Legislature(2007 - 2008)BUTROVICH 205

02/11/2008 01:30 PM HEALTH, EDUCATION & SOCIAL SERVICES


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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ SB 170 INSURANCE COVERAGE FOR WELL-BABY EXAMS TELECONFERENCED
Moved CSSB 170(L&C) Out of Committee
*+ SB 181 ANATOMICAL GIFTS TELECONFERENCED
Moved CSSB 181(HES) Out of Committee
Bills Previously Heard/Scheduled
                    ALASKA STATE LEGISLATURE                                                                                  
SENATE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE                                                               
                       February 11, 2008                                                                                        
                           1:34 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. 170                                                                                                             
"An Act requiring that health care insurers provide insurance                                                                   
coverage for well-baby exams."                                                                                                  
     MOVED CSSB 170(L&C) OUT OF COMMITTEE                                                                                       
                                                                                                                                
SENATE BILL NO. 181                                                                                                             
"An  Act  relating  to  the   Uniform  Anatomical  Gift  Act,  to                                                               
anatomical gifts,  to donations to the  anatomical gift awareness                                                               
fund, to  a registry  of anatomical  gifts, and  to organizations                                                               
that handle the  procurement, distribution, or storage  of all or                                                               
a part of an individual's body."                                                                                                
     MOVED CSSB 181(HES) OUT OF COMMITTEE                                                                                       
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: SB 170                                                                                                                  
SHORT TITLE: INSURANCE COVERAGE FOR WELL-BABY EXAMS                                                                             
SPONSOR(s): SENATOR(s) McGUIRE                                                                                                  
                                                                                                                                
05/03/07       (S)       READ THE FIRST TIME - REFERRALS                                                                        
05/03/07       (S)       L&C, HES, FIN                                                                                          
05/09/07       (S)       L&C AT 1:30 PM BELTZ 211                                                                               
05/09/07       (S)       --Meeting Postponed to Thursday, May                                                                   
                         10--                                                                                                   
05/10/07       (S)       L&C RPT CS  2DP 2AM   SAME TITLE                                                                       
05/10/07       (S)       DP: ELLIS, DAVIS                                                                                       
05/10/07       (S)       AM: BUNDE, STEVENS                                                                                     
05/10/07       (S)       L&C AT 1:30 PM BELTZ 211                                                                               
05/10/07       (S)       -- Rescheduled from 05/09/07 --                                                                        
02/11/08       (S)       HES AT 1:30 PM BUTROVICH 205                                                                           
                                                                                                                                
BILL: SB 181                                                                                                                  
SHORT TITLE: ANATOMICAL GIFTS                                                                                                   
SPONSOR(s): SENATOR(s) McGUIRE                                                                                                  
                                                                                                                                
05/15/07       (S)       READ THE FIRST TIME - REFERRALS                                                                        
05/15/07       (S)       HES, STA, JUD                                                                                          
02/11/08       (S)       HES AT 1:30 PM BUTROVICH 205                                                                           
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
DR. GEORGE BROWN, MD                                                                                                            
Douglas, AK                                                                                                                     
POSITION STATEMENT: Supported SB 170.                                                                                         
                                                                                                                                
STEPHANIE BIRCH, Section Chief                                                                                                  
RNC, BSN, MPH, MCH Title V and CSHCN Director                                                                                   
Women's, Children & Family Health                                                                                               
Anchorage, AK                                                                                                                   
POSITION STATEMENT: Supported SB 170.                                                                                         
                                                                                                                                
DENNY DEWITT, Director                                                                                                          
National Federation of Independent Business (NFIB)                                                                              
Juneau, AK                                                                                                                      
POSITION STATEMENT: Opposed SB 170.                                                                                           
                                                                                                                                
JODYNE BUTTO, MD, FAAP, President                                                                                               
Alaska Chapter of the American Academy of Pediatrics                                                                            
Anchorage, AK                                                                                                                   
POSITION STATEMENT: Supported SB 170.                                                                                         
                                                                                                                                
TREVOR FULTON, Staff to Senator McGuire                                                                                         
Anchorage, AK                                                                                                                   
POSITION STATEMENT: Provided testimony on SB 170 and an overview                                                              
of SB 181.                                                                                                                      
                                                                                                                                
KATIE CAMPBELL, Life and Health Actuary                                                                                         
Department of Commerce                                                                                                          
Division of Insurance                                                                                                           
Juneau, AK                                                                                                                      
POSITION STATEMENT: Answered questions regarding SB 170.                                                                      
                                                                                                                                
WHITNEY BREWSTER, Director                                                                                                      
Department of Motor Vehicles (DMV)                                                                                              
Anchorage, AK                                                                                                                   
POSITION  STATEMENT: Was  available  for  questions regarding  SB                                                             
181.                                                                                                                            
                                                                                                                                
