04/14/2011 02:00 PM Senate LABOR & COMMERCE
| Audio | Topic |
|---|---|
| Start | |
| HB164 | |
| SB74 | |
| SB119 | |
| HB188 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| += | SB 74 | TELECONFERENCED | |
| + | SB 119 | TELECONFERENCED | |
| += | HB 164 | TELECONFERENCED | |
| += | HB 188 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
SENATE LABOR AND COMMERCE STANDING COMMITTEE
April 14, 2011
2:03 p.m.
MEMBERS PRESENT
Senator Dennis Egan, Chair
Senator Joe Paskvan, Vice Chair
Senator Linda Menard
Senator Bettye Davis
Senator Cathy Giessel
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
COMMITTEE SUBSTITUTE FOR HOUSE BILL NO. 164(FIN)
"An Act relating to health care insurance, exemption of certain
insurers, reporting, notice, and record-keeping requirements for
insurers, biographical affidavits, qualifications of alien
insurers assuming ceded insurance, risk-based capital for
insurers, insurance holding companies, licensing, federal
requirements for nonadmitted insurers, surplus lines insurance,
insurance fraud, life insurance policies and annuity contracts,
rate filings by health care insurers, long-term care insurance,
automobile service corporations, guaranty fund deposits of a
title insurer, joint title plants, fraternal benefit societies,
multiple employer welfare arrangements, hospital and medical
service corporations, health maintenance organizations, and
alternate forms of payment to policyholders; and providing for
an effective date."
- MOVED SCS CSHB 164(L&C) OUT OF COMMITTEE
SENATE BILL NO. 74
"An Act requiring insurance coverage for autism spectrum
disorders, describing the method for establishing a covered
treatment plan for those disorders, and defining the covered
treatment for those disorders; and providing for an effective
date."
- MOVED SB 74 OUT OF COMMITTEE
SENATE BILL NO. 119
"An Act relating to the licensing and regulation of athletic
trainers."
- MOVED CSSB 119(L&C) OUT OF COMMITTEE
HOUSE BILL NO. 188
"An Act relating to the interest that may be charged by express
agreement."
- MOVED HB 188 OUT OF COMMITTEE
PREVIOUS COMMITTEE ACTION
BILL: HB 164
SHORT TITLE: INSURANCE: HEALTH CARE & OTHER
SPONSOR(s): LABOR & COMMERCE
02/18/11 (H) READ THE FIRST TIME - REFERRALS
02/18/11 (H) L&C, FIN
02/21/11 (H) L&C AT 3:15 PM BARNES 124
02/21/11 (H) Heard & Held
02/21/11 (H) MINUTE(L&C)
02/23/11 (H) L&C AT 3:15 PM BARNES 124
02/23/11 (H) Heard & Held
02/23/11 (H) MINUTE(L&C)
02/28/11 (H) L&C AT 3:15 PM BARNES 124
02/28/11 (H) Scheduled But Not Heard
03/07/11 (H) L&C AT 3:15 PM BARNES 124
03/07/11 (H) Moved CSHB 164(L&C) Out of Committee
03/07/11 (H) MINUTE(L&C)
03/09/11 (H) L&C RPT CS(L&C) NT 4DP 2NR
03/09/11 (H) DP: THOMPSON, HOLMES, MILLER, OLSON
03/09/11 (H) NR: CHENAULT, JOHNSON
03/09/11 (H) L&C AT 3:15 PM BARNES 124
03/09/11 (H) <Bill Hearing Canceled>
03/22/11 (H) FIN AT 1:30 PM HOUSE FINANCE 519
03/22/11 (H) Heard & Held
03/22/11 (H) MINUTE(FIN)
03/30/11 (H) FIN AT 1:30 PM HOUSE FINANCE 519
03/30/11 (H) Scheduled But Not Heard
04/06/11 (H) FIN AT 1:30 PM HOUSE FINANCE 519
04/06/11 (H) Moved CSHB 164(FIN) Out of Committee
04/06/11 (H) MINUTE(FIN)
04/07/11 (H) FIN RPT CS(FIN) NT 3DP 6NR 1AM
04/07/11 (H) DP: GARA, HAWKER, DOOGAN
04/07/11 (H) NR: GUTTENBERG, T.WILSON, JOULE,
COSTELLO, EDGMON, STOLTZE
04/07/11 (H) AM: FAIRCLOUGH
04/08/11 (H) TRANSMITTED TO (S)
04/08/11 (H) VERSION: CSHB 164(FIN)
04/11/11 (S) READ THE FIRST TIME - REFERRALS
04/11/11 (S) L&C
04/12/11 (S) L&C AT 2:00 PM BELTZ 105 (TSBldg)
04/12/11 (S) Heard & Held
04/12/11 (S) MINUTE(L&C)
04/14/11 (S) L&C AT 2:00 PM BELTZ 105 (TSBldg)
BILL: SB 74
