Legislature(2007 - 2008)BUTROVICH 205

02/18/2008 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 117 WORKERS' COMP: DISEASE PRESUMPTION TELECONFERENCED
Moved CSSB 117(L&C) Out of Committee
Bills Previously Heard/Scheduled
= SB 160 MANDATORY UNIVERSAL HEALTH CARE
Moved CSSB 160(HES) Out of Committee
-- Testimony <Invitation Only> --
                    ALASKA STATE LEGISLATURE                                                                                  
SENATE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE                                                               
                       February 18, 2008                                                                                        
                           1:35 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Senator Bettye Davis, Chair                                                                                                     
Senator Joe Thomas, Vice Chair                                                                                                  
Senator John Cowdery (via teleconference)                                                                                       
Senator Kim Elton                                                                                                               
Senator Fred Dyson                                                                                                              
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
All members present                                                                                                             
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
SENATE BILL NO. 117                                                                                                             
"An Act  relating to the  presumption of coverage for  a workers'                                                               
compensation  claim  for  disability   as  a  result  of  certain                                                               
diseases for certain occupations."                                                                                              
     MOVED CSSB 117(L&C) OUT OF COMMITTEE                                                                                       
                                                                                                                                
SENATE BILL NO. 160                                                                                                             
"An  Act establishing  an Alaska  health care  program to  ensure                                                               
insurance  coverage   for  essential  health  services   for  all                                                               
residents  of  the state;  establishing  the  Alaska Health  Care                                                               
Board  to  define  essential health  care  services,  to  certify                                                               
health care  plans that provide  essential health  care services,                                                               
and to administer  the Alaska health care program  and the Alaska                                                               
health   care  fund;   establishing   the   Alaska  health   care                                                               
clearinghouse to administer the  Alaska health care program under                                                               
the  direction  of the  Alaska  Health  Care Board;  establishing                                                               
eligibility  standards and  premium assistance  for persons  with                                                               
low income;  establishing standards  for accountable  health care                                                               
plans;  creating  the  Alaska health  care  fund;  providing  for                                                               
review  of  actions and  reporting  requirements  related to  the                                                               
health care program; and providing for an effective date."                                                                      
     MOVED CSSB 160(HES) OUT OF COMMITTEE                                                                                       
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: SB 117                                                                                                                  
SHORT TITLE: WORKERS' COMP: DISEASE PRESUMPTION                                                                                 
SPONSOR(s): SENATOR(s) SENATOR FRENCH                                                                                           
                                                                                                                                
03/14/07       (S)       READ THE FIRST TIME - REFERRALS                                                                        
03/14/07       (S)       L&C, HES, FIN                                                                                          
04/12/07       (S)       L&C AT 1:30 PM BELTZ 211                                                                               
04/12/07       (S)       Heard & Held                                                                                           
04/12/07       (S)       MINUTE(L&C)                                                                                            
05/03/07       (S)       L&C AT 1:30 PM BELTZ 211                                                                               
05/03/07       (S)       Heard & Held                                                                                           
05/03/07       (S)       MINUTE(L&C)                                                                                            
02/05/08       (S)       L&C AT 1:30 PM BELTZ 211                                                                               
02/05/08       (S)       Moved CSSB 117(L&C) Out of Committee                                                                   
02/05/08       (S)       MINUTE(L&C)                                                                                            
02/06/08       (S)       L&C RPT CS  2DP 1DNP 2NR    SAME TITLE                                                                 
02/06/08       (S)       DP: ELLIS, DAVIS                                                                                       
02/06/08       (S)       DNP: BUNDE                                                                                             
02/06/08       (S)       NR: STEVENS, HOFFMAN                                                                                   
02/18/08       (S)       HES AT 1:30 PM BUTROVICH 205                                                                           
                                                                                                                                
BILL: SB 160                                                                                                                  
SHORT TITLE: MANDATORY UNIVERSAL HEALTH CARE                                                                                    
SPONSOR(s): SENATOR(s) SENATOR FRENCH                                                                                           
                                                                                                                                
04/23/07       (S)       READ THE FIRST TIME - REFERRALS                                                                        
04/23/07       (S)       HES, L&C, FIN                                                                                          
09/10/07       (S)       HES AT 1:30 PM Anch LIO Conf Rm                                                                        
09/10/07       (S)       Heard & Held                                                                                           
09/10/07       (S)       MINUTE(HES)                                                                                            
01/30/08       (S)       HES AT 1:30 PM BUTROVICH 205                                                                           
01/30/08       (S)       Heard & Held                                                                                           
01/30/08       (S)       MINUTE(HES)                                                                                            
02/18/08       (S)       HES AT 1:30 PM BUTROVICH 205                                                                           
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
SENATOR HOLLIS FRENCH                                                                                                           
Alaska State Legislature                                                                                                        
Juneau, AK                                                                                                                      
POSITION STATEMENT: Presented overview of SB 117 and SB 160.                                                                  
                                                                                                                                
PAUL LISANKIE, Director                                                                                                         
Division of Worker's Compensation                                                                                               
Department of Labor and Workforce Development (DOLWD)                                                                           
Juneau, AK                                                                                                                      
POSITION STATEMENT: Answered questions on SB 117.                                                                             
                                                                                                                                
ANDY MODEROW, Staff                                                                                                             
to Senator French                                                                                                               
Alaska State Capitol                                                                                                            
Juneau, AK                                                                                                                      
POSITION STATEMENT: Answered questions on SB 117 and SB 160.                                                                  
                                                                                                                                
JEFF BRIGGS                                                                                                                     
Alaska Professional Fire Fighters Association (APFFA) and                                                                       
the International Association of Fire fighters (IAFF) Local 1264                                                                
Anchorage, AK                                                                                                                   
POSITION STATEMENT: Supported SB 117.                                                                                         
                                                                                                                                
MARK DRYGAS President                                                                                                           
Alaska Professional Fire Fighters Association (APFFA)                                                                           
Fairbanks, AK                                                                                                                   
POSITION STATEMENT: Supported SB 117.                                                                                         
                                                                                                                                
CANDY SIMS                                                                                                                      
Anchorage, AK                                                                                                                   
POSITION STATEMENT: Supported SB 160.                                                                                         
                                                                                                                                
PATRICIA SENNER, Advanced Nurse Practitioner                                                                                    
Alaska Nurses Association (ANA)                                                                                                 
Anchorage, AK                                                                                                                   
POSITION STATEMENT: Supported SB 160.                                                                                         
                                                                                                                                
LARRY WEISS, Executive Director                                                                                                 
Alaska Center for Public Policy                                                                                                 
Anchorage, AK                                                                                                                   
POSITION STATEMENT: Supported SB 160.                                                                                         
                                                                                                                                
MARK VINSEL, Executive Director                                                                                                 
United Fisherman of Alaska (UFA)                                                                                                
Juneau, AK                                                                                                                      
POSITION STATEMENT: Presented an overview of the health care                                                                
challenges facing commercial fishermen.                                                                                         
                                                                                                                                
WILLIAM STREUR, Deputy Commissioner                                                                                             
Medicaid and Health Care Policy                                                                                                 
Department of Health and Social Services (DHSS)                                                                                 
Anchorage, AK                                                                                                                   
POSITION STATEMENT: Supported SB 160.                                                                                         
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
CHAIR  BETTYE  DAVIS  called the  Senate  Health,  Education  and                                                             
Social Services  Standing Committee  meeting to order  at 1:35:27                                                             
PM. Present  at the  call to order  were Senators  Elton, Thomas,                                                             
Davis, Dyson and Cowdery (via teleconference).                                                                                  
                                                                                                                                
           SB 117-WORKERS' COMP: DISEASE PRESUMPTION                                                                        
                                                                                                                              
1:36:30 PM                                                                                                                    
CHAIR  DAVIS  announced  consideration  of SB  117.  [Before  the                                                               
committee was CSSB 117 (L&C)].                                                                                                  
                                                                                                                                