DEBORAH BAER, Uniform Law Commissioner                                                                                          
Alaska Department of Law                                                                                                        
Juneau, AK                                                                                                                      
POSITION STATEMENT: Answered questions regarding SB 181.                                                                      
                                                                                                                                
BRUCE ZALNERAITIS, CEO                                                                                                          
Life Alaska Donor Services                                                                                                      
Anchorage, AK                                                                                                                   
POSITION STATEMENT: Supported SB 181.                                                                                         
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
CHAIR  BETTYE  DAVIS  called the  Senate  Health,  Education  and                                                             
Social Services  Standing Committee  meeting to order  at 1:34:42                                                             
PM .  Present at the  call to  order were Senators  Elton, Dyson,                                                             
Thomas and Davis                                                                                                                
                                                                                                                                
                                                                                                                                
         SB 170-INSURANCE COVERAGE FOR WELL-BABY EXAMS                                                                      
                                                                                                                              
CHAIR  DAVIS announced  consideration of  SB 170.  [The committee                                                               
was considering CSSB 170(L&C).]                                                                                                 
                                                                                                                                
SENATOR MCGUIRE, Sponsor  of SB 170, presented  an overview. This                                                               
bill  mandates well-baby  exam coverage  by insurance  providers.                                                               
She  said that,  although some  people may  have a  philosophical                                                               
issue  with  state  interference   in  the  private  sector,  the                                                               
importance of  providing these critical examinations  to children                                                               
justifies such action.                                                                                                          
                                                                                                                                
She pointed out  that the bill makes  sense economically, because                                                               
well-baby exams  and prevention  save money in  the long  run. It                                                               
makes  sense to  ensure that  any issue  is discovered  and dealt                                                               
with  when a  child is  young, as  opposed to  later when  it has                                                               
become an expensive emergency treatment matter.                                                                                 
                                                                                                                                
1:40:32 PM                                                                                                                    
She  summarized  by  saying that,  from  a  societal  standpoint,                                                               
policy  makers have  an  obligation to  speak  for children,  who                                                               
cannot  speak for  themselves. From  a policy  standpoint, it  is                                                               
sometimes incumbent upon them to  step in when the private sector                                                               
does  not  recognize the  needs  of  the  citizens, and  from  an                                                               
economic standpoint, it makes sense  to have these exams early to                                                               
avoid higher  costs down the  road. She encouraged passage  of SB                                                               
170.                                                                                                                            
                                                                                                                                
1:42:11 PM                                                                                                                    
DR. GEORGE BROWN, Pediatrician, Douglas  AK, spoke in favor of SB                                                               
170.  He  said that  the  American  Academy of  Pediatrics  (AAP)                                                               
sponsored  research in  the 1990s  of  the cost-effectiveness  of                                                               
preventative  actions performed  in  well-baby  visits and  found                                                               
that for  every $1  spent, roughly $4.50  was saved.  He stressed                                                               
that  separating  physical  and mental  health  sometimes  causes                                                               
considerable  problems for  society and  for insurers,  but if  a                                                               
family has a "medical home," that  is a home in which the parents                                                               
have  a relationship  with their  pediatric  specialist and  feel                                                               
that  they are  being supported,  it can  help to  prevent child-                                                               
abuse. He said there is every  reason for leaders of the State of                                                               
Alaska  to make  this  investment to  ensure  that children  have                                                               
access  to these  examinations, and  saluted Senator  McGuire for                                                               
introducing the bill.                                                                                                           
                                                                                                                                
SENATOR DYSON asked  if Medicaid and Denali Kid  Care cover well-                                                               
baby exams.                                                                                                                     
                                                                                                                                
DR. BROWN answered that they do.                                                                                                
                                                                                                                                
SENATOR DYSON  asked what he  would do if  the parents of  one of                                                               
his  patients did  not have  insurance  and did  not qualify  for                                                               
Medicaid or Denali Kid Care.                                                                                                    
                                                                                                                                
DR BROWN responded that he  had never turned anyone away, whether                                                               
or  not they  had insurance,  but people  are often  reluctant to                                                               
come to him if they don't have insurance.                                                                                       
                                                                                                                                
SENATOR DYSON said that did not  really answer his question. If a                                                               
parent did  not have insurance,  would he encourage them  to have                                                               
the exams and how much would he charge?                                                                                         
                                                                                                                                
DR.  BROWN replied  that he  encourages all  parents to  have the                                                               
well-baby exams and charges the  same amount to everyone. In many                                                               
cases,  if parents  do not  have insurance  and cannot  afford to                                                               
pay, he works with them to pay what they can.                                                                                   
                                                                                                                                