SHORT TITLE: INS. COVERAGE: AUTISM SPECTRUM DISORDER
SPONSOR(s): ELLIS
01/28/11 (S) READ THE FIRST TIME - REFERRALS
01/28/11 (S) HSS, L&C
03/30/11 (S) HSS AT 1:30 PM BUTROVICH 205
03/30/11 (S) Moved SB 74 Out of Committee
03/30/11 (S) MINUTE(HSS)
04/01/11 (S) HSS RPT 4DP 1AM
04/01/11 (S) DP: DAVIS, MEYER, ELLIS, EGAN
04/01/11 (S) AM: DYSON
04/12/11 (S) L&C AT 2:00 PM BELTZ 105 (TSBldg)
04/12/11 (S) Scheduled But Not Heard
04/14/11 (S) L&C AT 2:00 PM BELTZ 105 (TSBldg)
BILL: SB 119
SHORT TITLE: ATHLETIC TRAINER LICENSING
SPONSOR(s): MEYER
04/01/11 (S) READ THE FIRST TIME - REFERRALS
04/01/11 (S) HSS, L&C
04/11/11 (S) HSS AT 1:30 PM BUTROVICH 205
04/11/11 (S) Moved CSSB 119(HSS) Out of Committee
04/11/11 (S) MINUTE(HSS)
04/12/11 (S) HSS RPT CS 4DP NEW TITLE
04/12/11 (S) DP: DAVIS, MEYER, EGAN, DYSON
04/12/11 (S) FIN REFERRAL ADDED AFTER L&C
04/14/11 (S) L&C AT 2:00 PM BELTZ 105 (TSBldg)
BILL: HB 188
SHORT TITLE: INTEREST RATES
SPONSOR(s): LABOR & COMMERCE
03/10/11 (H) READ THE FIRST TIME - REFERRALS
03/10/11 (H) L&C
03/23/11 (H) L&C RPT 6DP
03/23/11 (H) DP: CHENAULT, THOMPSON, SADDLER,
HOLMES, MILLER, JOHNSON
03/23/11 (H) L&C AT 3:15 PM BARNES 124
03/23/11 (H) Moved Out of Committee
03/23/11 (H) MINUTE(L&C)
03/30/11 (H) TRANSMITTED TO (S)
03/30/11 (H) VERSION: HB 188
04/01/11 (S) READ THE FIRST TIME - REFERRALS
04/01/11 (S) L&C
04/12/11 (S) L&C AT 2:00 PM BELTZ 105 (TSBldg)
04/12/11 (S) Scheduled But Not Heard
04/14/11 (S) L&C AT 2:00 PM BELTZ 105 (TSBldg)
WITNESS REGISTER
REPRESENTATIVE OLSON
Alaska State Legislature
Juneau, AK
POSITION STATEMENT: Sponsor of HB 164.
LINDA HALL, Director
Division of Insurance,
Department of Commerce, Community and Economic Development
(DCCED)
Juneau, AK
POSITION STATEMENT: Supported HB 164 and had no position on SB
74.
AMORY LELAKE
Staff to Senator Ellis
Alaska State Legislature
Juneau, AK
POSITION STATEMENT: Commented on SB 74 for the sponsor.
REPRESENTATIVE PETERSEN
Alaska State Legislature
Juneau, AK
POSITION STATEMENT: Sponsor of companion bill to SB 74, HB 79.
TONJA UPDIKE, member
Governor's Council on Disabilities and Special Education
State of Alaska
POSITION STATEMENT: Strongly supported SB 74.
MILLIE RYAN, Executive Director
Governor's Council on Disabilities and Special Education
POSITION STATEMENT: Strongly supported SB 74.
LEN SORREN, Legislative Affairs Group
BlueCross/BlueShield of Alaska
POSITION STATEMENT: Had concerns with SB 74.
LORRI UNUMB, counsel
National Office of Autism Speaks
State of South Carolina
POSITION STATEMENT: Strongly supported SB 74.
MARC LAMBRIGHT, principal and consulting actuary
Oliver Wyman Actuarial Consulting
POSITION STATEMENT: Opposed SB 74.
KARA THRASHER LIVINGSTON, representing herself
No address provided
POSITION STATEMENT: Supported SB 74.
DEBBIE THOMPSON, Executive Director
Alaska Nurses Association
POSITION STATEMENT: Supported SB 74.
LINDA ROBERTSON, business partner
Step-In Autism Services of Alaska
Fairbanks, AK
POSITION STATEMENT: Supported SB 74.
EMILY ICE, business partner
Step-In Autism Services of Alaska
Fairbanks, AK
POSITION STATEMENT: Supported SB 74.
SENATOR KEVIN MEYER
Alaska State Legislature
Juneau, AK
POSITION STATEMENT: Sponsor of SB 119.
CHRISTINE MARASEGAN
Staff to Senator Meyer
Alaska State Legislature
Juneau, AK
POSITION STATEMENT: Explained SB 119 for the sponsor.
BRENDA SHELDON, President
Alaska Athletic Trainers Association (AATA)
POSITION STATEMENT: Supported SB 119.
KONRAD JACKSON
Staff to Representative Olson
Alaska State Legislature
Juneau, AK
POSITION STATEMENT: Presented HB 188.
GLENDA SEEKEN
Alaska Association of Realtors
POSITION STATEMENT: Supported HB 188.