SENATOR FRENCH, sponsor  of SB 117, said the idea  of the bill is                                                               
to create  a presumption in  the workers' compensation  laws that                                                               
certain  diseases, cardio  vascular emergencies  and cancers  are                                                               
work related  when contracted by  fire fighters during  a limited                                                               
time frame and  within specific parameters. The  list of ailments                                                               
on page 2  of the bill is limited to  diseases that fire fighters                                                               
contract  more  often  the  general  public.  Certain  contagious                                                               
diseases such as tuberculosis and  meningitis are covered under a                                                               
presumption for fire fighters and  other first responders. In all                                                               
instances a preponderance of evidence  can negate or overcome the                                                               
presumption. For example,  someone with a history  of tobacco use                                                               
is specifically prevented from the  worker's comp presumption for                                                               
respiratory  and   heart  conditions.  Other   factors  including                                                               
physical fitness, work history  and non-employment activities can                                                               
be considered when the claim  is filed. A qualifying medical exam                                                               
will  insure that  an ailment  wasn't present  before a  claim is                                                               
filed.                                                                                                                          
                                                                                                                                
The presumption  for fire  fighters is  restricted to  only those                                                               
who have served seven years  or more, and coverage for qualifying                                                               
medical  events  extends  to  a maximum  of  sixty  months  after                                                               
employment  ends.  Exposure  to  a known  carcinogen  during  the                                                               
course  of employment  must  be established  for  a cancer  claim                                                               
presumption under  the legislation.  Alaska is  one of  only nine                                                               
states that has  not established a workers'  comp presumption for                                                               
fire fighters. The 41 states  that have enacted similar laws have                                                               
found  negligible effects  on  actuarial  assumptions for  claims                                                               
payouts.  The  California  retirement  system  (CALPERS)  did  an                                                               
extensive  study  of  this  issue to  see  if  establishing  this                                                               
presumption  in law  would raise  workers' comp  rates, and  they                                                               
found  no  noticeable impact  as  a  result of  the  presumption.                                                               
Workers' comp  claims actually  fell in  Illinois during  the six                                                               
years after a presumption was placed into law.                                                                                  
                                                                                                                                
The Labor and Commerce (L&C)  CS before the committee responds to                                                               
a single  concern that  qualifying medical  exams would  place an                                                               
unfunded  obligation  on  the  employers. The  CS  says  that  an                                                               
employer will  not have  an obligation  to cover  the costs  of a                                                               
qualifying exam.  It provides that  an individual has  the option                                                               
to  pay for  his own  exam if  an employer  doesn't provide  one.                                                               
Without  an  exam,  individuals would  not  get  the  presumption                                                               
although   they  could   still  make   a  workers'   comp  claim.                                                               
This legislation gives fire fighters  the back-up they  need when                                                               
their  life-saving work  produces  adverse effects  to their  own                                                               
personal health.                                                                                                                
                                                                                                                                
SENATOR  FRENCH  explained that  Section  1  of the  bill  amends                                                               
AS.23.30 the Alaska  Workers' Comp Act by adding  the new section                                                               
that follows.  Subsection (a) on  page 1, line 6, establishes the                                                               
presumption  that   specified  diseases  are   work-related  when                                                               
contracted by  certain emergency  workers in  the state.  It also                                                               
allows  for  the  presumption  to  be  challenged  and  it  gives                                                               
examples of evidence that can  be used to disprove a presumption.                                                               
Included  on  the list  are  tobacco  use, physical  fitness  and                                                               
exposures  to  hazards  in  other  employment  or  non-employment                                                               
activities.                                                                                                                     
                                                                                                                                
Subsection  (b)  starting  on  page  1,  line  13,  outlines  the                                                               
specific illnesses  and diseases that fall  under the presumption                                                               
for a  fire fighter in addition  to the time frame  for which the                                                               
presumption   lasts.  The   diseases  are:   respiratory;  cardio                                                               
vascular events or emergencies experienced  within 72 hours after                                                               
exposure  to smoke,  fumes or  toxic substances;  8 varieties  of                                                               
cancer which studies have shown  are experienced at greater rates                                                               
among fire fighters  than the general public. To  qualify for the                                                               
presumption,  a fire  fighter  must have  served  at least  seven                                                               
years and must have had a  medical exam that didn't show evidence                                                               
of the disease.  If the workers' compensation  claim involves any                                                               
of the  listed cancers,  the fire  fighter must  demonstrate that                                                               
during  the course  of employment  they were  exposed to  a known                                                               
carcinogen related to the disabling cancer.                                                                                     
                                                                                                                                
Subsection (c) establishes a  presumption that certain contagious                                                               
diseases listed on page 3, lines  8-13, are work related for fire                                                               
fighters  and emergency  rescue personnel.  This presumption  has                                                               
the  same challenge  process and  requires  a qualifying  medical                                                               
exam showing good health during employment.                                                                                     
                                                                                                                                
Subsection  (d)  on  Page  3  Line  21  states  that  respiratory                                                               
conditions  or cardio  vascular  events are  not  covered if  the                                                               
firefighter has a history of tobacco use.                                                                                       
                                                                                                                                
Subsection (e) is a new element  of the bill. It makes clear that                                                               
an employer will  not be forced to purchase  a qualifying medical                                                               
exam. This language is on page 3, line 24.                                                                                      
                                                                                                                                
Subsection  (f)  on  page  3,   line  31,  establishes  that  the                                                               
department  will  determine  through regulations  the  extent  of                                                               
medical examinations  necessary to eliminate evidence  of disease                                                               
in  an  active or  former  fire  fighter.  It also  requires  the                                                               
department to define what constitutes a history of tobacco use.                                                                 
                                                                                                                                
Subsection  (g)  defines  fire  fighter  as  written  in  statute                                                               
09.65.295.                                                                                                                      
                                                                                                                                
Section 2  makes clear  the presumption will  apply on  any claim                                                               
filed after  the legislation passes,  assuming all  provisions of                                                               
the bill including the qualified medical exam have occurred.                                                                    
                                                                                                                                
1:43:04 PM                                                                                                                    
SENATOR THOMAS  asked if annual  physicals were required  by most                                                               
departments.                                                                                                                    
                                                                                                                                
SENATOR FRENCH  replied they are.  He said in  90 cases out  of a                                                               
100, those  exams would satisfy  the requirement. There  are some                                                               
places that are too small with  four or five fire fighters on the                                                               
force; they  don't pay for annual  exams. The concern was  not to                                                               
burden those small departments with a new cost.                                                                                 
                                                                                                                                
SENATOR THOMAS asked about volunteer firemen.                                                                                   
                                                                                                                                
SENATOR FRENCH  said they would  qualify if they were  being paid                                                               
wages that would  allow them to file for workers'  comp. If there                                                               
are no  wages there is no  Workers' Comp claim. They  have to pay                                                               
for an exam if they want the presumption.                                                                                       
                                                                                                                                
SENATOR COWDERY  asked what  happens if they  fail the  exam they                                                               
are required to take in order to  keep the job, and if this would                                                               
have any effect on the presumption.                                                                                             
                                                                                                                                
SENATOR FRENCH said  he would defer that question  to someone who                                                               
can  explain how  that would  work. He  said he  thinks it  would                                                               
depend on what caused them to fail.                                                                                             
                                                                                                                                
1:46: 03 PM                                                                                                                   
PAUL  LISANKIE,  Director,  Division  of  Worker's  Compensation,                                                               
Department of  Labor, Juneau, AK  , said  it depends on  what the                                                               
exam disclosed.  If it was  something a fire fighter had to prove                                                               
he/she  didn't  have,  it  would  probably  disqualify  coverage,                                                               
assuming  it wasn't  already work  related. If  it was  something                                                               
that  developed during  the job,  it  could support  a claim  for                                                               
workers' comp under the existing statute.                                                                                       
                                                                                                                                