SENATOR DYSON asked for a rough estimate of what the exams cost.                                                                
                                                                                                                                
DR. BROWN  said the range  shown in the  bill is pretty  much the                                                               
same for all pediatricians.                                                                                                     
                                                                                                                                
CHAIR  DAVIS  interjected  that the  original  bill  included  an                                                               
annual cap of $1500, but it  was removed because of variations in                                                               
charges by  individual providers.  They were considering  a total                                                               
of $1500 for the ten suggested visits.                                                                                          
                                                                                                                                
DR. BROWN said  that sounds quite reasonable,  that the per-visit                                                               
cost is  generally from $125  to $250, with his  practice falling                                                               
in the lower range.                                                                                                             
                                                                                                                                
SENATOR COWDERY asked  if other states have this  type of mandate                                                               
on their books.                                                                                                                 
                                                                                                                                
CHAIR DAVIS answered that 21 or 22 states have mandated it.                                                                     
                                                                                                                                
1:48:31 PM                                                                                                                    
SENATOR  THOMAS asked  if insurance  companies usually  cover the                                                               
cost of immunizations.                                                                                                          
                                                                                                                                
CHAIR DAVIS  replied that immunizations  would be covered  in the                                                               
well-baby exams.                                                                                                                
                                                                                                                                
SENATOR  THOMAS  said,  although  they have  heard  a  lot  about                                                               
intervention  in  the  medical  area and  social  service  fields                                                               
having a  huge impact on savings  of money and services  down the                                                               
road,  he had  never  received any  feedback  that would  provide                                                               
incentive  to continue  supporting this  type of  legislation. He                                                               
felt  that  unless  they  could   show  the  insurance  companies                                                               
statistics to support those savings,  insurance premiums would go                                                               
up.                                                                                                                             
                                                                                                                                
DR.  BROWN  said  the  AAP   paper  he  referenced  did  look  at                                                               
immunizations  and preventing  injuries  when they  came up  with                                                               
their calculation of  how much was actually saved.  He added that                                                               
insurance companies seem  to be listening to  their customers and                                                               
are becoming more aware of it too.                                                                                              
                                                                                                                                
1:52:41 PM                                                                                                                    
STEPHANIE  BIRCH,  Section  Chief,  Women's,  Children  &  Family                                                               
Health, said  there have been  a number of studies  regarding the                                                               
importance  of preventative  health  care and  the dollars  saved                                                               
with early  intervention. The  studies about  early developmental                                                               
screenings for  children indicate  that from $4  to $6  are saved                                                               
for each $1 expended in early identification and treatment.                                                                     
                                                                                                                                
AAP  has long  stood behind  a  schedule of  routine visits  that                                                               
coincide  with expected  developmental  targets  in children.  In                                                               
addition,  the American  Academy  of  Family Practice  Physicians                                                               
(AFP) supports  not only  10 visits during  the first  24 months,                                                               
but scheduled  visits that follow toddlerhood,  childhood and the                                                               
teen  years. These  visits include  a  full head-to-toe  physical                                                               
assessment,  screening   for  visual  problems,   dental  caries,                                                               
inappropriate weight gain  or loss, any signs  of physical abuse,                                                               
mental health screenings and the  state of bonding with a parent,                                                               
as well as developmental milestones.                                                                                            
                                                                                                                                
MS. BIRCH went  on to say the Health  Supervision Guidelines that                                                               
have been  developed and published  by the Maternal  Child Health                                                               
Bureau  in collaboration  with several  national health  provider                                                               
organizations, recommend  a comprehensive  developmental approach                                                               
to health supervision that includes  not only physical assessment                                                               
but  social, emotional  and  cognitive  components. This  "Bright                                                               
Futures"  approach, offers  a uniform  standard of  care for  all                                                               
children.  Many  states'  Medicaid programs,  including  ours  in                                                               
Alaska,  known as  the "Early  Periodic Screening,  Detection and                                                               
Treatment Programs," have adopted these  standards as a basis for                                                               
program content.                                                                                                                
                                                                                                                                
1:55:49 PM                                                                                                                    
AAP  also published  a recommendation  that  pediatric visits  at                                                               
ages  18  and  24  months should  include  screening  for  autism                                                               
spectrum disorders.  Given that  the Centers for  Disease Control                                                               
and Prevention(CDC) estimates  1 in 150 children  have autism, it                                                               
is important to  identify it early and assist  in connecting them                                                               
with treatment services.                                                                                                        
                                                                                                                                
Obesity  is a  major health  factor nationwide.  Studies indicate                                                               
that children  under age 3  with weight over the  90th percentile                                                               
are  at risk  for long-term  obesity  if their  weight cannot  be                                                               
controlled with appropriate diet and exercise.                                                                                  
                                                                                                                                
