $50,000 per  year with  the  federal                                                                   
     government paying half of this.                                                                                            
                                                                                                                                
     Twenty-three states have passed legislation or instituted                                                                  
     special agreements requiring health plans to pay the cost                                                                  
     of   routine  medical   care   patients  receive  while                                                                    
     participating in clinical trials. Passage of SB 280 will                                                                   
     result in more successful outcomes in cancer treatments in                                                                 
     Alaska, increase retention of patients in Alaska for their                                                                 
     cancer care, and also, after full implementation, result in                                                                
     cost savings in the short and long term.                                                                                   
                                                                                                                                
1:49:17 PM                                                                                                                    
DR.  JEANNE ANDERSON,  Medical  Oncologist,  Anchorage, spoke  on                                                               
behalf  of Alaska  cancer physicians  and  patients. She  thanked                                                               
Chair Davis and the Health  and Social Services Committee members                                                               
for  sponsoring and  considering  this bill.  She disclosed  that                                                               
2650 Alaskans were expected to  be diagnosed with cancer in 2008,                                                               
and many more would be diagnosed  with a recurrence of cancer. In                                                               
the  1970's only  50 percent  of  cancer patients  lived 5  years                                                               
after  diagnosis. In  2008 it  was predicted  that 66  percent of                                                               
patients would survive 5 years.  Cancer physicians in Alaska were                                                               
committed to providing  the best care possible  to their patients                                                               
to  relieve suffering  and reduce  deaths from  cancer, and  they                                                               
often turned to  clinical trials as providing  the best treatment                                                               
for their patients. As the  sponsor statement indicated, clinical                                                               
trials provided  a formal  and scientific way  to test  whether a                                                               
new  treatment  was  safe, effective  and  superior  to  existing                                                               
treatments.  The physicians  and  hospitals  in Alaska  supported                                                               
clinical  trials and  there were  currently at  least 50  of them                                                               
open  in the  state for  cancer  patients however,  only a  small                                                               
number of their  patients, about 40 patients  per year, enrolled.                                                               
The reasons  included lack of  knowledge or interest on  the part                                                               
of either the  patient or the physician; lack  of availability of                                                               
an  appropriate trial  for  the patient;  and  lack of  insurance                                                               
coverage, or fear  by the patients that they  would lose coverage                                                               
if they  did enroll.  Passage of this  bill would  clearly remove                                                               
that  one important  barrier  to access  to  clinical trials  for                                                               
their patients.  She believed  it would  result in  improved care                                                               
for patients,  reducing the burden  of cancer in  the population,                                                               
and facilitating patients to stay  in Alaska for state-of-the-art                                                               
care.                                                                                                                           
                                                                                                                                
SENATOR  COWDERY asked  Mr. Obermeyer  why the  fraternal benefit                                                               
societies were excluded on page 2, line 5, Section C.                                                                           
                                                                                                                                
CHAIR DAVIS  said that they  would discuss the bill  after taking                                                               
public testimony and asked Senator Cowdery to hold his question.                                                                
                                                                                                                                
1:52:28 PM                                                                                                                    
DR.  ALAN LICHTER,  CEO, American  Society  of Clinical  Oncology                                                               
(ASCO)  said the  Society  had  close to  26,000  members in  112                                                               
countries around the  world. He reiterated that  a clinical trial                                                               
was a research study  to find out if a new  treatment was safe or                                                               
effective, if  treatment A  was better than  treatment B;  it was                                                               
governed by a  rigorous review and oversight process;  and it was                                                               
the critical step  in achieving progress in  cancer treatment. In                                                               
fact, the pace of progress  against cancer was largely determined                                                               
by the pace at which  they could complete clinical studies. While                                                               
they were making  progress in clinical studies, the  pace was not                                                               
fast enough to  satisfy them; less than 5 percent  of adults went                                                               
on to a  cancer clinical trial. There were many  reasons for that                                                               
but, as stated, one of them  was the uncertainty of whether their                                                               
insurance would cover  their routine clinical care  costs if they                                                               
were treated as  part of a trial, or the  certainty that it would                                                               
not.  He  found   it  ironic  when  he   realized  that  insurers                                                               
increasingly   asked   physicians  to   practice   evidence-based                                                               
medicine,  then turned  around  and told  patients  that if  they                                                               
participated in a  clinical trial to gather  such evidence, their                                                               
care  costs would  be denied.  For 15  years ASCO  had fought  to                                                               
ensure  coverage  for  those  routine  clinical  costs  and  were                                                               
successful in  convincing Medicare  to change their  policy about                                                               
10  years ago.  About 20  states had  already passed  legislation                                                               
such as this and, when they  asked their members in those states,                                                               
over  2/3 said  the  passage  of that  law  had  been helpful  in                                                               
facilitating  the  entry  of   patients  into  clinical  studies.                                                               
Insurance companies  were concerned  over costs;  and at  least 4                                                               
major studies  had been done  that showed the routine  care costs                                                               
of treating  a patient in a  clinical trial were no  greater than                                                               
the costs an  insurance company would pay anyway. He  said he was                                                               
extremely encouraged that Alaska  was considering passage of this                                                               
bill;  these bills  were critical  if they  were to  continue the                                                               
pace of discovery in cancer.                                                                                                    
                                                                                                                                