ACTION NARRATIVE
2:03:12 PM
CHAIR DENNIS EGAN called the Senate Labor and Commerce Standing
Committee meeting to order at 2:03 p.m. Present at the call to
order were Senators Paskvan, Menard, Giessel, and Egan.
HB 164-INSURANCE: HEALTH CARE & OTHER
2:04:17 PM
CHAIR EGAN announced HB 164 to be up for consideration [CSHB
164(FIN) was before the committee].
REPRESENTATIVE OLSON, sponsor of HB 164, came forward to answer
questions.
SENATOR GIESSEL asked if section 79 was removed.
2:05:24 PM
LINDA HALL, Director, Division of Insurance, Department of
Commerce, Community and Economic Development (DCCED), said the
CS did not delete section 79, but it does make a change in it.
SENATOR PASKVAN moved to adopt SCS CSHB 164 (L&C), labeled 27-
LS0444\X.
CHAIR EGAN objected for discussion.
2:07:15 PM
SENATOR DAVIS joined the committee.
MS. HALL explained that there was concern about the clarity of
the ability of an individual to purchase an individual health
insurance policy in the individual market. Section (c) was in
the original bill, but (d) is new language that clearly states
their intent that section 79 does not prohibit an individual
from purchasing a health insurance policy in the individual
market. Then (e) references the definition of "individual
market" in AS 21.51.500. It says any time an employer
contributes money, whether directly or indirectly, it becomes a
moot policy in the individual market.
SENATOR PASKVAN asked the reason for the tax increase set forth
in section 48.
MS. HALL replied that it is not a tax increase, but rather a
combination of taxes and fees that are charged separately at 2.7
percent plus a 1 percent filing fee. They have been combined for
simplification purposes.
SENATOR PASKVAN remarked that current statute says 3 percent on
gross premiums and now we're at 3.7 percent.
MS. HALL responded she would have to look at the statute. It is
not their intent to increase the taxes.
2:09:32 PM
MS. HALL pointed out that the 2.7 percent is mentioned in
several places; one is under "unauthorized independently
procured." She said the intent was to bring this in line with
the premium tax the department charges for admitted insurance so
it's the same, which would be the 2.7 percent plus surplus lines
that gets an additional 1 percent filing fee. It is actually a
reduction from 3 percent plus 1 percent.
SENATOR PASKVAN asked what would be the justification of the
reduction of taxes. He was trying to figure out how they get to
where they are now.
MS. HALL replied their intent was to bring premium taxes in line
with what the admitted insurance market is taxed, not to tax
them at a higher rate.
SENATOR PASKVAN asked where the 1 percent is in AS 21.33.061 (c)
and secondly, in trying to combine them, are they repealing the
1 percent that is elsewhere in the statute?
MS. HALL answered no; it is not their intent to repeal that; it
is their intent to combine them. The filing fee is in section AS
21.34.190 that states "The fee for filing this statement is an
amount equal to 1 percent on gross premium charged less...."
SENATOR PASKVAN asked what is being done to section 190, if
anything.
MS. HALL replied that section 57 amends section 190 and that 1
percent fee is on taxes in Chapter 34, which is surplus lines
and she didn't think the fee was previously charged in Chapter
33, which is unauthorized insurance and independently procured
insurance. The same filing fee was added to those two lines and
they were combined, so there probably is seven-tenths of a
percent increase on unauthorized and independently procured
insurance.
2:14:03 PM
SENATOR MENARD asked Representative Olson to explain one thing
that is of utmost importance in dealing with surplus lines,
since the bill is so long and no one on the committee had been
in the insurance industry before.
REPRESENTATIVE OLSON replied that clean up language mostly in
the first 22 pages of the bill is the most important. He always
thought the tax was 2.7 percent plus the 1 percent filing fee.
MS. HALL added that there are two pieces to the surplus lines
section; one is they need to bring state statutes in compliance
with changes in federal law, because it specifically preempts
state law. She thought the federal government would enforce
those changes if the state doesn't make them and that businesses
need to operate knowing that. When she talked about the home
state becoming the primary regulator of the transactions, her
one thing is to bring statutes into conformance with those
federal laws.
SENATOR MENARD asked if that was her number one thing in the
whole bill or was it the surplus lines.
MS. HALL replied that it is probably her number one thing in the
bill. She didn't want Alaska to be preempted and have the
potential for someone else to try to regulate how business is
done in the state.
CHAIR EGAN said they received a lot of confused testimony on
section 79 and asked if she feels all the concerns were
satisfied with the amendments.
2:18:16 PM
MS. HALL answered that the concerns are not totally satisfied,
although at first she thought they were. She explained that
section 79 does two things that are good and those would be lost
if it was deleted. She, however, said she would prefer to delete
it. One of the concerns is that it provides coverage for a new
group of people that don't currently get coverage. One group is
the part-time seasonal people who are not eligible for the group
coverage and this provision would allow them to purchase
individual policies with employer funds; she would hate to lose
that.
She would also like to save the protections in the small group
law and she said stripping out section 79 won't make the
situation any different than it is today.
SENATOR MENARD asked if she would entertain an interest in
sunseting just section 79 to maybe 2014 and let it play out for
a couple of years.
