Legislature(1995 - 1996)
02/15/1996 01:34 PM Senate L&C
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SENATE LABOR AND COMMERCE COMMITTEE
February 15, 1996
1:34 P.M.
MEMBERS PRESENT
Senator Tim Kelly, Chairman
Senator John Torgerson, Vice Chairman
Senator Judy Salo
MEMBERS ABSENT
Senator Mike Miller
Senator Jim Duncan
COMMITTEE CALENDAR
SENATE BILL NO. 193
"An Act requiring insurance coverage for certain costs of birth;
and providing for an effective date."
SENATE BILL NO. 197
"An Act prohibiting increases in health insurance premiums if the
insured is a victim of domestic violence."
SENATE BILL NO. 254
"An Act relating to expert advisory panels in medical malpractice
litigation and the definition of health care provider for medical
liability."
PREVIOUS SENATE COMMITTEE ACTION
SB 193 - No previous action to consider.
SB 197 - No previous action to consider.
SB 254 - No previous action to consider.
WITNESS REGISTER
Brian Gilbert, Administrator
P.O. Box 288
Wrangell, AK 99929
POSITION STATEMENT: Supported SB 193.
Gordon Evans
Health Insurance Association of America
318 4th St.
Juneau, AK 99801
POSITION STATEMENT: Opposed SB 193 and SB 197.
Carol Clausson, member
Alaska Nurses Association
Anchorage, AK
POSITION STATEMENT: Supported SB 193.
Pat Senner
Anchorage, AK
POSITION STATEMENT: Supported SB 193.
Veleta Murphy
Infant Learning Specialist
Tanana Chiefs
122 1St Ave.
Fairbanks, AK 99701
POSITION STATEMENT: Supported SB 193.
Don Koch, Marketing Surveillance
Division of Insurance
Department of Commerce and Economic Development
P.O. Box 110805
Juneau, Ak 99811-0805
POSITION STATEMENT: Supported SB 193.
Senator Dave Donley
State Capitol Bldg.
Juneau, AK 99801-1182
POSITION STATEMENT: Sponsor of SB 197.
John George
American Counsel of Life Insurance
National Association of Independent Insurers
3328 Fritz Cove Rd.
Juneau, AK 99801
POSITION STATEMENT: Commented on SB 197.
Marcia McKenzie, Program Coordinator
Counsel on Domestic Violence and Sexual Assault (CDVSA)
P.O. Box 111200
Juneau, AK 99811-1200
POSITION STATEMENT: Supported SB 197.
Marianne Burke, Director
Division of Insurance
Department of Commerce and Economic Development
P.O. Box 110805
Juneau, AK 99811-0805
POSITION STATEMENT: Supported SB 197.
Susan Cox, Chief Assistant Attorney General
Civil Division
Department of Law
P.O. Box 110300
Juneau, AK 99811-0300
POSITION STATEMENT: Supported SB 254.
Sherman Ernouf, Legislative Aide
% Senator Tim Kelly
State Capitol Bldg.
Juneau, AK 99801-1182
POSITION STATEMENT: Commented on SB 258.
ACTION NARRATIVE
TAPE 96-12, SIDE A
Number 001
SL&C 2/15/96
SB 193 MANDATORY INSURANCE FOR COSTS OF BIRTH
CHAIRMAN KELLY called the Senate Labor and Commerce Committee
meeting to order at 1:34 p.m. and announced SB 193 to be up for
consideration.
SENATOR SALO, sponsor of SB 193, said she introduced it because a
Kenai constituent called her after the birth of her third child and
said her insurance company would only allow her to stay in the
hospital 24 hours following the birth.
SENATOR SALO said she found that this is an increasing problem
across the United States, although it's just emerging in Alaska.
She followed the guidelines for the American Academy of Obstetrics
and Gynecology and the AMA who recommend that 48 hours is a much
more appropriate amount of time to be allowed.
The trend down south has been to reduce hospital time because of
HMO's. She wanted to alter the statutes relative to health
insurance rather than health care by saying 48 hours for a normal
vaginal birth or 96 hours in the case of a cesarian. She
emphasized this is not mandating a longer hospital stay, but is
rather saying that amount of coverage would be available should the
health care provider and the patient deem it is necessary.
SENATOR SALO said in Alaska, unlike in some other states, she did
not want to mandate follow-up care and home visits, given the wide
variety of health care within the State.
One of the reasons health care providers have been interested in
this legislation is because in Alaska we have many women who fly to
a central area, like Bethel or Nome, to have child and they many be
ready for discharge from a hospital, but they may not be ready to
travel immediately. Another reason for more time being allowed is
even with a normal vaginal birth, there is great variance in how
much time is needed afterwards. For the newborn more time is even
more important in some cases, PKU tests for example, which aren't
effective unless the blood is drawn 24 hours after birth.
BRIAN GILBERT, Administrator, Wrangell General Hospital, commented
that we have reached a point in health care, where we're allowing
insurance companies to make decisions for the physician and
patient. He said they have a lot of people coming into Wrangell to
have babies and the first day is usually the most expensive day.