Health supervision visits also provide  an opportunity to observe                                                               
parental  behaviors,  answer   questions,  provide  guidance  and                                                               
expectations for child safety, feeding etc.                                                                                     
                                                                                                                                
MS. BIRCH summarized by saying  that the Department of Health and                                                               
Social Services (DHSS) supports SB  170 and the intent to promote                                                               
health, detect problems early, and  refer them to the appropriate                                                               
providers for treatment.                                                                                                        
                                                                                                                                
CHAIR  DAVIS  said  that  Dr.  Butler  was  available  to  answer                                                               
questions.                                                                                                                      
                                                                                                                                
1:59:00 PM                                                                                                                    
SENATOR ELTON  asked if  savings would accrue  both to  the state                                                               
and the insurer.                                                                                                                
                                                                                                                                
MS. BIRCH  replied that when  they talk about savings,  they mean                                                               
that  by identifying  problems early  you may  avoid a  much more                                                               
expensive  intervention  later.  For  example,  if  you  identify                                                               
dental  caries  early,  when  the child  has  cavities,  you  can                                                               
probably save  the teeth and  avoid expensive oral  surgery under                                                               
anesthesia.                                                                                                                     
                                                                                                                                
She  related an  illustration from  her  work as  a family  nurse                                                               
practitioner  regarding treatment  for  ear infections,  commonly                                                               
called  Otitis Media.  Many families  did  not see  the value  of                                                               
well-child visits or could not afford  to see a care provider, so                                                               
they would  shop around for services.  A child with a  history of                                                               
ear infections  would not necessarily receive  consistent follow-                                                               
up treatment or  evaluation for hearing loss or  speech delays as                                                               
a result.                                                                                                                       
                                                                                                                                
SENATOR  ELTON stated  that those  savings would  then accrue  to                                                               
both the private insurer and, potentially, to the state.                                                                        
                                                                                                                                
MS. BIRCH confirmed that they would.                                                                                            
                                                                                                                                
2:01:23 PM                                                                                                                    
DENNY  DEWITT,  Director,   National  Federation  of  Independent                                                               
Business  (NFIB), opposed  the legislation.  He did  not disagree                                                               
that the  services are  a good  idea, but with  the issue  of who                                                               
pays. This  bill would assign  responsibility for payment  to any                                                               
employer that chose to offer  its employees and dependents health                                                               
insurance.  He felt  that  it  should be  left  to employees  and                                                               
employers to  decide how  the limited pool  of dollars  set aside                                                               
for employee  compensation would be distributed.  He referenced a                                                               
study  by  Legislative Research  indicating  that  49 percent  of                                                               
children are  covered by employer  insurance plans and  4 percent                                                               
by  individual plans.  The individual  plans  would certainly  be                                                               
impacted, but a  large number of those covered  by employer plans                                                               
have Employee  Retirement Income Security Act  (ERISA) plans that                                                               
are not covered  by this bill. He stressed that  the bill did not                                                               
include the State  of Alaska, which is a primary  insurer in this                                                               
state  and does  not provide  benefits in  this area.  Only small                                                               
employers that cannot use ERISA plans would be affected.                                                                        
                                                                                                                                
MR. DEWITT said  his best guess was that this  would increase the                                                               
insurance premiums  for those employers  by 1 to 3  percent. NFIB                                                               
is seeing  a 1 to 2  percent reduction annually in  the number of                                                               
small  employers  that are  offering  health  insurance to  their                                                               
employees,  which   just  makes  it  more   expensive  for  those                                                               
companies  that are  trying  to decide  whether  to offer  health                                                               
benefits and  is driving  them out of  the market.  He maintained                                                               
that  insurance companies  just move  money around;  the $150  to                                                               
$250  a  year  added  to  the  amount  of  benefits  provided  by                                                               
insurance companies would  have to be returned  by the individual                                                               
or small  employer paying  the premium. It  would not  impact the                                                               
health benefit program offered by  the State of Alaska. He stated                                                               
that the Legislature,  as the "Board of Directors"  for the State                                                               
of  Alaska, should  be making  decisions for  its employees,  and                                                               
felt it  was ironic that  they were considering  legislation that                                                               
would  not  impact their  own  employees  but the  small  private                                                               
businesses in the state.                                                                                                        
                                                                                                                                
2:05:38 PM                                                                                                                    
MR. DEWITT  said NFIB believed  a more reasonable  approach would                                                               
be for  the state to make  an investment in expanding  the use of                                                               
health  clinics throughout  the state.  While he  appreciated the                                                               
intent  of  the   bill  sponsor  and  others,  he   felt  it  was                                                               
inappropriate that the bill would  require a small third party to                                                               
pay the price for their good intentions.                                                                                        
                                                                                                                                