SENATOR  DYSON said  Senator French  why the  list of  contagious                                                               
diseases was included (page 3, line 6).                                                                                         
                                                                                                                                
SENATOR   FRENCH   replied   that  those   diseases   are   human                                                               
immunodeficiency   virus    (AIDS),   acquired   immunodeficiency                                                               
syndrome   (AIDS),  all   strains  of   hepatitis,  meningococcal                                                               
meningitis;  micro  bacterium  tuberculosis;,  and  any  uncommon                                                               
infectious diseases  the U.S. Secretary  of Labor  determines are                                                               
related to  hazards a  fire fighter faces.  The common  factor in                                                               
these six diseases  is they are things you get  from the blood of                                                               
another person. Since  these individuals go to  places where they                                                               
are   rescuing   people   and  giving   them   Cardio   Pulmonary                                                               
Resuscitation  (CPR) under  emergency  situations, it's  entirely                                                               
foreseeable that  fire fighters will  come in contact  with these                                                               
diseases  more than  the general  public.  The research  supports                                                               
this. Therefore,  when they  diseases come up,  they get  a work-                                                               
related  presumption.  It  can  be rebutted,  but  they  get  the                                                               
benefit of the doubt initially.                                                                                                 
                                                                                                                                
SENATOR  DYSON said  there a  lot of  people in  Alaska who  work                                                               
seasonally  fighting forest  fires from  three to  five months  a                                                               
year. He  asked if they would  have to have the  same seven times                                                               
12 months of on-the-job service to get covered under this bill.                                                                 
                                                                                                                                
ANDY  MODEROW, staff  to Senator  French, replied  the definition                                                               
does not  include wild land  volunteer fire fighters but  it does                                                               
include the other employees.                                                                                                    
                                                                                                                                
SENATOR DYSON said the forest  fire fighters may have volunteered                                                               
to  go but  they  are paid  on  contract. He  asked  if they  are                                                               
volunteers or employees.                                                                                                        
                                                                                                                                
1:51:23 PM                                                                                                                    
MR. MODEROW  replied they are  not included in the  definition as                                                               
the bill is written.                                                                                                            
                                                                                                                                
CHAIR DAVIS asked if the  department had any clarification on who                                                               
would be eligible for compensation.                                                                                             
                                                                                                                                
MR. LISANKIE  said Mr.  Moderow is  correct. The  definition will                                                               
control who is  eligible for coverage and the  definition of fire                                                               
fighter  in Alaska  statutes  describes a  person  employed by  a                                                               
municipal fire department or who is  a member of a volunteer fire                                                               
department registered  with the  state fire  marshal or  a person                                                               
registered for  purposes of workers' compensation  with the state                                                               
fire  marshal as  a member  of a  volunteer fire  department. The                                                               
delineation  is  going  to  be what  they're  doing  rather  than                                                               
whether they're paid.                                                                                                           
                                                                                                                              
SENATOR DYSON said it sounds  like many folks who work seasonally                                                               
fighting forest  fires are not  going to  be covered and  most of                                                               
those   will  not   be  directly   working  for   the  state   or                                                               
municipality.                                                                                                                   
                                                                                                                                
SENATOR FRENCH said forest fire  fighters might get workers' comp                                                               
coverage, but not the presumption.                                                                                              
                                                                                                                                
1:53:05 PM                                                                                                                    
JEFF  BRIGGS,  Alaska   Professional  Fire  Fighters  Association                                                               
(APFFA),and  the  International   Association  of  Fire  fighters                                                               
(IAFF)  Local  1264,  Anchorage,  AK,  said  this  bill  is  long                                                               
overdue. There are  40 other states and provinces  in Canada that                                                               
currently have some  sort of presumption in place,  none of which                                                               
are experiencing  fiscal problems  through the  implementation of                                                               
the legislation.  Several of the  states have many  more diseases                                                               
and cancers covered. Some cover  all cancers for a fire fighter's                                                               
entire life after he retires.                                                                                                   
                                                                                                                                
In Alaska,  the workers' compensation  rate for fire  fighters is                                                               
$4.68 per hundred  dollars of payroll. The claim  that Alaska has                                                               
the  highest rate  in the  nation is  erroneous. Vermont  in 2007                                                               
paid  $14.52 per  hundred dollars.  This year  nationwide already                                                               
there  have been  17  on-duty fire  fighter  fatalities. In  2007                                                               
there were 115. The numbers from  9/11 are well known. The Alaska                                                               
Supreme Court  has ruled that  fire fighters and  police officers                                                               
are not allowed to sue  negligent parties to recover damages from                                                               
negligent acts.  Considering that  fire fighters don't  have many                                                               
benefits, this would be a good place to start.                                                                                  
                                                                                                                                
He said the  Alaska Municipal League suggests  that workers' comp                                                               
rates  will skyrocket  yet  the same  statement  says that  these                                                               
diseases are  already covered  by workers'  comp so  there should                                                               
not  be  an  additional  cost.   If  anything,  the  bill  should                                                               
streamline the process  and possibly save money.  Last week Kevin                                                               
Smith sent a  letter to the House  Finance committee. Ironically,                                                               
he supported  one of IAFF's  claims. Night workers have  a higher                                                               
cancer rate  than the  general public.  Fire fighters  often work                                                               
24-hour  shifts,  56   hours  a  week.  It   appears  that  sleep                                                               
deprivation  increases cancer  risk.  He urged  the committee  to                                                               
pass SB 117.                                                                                                                    
                                                                                                                                
SENATOR THOMAS asked if Mr. Briggs  had a list of where the rates                                                               
went down and  if that was based on the  concept that there would                                                               
be early  detection and intervention potentially  under the terms                                                               
of this bill, rather than down  the road when one of the diseases                                                               
that are listed ends up being an extremely expensive item.                                                                      
                                                                                                                                
MR. BRIGGS  said he  thought rates  have dropped  because workers                                                               
tend  to be  safer. Every  year  equipment is  improved and  more                                                               
training is available.  IAFF is in the process  of gathering more                                                               
data on rates in other states.                                                                                                  
                                                                                                                                
SENATOR DYSON said he's like to see  a copy of the data when it's                                                               
collected.                                                                                                                      
                                                                                                                                
1:57:43 PM                                                                                                                    
MARK   DRYGAS  President,   Alaska  Professional   Fire  Fighters                                                               
Association (APFFA),  Fairbanks, AK, said he  represents 500 fire                                                               
fighters and emergency medical service  providers. The members of                                                               
APFFA respond to 75 per cent of  the 911 calls in Alaska. He said                                                               
he is  also employed as a  battalion chief in the  Fairbanks Fire                                                               
Department.  He supported  SB 117.  Fire  fighters face  multiple                                                               
hazards every  day. They expose  themselves to  possible injuries                                                               
from  falls, buildings  collapsing, burns,  et cetera.  The risks                                                               
they take  to provide for  the safety and protection  of property                                                               
of others is  part of the job. If they  are unfortunate enough to                                                               
suffer  an  injury,  they  know  they will  be  provided  for  by                                                               
workers' compensation.  No one gains,  but at least  the negative                                                               
effects  are  lessened  by  this   coverage.  Fire  fighters  are                                                               
becoming   increasingly  aware   of  the   new  dangers   of  the                                                               
profession. In  addition to exposure  to injuries,  fire fighters                                                               
are exposed  to disease-causing elements  on a daily  basis. Fire                                                               
fighters are contracting  cancer in all its forms at  a rate that                                                               
exceeds the general public.                                                                                                     
                                                                                                                                