They usually keep the mother and the baby in the hospital another
24 hour period, usually just a room and board charge, and then just
"eat the bill" if people can't pay.
GORDON EVANS, Health Insurance Association of America, said they
oppose mandatory coverage for maternity stays because they believe
that patients and their physicians and not the government can best
determine when a mother and her newborn are ready to leave the
hospital safely. The Legislature should not be making medical
decisions or embodying such decisions in law. State and federal
regulations already exist to assure quality health care. State
mandated benefits always drive up costs and ultimately limit access
to quality care.
MR. EVANS said that health plans right now do not discharge mothers
and newborns until they are medically ready to leave. He suggested
that this bill could be amended to provided that the doctor has the
ability to discharge a patient earlier if that is proper and the
patient concurs.
Number 173
SENATOR SALO responded that was the content of the proposed
amendment and is also the content of the bill. The insurance part
of the bill simply says that the care has to be offered to the
person, not that it has to be used. This bill does not require
mandatory coverage and the proposed amendment clarifies that.
Number 209
SENATOR SALO said part of the problem stems from the fact that
hospitals have different discharge policies. Some hospitals
discharge at noon, for instance, and the baby was born at 4:00 a.m.
If it's a strict 24 hour rule, you get only eight hours before you
have to leave the hospital.
MR. EVANS responded that some people think the hospitals are
driving this legislation because of the number of beds they have to
fill.
CAROL CLAUSSON, registered nurse and member of the Alaska Nurses
Association, supported SB 193. There are problems associated with
early discharge of mothers after the birth of their child. These
include mothers not being able to get infants to breast feed
properly and therefore shifting to formula, mothers not
understanding the teaching that is given to them in the hospital
because it occurs too soon after the birth of the child, and
infants are developing problems like jaundice, weight loss, and
infection which are not identified quickly because they have been
discharged.
Even nurses have difficulty in getting newborns to nurse properly.
Having a baby is a major change and young families in Alaska
frequently lack extended family to help with this change. They
feel patients should have the option of a 48 hour hospital stay
and/or home visits by a maternal child nurse or lactation nurse.
PAT SENNER, mother of three children, added that when you have a
two year old at home, it's very helpful to have the extra day to
recuperate and have that time alone with the new infant before you
have to go home and assume your duties there.
Number 250
VELETA MURPHY, Infant Learning Specialist, supported SB 193 saying
they have a lot of new mothers who are being sent away after 24
hours and they have not had time for bonding and to learn feeding
skill. She said if they don't have time with the parent or child
they can not identify skills they need that they can provide for
them. She knew of babies who would have been much healthier if
they had another 24 hours in the hospital so someone could notice
their problem.
Number 280
DON KOCH, Division of Insurance, said they support this
legislation. He had two technical suggestions. On page 1, lines 12
- 13 where there is a reference to the federal statute (ARISA)
which includes self insured plans, but his Division has no
jurisdiction over those. He wanted it clear that this deals with
insured plans.
SENATOR SALO replied that she understood the Division's inability
to control self-insured plans, but she has the same concern for
mothers who are employed under one of those plans and she
understands that a lot of people in Alaska are. She asked what
legal problems we face with the inclusion. MR. KOCH explained that
Chapter 42 deals with insurance contracts and since a self insurer
doesn't technically have an insurance contract this will be a piece
of language that sits out there intending to do a purpose which it
doesn't do. If they create the perception that this is reaching
self insured plans when it really doesn't, that tends to mislead
people into thinking that some protection is there when it isn't.
MR. KOCH's second concern was on page 2, lines 4 and 5 dealing with
nursing home administrators. If the intent is to reach entitlement
plans, this statute, since it deals with insurance contracts,
doesn't accomplish that. If it's dealing with an insured plan,
subsection 1 already takes care of that.
SENATOR SALO said that her preference would be to leave it alone,
because she didn't hear there was some catastrophic problem caused
by it being there.
She said the first amendment inserts a new subsection, "except as
otherwise required to provide coverage specified under A of this
section." This section does not affect a payment arrangement
entered into between the hospital or physician and an insurer.
There is no intent to interfere with the way hospitals and
insurance companies deal with each other in terms of business. It
is common practice with some insurance companies to have a flat
rate they use as reimbursement for a pregnancy. That rate is
subject to negotiation between the hospital and the insurer.
SENATOR SALO moved to adopt amendment 1. There were no objections
and it was so ordered.
SENATOR SALO said amendment 2 simply makes it crystal clear the
bill is not mandating an hospital stay.
SENATOR SALO moved to adopt amendment 2. There were no objections
and it was so ordered.
Number 367
SENATOR SALO moved to pass SB 193 (am) from Committee with
individual recommendations. There were no objections and it was so
ordered. #
SL&C 2/15/96
SB 197 INSURANCE FOR DOMESTIC VIOL. VICTIMS
SENATOR KELLY announced SB 197 to be up for consideration.
SENATOR DONLEY, sponsor of SB 197, said it prohibits discrimination
against victims of domestic violence in medical insurance matters.
It is a national trend and ten other states have adopted similar
legislation; it is also pending in Congress.