CHAIR  DAVIS recognized  that it  is  a problem  that many  small                                                               
businesses cannot afford to provide insurance.                                                                                  
                                                                                                                                
MR.  DEWITT  assured  the  committee  that  NFIB  was  trying  to                                                               
encourage their employers  to provide a good  package of benefits                                                               
to  their  employees;  but  each   mandate  added  made  it  more                                                               
difficult.   NFIB  was   seeing   new  businesses,   particularly                                                               
startups,  were less  likely  to offer  coverage.  Those who  did                                                               
offer health  insurance were finding  it difficult to get  out of                                                               
the  commitment,  but  some were  moving  from  providing  health                                                               
insurance to  providing an amount  of money for employees  to use                                                               
to purchase their own policies.                                                                                                 
                                                                                                                                
He  added that  some employees  might prefer  the option  of more                                                               
income  in their  checks instead  of well-baby  exam coverage  in                                                               
their health insurance.  He reiterated that the  question was not                                                               
the value  of the benefit,  but whether  or not the  state should                                                               
interject itself in compensation issues.                                                                                        
                                                                                                                                
CHAIR  DAVIS  asked if  Mr.  DeWitt  knew  whether any  of  their                                                               
employers were offering this as an option to their employees.                                                                   
                                                                                                                                
MR. DEWITT  replied that he did  not know, but would  try to find                                                               
out. Their surveys were not generally that specific.                                                                            
                                                                                                                                
He commented  that there  is a  difference between  insurance and                                                               
pre-payment. Insurance  is when  a group  puts money  together to                                                               
indemnify themselves  against an unusual  occurrence. Pre-payment                                                               
for services is always more expensive.                                                                                          
                                                                                                                                
2:11:32 PM                                                                                                                    
SENATOR ELTON said when he  asked Ms. Birch whether savings would                                                               
accrue to the  insurance companies, she suggested  that was true.                                                               
He then  reminded Mr. DeWitt  that he began his  testimony saying                                                               
his "best guess" was that  additional costs would accrue to small                                                               
businesses. Senator  Elton said  he would  need to  see something                                                               
other than  a best guess to  support the fact the  premiums would                                                               
go up and that there would be  no savings to the insurer by doing                                                               
healthy baby exams.                                                                                                             
                                                                                                                                
MR. DEWITT explained  that his 1 to 3 percent  estimate came from                                                               
the Council of Affordable Health  Insurance and he would be happy                                                               
to make a copy of their report available.                                                                                       
                                                                                                                                
SENATOR   ELTON   asked   if   it   addressed   well-baby   exams                                                               
specifically.                                                                                                                   
                                                                                                                                
MR. DEWITT answered "Yes."                                                                                                      
                                                                                                                                
SENATOR DYSON  added that  if this  is a  good investment  as the                                                               
proponents  of mandates  say, he  has  to ask  why the  insurance                                                               
companies  aren't  jumping on  board  to  do  this in  their  own                                                               
interests.  It   makes  him  think  that   either  the  insurance                                                               
companies  are very  short-sighted or  they aren't  sure that  it                                                               
pencils out for them. He said his  office has been doing a lot of                                                               
work to  find out how to  make medical care more  affordable, and                                                               
they  have  found  that  the  cost  of  insurance  is  higher  in                                                               
jurisdictions  that  have  the  most  mandates,  which  seems  to                                                               
contradict some of the testimony.                                                                                               
                                                                                                                                
2:15:07 PM                                                                                                                    
SENATOR ELTON  said one thing  that points  the other way  is the                                                               
experience  of employers  like  the City  and  Borough of  Juneau                                                               
(CBJ), which  has lowered  its health  care costs  by encouraging                                                               
healthy behaviors including preventative  medicine. He voiced his                                                               
suspicion   that  the   insurance   industry   looks  for   every                                                               
opportunity to increase their profit-margin.                                                                                    
                                                                                                                                
JODYNE BUTTO, MD, FAAP, pediatrician, President of the Alaska                                                                   
Chapter of the American Academy of Pediatrics, supports                                                                         
requiring insurance companies to cover well-baby visits. She                                                                    
observed that insurance companies count on the fact that they                                                                   
will get their money now and the savings will come later. She                                                                   
said that an analysis of data from the Pregnancy Risk Assessment                                                                
Monitoring System (PRAMS) from 2004 to 2006 shows the number of                                                                 
people who said they could not afford well-baby visits went from                                                                
about 5.1 to 23.4 percent of respondents. Part of the reason for                                                                
that change is that fewer people are covered by Denali Kid Care.                                                                
                                                                                                                                
