Legislature(1993 - 1994)
04/14/1993 01:40 PM Senate HES
| Audio | Topic |
|---|
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
SENATE HEALTH, EDUCATION AND SOCIAL SERVICES COMMITTEE
April 14, 1993
1:40 p.m.
MEMBERS PRESENT
Senator Steve Rieger, Chairman
Senator Bert Sharp, Vice-Chairman
Senator Loren Leman
Senator Mike Miller
Senator Jim Duncan
Senator Johnny Ellis
Senator Judy Salo
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
SPONSOR SUBSTITUTE FOR SENATE BILL NO. 114
"An Act establishing the Alaska Health Care Authority;
relating to the delivery, quality, access, and financing of
health care; requiring the establishment of health care
expenditure limits; relating to approval of disability
insurance rates; relating to the issuance of certificates of
need; relating to health insurance for small employers; and
providing for an effective date."
SENATE BILL NO. 123
"An Act relating to civil actions; and providing for an
effective date."
HB 97 (PARENTAL CARE FOR CHILD IN STATE CUSTODY) was
scheduled, but not heard this date.
HJR 30 (QUARANTINE SERVICES AT PORTS OF ENTRY) was scheduled,
but not heard this date.
PREVIOUS SENATE COMMITTEE ACTION
SB 114 - No previous action to record.
SB 123 - No previous action to record.
HB 97 - No previous action to record.
HJR 30 - No previous action to record.
WITNESS REGISTER
Senator Jim Duncan
State Capitol
Juneau, AK 99801-1182
POSITION STATEMENT: Prime Sponsor of SSSB 114
Mary Lou Meiners, Chair
State Legislative Committee
American Association of Retired Persons
P.O. Box 20412
Juneau, AK 99802
POSITION STATEMENT: Testified in support of SSSB 114
Karen Perdue
Fairbanks, AK
POSITION STATEMENT: Supports SSSB 114
Dr. Rodman Wilson
6234 Tanaina Drive
Anchorage, AK 99502
POSITION STATEMENT: Supports SSSB 114
ACTION NARRATIVE
TAPE 93-36, SIDE A
Number 001
CHAIRMAN RIEGER called the Senate Health, Education and Social
Services (HESS) Committee to order at 1:40 p.m. He then
brought SSSB 114 (STATE HEALTH RESOURCES AUTHORITY) and SB 123
(CIVIL LIABILITY: MEDICAL MALPRACTICE) before the committee,
stating that both pieces of legislation were the
recommendations of the Health Resources and Access Task Force.
SENATOR DUNCAN, prime sponsor of SSSB 114, said the two pieces
of legislation are the health care reform proposals
recommended by the task force that worked over the past two
years. They are designed to bring about a comprehensive
reform plan to bring health care costs under control, as well
as to provide universal access of health care to Alaskans.
The task force made recommendations that centered around cost
containment, improvements in the access and service delivery
system, as well as medical malpractice reforms.
Senator Duncan noted that SSSB 114 contains one provision that
does not appear in the task force recommendations, which is
the requirement that there be a comprehensive long-term care
plan developed. He believes the development of a
comprehensive long-term care plan is an important component
of comprehensive reform of the state's health care system.
Senator Duncan said basic health care is not available to all
Alaskans. The task force concluded that there are
approximately 76,000 non-elderly, non-native Alaskans who have
no health care coverage. About 21,000 of that 76,000 are
under the age of 18 and it is a serious problem for these
young people. The task force also found that nearly nine out
of ten Alaskans without health care coverage are "working
uninsured" and their dependents.
Senator Duncan said the rising cost of health care and health
insurance in Alaska is one of the most critical problems
facing the state. It is projected that if the inflationary
trends continue unabated, in ten years Alaskans will pay $5.6
billion annually for health care services, up from the $1.5
billion in 1991. Enactment of meaningful health care reform
as contained in SB 114 will significantly reduce the rate of
increase and provide access to health care for more Alaskans,
he stated.
Number 100
Senator Duncan explained that SB 114 establishes the Alaska
Health Care Authority to manage the health care cost
containment and access initiatives proposed by the task force.
Some of the specific duties of the Authority will be to:
design and establish a statewide health care expenditure
limit; establish state sponsored health insurance pooling
arrangements; and design a single-payer health care financing,
uniform billing and claims system.
Senator Duncan outlined the following reasons why the task
force concluded that the single payer approach was preferable:
(1) The current mix of public, employer, and individual
financing inevitable creates coverage gaps for some people,
particularly when their employment status changes.
(2) Health care financing plans that require all
businesses to provide health care benefits, or that levy
additional taxes on employers who do not provide benefits, may
threaten the economic viability of many small businesses in
Alaska.
(3) Multiple-payer systems would not necessarily address
the problems of cost shifting that exist in our current
system, and
(4) Systems that are built upon existing public-private
financing arrangements can be expected to inherit the
inefficiencies of those systems.
The task force has recommended that until universal access is
attained, interim steps be taken to provide increased health
care access to unserved or underserved groups through the
following statutory changes which are included in SB 114:
(1) General reform of the small employer health
insurance market to prevent abusive rating practices, require
disclosure of rating practices, regulate policy renewal, and
limit exclusion of preexisting medical conditions.
(2) Phase in a community rating system for establishing
premiums in the small group insurance market, and
(3) Implement publicly subsidized coverage of uninsured
low-income pregnant women and children who are not eligible
for Medicaid.
Number 200
Addressing SB 123, Senator Duncan explained that it includes
a recommendation made by the task force which reduces the
statute of limitations for birth-related injuries from the
current law up to the eighth birthday of the child. It also
includes the recommendation by the task force that the state's
existing pretrial screening process for medical malpractice
suits be replaced with a court ordered non-binding arbitration
process. Further, it recommends that there be a change in the
level of prejudgment interest charged in medical malpractice
cases from the 10.5 percent, which is currently in statute,
to the prevailing interest rate.