The proposed CS expands the protections in the original bill to
include cancellation, denial, increasing premiums, and refusal to
issue a new premium.
Number 402
GORDON EVANS, Health Insurance Association of America, opposed SB
197 that requires health insurers presumptively to ignore physical
or mental conditions attributable to domestic violence.
Underwriting should not depend on a condition's underlying cause,
but rather on the physical and mental condition of the patient at
the time of application regardless of the underlying cause.
Coverage of injuries or conditions resulting from domestic abuse or
violence should be subject to the same conditions, limitations,
exclusions, deductibles, and co-payments applied to any other
injury or condition.
They have no objection that prohibits the use of specific
exclusions or benefit caps for claims resulting from domestic
violence or legislation that prohibits questions on applications
that are designed specifically to elicit evidence of domestic
violence or abuse.
MR. EVANS reiterated that they believe that contractual limitations
such as waiting periods for preexisting conditions or that which is
proposed in this bill should relate to the person's physical or
mental condition at the time of application regardless of the
condition's underlying cause.
Number 430
JOHN GEORGE, American Counsel of Life Insurance and National
Association of Independent Insurers, said he wasn't concerned with
the bill as amended. This could potentially carry on to life
insurance, automobile insurance, home owners, etc. An insurer
likes to underwrite based on the conditions at the time of
application.
MARSHA MCKENZIE, Program Coordinator for the Counsel on Domestic
Violence and Sexual Assault, strongly supported SB 197. Although
there doesn't seem to be a real problem with insurance related to
domestic violence, here it is an issue in the lower 48. Passage of
this bill will help to protect victims in Alaska.
In 1994 an informal survey done by a subcommittee of the U.S. House
Judiciary Committee showed that eight of the 16 largest insurers in
the country were using domestic violence as a factor in deciding
whether to issue insurance and how much to charge for it. Since
insurers in the past haven't been required to tell why they are
being denied, victims or former victims might not know why they are
being denied coverage. Knowing insurance might be denied could
stop victims from getting medical attention they need.
MARIANNE BURKE, Director, Division of Insurance, testified in favor
of the bill. She said there is one word in this bill that is
absolutely critical and is the bill's major strength. That word is
"only." The fact that a person is a victim of domestic violence
should not be reason to deny a claim, deny coverage, cancel
coverage, or increase the premium for the coverage. If the person
has other medical problems, they would still be considered as they
have been in the past.
SENATOR KELLY said since the committee substitute is considerably
different from the original bill, he would let it circulate and
bring it up again at next Tuesday's meeting.
SENATOR SALO said she assumed Senator Donley's concern mostly has
to do with insurance companies canceling victims of domestic
violence more as a preventative measure than the question hovering
of pre-existing conditions. SENATOR DONLEY said the committee
substitute avoids the pre-existing condition issue on page l, line
9 by inserting that it would be the "only" prohibition.
SL&C 2/15/96
SB 254 MEDICAL MALPRACTICE: PANEL & DEFINITIONS
SENATOR KELLY announced SB 254 to be up for consideration.
SUSAN COX, Department of Law, said there are two purposes to this
bill which clarifies what they believe to be existing law.
However, they have found sometimes that when a suit is filed
against a health care provider, and the State is the defendant the
question arises whether the malpractice action can or should be
referred to an expert advisory panel. Present statute, AS 955.536
as currently worded does not distinguish between cases brought
against governmental entities or others. In most cases the court
has referred these cases to an expert advisory panel. So they
believe sections two and three merely clarify existing law so the
issue does not have to basically waste time being argued in court.
There has been one time when the court has refused to send a
malpractice case to an expert advisory panel simply on the basis
that the State was named as a defendant - although the case did
involve malpractice.
Section 4 would revise the definition of health care provider.
Initially they sought to include physician assistant in the
definition. They get occasional malpractice cases brought against
the Department of Corrections where care is often provided by
physician assistants. There is a question of whether those
malpractice actions can be referred to an expert advisory panel.
The definition is now extremely broad, but for some reason
physician assistants are not included.
SENATOR SALO moved to pass SB 254 from Committee with individual
recommendations. There were no objections and it was so ordered.
SENATOR KELLY noted that there was a $0 fiscal note and it has
additional referrals to the Judiciary and Finance Committees.
SL&C 2/15/96
SB 258 TRUSTS & PROPERTY TRANSFERS IN TRUST
SENATOR KELLY announced SB 258 to be up for consideration.
SHERMAN ERNOUF, Legislative Aide to Senator Kelly, explained that
the proposed committee substitute conforms this bill to the House
bill. It allows national banks to be recognized in the definition
and allows the property to be managed by Alaskans only.
SENATOR KELLY stated they have heard no opposition to this bill.
The Alaska Banking Industry does support this bill.
SENATOR TORGERSON moved to adopt the CS to SB 258. There were no
objections and it was so ordered.
SENATOR TORGERSON moved to pass CSSB 258 from Committee with
individual recommendations. There were no objections and it was so
ordered.
SENATOR KELLY adjourned the meeting at 2:20 p.m.
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