2:19:08 PM                                                                                                                    
SENATOR DYSON wondered why people aren't putting the mandate on                                                                 
parents as opposed to a third party, and asked Ms. Butto if she                                                                 
would support legislation to do that.                                                                                           
                                                                                                                                
DR. BUTTO  responded that  it would be  too difficult  to enforce                                                               
such  legislation, while  requiring  the  insurance companies  to                                                               
cover  it as  a  condition  to do  business  in  Alaska would  be                                                               
possible.                                                                                                                       
                                                                                                                                
SENATOR DYSON  suggested that making the  requirement a condition                                                               
for  parents  to receive  their  Permanent  Fund Dividends  would                                                               
almost certainly change their behavior.                                                                                         
                                                                                                                                
2:22:06 PM                                                                                                                    
CHAIR DAVIS asked the sponsors to  return to the table to discuss                                                               
the State of Alaska's insurance  and wondered whether anyone from                                                               
the  state's  insurance office  was  available  to speak  to  the                                                               
matter.                                                                                                                         
                                                                                                                                
SENATOR McGUIRE  responded to Senator Dyson's  comments regarding                                                               
who  has   responsibility.  She  agreed  that   the  parents  are                                                               
certainly responsible,  but felt that  all of us  are responsible                                                               
for the children  who are part of our society,  and their care is                                                               
to our  benefit. On the  issue of state coverage,  she absolutely                                                               
agreed with Mr.  DeWitt that the state should be  included in the                                                               
mandate. She explained that multiple  sections of state law would                                                               
have to  be changed however, and  although she was not  afraid to                                                               
take that on, she felt it  was important to move forward with the                                                               
existing bill and send a letter  of intent to the state provider.                                                               
If they  have not  agreed to  follow the mandate  in a  year, she                                                               
would  begin the  process  to  change state  law  as required  to                                                               
mandate compliance.                                                                                                             
                                                                                                                                
TREVOR FULTON,  Staff to Senator  McGuire, confirmed that  a long                                                               
list of coverages  were already mandated under  state statute and                                                               
noted that  the state has picked  up every one. He  saw no reason                                                               
why the state would not fall in line with this.                                                                                 
                                                                                                                                
KATIE CAMPBELL,  Life and Health Actuary,  Division of Insurance,                                                               
Department of Commerce, said she could  not speak to the State of                                                               
Alaska's  insurance  policy.  She agreed  that  historically  the                                                               
state has  covered the  mandates, but the  insurance laws  do not                                                               
apply to the state plan.                                                                                                        
                                                                                                                                
2:26:58 PM                                                                                                                    
CHAIR DAVIS  said the director  of insurance testified  last year                                                               
to some  of the problems they  would have including the  state in                                                               
this type  of mandate. She  asked Ms. Campbell what  mandates she                                                               
was referring to.                                                                                                               
                                                                                                                                
MS.  CAMPBELL replied  that she  was referring  to the  insurance                                                               
mandates in title 21, which do  not apply to any other government                                                               
program.                                                                                                                        
                                                                                                                                
CHAIR DAVIS asked  Ms. Campbell if she  had a list of  all of the                                                               
mandates that apply only to private insurance.                                                                                  
                                                                                                                                
MS.  CAMPBELL said  she  did not  have  a list,  but  all of  the                                                               
mandates could be found in AS 21.42.                                                                                            
                                                                                                                                
SENATOR ELTON asked  if the mandates she referred  to are handled                                                               
in the contract with our  insurance provider, or if compliance is                                                               
left up to the provider.                                                                                                        
                                                                                                                                
MS. CAMPBELL said the answer would  depend on what group you were                                                               
looking at.  Large employers  like the State  of Alaska  or other                                                               
big  employers  that  self-fund  their  health  plans,  negotiate                                                               
everything with  the insurance company. Small  employers normally                                                               
buy  packaged plans  that are  approved through  the Division  of                                                               
Insurance. The  insurance companies  conduct surveys and  stay in                                                               
touch with the needs of  their market, adjusting benefit plans as                                                               
necessary.                                                                                                                      
                                                                                                                                
SENATOR ELTON agreed that a letter  of intent ought to be part of                                                               
contract negotiations.                                                                                                          
                                                                                                                                
2:30:29 PM                                                                                                                    
SENATOR   DYSON  cautioned   that   they  will   always  have   a                                                               
responsibility to  be very  careful of  the decisions  they make,                                                               
particularly  those that  spend  someone else's  money or  assume                                                               
responsibility on others' behalf.                                                                                               
                                                                                                                                