Senator Duncan added that as the task force was doing its work
there was a lot of interest and concern, especially among the
provider community, to try to put everything into one piece
of legislation, but the attorneys advised that those two items
could not be rolled together because of the violation of the
single subject rule. He noted that the effective dates on
both bills have been tied together so that they go through as
a package and not as individual pieces of legislation.
Number 241
CHAIRMAN RIEGER commented that as the committee moves into the
health care issue, there are several other approaches that he
believes are important for the committee to have before it to
have the benefit of seeing what the various approaches are.
Number 275
SENATOR LEMAN noted that SB 161 (INTEREST RATES:
JUDGMENTS/TAXES/ROYALTIES) also relates to both prejudgment
interest and postjudgment interest, and he is hopeful that it
will pass this session.
Number 307
SENATOR ELLIS, Co-chair of the Health Resources and Access
Task Force, commented that one of the most startling things
he learned during the approximately 18 months of the task
force's work is that competition can be a startling success
in some facets of health care reform and can be an incredible
nightmare in other areas, that market forces are extremely
distorted in this arena. He also noted that so much of what
is read about the national debate on health care is not
applicable to the State of Alaska and, in the task force work,
they found just how different Alaska is from most other
states.
Number 365
MARY LOU MEINERS, Chairperson for the State Legislative
Committee for the American Association of Retired Persons,
stated their organization advocates the creation of an Alaska
health care plan which includes comprehensive long-term care
that provides for a continuum of home, community and
institutional services.
In the interest of achieving these reforms, AARP advocates:
(1) The creation of an authority to manage the access,
delivery, quality, planning and financing of health care in
Alaska, and establish a voluntary health care procurement and
financing tool to maximize the purchasing power for state and
local governments and political subdivisions, for state
residents who uninsured and underinsured and for public and
small employer plans.
(2) The collection and analysis of state health care
utilization and data cost.
(3) The expanding, monitoring and certifying of
facilities expansion and substantial equipment technology
purchases to assure the need and eliminate duplication of
unnecessary expenses which would require certificate of
statutes now in place.
(4) Promoting health awareness, preventative medicine
and quality health care for all state residents.
(5) Providing quality, affordable health care access for
underinsured and uninsured Alaska residents.
(6) Continuing evaluation of the effect of federal
program changes and maximizing the use of federal funds.
(7) Promoting health care professional training and
retention in Alaska, and developing a program for recruitment
of health care professionals.
(8) Developing a way for the sole proprietor and small
employer to provide health coverage to employees and to their
dependents.
(9) Continuing to evaluate alternative and self-funding
as the option for state employees' and retirees' plans, and
(10) Formation of a cross-section focus task force to
continue to study and make recommendations to assure quality,
affordable health care for all Alaskans.
Number 432
KAREN PERDUE, a former Health Resources & Access Task Force
member who is currently in private business with her husband
in Fairbanks, said they are being saddled with costs for
health care insurance that are unbelievable, so her interest
in this subject has changed over time to understanding the
needs of people who are having an ongoing problem managing the
cost of health care premiums in Alaska.
Ms. Perdue said over the past four or five years there has
been a tremendous amount of activity at the state level to
explore what's right for certain states, and there have been
two categories of things that have been done: some states
have moved forward with their own plans, such as the State of
Washington and the State of Oregon; and there have been states
who have chosen to wait for the federal government to come
forward with their plan, and Alaska is in the later plan.
Ms. Perdue cautioned that Alaska really needs to start
thinking about what kinds of plans it is going to make for the
day that the Clinton Administration releases its plan. She
said there are some good experts in the state system, but we
are not organized in a way to fully analyze some of the
proposals that will be coming down from the federal
government. She stressed that the health care authority would
provide the state with the tool to do that.
Number 485
DR. RODMAN WILSON, a retired internist living in Anchorage and
a member of the Health Resources and Access Task Force, said
his main criticism of the task force report and SSSB 114 is
that it emphasizes the primacy of cost, which he agrees with,
but it doesn't stress access quite enough.
Mr. Wilson also stressed that the state needs to be ready to
respond to what will be coming from Washington, D.C., and the
more sound proposals that are on the table for discussion, the
better. It is his hope that something can be fashioned that
is a hybrid between SSSB 114 and the CHIPRA bill (HB 273).
Mr. Wilson also noted that the Clinton Administration is
talking about doing away with Medicaid and incorporating it
into state plans, which is something that could be part of
either SB 114 or HB 273 or an amalgamation of those issues.
Number 562
CHAIRMAN RIEGER commented that one of reasons that managed
competition seems like an interesting idea is that it seems
to address some of the principles which make sense. He said
if there is going to be a health care policy of some sort, it
is necessary to guard against adverse selection. Without
mandatory participation, there is always the possibility of
adverse selection and the healthy people end up being insured
and the others are left out. The high risk pool tends to
become higher and higher risk as the dynamics of the system
work themselves through.
Chairman Rieger said there are number of other medical issues
that should be addressed such as the philosophy of treating
illness rather than prevention, high markups for distribution
of health care, tort law, as well as reviewing some of the
things that the State of Oregon has addressed.
TAPE 93-36, SIDE B
Number 012
CHAIRMAN RIEGER said it was his intention to have the CHIPRA
measure introduced and before the committee, as well as other
proposals before the committee for its consideration.
There being no further business to come before the committee,
the meeting was adjourned at 2:27 p.m.
| Document Name | Date/Time | Subjects |
|---|