MS. HALL replied that she would be fine with that.
SENATOR PASKVAN said he understood that section 79 is intended
to be consumer friendly.
MS. HALL responded that it is her intent that it is to be
consumer friendly. It provides coverage for a group that today
cannot purchase coverage through an employer plan and it
protects people in group plans who have health conditions and
who would be unable to purchase individual policies in the
individual market place.
SENATOR PASKVAN said specifically as to that later category if
it provides them with a method of retaining insurance that they
would otherwise lose.
MS. HALL responded that they would be underwritten for their
health conditions and likely to be refused coverage any place
other than the high risk pool.
CHAIR EGAN said one thing concerns him and that is if section 79
is repealed that there would still be issues in current law and
he is not comfortable moving it forward now. He would like to
work on it until the start of session next year.
MS. HALL replied that was okay with her.
2:22:36 PM
At ease from 2:22 PM to 2:23 PM.
2:23:27 PM
SENATOR PASKVAN moved conceptual Amendment 1 to put a one-year
sunset on section 79.
MS. HALL responded that was fine with her.
There were no objections and conceptual Amendment 1 was adopted.
2:24:35 PM
SENATOR PASKVAN moved to report SCS CSHB 164(L&C), version 27-
LS0444\X, as amended from committee with individual
recommendations and attached fiscal note. There were no
objections and it was so ordered.
2:24:52 PM
At ease from 2:24 PM to 2:26 PM.
SB 74-INS. COVERAGE: AUTISM SPECTRUM DISORDER
2:26:41 PM
CHAIR EGAN announced SB 74 to be up for consideration. He opened
public testimony.
2:26:58 PM
AMORY LELAKE, staff to Senator Ellis, sponsor of SB 74, said
this bill would help children with autism get the treatment they
need while increasing the number of autism service providers in
Alaska and lowering special education and social service costs.
Autism is a devastating disorder affecting at least 1 in 110
American children and despite being treatable, most children
diagnosed with autism spectrum disorders (ASD) don't receive the
treatment they need.
SB 74 would require insurance coverage for ASDs including
evidence-based medically necessary applied behavior analysis
(ABA) that have shown to be an extremely effective treatment of
these disorders. ABA is a scientifically driven, validated
approach to learning and/or change of behavior and has been
widely accepted as an effective treatment. The American Academy
of Pediatrics and the U.S. Surgeon General have both issued
reports corroborating these findings.
MS. LELAKE said that most insurance policies specifically
exclude coverage for treating autism even when the services are
otherwise covered by a health plan. In the absence of coverage,
families are often forced to cover expenses out of pocket. In
the process, many risk their homes and the educations of their
unaffected children.
According to the Alaska Department of Education and Early
Childhood Development, in 1994, 37 children enrolled in special
education were classified as having autism. In 2006, that number
had grown to 477, an increase of 1200 percent.
She said for many parents school services are a substitute from
private insurance services. The goal of the educational system,
of course, is not to provide medical service. Schools provide
speech therapy and other related services to enable a child with
a disability to receive a free appropriate public education. The
ability of schools to educate children is compromised when
children with autism don't receive appropriate care through
private insurance.
MS. LELAKE said a total of 35 states and the District of
Columbia have laws related to autism and insurance coverage. At
least 25 states specifically require insurers to provide
coverage for the treatment of autism.
According to the Governor's Council on Disabilities and Special
Education, insurance coverage of treatment of ASDs will save the
state $208,500 per capita in avoided special education costs
with a lifetime savings of $1.8 million per capita.
2:30:22 PM
According to a Harvard economist's study of the societal costs
of autism, every new child diagnosed with autism that is not
treated costs an estimated $3.2 million over their lifetime. A
majority of children with autism who receive appropriate
intervention and treatment experience marked improvement; 47
percent recover typical function, 40 percent make significant
improvement and the remaining 13 percent unfortunately make
little progress.
Early intervention and treatment work, she said. Insurance
coverage of ASDs can save the state millions and significantly
improve the lives of thousands of Alaskan children and families.
MS. LELAKE said that many families are unable to afford
treatment and this limits the number of providers available in
Alaska. According to the Behavior Analyst Certifying Board
(BACB) there are currently only seven certified applied behavior
analysts in Alaska. Although, since South Carolina adopted
similar legislation three years ago, the number of certified
applied behavior analysts has increased three-fold. The
University of Alaska is working to increase the ABA workforce in
Alaska and currently 17 people are working towards
certification.
Without the help of private insurance coverage, families
affected by autism may never be able to get their heads above
water and provide their children with the medically necessary
evidence-based treatments they need. It is to the advantage of
these Alaskan families and to all of society that private health
insurance coverage provides these services.
MS. LELAKE said the supporters of this legislation are: Senator
Ellis, Representative Peterson, the Governor's Council on
Disabilities, the Mental Health Trust Authority, the Stone Soup
Group, the Alaska Primary Care Association, the Alaska
Association of Homes for Children, the Key Coalition, the Alaska
Nurses Association and many others.