1:56:47 PM                                                                                                                    
DR.   STEPHEN  COMPTON,   Clinical  Cardiologist,   Alaska  Heart                                                               
Institute  (AHI),   said  he  specialized  in   clinical  cardiac                                                               
electrophysiology, the care of heart  rhythm problems. He was one                                                               
of  about 23  cardiologists  in  the state,  and  they wanted  to                                                               
second  the testimony  of Dr.  Lichter and  others. Cardiologists                                                               
faced the same problems; they  clearly had not solved the problem                                                               
of  heart disease  in the  world and  there were  many unanswered                                                               
clinical questions that  needed to be addressed.  In Alaska, they                                                               
had had 2,000  patients involved in various  clinical studies and                                                               
trials during  the previous 8 years.  He thought it was  naïve of                                                               
insurance companies  to think that  medicine was a  static issue;                                                               
his own  job didn't exist 20  years ago because it  had been only                                                               
in the  past 20 years  that they  had learned enough  about heart                                                               
rhythm problems  to routinely cure disabling  or life-threatening                                                               
arrhythmias.  Treatments  for  these  conditions  were  developed                                                               
through progress in  research based on clinical  trials. He cited                                                               
the  development   of  implantable  devices  for   heart  failure                                                               
monitoring  and  treatment as  another  example  of devices  that                                                               
clearly improved  quality of life,  heart function  and survival;                                                               
the  only  way  to  learn  about  these  strategies  was  through                                                               
clinical trials.                                                                                                                
                                                                                                                                
In  closing,  Dr.  Compton  said the  need  for  clinical  trials                                                               
applied to  every area  of medicine and  he fully  supported this                                                               
bill.                                                                                                                           
                                                                                                                                
2:00:36 PM                                                                                                                    
MR.  OBERMEYER  advised  Chair  Davis  that  Dennis  Bailey  with                                                               
legislative legal  would be  available for only  a short  time to                                                               
address Senator  Cowdery's question about the  inapplicability of                                                               
fraternal benefit societies that now  appeared on page 2, line 20                                                               
of Version \C. He restated the question for Mr. Bailey.                                                                         
                                                                                                                                
DENNIS BAILEY, Legislative Legal  and Research Services Division,                                                               
Legislative Affairs  Agency, Juneau,  explained that  a fraternal                                                               
benefit society was an organization  similar to the Elks or Moose                                                               
Lodge, that provided specific benefits  for their members. It was                                                               
a category that  was not exactly insurance and  that was exempted                                                               
from  almost all  mandatory insurance  coverages  already in  the                                                               
statutes.                                                                                                                       
                                                                                                                                
CHAIR DAVIS  asked if such  organizations could voluntarily  be a                                                               
part of this despite the exclusion.                                                                                             
                                                                                                                                
MR. BAILEY  replied that, if  a fraternal benefit  society wished                                                               
to include  coverage or  provide a  benefit for  clinical trials,                                                               
they could do so.                                                                                                               
                                                                                                                                
2:03:07 PM                                                                                                                    
DEBORAH  APPERSON,  representing herself,  was  a  3 time  cancer                                                               
patient. She  said she  would like to  participate in  a clinical                                                               
trial but  could not  do so  unless insurance  would pay  for the                                                               
routine  care. The  treatments she  had undergone  were available                                                               
due to  the participation of  others in clinical trials,  and she                                                               
wanted to "pay it forward" for  those patients to come. With this                                                               
bill, she could do so.                                                                                                          
                                                                                                                                