He said fire fighters generally  represent a healthier segment of                                                               
the workforce.  They are learning  to accept some of  these risks                                                               
while  making every  effort to  limit their  exposure to  toxins.                                                               
Progress has  been made in  making equipment safer  and improving                                                               
training. Meanwhile,  exposure to cancer toxins  increases. Years                                                               
ago  most  fires  consumed   natural  products.  Nowadays,  fires                                                               
consume  a  vast  array  of  synthetics,  plastics,  and  unknown                                                               
chemicals.   Advanced   breathing   apparatuses   have   lessened                                                               
inhalation hazards, but  many toxins enter the  body through skin                                                               
absorption.  It used  to be  a  badge of  honor to  have a  soot-                                                               
covered bunker coat,  but today's fire fighter knows  to keep his                                                               
gear clean. There are hazards  in every profession but workers in                                                               
other professions  are informed  of the  hazards facing  them and                                                               
can establish  a safe work  environment. A materials  safety data                                                               
sheet (MSDS) is posted in all workplaces.                                                                                       
                                                                                                                                
He  asked committee  members to  imagine the  chemicals in  their                                                               
garages, under  their sinks, in  their laundry rooms, as  well as                                                               
the  synthetics  and  components  of a  home,  from  curtains  to                                                               
stereos with  no way of  knowing what kind of  lethal combination                                                               
they might produce in a fire.                                                                                                   
                                                                                                                                
MR.  DRYGAS said  fire fighters  cannot pinpoint  where and  when                                                               
they become  exposed to hazards  that may cause cancer.  It could                                                               
be  from a  combination of  exposure to  different fires  or from                                                               
handling fire  hose after  a fire which  is routinely  cleaned by                                                               
the fire fighters on the next  shift. A state of Alaska report on                                                               
occupational injury or illness asks  for the date, time and place                                                               
the exposure  occurred. A  fire fighter  is at  a loss  trying to                                                               
fill out one of  those forms after being on the job  for 10 or 20                                                               
years. SB 117  provides for a presumption of coverage,  but it is                                                               
not a guarantee.  The employer or insurer must  prove that cancer                                                               
was not  related to  the job.  There are  provisions in  the bill                                                               
that  allow  the  insurers to  raise  family  history,  lifestyle                                                               
habits,  and smoking  in challenging  a claim.  The insurer  must                                                               
prove by a  preponderance of evidence that it is  not job related                                                               
instead of the employee having to prove that it is job related.                                                                 
                                                                                                                                
He said  the bill  provides for  coverage of  certain respiratory                                                               
diseases  and for  heart  disease or  heart  attacks following  a                                                               
major  event like  a structure  fire.  Exposure to  fire and  its                                                               
accompanying  chemical   compounds  has   led  to   an  increased                                                               
incidence  of heart  attacks in  the first  72 hours  following a                                                               
fire. The  bill also  has a presumption  of coverage  for certain                                                               
blood-borne  communicable  diseases.  As first  responders,  fire                                                               
fighters enter situations  where they don't have  the luxuries of                                                               
a  hospital environment  or good  lighting. They  don't know  the                                                               
history of the  patient before they deal with  them. These claims                                                               
of  disease are  at  the same  time open  to  proof the  exposure                                                               
occurred outside the  job. Some people in  the insurance industry                                                               
will  say  it's too  expensive  and  not  needed, and  that  fire                                                               
fighters are already covered. He remarked:                                                                                      
                                                                                                                                
     I  expect that.  That's  their  job. They're  insurance                                                                    
     people.  Compassion  isn't  part of  their  vocabulary.                                                                    
     They'll try  a counter or scientific  research. They'll                                                                    
     say  it's  skewed,  that  we  used  poor  studies,  but                                                                    
     they're never going to be able to  show that  . . . our                                                                    
     cancer rate  is the same  as the general  public. Every                                                                    
     study  shows  that  fire  fighters  are  getting  these                                                                    
     cancers. We  worked hard  on the bill  to come  up with                                                                    
         the eight cancers that we thought had the best                                                                         
     evidence behind [them], the best scientific study.                                                                         
                                                                                                                                
2:04:27 PM                                                                                                                    
MR.  DRYGAS  said he  and  the  others  testifying are  not  paid                                                               
lobbyists; they chose to volunteer  their time. It is devastating                                                               
to  a  fire  fighter  to  contract  one  of  these  diseases  and                                                               
devastating  to their  families.  They are  just  asking that  it                                                               
isn't made  worse by having to  go through the stress  of that in                                                               
addition to  their disease  or illness  to prove  that it  is job                                                               
related. Few people  would say that the work of  fire fighters is                                                               
not appreciated.  This isn't  a labor  bill or  a union  bill. He                                                               
doesn't  even like  referring to  it as  a workers'  compensation                                                               
bill.  It's  a fire fighters' bill and it  shows that people care                                                               
about their fire fighters.                                                                                                      
                                                                                                                                
SENATOR  DYSON  asked  if  the  record  shows  that  forest  fire                                                               
fighters have much less of these kinds of diseases.                                                                             
                                                                                                                                
MR. DRYGAS replied that forestry  is a different type of problem.                                                               
Those are  wood smoke and  not the type  of situation found  in a                                                               
structure fire, especially  the interior of a  structure fire. He                                                               
said  he  has  talked  with   people  from  the  Bureau  of  Land                                                               
Management   (BLM)  who   have  asked   him  about   the  various                                                               
protections  they  use,  especially fighting  fires  around  dump                                                               
sites.                                                                                                                          
                                                                                                                                
2:08:31 PM                                                                                                                    
SENATOR THOMAS  asked if the  physicals fire fighters  receive in                                                               
Fairbanks are adequate for detecting these diseases early.                                                                      
                                                                                                                                
MR.  DRYGAS   replied  that  Fairbanks  has   an  extensive  pre-                                                               
employment  physical  as  well as  an  extensive  annual  two-day                                                               
physical. It  is in place to  protect both the city  and the fire                                                               
fighters. Smaller  departments, especially  volunteer departments                                                               
don't have an extensive annual physical.                                                                                        
                                                                                                                                
2:10:15 PM                                                                                                                    
SENATOR THOMAS  made a clarifying  motion that the  committee was                                                               
considering  the Senate  Labor &  Commerce committee  substitute,                                                               
version \M, and there was no objection.                                                                                         
                                                                                                                                
CHAIR DAVIS called back the sponsors of the bill.                                                                               
                                                                                                                                
SENATOR FRENCH said he had no further statements.                                                                               
                                                                                                                                
SENATOR  DYSON asked  if  the administration  is  okay with  this                                                               
bill.                                                                                                                           
                                                                                                                                
MR. LISANKIE  replied that the  administration is neutral  on the                                                               
bill.                                                                                                                           
                                                                                                                                
SENATOR  THOMAS  moved  to  report CSSB  117,  version  \M,  from                                                               
committee  with individual  recommendations  and attached  fiscal                                                               
note(s).  There  being no  objection,  CSSB  117(L&C) moved  from                                                               
committee.                                                                                                                      
                                                                                                                                
             SB 160-MANDATORY UNIVERSAL HEALTH CARE                                                                         
                                                                                                                                
2:12:17 PM                                                                                                                    
CHAIR DAVIS announced the consideration of SB 160.                                                                              
                                                                                                                                
SENATOR FRENCH, sponsor  of SB 160, said this  is a comprehensive                                                               
bill.  He  said the  basic  idea  is  to make  affordable  health                                                               
insurance  available to  every Alaskan  by establishing  a health                                                               
care  board that  would oversee  a fund  and help  certify health                                                               
care  plans.  Four  to  five private  insurance  plans  would  be                                                               
available  to Alaska  citizens who  would get  a voucher  to help                                                               
them buy  one of  these plans.  Most people  would fall  into the                                                               
zone  of between  100  and  300 percent  of  the federal  poverty                                                               
level. They would get a  sliding scale voucher depending on their                                                               
income  which would  help them  buy a  plan. This  doesn't affect                                                               
anyone who currently  has health insurance; it is  only meant for                                                               
those who don't get health insurance  as part of their job. It is                                                               
not government run  or socialized medicine, but  rather using the                                                               
private  market  place to  make  private  insurance available  to                                                               
Alaska citizens through the creation of a health care fund.                                                                     
                                                                                                                                