2:32:33 PM
She walked the committee through the bill. Section 1, page 1,
line 1, through page 3, line 21, amends as AS 21.42 by creating
a new section AS 21.42.397 relating to insurance coverage for
autism spectrum disorders. Subsection (a), page 1, line 1,
through page 2, line 12, requires insurance plans to cover
medically necessary treatment for ASDs and exempts plans offered
by fraternal benefit societies.
Subsection (b), page 2, lines 13-23, further defines the
coverage that must be provided. Subsection (c), page 2, lines
24-25, establishes that this section does not limit coverage
already provided. Subsection (d), page 2, lines 26-28, prohibits
an insurance company from denying coverage to someone because
they have an ASD. Subsection (e), page 2, line 29, through page
3, line 21, defines "autism service provider," "autism spectrum
disorders," "health care insurance plan," "health care
insurance," and "medically necessary."
Section 2, page 2, lines 22-26, establishes that these
provisions in section 1 only apply to insurance policies issued
after January 1, 2012. Section 3, page 3, line 27, establishes
and immediate effective date.
2:34:18 PM
REPRESENTATIVE PETERSEN, sponsor of HB 79, companion bill to SB
74, said they had worked very hard on this bill going on three
years and he supported it. He said every day this bill is
delayed there are children who are losing opportunities to have
a chance at a normal life.
2:35:44 PM
TONJA UPDIKE, member, Governor's Council on Disabilities and
Special Education, said she is also the mother of an ASD child.
She very strongly supported SB 74. She said it is frustrating to
not be able to get private insurance for him. They will cover
the rest of her family, but not her ASD child. When he was
diagnosed he was not quite 2 and now he's 8 years old and has
come very far in so many ways, a real testament to the treatment
he has received. She said she knows that everybody wants to save
money, so it's important to note that if you spend money early
on to treat ASD, you're not going to be spending as much later
on through the child's life. She said 1,512 students across
Alaska are now diagnosed with autism; many more will be
diagnosed in the future.
2:38:01 PM
MILLIE RYAN, Executive Director, Governor's Council on
Disabilities and Special Education, said that the Council
strongly supports SB 74. She said their letter goes into a
little more detail and offered to answer questions.
2:38:55 PM
LEN SORREN, Legislative Affairs Group, BlueCross/BlueShield of
Alaska, said their several concerns about SB 74 were outlined in
a letter submitted to the committee. He said "this benefit
mandate" will increase costs for individual and small group
employer plans across the State of Alaska on top of federal
health care reform requirements which were implemented for most
plans in January. Individual plans at that time saw a 2-4
percent increase. Their estimates indicate that the mandate in
this bill could add as much as 3 percent to the cost of health
insurance premiums in Alaska.
He shared a cost analysis provided to the Washington State
Legislature on a very similar bill that was introduced this
session. Washington State's Office of Financial Management
estimated that the impact of the autism mandate to state health
plans would be $140 million over the two-year budget growing to
over $200 million over subsequent years.
He said any state mandates that go beyond the essential health
benefits package that will be designated under federal law must
be paid for by the state for all individuals receiving subsidies
through the exchanges. The federal government is currently
working on these benefits and he believes it is prudent to see
how their work is completed to determine whether the state would
have substantial additional benefit costs.
MR. SORREN said individual and small group insurance markets are
already under tremendous cost and price pressures and they are
concerned that SB 74 will simply add another cost burden.
2:41:34 PM
SENATOR MENARD said he was citing Washington State legislation,
but does exactly mirror SB 74?
MR. SORREN replied yes. The $140 million was a fiscal note
attached to the Washington bill that relates to the Washington
employee health plans (called Healthy Options in Washington) and
Medicaid.
SENATOR MENARD asked if he agreed that by doing nothing society
faces $3.2 million in costs over the lifetime of an autistic
child.
MS. SORREN replied that he didn't know. There are a variety of
requirements under federal law that requires ASD services
through public schools across the United States. They have some
concern that this becomes a cost transfer from the existing
federal requirement to the private insurance market in Alaska
that is already stressed.
SENATOR GIESSEL asked if SB 74 places this mandate on the State
of Alaska's insured population, that is to say, state employees.
MR. SORREN replied that he didn't know the answer, but he wanted
to provide them with the State of Washington's Office of
Financial Management estimate so they have an idea of the cost
of the mandate without specific reference to the State of
Alaska's health plan.
2:44:24 PM
SENATOR DAVIS said Washington has a bigger population than
Alaska and she asked what his estimate was for implementing SB
74 in Alaska.
MR. SORREN replied he didn't have those figures for Alaska, but
he did have an actuarial estimate that the mandate in this bill
could add as much as 3 percent to the cost of health insurance
premiums across the individual and small group markets in the
State of Alaska.
SENATOR DAVIS responded that even at 3 percent, it wouldn't come
anywhere near the Washington State figures he provided.
MR. SORREN responded, "It may or it may not." He didn't know the
number of covered persons involved in Alaska that the 3 percent
would need to be multiplied by. But by anyone's estimation, a 3
percent increase in response to a single mandate is substantial.
SENATOR DAVIS asked when would be the right time to take action
if not now.
