Legislature(2015 - 2016)BELTZ 105 (TSBldg)

03/29/2016 01:30 PM Senate LABOR & COMMERCE

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01:32:43 PM Start
01:33:12 PM Confirmation Hearings
02:11:18 PM SB206
02:42:01 PM SB55
03:36:06 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ Consideration of Governor's Appointees: TELECONFERENCED
Alaska Gasline Development Corporation Board of
Directors
*+ SB 206 REINSURANCE PROGRAM; HEALTH INS. WAIVERS TELECONFERENCED
Heard & Held
+= SB 55 OPTOMETRY & OPTOMETRISTS TELECONFERENCED
Heard & Held
+ Bills Previously Heard/Scheduled TELECONFERENCED
-- Public Testimony --
                    ALASKA STATE LEGISLATURE                                                                                  
          SENATE LABOR AND COMMERCE STANDING COMMITTEE                                                                        
                         March 29, 2016                                                                                         
                           1:32 p.m.                                                                                            
                                                                                                                              
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Senator Mia Costello, Chair                                                                                                     
Senator Cathy Giessel, Vice Chair                                                                                               
Senator Kevin Meyer                                                                                                             
Senator Gary Stevens                                                                                                            
Senator Johnny Ellis                                                                                                            
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
All members present                                                                                                             
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
CONFIRMATION HEARINGS                                                                                                           
                                                                                                                                
     Alaska Gasline Development Corporation Board of Directors                                                              
                                                                                                                                
          DAVID CRUZ - Palmer, Alaska                                                                                           
          LUKE THOMAS HOPKINS - Fairbanks, Alaska                                                                               
                                                                                                                                
     - HEARD AND HELD                                                                                                           
                                                                                                                                
SENATE BILL NO. 206                                                                                                             
"An Act relating  to a reinsurance program for  residents who are                                                               
high  risks and  insurer assessments  to cover  the costs  of the                                                               
reinsurance   program;   relating   to  application   for   state                                                               
innovation  waivers  for  health   care  insurance;  relating  to                                                               
definitions  of  'residents  who  are high  risks'  and  'covered                                                               
lives'; and providing for an effective date."                                                                                   
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
SENATE BILL NO. 55                                                                                                              
"An Act relating to the practice of optometry."                                                                                 
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: SB 206                                                                                                                  
SHORT TITLE: REINSURANCE PROGRAM; HEALTH INS. WAIVERS                                                                           
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR                                                                                    
                                                                                                                                
03/25/16       (S)       READ THE FIRST TIME - REFERRALS                                                                        
03/25/16       (S)       L&C, FIN                                                                                               
03/29/16       (S)       L&C AT 1:30 PM BELTZ 105 (TSBldg)                                                                      
                                                                                                                                
BILL: SB 55                                                                                                                   
SHORT TITLE: OPTOMETRY & OPTOMETRISTS                                                                                           
SPONSOR(s): GIESSEL BY REQUEST                                                                                                  
                                                                                                                                
02/18/15       (S)       READ THE FIRST TIME - REFERRALS                                                                        
02/18/15       (S)       HSS, L&C                                                                                               
03/18/15       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
03/18/15       (S)       Heard & Held                                                                                           
03/18/15       (S)       MINUTE (HSS)                                                                                           
02/01/16       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
02/01/16       (S)       Moved SB 55 Out of Committee                                                                           
02/01/16       (S)       MINUTE (HSS)                                                                                           
02/08/16       (S)       HSS RPT 3DP 1NR                                                                                        
02/08/16       (S)       DP: STEDMAN, STOLTZE, GIESSEL                                                                          
02/08/16       (S)       NR: ELLIS                                                                                              
03/10/16       (S)       L&C AT 1:30 PM BELTZ 105 (TSBldg)                                                                      
03/10/16       (S)       Heard & Held                                                                                           
03/10/16       (S)       MINUTE (L&C)                                                                                           
03/29/16       (S)       L&C AT 1:30 PM BELTZ 105 (TSBldg)                                                                      
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                              
DAVID CRUZ, Appointee                                                                                                           
Alaska Gasline Development Corporation Board of Directors                                                                       
Palmer, Alaska                                                                                                                  
POSITION STATEMENT: Testified as appointee to the Alaska Gasline                                                              
Development Corporation Board of Directors.                                                                                     
                                                                                                                                
LUKE THOMAS HOPKINS, Appointee                                                                                                  
Alaska Gasline Development Corporation Board of Directors                                                                       
Fairbanks, Alaska                                                                                                               
POSITION STATEMENT: Testified as appointee to the Alaska Gasline                                                              
Development Corporation Board of Directors.                                                                                     
                                                                                                                                
LORI WING-HEIER Director                                                                                                        
Division of Insurance                                                                                                           
Department of Commerce, Community and Economic Development                                                                      
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Discussed the two parts of SB 206.                                                                        
                                                                                                                                
SHEELA TALLMAN, Legislative Policy Manager                                                                                      
Premera Blue Cross Blue Shield of Alaska                                                                                        
Seattle, Washington                                                                                                             
POSITION STATEMENT: Testified in support of SB 206.                                                                           
                                                                                                                                
ALBERT FOGLE                                                                                                                    
Alaska Association of Health Underwriters                                                                                       
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified in support of SB 206.                                                                           
                                                                                                                                
KRAIG ANDERSON, Senior Vice President and Actuary                                                                               
Moda Health                                                                                                                     
Portland, Oregon                                                                                                                
POSITION STATEMENT: Testified in support of SB 206.                                                                           
                                                                                                                                