He  said this  is the  third time  the committee  has heard  this                                                               
bill.  There  was  a  hearing  in  September  2007  in  which  12                                                               
stakeholders including  representatives from small  business, the                                                               
medical  profession, and  the insurance  industry helped  outline                                                               
problems  and difficulties  with one  hundred thousand  uninsured                                                               
Alaskans. Two  nationally prominent health care  experts from the                                                               
Heritage  Foundation  and the  Cato  Institute  commented on  the                                                               
problem  here  and  the  solutions  proposed.  The  CS  that  was                                                               
presented   in  January   2008   was  the   result  of   numerous                                                               
conversations  and comments  since  the bill  was introduced.  He                                                               
said  his  office  has  had   meetings  with  the  Alaska  Nurses                                                               
Association,  Aetna,  representatives   from  the  Department  of                                                               
Health  and  Social  Services, the  Division  of  Insurance,  and                                                               
Commonwealth  North's  Health  Care  Roundtable.  He  has  spoken                                                               
personally with  over a dozen  groups in the  community including                                                               
the Alaska  Association of Health Underwriters,  AFL-CIO's Alaska                                                               
Conference, AARP, and the Alaska  Chamber of Commerce. He will be                                                               
meeting with  the National Federation of  Independent Businesses.                                                               
His office  has had  hundreds of emails  from Alaskans  about the                                                               
bill.                                                                                                                           
                                                                                                                                
2:15:42 PM                                                                                                                    
SENATOR FRENCH  said there are misunderstandings  about the bill.                                                               
He recently  received an email  from a small businessman  who was                                                               
unhappy with an employer levy  because while he'd like to provide                                                               
health insurance  for his  employees, the levy  would put  him in                                                               
the hole.  In fact, Senator French  said, the bill says  there is                                                               
no levy  if an employer  has zero to  10 employees. So,  it would                                                               
actually help his employees at no cost to him.                                                                                  
                                                                                                                                
If  an employer  has between  10 and  20 employees,  the levy  is                                                               
percent  of the  gross payroll.  If an  employer has  20 or  more                                                               
employees  the levy  is 2  percent. There  are even  ways to  get                                                               
around those levies.  If an employer offers to pay  33 percent of                                                               
the premium  costs of a  health insurance plan, there's  no levy.                                                               
If  employers  enroll 25  percent  of  employees in  an  employer                                                               
sponsored  plan,  there's no  levy.  If  an  employer sets  up  a                                                               
Section 125 cafeteria plan, a  plan made available by the federal                                                               
government  to small  businesses, that  plan allows  employees to                                                               
purchase  health  care coverage  with  pre  federal tax  dollars,                                                               
making employers exempt  from the levy.  The cost  of a basic 125                                                               
plan to an employer is $300.                                                                                                    
                                                                                                                                
SENATOR FRENCH said he has used  the internet to get the word out                                                               
to employees with a website.  They have an interactive calculator                                                               
that allows  people to go  to the  website, plug in  their income                                                               
level, and  find out what  it would actually  cost them to  get a                                                               
health  insurance policy.  People from  all over  the state  have                                                               
signed  a letter  of  support  and are  signed  up  to get  email                                                               
updates.                                                                                                                        
                                                                                                                                
He  said the  bill  will not  address  Medicare or  reimbursement                                                               
rates. People  over 65 years  of age  in Alaska will  continue to                                                               
face  difficulties  getting  a  medical doctor  as  long  as  the                                                               
medical reimbursement rates set  by the federal government remain                                                               
so far from  the demands of the market. The  legislation will not                                                               
establish a single payer government-run  program. He said he gets                                                               
some  flack from  the right  alleging  that he's  trying to  push                                                               
socialized  medicine which  is  not true.  The  same people  that                                                               
object to  government run  medical care are  often are  signed up                                                               
for Medicare which  is a single payer system  which covers anyone                                                               
over 65.  This bill  relies on market  forces and  competition to                                                               
lower costs  while at the  same time ensuring that  patients have                                                               
the financial  capability to get  the care they need.  It doesn't                                                               
increase the number of doctors in Alaska.                                                                                       
                                                                                                                                
2:19:51 PM                                                                                                                    
SENATOR FRENCH said  the bill will reduce  the unspoken financial                                                               
penalty  paid by  individuals and  businesses  who currently  buy                                                               
coverage for  people who  opt out or  cannot afford  health care.                                                               
Federal  law requires  that hospitals  give medical  attention to                                                               
everyone who needs  emergency care. When someone  cannot pay, the                                                               
costs are  transferred to those  of us  who can pay.  Fixed state                                                               
and  federal reimbursement  rates for  medical care  prevent this                                                               
cost  shifting  from  being borne  by  government  programs  like                                                               
Medicare and  Medicaid. In 2005  after modest  uncompensated care                                                               
reimbursement from  the state and  federal government,  over $100                                                               
million worth  of unpaid medical  bills were left  outstanding in                                                               
Alaska.  Last   September  during   the  SB  160   hearings  Joel                                                               
Gilbertson reported  that Providence  was likely to  surpass $100                                                               
million  of uncompensated  care  in 2007.  Families USA  estimate                                                               
that this  unspoken tax  will easily surpass  $1000 per  year per                                                               
family  in 2010.  As  costs continue  to go  up,  the free  rider                                                               
problem  will only  get larger  increasing the  penalty of  being                                                               
unprepared with a health care coverage plan.                                                                                    
                                                                                                                                
SENATOR FRENCH  said SB 160 is  a work in progress  and he'd like                                                               
to  offer  an  amendment  inspired by  conversations  with  Chair                                                               
Davis. It  states that Medicaid  will continue to have  a crucial                                                               
role to play in health  reform efforts. The amendment charges the                                                               
health care board to offer  recommendations on possible expansion                                                               
of  Medicaid, taking  into  account the  fiscal  impact of  those                                                               
changes. From these recommendations  the legislature would have a                                                               
basis to act with the fiscal  interests of the state in mind. The                                                               
legislation is  methodical and it's  a well  thought-out proposal                                                               
that won't address all medical issues but it's a good start.                                                                    
                                                                                                                                
2:22:29 PM                                                                                                                    
CANDY SIMS,  Anchorage, AK,  said she  has three  major concerns:                                                               
the cost to the individual if  her family doesn't qualify for the                                                               
voucher system  by making  too much money.  She asked  if there's                                                               
going  to  be some  kind  of  a  sliding  scale. She  said  she's                                                               
concerned about the  penalties mentioned in the  last hearing one                                                               
of which  was if you don't  have insurance, perhaps you  won't be                                                               
able to  go to  college. This would  kill her  daughter's dreams.                                                               
Her  family  doesn't currently  have  insurance  and she  has  an                                                               
incurable disease. She  was able to afford insurance  for a while                                                               
but  at  a  certain  point she  couldn't  afford  both  insurance                                                               
coverage and  the cost  of prescriptions. When  she tried  to get                                                               
coverage for herself and her  daughter, carriers refused to cover                                                               
her when she mentioned her disease.                                                                                             
                                                                                                                                
MS. SIMS said  she received an email from  Senator French stating                                                               
that pre existing  conditions would not be a problem.   She asked                                                               
if the clearing house that would  be set up would offer insurance                                                               
policies for people  with chronic illness. If she  has a problem,                                                               
for example,  if she's  been overcharged, she  asked how  the two                                                               
medical boards would interact.                                                                                                  
                                                                                                                                