MR. SORREN answered that it would be prudent for Alaska to wait
until the essential benefits package under the federal health
care reform bill is made clear from Washington, D.C. Then Alaska
could make an informed judgment whether this additional benefit
would be the state's cost for all subsidized folks going through
the exchange or a benefit under federal law and therefore not at
the state's expense.
The other possible avenue to think through as a way for making
this available is giving individual employers the option of
covering this in the event they chose to bear the additional
cost.
2:47:21 PM
LORRI UNUMB, counsel, National Office of Autism Speaks, South
Carolina, said she is also the parent of a child with autism,
and said she supported SB 74. She provided a power point and
asked them to go to slide 17, the hard cost data for autism
insurance.
She explained that in 2007 South Carolina passed legislation
very similar to what they are considering. So, rather than
looking at any estimates from states that are still considering
legislation, she suggested they look at the hard cost data. The
entire cost to the state for providing coverage to the state
employee health plan during 2010 was $2 million, a per-member,
per-month increase of 44 cents. So, yes, this does cost
something, but there has been no state that has documented a 3
percent cost increase or even 2 or 1 percent cost increase. The
states that now have data on this coverage have documented costs
increases of around .1 percent or .2 percent. Translated into
dollars in South Carolina that came out to 44 cents per member
per month. She didn't know of anyone who would not be willing to
an extra pay 44 cents a month so that all of the children in
Alaska could get the treatment their doctors prescribe.
She asked them to be mindful that these families are not asking
for a handout; these are families who are working, they've
bought insurance and are paying their premiums every month. They
want their end of the bargain; they have insured against medical
disaster. It has now befallen their children and they want
coverage for the recommended treatments.
MS. UNUMB said state employees are not included in the Alaska
bill, so the $100 million cost impact is not transferable to the
state even if it were a close to accurate figure. She also said
that 25 other states have already passed similar legislation.
Two states have already passed it this year and waiting for
federal health care reform is not a good reason to wait on
moving this legislation forward. They do not know what the
essential benefits package under federal health care reform will
include, but they have lots of reasons to believe it will
include ABA therapy for children with autism.
2:51:46 PM
SENATOR MENARD said for the record that she read that autism has
had a 600 percent increase over the last 20 years. Is that
nation-wide?
MS. UNUMB replied yes.
SENATOR MENARD asked Ms. Lelake what the increase is in Alaska.
MS. LELAKE replied that she didn't know the percentage, but they
do know according to the Governor's Council on Disabilities and
Special Education there are about 1500 children in Alaska with
autism. Between 1994 and 2006 the school district saw a 1200
percent increase.
SENATOR MENARD said she knows the MatSu Borough has over 2500
students (6.5 percent) with special disabilities; it is an
increasing cost that has to be looked at. She wanted realistic
numbers because of Alaska's small population.
2:53:36 PM
MARC LAMBRIGHT, principal and consulting actuary, Oliver Wyman
Actuarial Consulting, said he prepared a very detailed cross
analysis of the cost for various insurance markets in Alaska. He
said he completed similar analyses in approximately 20 other
states; and the analysis has been made available to the
committee.
Brief highlights of the report are that page 8 provides several
examples of some very low initial and ongoing costs for states
that have mandated autism coverage. Pages 9-15 of the report
provide very extensive detail regarding the drivers of cost
estimates including treated prevalency to diagnosis, ABA
utilization and unit costs. His cost estimates are outlined on
page 17; they indicate an anticipated cost per member of about
$20 per year or about $1.50 per month. That would translate into
about .04 to .05 percent of the average premiums in Alaska and
an increase of .3 to .7 percent in premiums.
He said there has been no indication anywhere cost data has been
collected that costs have been anywhere near the 3 percent level
and typically they are less than one-half of 1 percent.
Secondly, he said there have been a lot of other independent
actuarial analyses completed and typically the cost estimate
outlined in them is one-half of 1 percent of premium.
2:56:29 PM
KARA THRASHER LIVINGSTON, representing herself, said she
supported SB 74. She said she has two children who experience
autism and received early intervention and special education
from the school district. But it would have been nice to have
the choice of having their therapy covered by insurance as well.
Having worked in long term care, she can understand how having
enhanced early intervention available through therapy such as
ABA would result in lower costs over a child's lifespan. She
thought Alaskans would be willing to pay the added cost.
2:58:17 PM
DEBBIE THOMPSON, Executive Director, Alaska Nurses Association,
said they support SB 74. It is the right thing to do.
They must look at what the costs are now as opposed to what they
would be later in an autistic child's life. The treatment will
impact the lives of not only the child with autism, but all of
their family members and those that are around them.
2:59:13 PM
LINDA ROBERTSON, business partner, Step-In Autism Services of
Alaska, Fairbanks, supported SB 74. They are finding families
that are very desperate for services and they can't provide
them, because these families are not able to provide insurance
payments and are not eligible for Medicaid or Tri-Care
Insurance. The reason they provide ABA applied behavior analysis
is because it is the most effective treatment they have found
for kids with autism. She said she had worked in Alaska since
1981 and has spent 35 years as a special educator and found that
children with autism are the most difficult to reach and applied
behavior analysis allows them to do that. The right services
provide incredible differences.