2:04:32 PM                                                                                                                    
KRISTA  RANGISCH, representing  herself,  said she  was a  cancer                                                               
research nurse at Providence Alaska  Medical Center in Anchorage.                                                               
She said that when a clinical  trial was recommended to a patient                                                               
by his  physician as the  best treatment option, the  patient was                                                               
referred to her  office. Part of her discussion  with the patient                                                               
about  that study  included informing  them that  insurance might                                                               
not cover  some or all  of the  costs associated with  the cancer                                                               
care while on the study;  she strongly encouraged all patients to                                                               
find out  what their policy  said about clinical  trial coverage.                                                               
It  was at  this  stage  that they  encountered  the majority  of                                                               
roadblocks.  She  stressed  that  patients  went  through  a  lot                                                               
emotionally and financially when  they were diagnosed with cancer                                                               
and the  last thing they  needed to  worry about was  finding out                                                               
whether their  insurance would  cover a  clinical trial  that the                                                               
physician thought was in their  best interest. One of the biggest                                                               
reasons that patients  did not go on in clinical  trials was lack                                                               
of, or  fear of lack  of, insurance coverage. In  addition, there                                                               
were many instances in which, due  to the severity of the cancer,                                                               
it was necessary to start treatment  right away and there was not                                                               
sufficient  time  to investigate  coverage  or  to wait  for  the                                                               
insurance  company to  determine coverage.  In closing,  she said                                                               
that  if  insurance companies  were  mandated  to cover  clinical                                                               
trial costs, she was confident many  more people would be able to                                                               
participate in clinical trials, which  in turn would increase the                                                               
likelihood of improved cancer care and someday finding a cure.                                                                  
                                                                                                                                
2:06:48 PM                                                                                                                    
DR  MARY  STEWART,  Oncologist,   Anchorage,  had  been  treating                                                               
patients  for over  20 years.  During that  time she  had treated                                                               
hundreds  of patients  with cancer;  some  went on  to cure,  but                                                               
others  traveled the  path of  a terminal  disease, seeking  more                                                               
time to be  with friends and loved ones. Every  day radiation and                                                               
medical  oncologists struggled  with difficult  and life-altering                                                               
questions. She  related the cases  of three patients  whose lives                                                               
were cut  short by  diagnoses of  cancer and  said she  wanted to                                                               
know how to do a better job for them.                                                                                           
                                                                                                                                
DR.  STEWART  said  that  the  oncologists'  collegial  group  in                                                               
Alaska,   the  Denali   Oncology   Group  (DOG),   had  a   loose                                                               
affiliation, putting  together yearly  conferences on  the latest                                                               
in cancer treatment for the past  24 years. Last year they became                                                               
an  official  affiliate  of  The  American  Society  of  Clinical                                                               
Oncology (ASCO). When they met  in Homer in September, they asked                                                               
what they should  do to make their first priority  to improve the                                                               
treatment of all  Alaskans. They wanted to  enhance enrollment of                                                               
patients  on clinical  trials, for  that was  where they  learned                                                               
what  worked and  what didn't.  SB 280  would reduce  barriers to                                                               
patient enrollment.  She pointed  out that  the costs  of patient                                                               
care  changed very  little and  those patients  would still  need                                                               
blood  tests, X-rays,  CT  scans  and MRIs  no  matter what.  The                                                               
physicians did not gain financially  from this, but hoped to gain                                                               
better clinical insight  and treatment for the  patients in their                                                               
care. She urged the committee to move SB 280 forward.                                                                           
                                                                                                                                
2:09:42 PM                                                                                                                    
EMILY  NENON,  Alaska  Government  Relations  Director,  American                                                               
Cancer Society,  Anchorage, emphasized that clinical  trials were                                                               
a  critically important  part of  the fight  against cancer.  She                                                               
also confirmed  what Dennis Bailey  had said, that  the fraternal                                                               
benefit  society exclusion  was common  to  all of  this type  of                                                               
legislation but did not preclude participation.                                                                                 
                                                                                                                                
2:11:20 PM                                                                                                                    
CLAIRE WADDOUP, representing herself,  Anchorage, said she was in                                                               
a clinical trial  that involved treatment to  improve her chances                                                               
of not having a recurrence  of cancer. Ultimately, this treatment                                                               
would save the  insurance company money if she  stayed clear. She                                                               
wished Deb Apperson  the very best and thanked  the committee for                                                               
hearing her testimony.                                                                                                          
                                                                                                                                