CHAIR DAVIS said that she would  bring the sponsor back to answer                                                               
some of  Ms. Sims' questions, but  some of the questions  did not                                                               
pertain  to the  bill. This  bill is  not the  answer to  all the                                                               
problems.                                                                                                                       
                                                                                                                                
2:28:55 PM                                                                                                                    
ANDY MODOROW, staff, Senator French,  said the guarantee issue as                                                               
stated in the  bill does require that an  insurance company issue                                                               
a policy  to an individual who  is within the Alaska  health care                                                               
program. Currently there  is such a law for  Alaska's small group                                                               
market with between two and fifty  and it's one of the things the                                                               
responsibility clauses  in the bill  provide for. It  reduces the                                                               
moral  hazard  that  would come  about  without  having  coverage                                                               
required for everyone.                                                                                                          
                                                                                                                                
He  said  college  access  being   tied  to  health  care  as  an                                                               
enforcement  tool  is not  in  the  bill.  Some people  on  ACHIA                                                               
(Alaska  Comprehensive  Health  Insurance  Association) expressed                                                             
concern about being able to  get coverage. ACHIA is Alaska's high                                                               
risk pool and the current draft  of the bill provides vouchers of                                                               
up to  450 percent  of the  federal poverty  line -  an increased                                                               
amount that should  make coverage affordable for  them. While the                                                               
guarantee issue  clause does  overlap, it  will provide  a safety                                                               
valve while this legislation is being implemented.                                                                              
                                                                                                                                
2:30:50 PM                                                                                                                    
PATRICIA  SENNER,  Advanced  Nurse  Practitioner,  Alaska  Nurses                                                               
Association  (ANA),   Anchorage,  AK   said  the   Alaska  Nurses                                                               
Association  is   very  appreciative   of  Senators   French  and                                                               
Wielechowski  for   introducing  this   bill  and   starting  the                                                               
discussion of how  to solve Alaska's current  health care crisis.                                                               
The members are concerned about  their patients who are unable to                                                               
afford  health care  insurance. She  personally had  to advise  a                                                               
young  man not  to get  a  job so  he could  remain eligible  for                                                               
Medicaid and  be treated for  his leukemia. Many members  work in                                                               
hospitals  where  fewer  and  fewer  patients  have  health  care                                                               
insurance while  at the same time  many of the sources  of income                                                               
for the  hospital are being  siphoned off by private  surgery and                                                               
imaging centers.                                                                                                                
                                                                                                                                
She said it  is difficult for the members to  analyze whether the                                                               
model  outlined in  SB 160  is financially  viable, but  they are                                                               
convinced  that the  solution to  getting affordable  health care                                                               
for  Alaskans is  to have  the cost  of that  insurance be  split                                                               
between the  individual, the  state and  the employer.  They also                                                               
think it is appropriate for the  individual to assume some of the                                                               
responsibility  for  insuring  that   health  care  services  are                                                               
available in Alaska. If Alaskans  want a hospital to be available                                                               
when they  need it, they should  be willing to help  pay for them                                                               
to keep their doors open.                                                                                                       
                                                                                                                                
The  members also  want to  thank  the senators  for including  a                                                               
nurse on the  Alaska Health Care Board. If the  board does become                                                               
a reality, there probably should  be two boards, one dealing with                                                               
financial issues  and running  the program,  and the  other board                                                               
dealing with clinical issues concerning coverage services.                                                                      
                                                                                                                                
2:33:17 PM                                                                                                                    
LARRY  WEISS,  Executive  Director,   Alaska  Center  for  Public                                                               
Policy,  Anchorage,  AK,  said  legislators  have  shown  serious                                                               
interest  in a  difficult problem  and they  have put  it on  the                                                               
table for  wide discussion.  He said he  does have  some concerns                                                               
about the way  the bill is structured and that  SB 160 was chosen                                                               
in  comparison to  several other  possible  health reform  plans.                                                               
When California was considering  health care reform, state policy                                                               
analysts   invited  nine   different   organizations  to   submit                                                               
comprehensive  proposals.  On  one   end  of  the  spectrum  were                                                               
proposals that  recommended minor  tinkering around the  edges of                                                               
the health  care industry.  At the  other end  was a  proposal to                                                               
create the  California Health Service,  a health plan  which made                                                               
all health care facilities publicly owned.                                                                                      
                                                                                                                                
The nine  plans were submitted  to a large East  Coast consulting                                                               
firm.  The final  report provides  a detailed  discussion of  the                                                               
cost and coverage  implications of each of the  nine proposals. A                                                               
second  selected contractor  did  a qualitative  analysis of  the                                                               
options  which  included  such  things  as  access,  utilization,                                                               
continuity  of   care,  quality   of  appropriateness   of  care,                                                               
etcetera. All the documentation is  online.  Anyone in California                                                               
has the ability to look this information up and comment on it.                                                                  
                                                                                                                                
MR. WEISS  said he's  also concerned about  the over  reliance on                                                               
private  health   insurance.  That   means  very   expensive  and                                                               
unnecessary overhead  for the state that  isn't characteristic of                                                               
other approaches.  It will include expensive  deductibles and co-                                                               
payments  for patients.  Research  shows that  this will  prevent                                                               
people  from using  the insurance  once they  have it.  He's also                                                               
concerned that private  health insurance in Alaska  is actually a                                                               
very  concentrated  market where  only  one  insurer controls  60                                                               
percent of all private health  insurance in the state. The market                                                               
here is not competitive.                                                                                                        
                                                                                                                                
MR.  WEISS  expressed concern  for  the  lack of  provisions  for                                                               
quality of  care and  the notion of  individual mandates.  It's a                                                               
punitive  approach  that is  stumbling  in  Massachusetts and  is                                                               
unnecessary with  other plans. He  suggested they take  a serious                                                               
look at programs already in  place that have a demonstrated track                                                               
record, that  are cost  effective and that  have quality  of care                                                               
elements already built in.                                                                                                      
                                                                                                                                
He  thought Medicaid  should be  expanded to  the maximum  extent                                                               
possible and went on to discuss some of its benefits.                                                                           
                                                                                                                                
He  also  recommended  developing   a  comprehensive  package  of                                                               
funding  for the  130 community  health clinics  scattered across                                                               
Alaska to  enable these  non-profit federally  subsidized clinics                                                               
to recruit and retain staff and  to directly serve those who need                                                               
health   care.   This   approach  would   eliminate   unnecessary                                                               
administrative and  other costs  of private health  insurance and                                                               
at the same time directly provide  medical care to those in need.                                                               
Care costs for  community health centers have  been documented to                                                               
be  far below  those  in for-profit  health  care settings.  This                                                               
approach  would   also  address  the  Medicare   problem  because                                                               
Medicare patients  are accepted at every  community health clinic                                                               
in Alaska.                                                                                                                      
                                                                                                                                
2:39:37 PM                                                                                                                    
CHAIR DAVIS said  that Medicaid can be expanded but  this bill is                                                               
strictly intended to provide health care for all Alaskans.                                                                      
                                                                                                                                
2:40:41 PM                                                                                                                    
MARK  VINSEL,  Executive  Director, United  Fisherman  of  Alaska                                                               
(UFA), Juneau, AK, said that UFA  doesn't have a position on this                                                               
bill, but  gave an overview  of the challenges  facing commercial                                                               
fishermen  regarding access  to  health care  and insurance.  UFA                                                               
thinks that  commercial fishermen fall  through the cracks  to an                                                               
extent that  is not seen  in any other demographic  or occupation                                                               
that they might compare themselves  to. A higher percentage lives                                                               
in rural  areas that are less  likely to be served  by a hospital                                                               
or a road system that would  provide the ability to get to health                                                               
care facilities.  Being largely  self-employed with  variable and                                                               
seasonable income  opportunities, affordable health  insurance is                                                               
difficult  to  come by.  This  is  a  problem  that needs  to  be                                                               
addressed.                                                                                                                      
                                                                                                                                