MS. ROBERTSON said the intensive ABA is not offered in the
school system, although many families get it privately. She said
they are very eager to bring this service to as many families in
Alaska as possible who have children with autism or other
disabilities.
3:01:39 PM
EMILY ICE, business partner, Step-In Autism Services of Alaska,
Fairbanks, offered her support for SB 74, as well.
SENATOR GIESSEL said one paper provided by Ms. Hall summarized
those who are affected by SB 74. It says self-insured plans are
not currently subject to mandates. That means that TERS and PERS
beneficiaries would not be required to provide this coverage.
LINDA HALL, Director, Division of Insurance, Department of
Commerce, Community and Economic Development (DCCED), answered
that is accurate.
SENATOR GIESSEL said that shows to be 34 percent of the state's
population. And 15 percent of the plans that are directly
affected by SB 74 are those that are bought privately.
MS. HALL agreed.
SENATOR GIESSEL asked if that includes small businesses and
employers that provide insurance.
MS. HALL replied yes; it applies to the individual market and
predominantly the small group market. Most but not all large
employers do their health benefits through a self-insured plan
which is regulated the federal Department of Labor.
SENATOR GIESSEL asked if Medicaid in Alaska currently provides
some treatment for ASD.
MS. HALL replied that she didn't know what Medicaid covers.
SENATOR GIESSEL asked if SB 74 would affect Medicaid.
MS. HALL replied no.
SENATOR GIESSEL asked if she said the Indian Health Service
already covers autism.
MS. HALL replied that she would not have commented on those
types of programs, because she didn't have any particular
knowledge of them.
SENATOR GIESSEL said she was trying to figure out who is going
to be affected by SB 74 and it looks like on her chart that it's
going to be 15 percent of the Alaska population. Is that true?
MS. HALL replied that is true; when you add a mandate to Title
21, the insurance code, it only impacts the private regulated
insurance market unless the bill contains other provisions that
broaden the mandate.
SENATOR GIESSEL asked what she thought about the added costs
being applied to only 15 percent of the state's population.
MS. HALL replied that she didn't have that estimate. She said
her division does a rate review of just one company and she
wouldn't have any way to estimate the cost of a particular
mandate going forward.
SENATOR GIESSEL asked how many insurance mandates Alaska has
now.
MS. HALL replied 15 benefit mandates.
SENATOR GIESSEL asked how much that adds to the cost of the
premium.
MS. HALL answered that don't have that information although they
have tried to get it.
3:08:25 PM
SENATOR PASKVAN asked if testimony about avoided costs is
accurate.
MS. HALL replied that she didn't have any idea about the other
costs.
SENATOR GIESSEL asked her why the cost of health care is higher
in Alaska than in other states.
MS. HALL answered no; their study only shows what the
differentials are and that Alaska has the highest health care
costs in the country. Correspondingly, Alaska also has the
highest health insurance premiums in the country. She estimates
just between Seattle and Anchorage there is anywhere from a 30
to 150 percent higher cost for procedures in Alaska.
CHAIR EGAN asked if the administration had a position on SB 74.
MS. HALL replied that the administration had not taken a
position.
SENATOR GIESSEL said she thought there were things they don't
know about the impacts of adding this mandate to the 15 percent
of Alaskans. Already, 16 percent of the Alaska population can't
afford health insurance now and she wanted more information
about what the premiums would look like.
SENATOR PASKVAN said they had heard a lot of testimony about how
the avoided costs of early treatment are so significant that the
cost of not doing something to society is much greater than the
cost of the de minimis expenditure at this time. He would like
to move the bill.
SENATOR DAVIS said she would like to move it, too. But she
stated that she didn't think the impact would be on just the 15
percent population and that other agencies provide some services
for autism.
SENATOR GIESSEL clarified that the cost of this will be shifted
to 15 percent of the population who are at this time under state
regulated health insurance. Her concern is that this will shift
the cost to small businesses that are struggling right now to
provide insurance for their employees and are managing to do it;
but additional cost will cause those employers to maybe say they
can no longer provide insurance. Moving that 15 percent piece of
the pie over to the 16 percent of uninsured in Alaska will
escalate health care problems.
SENATOR PASKVAN moved to report SB 74 from committee with
individual recommendations and attached fiscal note. There were
no objections and it was so ordered.
3:14:56 PM
At ease from 3:14 PM to 3:16 PM.
SB 119-ATHLETIC TRAINER LICENSING
3:16:53 PM
CHAIR EGAN announced SB 119 to be up for consideration.
SENATOR PASKVAN moved to bring CSSB 199( ), 27-LS0732\D before
the committee for purposes of discussion.
CHAIR EGAN objected for discussion.
SENATOR MEYER, sponsor of SB 119, said that athletic trainers
are certified health care professionals who practice in the
field of sports medicine. Athletic training has been recognized
by the American Medical Association; the profession plays a
significant role in the management, prevention and recognition
of rehabilitation of injured athletes.
He explained that when the traumatic brain injury bill came
before the legislature, it was found that there wasn't a group
association to deal with it; so Alaska athletic trainers brought
it to their attention. Alaska is one of only three states that
doesn't license athletic trainers.