2:12:39 PM                                                                                                                    
LINDA  HALL,  Director,  Division  of  Insurance,  Department  of                                                               
Commerce,  Community  &  Economic Development,  wanted  first  to                                                               
comment on mandates  in general. The division  was concerned that                                                               
mandates in  Title 21  tended to apply  only to  approximately 40                                                               
percent of Alaskans because the  other 60 percent were covered by                                                               
some type  of self-insurance  plan that would  not be  subject to                                                               
the mandate.  That meant the  mandate applied only  to individual                                                               
and  small  group  policies;  none   of  the  self-insured  large                                                               
employer  plans would  be subject  to it.  She felt  there was  a                                                               
misunderstanding  that  when they  did  a  state mandated  health                                                               
benefit, it  applied to  everyone who had  coverage and  that was                                                               
not accurate.                                                                                                                   
                                                                                                                                
MS. HALL  said the  division had reviewed  other states  that had                                                               
coverage for clinical trials and  felt that this bill was written                                                               
with   a  fairly   broad  scope.   She   mentioned  the   medical                                                               
oncologists' reference  to coverage  of "routine  medical costs,"                                                               
and noted that 17 out of  20 states, according to their research,                                                               
had  language  that only  required  coverage  of routine  medical                                                               
costs. She  said she would  like to  work with Senator  Davis and                                                               
her staff on  the ability to have deductibles or  co-pays more in                                                               
line with  other mandates in  Title 21, and  to make sure  it did                                                               
not  expand into  areas that  were traditionally  covered by  the                                                               
sponsors of the clinical trials.                                                                                                
                                                                                                                                
2:17:08 PM                                                                                                                    
DR.  LARRY  WICKERHAM,   Associate  Chairman,  National  Surgical                                                               
Adjuvant Breast  and Bowel Project  (NSABP), one of  the National                                                               
Cancer  Institute's cooperative  trials  groups,  said the  NSABP                                                               
conducted large  studies that  compared standard  treatments with                                                               
newer, innovative  therapies in patients with  early stage breast                                                               
and bowel  cancers. The group's  mission was to  improve survival                                                               
and quality of life for these  patients. Over the years, they had                                                               
entered over 130,000 individuals  into their various trials; they                                                               
had 200  centers and  300 satellite  centers located  through the                                                               
US,  Canada, Puerto  Rico and  Ireland, and  had several  centers                                                               
participating in trials in Alaska.  The results of their previous                                                               
trials had  a major impact on  the care of both  breast and bowel                                                               
cancers;  the   results  of  their  breast   cancer  trials  were                                                               
invaluable in  eliminating radical mastectomies,  demonstrating a                                                               
lumpectomy  was  an  effective   alternative  and  that  adjuvant                                                               
therapy in addition to  surgery, (chemo-therapy, hormonal therapy                                                               
and the  newer targeted agents)  could improve  survival. Figures                                                               
from the American Cancer Society  demonstrated that the mortality                                                               
rates  from breast  cancer  in the  US had  declined  for over  a                                                               
decade.  These improvements  were  thought to  be  the result  of                                                               
screening  mammograms   and  improvements  in   treatment.  These                                                               
improvements  in care  came primarily  from clinical  trials like                                                               
those  conducted by  the  NSABP. The  more  patients who  entered                                                               
these  trials, the  more quickly  they  got the  results and  the                                                               
faster they could  improve care. Unfortunately, for  a variety of                                                               
reasons as  Dr. Lichter mentioned,  less than 5 percent  of adult                                                               
cancer  patients  actually  entered  clinical  trials.  Cost  was                                                               
indeed a  major barrier to their  participation. Requiring health                                                               
care   insurers  to   cover   the   standard-of-care  costs   for                                                               
individuals  participating   in  cancer  clinical   trials  would                                                               
substantially  remove   one  of   the  significant   barriers  to                                                               
increasing participation.  Any research trial included  2 general                                                               
categories:  research  costs,  expenses  the  patient  would  not                                                               
routinely  incur if  he/she  were  not part  of  that trial;  and                                                               
routine  standard-of-care   costs,  expenses  that   would  occur                                                               
whether  or not  that  patient entered  a  clinical study.  NSABP                                                               
studies   routinely    identified   the    non   standard-of-care                                                               
components; they  provided the drug  or drugs being  studied free                                                               
of charge  and typically provided additional  non-federal funding                                                               
to  help  defray  the  costs  of  clinical  trial  participation,                                                               
including the  cost of non  standard-of-care items. The  goal was                                                               
to minimize  any additional  cost to  the patient,  improve trial                                                               
participation and improve  cancer care in general.  He urged them                                                               
to enact this  bill so that patients in Alaska  would have access                                                               
to  state-of-the-art  studies  like those  already  available  to                                                               
patients in other states.                                                                                                       
                                                                                                                                