2:43:15 PM                                                                                                                    
WILLIAM STREUR, Deputy Commissioner  for Medicaid and Health Care                                                               
Policy,  Department   of  Health  and  Social   Services  (DHSS),                                                               
Anchorage, AK, said Senator French's  new amendment has increased                                                               
his  interest. He  supported this  bill  and the  intent to  make                                                               
health  care  a reality  for  all  Alaskans.  He spent  30  years                                                               
helping people  get access  to health care  when there  was none,                                                               
mostly  through Medicaid.  He advised  that the  state must  also                                                               
ensure  that there  are providers  of health  care available  and                                                               
willing to accept those seeking  services. Health insurance alone                                                               
does not  guarantee that those  seeking services will  receive it                                                               
if there are no providers.                                                                                                      
                                                                                                                                
MR. STREUR  said this bill  is primarily an access  and insurance                                                               
issue,  and is  not best  placed  under the  sole management  and                                                               
implementation  of   DHSS.  The  issues  DHSS   deals  with  like                                                               
eligibility,  provider  systems,  rates,  and  premiums  are  not                                                               
familiar Medicaid issues.  This is a new paradigm  for Alaska and                                                               
no  one department  may  be currently  equipped  to address  this                                                               
legislation.                                                                                                                    
                                                                                                                                
2:45:40 PM                                                                                                                    
SENATOR COWDERY asked if there  were any cost estimates and where                                                               
the money would come from.                                                                                                      
                                                                                                                                
CHAIR  DAVIS  replied  that  was  not  an  issue  that  would  be                                                               
considered in this committee.                                                                                                   
                                                                                                                                
2:46:36 PM                                                                                                                    
SENATOR  THOMAS  asked  if the  administration  agreed  with  the                                                               
requirement for every Alaskan to have health insurance.                                                                         
                                                                                                                                
MR.STREUR said  the department itself  has not taken  a position,                                                               
but it is a goal that access is available to every citizen.                                                                     
                                                                                                                                
SENATOR DYSON said  that access is different  than requiring that                                                               
everyone have health insurance.  This bill requires that everyone                                                               
have  health insurance  leaving no  self-payers in  the state.  A                                                               
multi-millionaire who chooses  to pay his own bills  would not be                                                               
allowed  to  do  that.  He  asked Mr.  Streur  if  that  was  his                                                               
position.                                                                                                                       
                                                                                                                                
MR. STREUR replied he was not prepared to answer.                                                                               
                                                                                                                                
SENATOR  DYSON  asked  for  confirmation   that  Mr.  Streur  was                                                               
personally in favor of this bill.                                                                                               
                                                                                                                                
MR. STREUR replied he was.                                                                                                      
                                                                                                                                
SENATOR  DYSON  asked  if  Mr.  Streur's  support  included  that                                                               
provision.                                                                                                                      
                                                                                                                                
MR. STREUR replied yes.                                                                                                         
                                                                                                                                
SENATOR DYSON  asked if  Mr. Streur  was in  favor of  forcing an                                                               
insurance company to take any  citizen including one who is being                                                               
very reckless their health, swapping  body fluids or weighing 800                                                               
pounds or  all kinds  of toxic things  and the  insurance company                                                               
would have  to take  that person even  though their  behavior was                                                               
destructive and they were unrepentant.                                                                                          
                                                                                                                                
MR. STREUR replied that as a  former health care insurer that was                                                               
what he was faced with.                                                                                                         
                                                                                                                                
SENATOR  DYSON asked  if Mr.  Streur  was in  favor of  insurance                                                               
companies  being  forced to  take  people  with any  pre-existing                                                               
conditions including ones that are behavior-related.                                                                            
                                                                                                                                
MR.  STREUR  replied  that  if  the  senator  was  talking  about                                                               
destructive  behavior  being allowed,  [he  thought]  it was  not                                                               
covered under this bill but would defer to the sponsor.                                                                         
                                                                                                                                
2:48:54 PM                                                                                                                    
SENATOR ELTON asked who is  paying for the health consequences of                                                               
the behavior  previously cited.  He said  his impression  is that                                                               
much of  those health care costs  are being borne by  the general                                                               
public.  The hospital  in his  community is  a taxpayer-supported                                                               
hospital.  He said  it  would be  helpful to  talk  about who  is                                                               
paying  for  the  health  care   consequences  of  that  kind  of                                                               
behavior.                                                                                                                       
                                                                                                                                
MR. STREUR  replied that  everyone is  paying for  it. Providence                                                               
Hospital has $11 million in write-offs.                                                                                         
                                                                                                                                
SENATOR  DYSON  said instead  of  everyone  paying through  cost-                                                               
shifting, individual  insurance companies will be  forced to take                                                               
anyone  who  applies  even  with  pre-existing  conditions.  Even                                                               
though everyone  is paying now, it  is still a paradigm  shift to                                                               
go out  there and force  someone in private enterprise  to assume                                                               
this burden.                                                                                                                    
                                                                                                                                
CHAIR  DAVIS said  people  who already  have  insurance won't  be                                                               
affected by the bill.                                                                                                           
                                                                                                                                
SENATOR DYSON  said that according  to the  bill if a  person has                                                               
pre-existing  bad  behavior  and is  unrepentant,  the  insurance                                                               
company has  to take him/her,  which is different than  paying as                                                               
part of a public responsibility.                                                                                                
                                                                                                                                
2:52:02 PM                                                                                                                    
SENATOR THOMAS asked for an interpretation  of lines 30 and 31 on                                                               
page 2.                                                                                                                         
                                                                                                                                
SENATOR  FRENCH said  he  appreciated  the committee's  wrestling                                                               
with the essence  of the bill. Those lines  state the requirement                                                               
that an  individual has to  have a health insurance  policy. This                                                               
is a  topic that's playing  out on a  national level. One  of the                                                               
big  disputes between  Barak Obama  and Hillary  Clinton is  that                                                               
Senator Clinton's  plan has a  mandatory insurance  provision and                                                               
Senator Obama's does not.                                                                                                       
                                                                                                                                
He  believes the  mandatory  requirement has  the  better of  the                                                               
argument.  Universal health  care  is not  achievable by  letting                                                               
healthy adults  out of  the insurance  net. Insurance  works best                                                               
when everyone  participates; that  is the  basic idea  behind it.                                                               
Every human being has a body and  they are going to need a doctor                                                               
sooner or later.  If they  don't have insurance someone else will                                                               
pay when  they get sick  or have an  accident. It is  possible to                                                               
set a  policy for young  healthy adults  and people that  hate to                                                               
pay into  the system  in a  way that fits  their needs  but isn't                                                               
onerous and doesn't cost a lot, more  like a cell phone bill or a                                                               
cable bill.  They chip in to  the system to cover  themselves for                                                               
when they do need it. It's part of the human compact.                                                                           
                                                                                                                                
2:54:41 PM                                                                                                                    
SENATOR  DYSON restated  his concern  about the  person who  is a                                                               
multi-millionaire and has never had  a dime's worth of welfare or                                                               
had   anyone  else   pay   his  bill   and   can  easily   assume                                                               
responsibility for their health care but  would not be able to do                                                               
it under this bill.                                                                                                             
                                                                                                                                
SENATOR  FRENCH said  he'd be  happy to  write an  amendment that                                                               
would excuse the half dozen  multi-millionaires in the state that                                                               
currently don't have insurance if  they're willing to post a bond                                                               
sufficient  to cover  their health  insurance problems  when they                                                               
arise or with the posting of  some financial net worth to satisfy                                                               
the health care board.                                                                                                          
                                                                                                                                
SENATOR DYSON said  he suspected that both he  and Senator French                                                               
were guilty  of demagoguing the  issue. To  him it is  a personal                                                               
liberties issue.  Everyone in the  state being forced to  do this                                                               
because of the worry that  this multimillionaire might run out of                                                               
his wealth and  not be able to pay his  own bills is questionable                                                               
policy.                                                                                                                         
                                                                                                                                