CHAIR DAVIS  stated that no  one piece of legislation  could meet                                                               
all the  needs that  must be  met. She  hoped that  the committee                                                               
would not  decide on the  bill based  on a possibility  that some                                                               
businesses would  have to rework  their plans. She felt  that, if                                                               
it  took  more small  businesses  "out  of the  loop"  subsequent                                                               
legislation would be passed to correct it.                                                                                      
                                                                                                                                
SENATOR THOMAS said  he would like to see  additional research to                                                               
ensure they are operating on  sound information as they move this                                                               
measure forward.                                                                                                                
                                                                                                                                
CHAIR  DAVIS said  she  did not  wish to  hold  the bill  pending                                                               
further  information but  would  prepare a  letter  of intent  to                                                               
accompany the bill to finance.                                                                                                  
                                                                                                                                
2:35:56 PM                                                                                                                    
SENATOR  DYSON said  he would  be more  comfortable if  the state                                                               
agreed  to subsidize  $1500 for  infants born  to families  whose                                                               
incomes  fall  below  the  Federal  Poverty  Level,  rather  than                                                               
putting a mandate on small businesses.                                                                                          
                                                                                                                                
SENATOR ELTON  believed that downstream  savings would  accrue to                                                               
the parents and  perhaps to the insurance  industry when problems                                                               
are  discovered  and  treated early.  The  problem  with  Senator                                                               
Dyson's suggestion that  the state pay the upfront  costs is that                                                               
there would be no way to recover those savings.                                                                                 
                                                                                                                                
2:39:14 PM                                                                                                                    
SENATOR  DYSON  contended  that   Senator  Elton's  own  argument                                                               
defeats  itself.  If  the  state  helped  the  children  of  poor                                                               
families get  the care  they need, the  children would  have much                                                               
better incomes  and be less likely  to be a burden  on the public                                                               
health system.  The state  would be one  of the  beneficiaries of                                                               
more  healthy children  and more  families that  are not  weighed                                                               
down by excessive health care costs.                                                                                            
                                                                                                                                
CHAIR DAVIS  commented that there  was a bill sitting  in Finance                                                               
that would provide healthcare to  all children; that there were a                                                               
number  of  bills  in  other committees  designed  to  help  poor                                                               
people, but  they did  not address help  for families  that don't                                                               
fall below  the federal poverty  level, don't qualify  for Denali                                                               
Kid Care,  and yet cannot  afford health care. She  asked Senator                                                               
McGuire to comment.                                                                                                             
                                                                                                                                
SENATOR  McGUIRE asked  the committee  to pass  the bill  on. She                                                               
commented that when the diabetes  and colorectal cancer screening                                                               
bills were moving through the  committee, the same arguments were                                                               
made about prevention and treatment.                                                                                            
                                                                                                                                
2:44:18 PM                                                                                                                    
SENATOR  McGUIRE supposed  they might  only be  able to  reach 15                                                               
percent of  insurance companies due  to the ERISA  exclusion, but                                                               
they  would send  a strong  statement that  the health  and well-                                                               
being  of children  is important  to the  state, and  may provide                                                               
some  ammunition  to  employers  in  negotiating  with  insurance                                                               
companies.                                                                                                                      
                                                                                                                                
2:46:15 PM                                                                                                                    
SENATOR ELTON moved to report  CSSB 170, version /E, and attached                                                               
fiscal  note(s) from  committee  with individual  recommendations                                                               
and a  notation that the  chair is going  to include a  letter of                                                               
intent.                                                                                                                         
                                                                                                                                
He objected  in order  to state that  he felt  comfortable making                                                               
the motion  because he believed  the sponsor  had a good  idea of                                                               
what  would  be  needed  regarding  cost/benefits  for  the  next                                                               
committee. With that he withdrew his objection.                                                                                 
                                                                                                                                
There  being  no  further objection,  CSSB  170(L&C)  moved  from                                                               
committee.                                                                                                                      
                                                                                                                                
                                                                                                                                
                    SB 181-ANATOMICAL GIFTS                                                                                 
                                                                                                                                
2:47:08 PM                                                                                                                    
CHAIR DAVIS announced consideration of SB 181.                                                                                  
                                                                                                                                
SENATOR  McGUIRE   summarized  that  this  bill   simply  updates                                                               
existing statute  with respect to  anatomical gifts,  bringing it                                                               
into line with federal law.                                                                                                     
                                                                                                                                
2:48:48 PM                                                                                                                    
TREVOR  FULTON advised  that the  bill  is based  on the  federal                                                               
Anatomical  Gift Act.  It was  designed to  facilitate organ  and                                                               
tissue  donation and  transplantation,  remove  obstacles in  the                                                               
donation  process,  and  increase participation  in  organ  donor                                                               
programs.  He pointed  out the  blank  committee substitute  that                                                               
came from discussions  with the Department of  Law and Department                                                               
of Health and Social Services; they concur with the changes.                                                                    
                                                                                                                                