2:20:22 PM                                                                                                                    
BEVERLY K.  WOOLEY, Director, Alaska  Division of  Public Health,                                                               
speaking for  herself as  a cancer survivor,  said few  things in                                                               
life  could rock  you  to the  core like  hearing  that you  have                                                               
cancer. She  had to go through  that with her diagnosis  in 2004;                                                               
despite her family history of  extensive cancer, her diligent and                                                               
aggressive check-ups,  it did hit her  and she was not  ready for                                                               
the emotional turmoil.  She admitted that her whole  focus was on                                                               
survival at that point; and it  was soon after her diagnosis that                                                               
she was  told she was  eligible for  a clinical trial.  She spent                                                               
days researching  it and  came to  the decision  that it  was the                                                               
best news for  her, not only because it gave  her the best chance                                                               
for  survival, but  because her  young daughter,  because of  her                                                               
diagnosis, was  at a higher risk.  "At a time when  I didn't have                                                               
much  hope,"  she  said,  "thinking   that,  regardless  of  what                                                               
happened to  me, I could take  part in something that  might make                                                               
her  future and  that  of other  young women  better,  gave me  a                                                               
silver  lining. My  enthusiasm was  short lived  however, when  I                                                               
found  out  my  insurance  might  not pay."  She  started  on  an                                                               
emotional roller-coaster,  due in part  to the fact that  she had                                                               
lost her father  to cancer at 17  after a 3 year  fight that took                                                               
all of  their family's savings  and nearly cost them  their home.                                                               
Her 80  year old mother  was still paying  for the loss  of those                                                               
savings  that could  have made  her life  better, and  Ms. Wooley                                                               
feared that  it was  going to  happen to her.  It took  time, but                                                               
fortunately  they worked  with her  and eventually  her insurance                                                               
did come through  so she was able to go  forward with the trials.                                                               
She  got the  best care  possible and  was able  to give  hope to                                                               
future generations  through the  research that  was done  at that                                                               
time.                                                                                                                           
                                                                                                                                
MS. WOOLEY  closed by  saying that  she did  not know  what would                                                               
have happened if she had not  been able to take advantage of that                                                               
trial. To  have the hope  of the best  possible care held  out to                                                               
you  and to  be afraid  you could  not take  advantage of  it was                                                               
absolutely devastating.  She pressed that  they had the  power to                                                               
make a statement against cancer  by moving this bill forward, and                                                               
asked them  to please move the  bill out and get  clinical trials                                                               
for as many people in Alaska as possible.                                                                                       
                                                                                                                                
2:23:54 PM                                                                                                                    
CHAIR DAVIS announced she would hold  SB 280 in order to complete                                                               
some work on  it with the division of insurance,  and would bring                                                               
it back in a short time.                                                                                                        
                                                                                                                                
2:25:13 PM                                                                                                                    
CHAIR DAVIS announced a brief at ease.                                                                                          
                                                                                                                                
                  SJR 18-CHILD PRODUCT SAFETY                                                                               
                                                                                                                              
2:26:05 PM                                                                                                                    
CHAIR DAVIS announced consideration of SJR 18.                                                                                  
                                                                                                                                
SENATOR BILL WIELECHOWSKI,  sponsor of SJR 18 said  he had first-                                                               
hand experience  with concerns  about toy  safety because  his 15                                                               
month old daughter had a lot  of toys and put everything into her                                                               
mouth. He  had no idea  whether the toys  were safe, if  they had                                                               
lead or  methylates in them  or not. The testing  mechanisms just                                                               
didn't exist.                                                                                                                   
                                                                                                                                
KAT  PUSTAY,  Staff to  Senator  Wielechowski,  read the  sponsor                                                               
statement as follows:                                                                                                           
                                                                                                                                