He restated  his question about not  allowing insurance companies                                                               
to opt out of taking people with bad behavior.                                                                                  
                                                                                                                                
SENATOR FRENCH said  the flip side of requiring  every citizen to                                                               
get insurance is to make  insurance available in a meaningful way                                                               
to  every citizen.  If people  who  are overweight  or who  smoke                                                               
can't  be issued  policies the  whole thing  falls apart.  As the                                                               
former  witness stated,  everyone pays  those bills.  If a  drug-                                                               
addicted prostitute  wakes up tomorrow  on the streets  of Juneau                                                               
with HIV, the Juneau hospital will  take her in and care for her,                                                               
and everyone  in the state  is going  to pay those  bills because                                                               
this is  a humane society. The  idea that we would  exclude those                                                               
individuals  from an  insurance policy  because of  the decisions                                                               
they  made is  not  part  of a  humane  society.  He agreed  that                                                               
positive lifestyle choices  should get someone a  cheaper form of                                                               
insurance. Healthy  people who  don't smoke  should pay  less for                                                               
insurance but at  some level every person must be  allowed to buy                                                               
a policy.                                                                                                                       
                                                                                                                                
2:57:27 PM                                                                                                                    
SENATOR ELTON said Senator Dyson  always makes him think. He said                                                               
there's a  model for  forcing rich people  to buy  insurance that                                                               
everyone has become accustomed to  - mandatory auto insurance and                                                               
nobody  has protested  it.  He  asked Senator  French  if he  had                                                               
thought  of his  bill in  terms  of what  is now  done with  auto                                                               
insurance.                                                                                                                      
                                                                                                                                
SENATOR  FRENCH  said the  parallels  are  profound. Some  states                                                               
allow people to  post a $100,000 bond to cover  expenses in a car                                                               
crash. It's  conceivable to write  this kind of an  exception for                                                               
health insurance.                                                                                                               
                                                                                                                                
SENATOR DYSON said he didn't  think they were parallel situations                                                               
because what is  required for car insurance is  liability so that                                                               
other people who might be harmed  are covered. It you could force                                                               
people who  were swapping needles or  body fluids, it would  be a                                                               
parallel  situation. Auto  insurance is  not required  unless the                                                               
car is  driven on public roads  which is why that  analogy breaks                                                               
down. It's a difference between  liability coverage and harm done                                                               
to  others as  opposed to  the damage  one does  to oneself.  The                                                               
system  must reward  individual  responsibility  and institute  a                                                               
downside to irresponsible behavior.                                                                                             
                                                                                                                                
He appreciates having an auto  insurance company that gives him a                                                               
reward  for having  25  years of  accident  free insurance.  He'd                                                               
liked to  have a reward  for having  fire alarms and  a sprinkler                                                               
system in his  house. He'd like to have his  brakes and excellent                                                               
tires  inspected  and  he'd  like  to  be  rewarded  for  prudent                                                               
behavior.  Ultimately this  must be  done with  health insurance.                                                               
His  concern  is  that  the   system  is  so  bastardized.  Frank                                                               
Murkowski talked about having the  tax base pay the hospitals for                                                               
taking care  of the indigent.   Then those who assume  the public                                                               
and  human   responsibility  would  pay  directly.   Instead  the                                                               
hospitals  are  forced  to  do this  perverted  system  of  cost-                                                               
shifting so that they shift the  cost to their profit centers and                                                               
the high  return businesses  like imaging in  order to  cover the                                                               
indigent.  It's a  shell game  that masks  the real  cost.   As a                                                               
result, a  part of the  bill has responsible people  covering the                                                               
indigent. He wished  for legislation that would  at least provide                                                               
a  tax deduction  for this  charitable gift  to the  indigent but                                                               
instead there's a refusal to get at the fundamental issues.                                                                     
                                                                                                                                
3:01:27 PM                                                                                                                    
SENATOR THOMAS asked for clarification  of what premiums would be                                                               
paid by different income levels.                                                                                                
                                                                                                                                
SENATOR FRENCH responded  if this bill passes,  a millionaire who                                                               
doesn't have  insurance should get  a 15 percent reduction  in an                                                               
insurance policy through the clearing  house; they wouldn't get a                                                               
voucher since  they are over  300 percent of the  federal poverty                                                               
limit.                                                                                                                          
                                                                                                                                
3:03:54 PM                                                                                                                    
SENATOR ELTON asked  if the board of the  proposed clearing house                                                               
would  approve  private health  insurance  plans  and not  others                                                               
based on deductibles or services covered.                                                                                       
                                                                                                                                
SENATOR FRENCH  replied yes  and he  envisioned a  plan something                                                               
like the state  has now and the voucher would  get the price down                                                               
to where a working Alaskan could afford it.                                                                                     
                                                                                                                                
3:05:41 PM                                                                                                                    
SENATOR ELTON said  he was intrigued by the list  of services and                                                               
asked what happens  if there is no private insurer  that wants to                                                               
participate.                                                                                                                    
                                                                                                                                
SENATOR  FRENCH replied  he didn't  have the  answer. He  said he                                                               
assumed someone would move into that market.                                                                                    
                                                                                                                                
3:06:32 PM                                                                                                                    
CHAIR DAVIS asked Senator French to explain Amendment 1.                                                                        
                                                                                                                                
                          AMENDMENT 1                                                                                       
                                                                                                                                
     OFFERED IN THE SENATE                    BY SENATOR FRENCH                                                                 
         TO:  CSSB 160(   ), Draft Version "V"                                                                                  
                                                                                                                                
     Page 10, line 23, following "Medicaid":                                                                                    
          Insert "and the potential expansion of the Alaska                                                                     
     Medicaid  program, including  a comparison  between the                                                                    
     costs of expanding the Alaska  Medicaid program and the                                                                    
     cost of  providing benefits  through the  Alaska health                                                                    
     care program"                                                                                                              
                                                                                                                                
SENATOR FRENCH  said Amendment 1  was prompted by  a conversation                                                               
between himself  and the chair  to make  the most of  Medicaid by                                                               
comparing  it to  the  cost of  providing  benefits through  this                                                               
bill. If a huge imbalance was  found, a push could be made toward                                                               
Medicaid.                                                                                                                       
                                                                                                                                
3:08:42 PM                                                                                                                    
SENATOR ELTON moved to adopt Amendment 1, labeled 25-LS0728\V.1.                                                                
There being no objection, the motion carried.                                                                                   
                                                                                                                                
He said this amendment adds  a requirement to report on something                                                               
that makes sense. It does  not require action by the legislature,                                                               
but provides information  upon which a decision could  be made in                                                               
the future.                                                                                                                     
                                                                                                                                
SENATOR  DYSON  said  that most  providers  argue  that  Medicaid                                                               
reimbursement  rates  are significantly  less  than  the cost  of                                                               
providing  the  service  and  that's  why  indigent  people  have                                                               
difficulty finding  someone to provide  the service. He  asked if                                                               
it's possible  for the  state to reimburse  the provider  for the                                                               
difference between the Medicaid rate and the actual cost.                                                                       
                                                                                                                                
3:11:19 PM                                                                                                                    
SENATOR ELTON moved to report committee substitute for SB 160,                                                                  
as amended, from committee with individual recommendations and                                                                  
attached fiscal note(s).                                                                                                        
                                                                                                                                
SENATOR DYSON objected.                                                                                                         
                                                                                                                                
A roll call vote was taken. Senators Elton, Thomas, Davis voted                                                                 
yea; and Senator Dyson voted nay; so CSSB 160(HES) moved from                                                                   
committee.                                                                                                                      
                                                                                                                                
There being no further business to come before the committee,                                                                   
Chair Davis adjourned the meeting at 3:13:32 PM.                                                                              

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