SENATOR MENARD said they are most familiar with high school
sports where you have an assistant coach who does things like
wrap ankles and apply ice to injuries and asked if those
assistants could still be used if they weren't licensed
trainers.
CHRISTINE MARASEGAN, staff to Senator Meyer, pointed out that
this bill is about licensing. All athletic trainers that call
themselves athletic trainers are certified through a national
board. In terms of how this would play out in Alaska, they want
to make sure that personnel are licensed in the State of Alaska
to be able to provide treatment. Forty-two people have met all
of the certification for being an athletic trainer but aren't
licensed in the state. So, they could be at the game and they
would not be able to provide service because they are not
licensed.
SENATOR MENARD said the glitch for her is that assistant coaches
aren't licensed and she didn't want to get them in trouble.
MS. MARASEGAN responded that this bill would not get them in
trouble. A provision on page 1, lines 14-15, and (b) on the next
page says if you have personnel that can provide assistance that
they can provide it. She also pointed out that language on page
2, line 14, of the CS effectively removes the cap on the fee.
3:22:12 PM
BRENDA SHELDON, President, Alaska Athletic Trainers Association
(AATA), supported SB 119. She said they recognize the changes in
the CS and acknowledge the challenges of their small number. But
2008 data places the mid-point salary for a full-time athletic
trainer in their district at $40,000. She said many members
volunteer as athletic trainers and are not in paid positions.
Alaska has many non-profit and community events that they serve
and SB 119, section 3, will include Alaska trainers in the
immunity for providing free health care services. This is very
important to them.
She said what they lack in size they make up for with their
certification agency, the Board of Certification. This agency
will ensure that athletic training professionals have completed
their proper college education; it will administer the entry
level examination, track continuing education and continue to
enforce the renewal for certification. Because of the board's
role they feel their fees should be comparable to that of speech
and language pathologists, geologists and dieticians.
MS. SHELDON assured Senator Menard that this bill intends to
only speak to athletic trainers and in no way limits what others
can do at events with student athletes.
3:24:41 PM
SENATOR PASKVAN remarked that his daughter is certified by the
National Athletic Trainers Association Board of Certification
and has been for a long time. She works in a high school of
4,500 students and to address Senator Menard's question, she
works with the coaches and the assistant coaches particularly in
the area of the football team and concussions. It's her decision
as compared to any coach or assistant coach or anyone else on
field that controls whether the kid goes back in. His daughter
told him that there is no other certifying organization out
there and this is the one that should be looked to as the
"national gold standard." Therefore, he supported the bill.
SENATOR MENARD said the fees will be collected by the Division
of Licensing and asked if it would be necessary to have board
representation.
MS. MARASEGAN answered that could be worked out between the
Alaska Athletic Trainers Association and the Division of
Corporations, Business and Professional Licensing. The ATTA
didn't want to create a whole board, because they go through so
much for certification already. They simply wanted licensure for
the State of Alaska and Alaska would issue the license, but it
would be referring back to the national organization, which is
the only one that has been doing so for a number of years.
SENATOR MENARD said she would support having a board member that
is representative of what they are trying to do if that ever
came up.
3:28:29 PM
SENATOR PASKVAN moved to report CSSB 119(L&C), version D, from
committee with individual recommendations and attached fiscal
note. There were no objections and it was so ordered.
3:29:11 PM
At ease from 3:29 PM to 3:30 PM.
HB 188-INTEREST RATES
3:30:47 PM
CHAIR EGAN announced HB 188, sponsored by the House Labor and
Commerce Committee, to be up for consideration.
KONRAD JACKSON, staff to Representative Olson, chair of the
House Labor and Commerce Committee, explained that HB 188
addresses maximum interest allowed on private loans of $25,000
or less. AS 45.45.010 (b) sets the rate on these loans at 5
percent above the rate charged to banks by the 12th Federal
Reserve District. Currently that rate is .75 percent. When the
statute was written, people were not imagining that rates would
be as low as they are now. HB 188 would allow an individual
offering a loan of $25,000 or less to charge an interest rate
the greater of either 10 percent above the interest rate from
the Federal Reserve District or 10 percent. So, today the
maximum rate would be 10 percent.
The hope is that this bill will encourage more commerce and
allow individuals to finance small loans for real property and
basically carry the note and get a little bit of return as
opposed to 5.75 percent. This law is a default; so if it
conflicts with other statutes, those statutes take precedence.
3:33:03 PM
He said some questions were raised earlier and they have been
addressed and since then this bill had had no opposition. The
questions that have been asked are about whether this bill
applies to credit card interest rates, pay day loans or credit
unions and it doesn't; those are all covered under Title 6.
GLENDA SEEKEN, Alaska Association of Realtors, supported HB 188.
She said it would help realtors to be able to sell more land.
SENATOR PASKVAN moved to report HB 188 from committee with
individual recommendations and attached zero fiscal note. There
were no objections and it was so ordered.
3:35:08 PM
At ease from 3:35 PM to 3:36 PM.
3:37:25 PM
CHAIR EGAN thanked members of the committee and staff for their
hard work this year and adjourned the meeting at 3:37 PM.
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