     SJR 18 calls on the United States Consumer Product                                                                         
     Safety Commission (CPSC) to test the materials used in                                                                     
     toys and children's products for hazardous chemicals                                                                       
     like lead. Over $15 billion worth of toys and                                                                              
     children's products were brought into the United                                                                           
     States in 2006. In 2007 almost $10 billion came in                                                                         
     from China alone. In 2007 over half the toy and child                                                                      
     product recalls by the CPSC were due to lead or                                                                            
     chemical poisoning hazards.                                                                                                
     The CPSC is an independent federal regulatory agency                                                                       
     that was created in 1972 by the Consumer Product                                                                           
     Safety Act to protect the public against unreasonable                                                                      
     risks of injury and death associated with consumer                                                                         
     products. Currently the CPSC conducts tests only to                                                                        
     determine if a toy presents a choking, aspiration or                                                                       
     ingestion hazard, but relies on toy and child product                                                                      
     manufacturers to self-regulate the materials used (and                                                                     
     thus toxicity levels) in their products.                                                                                   
                                                                                                                                
     In essence, the CPSC checks for choking hazards but                                                                        
     not the effects of sucking on a pacifier for many                                                                          
     hours a day. Children's bodies and brains are                                                                              
     developing and are more susceptible to the hazardous                                                                       
     impacts than adults. We should do what we can to limit                                                                     
     their exposure.                                                                                                            
                                                                                                                                
     Alaskan parents rely on the regulatory agency to                                                                           
     insure the health of their children just as Senator                                                                        
     Wielechowski said in his own experience, so we ask                                                                         
     that the Alaska State Legislature urge the CPSC to                                                                         
     increase safety testing on chemicals used in toys and                                                                      
     child products.                                                                                                            
                                                                                                                                
2:29:11 PM                                                                                                                    
KRISTIN  RYAN,   Director,  Division  of   Environmental  Health,                                                               
Department  of Environmental  Conservation,  offered support  for                                                               
the  legislation  .  She  said   that  Congress  was  considering                                                               
legislation  called  the  Consumer Product  Safety  Modernization                                                               
Act,  which addressed  this issue  and others;  so it  was timely                                                               
that they would urge the President to approve this legislation.                                                                 
                                                                                                                                
2:30:17 PM                                                                                                                    
Susan  Ely,   Legislative  and  Communications   Manager,  Alaska                                                               
Conservation  Alliance (ACA),  a  consortium  of 40  conservation                                                               
groups based  in Alaska, thanked  the committee for  allowing her                                                               
to testify in  support of SJR 18 . This  legislation addressed an                                                               
issue that had recently come to  the forefront as over 29 million                                                               
toys  were  recalled the  previous  year,  many because  of  high                                                               
levels of  lead, sometimes as much  as 200 times over  the safety                                                               
limit. The  most recent recall  occurred on Wednesday  [March 12,                                                               
2008] when the CPSC recalled  the X Force Commander airplanes and                                                               
Super  Famous cars  and motorcycles  because of  excessively high                                                               
lead concentrations.                                                                                                            
                                                                                                                                
MS. ELY  stated that Congress  had not adopted any  major changes                                                               
to this  legislation in over  18 years;  85 percent of  toys were                                                               
being  manufactured  in other  countries,  many  of them  without                                                               
product  safety standards.  The number  of imports  had increased                                                               
about 200 percent  in 10 years and, as of  October 2007, the CPSC                                                               
had only  one person  testing toys,  only 15  inspectors policing                                                               
all of the  consumer imports, and no federal  agency studying the                                                               
cumulative  effects  of  toxicity.  She said  the  United  States                                                               
Senate recently  approved a  bill that  would increase  staff and                                                               
budget and  create a  public database  of product  complaints. It                                                               
would also give power to state  prosecutors if they felt that the                                                               
federal government  was not  doing enough.  In closing,  she said                                                               
this resolution  would encourage  the federal government  to give                                                               
the  CPSC the  tools and  resources it  needed to  test the  toys                                                               
entering homes across America and  give Alaskan parents a tool to                                                               
make  sure they  can make  safe and  healthy decisions  about the                                                               
toys they  are buying  and bringing into  their homes.  She added                                                               
that  Alaskans were  exposed  to more  than  the average  citizen                                                               
because of the  deposition of chemicals in  Northern climates and                                                               
encouraged the committee to pass SJR 18.                                                                                        
                                                                                                                                
CHAIR DAVIS  said she didn't  have a quorum  to move the  bill so                                                               
she would hold SJR 18 in committee until Monday.                                                                                
                                                                                                                                
There being  no further  business to  come before  the committee,                                                               
Chair Davis adjourned the meeting at 2:34:18 PM.                                                                              
                                                                                                                                

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