CHAIR DAVIS asked if Mr. Fulton was referring to version E.                                                                     
                                                                                                                                
MR. FULTON confirmed that it was version E.                                                                                     
                                                                                                                                
SENATOR THOMAS  moved to adopt  committee substitute  (CS)SB 181,                                                               
version E,  as the  working document.  There being  no objection,                                                               
version E was before the committee.                                                                                             
                                                                                                                                
2:50:43 PM                                                                                                                    
WHITNEY BREWSTER,  Director, Department of Motor  Vehicles (DMV),                                                               
directed  the committee's  attention  to section  14  on page  4,                                                               
subsection  (b), line  17 of  the  bill, which  would change  the                                                               
legal age  to sign up as  an organ donor  from 18 to 16  years of                                                               
age and questioned the implications of that change.                                                                             
                                                                                                                                
DEBORAH  BAER,  Department  of   Law,  Uniform  Law  Commissioner                                                               
clarified that a  minor must have permission from  his parents to                                                               
drive  before he  can  check the  box to  donate.  If allowed  to                                                               
drive, a  child would  also be  allowed to  make the  decision on                                                               
anatomical  gifts. However,  the  gift could  be  revoked if  the                                                               
child died before  reaching age 18. She summarized  that the bill                                                               
would not change drivers license  law in the state, children must                                                               
still have parental consent to drive or sign up as organ donors.                                                                
                                                                                                                                
SENATOR THOMAS asked what the law meant by "emancipated."                                                                       
                                                                                                                                
MS. BAER explained that the age of majority in Alaska is 18, but                                                                
a court can decided  a minor child is able to live  on his or her                                                               
own.                                                                                                                            
                                                                                                                                
2:54:42 PM                                                                                                                    
SENATOR COWDERY  directed Ms. Baer to  page 8, line 31  and asked                                                               
who is meant by "any other  person having authority to dispose of                                                               
the decedent's body."                                                                                                           
                                                                                                                                
MS. BAER  responded that one  would need to have  legal authority                                                               
to dispose  of the  body. For example,  the medical  examiner, at                                                               
some  point, has  legal authority  to  dispose of  the body.  She                                                               
affirmed  the bill  did not  create legal  authority that  is not                                                               
already in state law.                                                                                                           
                                                                                                                                
SENATOR  COWDERY asked  how  the  matter of  a  living will  that                                                               
declines life support  would be addressed, since  it is necessary                                                               
to keep  the donor  on life  support to  ensure viability  of the                                                               
organ.                                                                                                                          
                                                                                                                                
2:56:21 PM                                                                                                                    
MS. BAER explained  that the bill does not try  to trump a living                                                               
will. If a potential donor had  a "do not resuscitate order," the                                                               
doctor would honor that, but if  necessary in order to honor both                                                               
that directive and the wish to  donate, the doctor would have the                                                               
authority   to  maintain   support  until   the  organ   donation                                                               
organization could  review the documentation and  arrange for the                                                               
procedure.                                                                                                                      
                                                                                                                                
SENATOR  COWDERY asked  if a  patient's decision  to refuse  life                                                               
support would be tantamount to a decision not to donate?                                                                        
                                                                                                                                
MS.  BAER said  they are  two separate  decisions that  a patient                                                               
would have to make with a doctor and/or legal adviser.                                                                          
                                                                                                                                
2:58:12 PM                                                                                                                    
BRUCE  ZALNERAITIS, CEO,  Life  Alaska  Donor Services  testified                                                               
that close  to 100,000 people  in the United States  were waiting                                                               
for organ transplants, 180 of them  in Alaska, and that 18 people                                                               
in  the United  States die  each day  while waiting.  By updating                                                               
Alaska's Uniform Anatomical Gift Act  (UAGA) to the 2006 version,                                                               
SB 181  would remove  obstacles to organ  and tissue  donation by                                                               
clarifying language on  who can grant consent  to organ donation.                                                               
The  revised   version  would   also  prioritize   donations  for                                                               
transplant over research and improve  relations between the donor                                                               
organizations and the medical examiner's office.                                                                                
                                                                                                                                
3:01:25 PM                                                                                                                    
SENATOR  DYSON  moved to  report  CSSB  181 from  committee  with                                                               
individual  recommendations  and  attached zero  fiscal  note(s).                                                               
There being no objection, CSSB 181(HES) moved from committee.                                                                   
                                                                                                                                
There being  no further  business to  come before  the committee,                                                               
Chair Davis adjourned the meeting at 3:01:51 PM.                                                                              
                                                                                                                                

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