02/18/2008 01:30 PM Senate HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| SB117 | |
| SB160 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| + | SB 117 | TELECONFERENCED | |
| = | SB 160 | ||
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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