MIKE BENNETT, OD                                                                                                                
Alaska Optometric Association                                                                                                   
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Testified in support of SB 55.                                                                            
                                                                                                                                
BOB PALMER, State Affairs Policy Director                                                                                       
American Academy of Ophthalmology                                                                                               
Washington, D.C.                                                                                                                
POSITION STATEMENT: Testified in opposition to SB 55.                                                                         
                                                                                                                                
PAUL MARKS, representing himself                                                                                                
POSITION STATEMENT: Testified in opposition to SB 55.                                                                         
                                                                                                                                
GRIFFITH STEINER, MD, representing himself                                                                                      
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified in opposition to SB 55.                                                                         
                                                                                                                                
MICHEAL GUZMAN, representing himself                                                                                            
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified in opposition to SB 55.                                                                         
                                                                                                                                
MATTHEW GLYNN, representing himself                                                                                             
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified in opposition to SB 55.                                                                         
                                                                                                                                
TIM SMITH, representing himself                                                                                                 
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified in opposition to SB 55.                                                                         
                                                                                                                                
EDDY IVIZARY, representing himself                                                                                              
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified in opposition to SB 55.                                                                         
                                                                                                                                
MICHAEL BRENNAN, MD - Ophthalmologist                                                                                           
Alaska Ophthalmology Society                                                                                                    
North Carolina                                                                                                                  
POSITION STATEMENT: Testified in opposition to SB 55.                                                                         
                                                                                                                                
LUCRETIA ANN DEMIS, representing herself                                                                                        
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified in opposition to SB 55.                                                                         
                                                                                                                                
ALFRED DERAMUS, MD - Ophthalmologist representing himself                                                                       
Fairbanks, Alaska                                                                                                               
POSITION STATEMENT: Testified in opposition to SB 55.                                                                         
                                                                                                                                
PAUL BARNEY, Chair                                                                                                              
Alaska Board of Optometry Examiners                                                                                             
POSITION STATEMENT: Testified in support of SB 55.                                                                            
                                                                                                                                
DAVID ZUMBRO, MD - Ophthalmologist representing himself                                                                         
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in opposition to SB 55.                                                                        
                                                                                                                                
ROBERT ARNOLD, Ophthalmologist representing himself                                                                             
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified in opposition to SB 55.                                                                         
                                                                                                                                
STEVE DOBSON, President                                                                                                         
Alaska Optometric Association                                                                                                   
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified in support of SB 55.                                                                            
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
1:32:43 PM                                                                                                                    
CHAIR MIA COSTELLO called the Senate Labor and Commerce Standing                                                              
Committee meeting to order at 1:32 p.m. Present at the call to                                                                  
order were Senators Giessel, Ellis, Stevens, and Chair Costello.                                                                
                                                                                                                                
^Confirmation Hearings                                                                                                          
                     Confirmation Hearings                                                                                  
   Alaska Gasline Development Corporation Board of Directors                                                                
                                                                                                                                
1:33:51 PM                                                                                                                    
CHAIR COSTELLO announced the first order of business would be                                                                   
confirmation hearings of governor appointments to the Alaska                                                                    
Gasline Development Corporation Board of Directors.                                                                             
                                                                                                                                
1:33:50 PM                                                                                                                    
At ease                                                                                                                         
                                                                                                                                
1:35:27 PM                                                                                                                    
CHAIR COSTELLO reconvened the hearing  and asked Mr. Cruz to tell                                                               
the committee his  interest in continuing to serve  on the Alaska                                                               
Gasline Development Corporation (AGDC) Board of Directors.                                                                      
                                                                                                                                
1:36:17 PM                                                                                                                    
DAVID  CRUZ, Appointee,  Alaska  Gasline Development  Corporation                                                               
(AGDC) Board  of Directors, said  he has  been on the  AGDC Board                                                               
since its  inception. He is  engaged in  the industry on  a daily                                                               
basis and  he owns and  operates several companies  involved with                                                               
pipeline construction. He has served on  the board in a number of                                                               
capacities and is  willing to continue to serve.  He believes the                                                               
projects are essential for Alaska going forward.                                                                                
                                                                                                                                
CHAIR COSTELLO asked how progress currently is going with AKLNG.                                                                
                                                                                                                                
MR.  CRUZ  said  the  project  is going  well  and  good  working                                                               
relationships with the producers  continues. All participants are                                                               
willing to help the project  move forward. His overall experience                                                               
is  that  this  is  a  large  endeavor  to  make  either  project                                                               
successful and economic. It is  important that Alaska is an equal                                                               
partner with the producers                                                                                                      
                                                                                                                                
CHAIR COSTELLO  asked what he  sees as the largest  challenge and                                                               
how the board can facilitate it.                                                                                                
                                                                                                                                
MR.  CRUZ said  it is  advantageous that  the state  is an  equal                                                               
partner  to  facilitate  the  project.  Getting  three  producers                                                               
together  and  working  on  the  terms is  the  tough  part;  the                                                               
technical side is the easy part.                                                                                                
                                                                                                                                
1:40:57 PM                                                                                                                    
SENATOR  GIESSEL  asked  if  he   has  signed  a  confidentiality                                                               
agreement.                                                                                                                      
                                                                                                                                
MR. CRUZ said yes.                                                                                                              
                                                                                                                                
SENATOR GIESSEL asked how many have signed such agreements.                                                                     
                                                                                                                                
MR. CRUZ said he's the only one.                                                                                                
                                                                                                                                
SENATOR  GIESSEL asked  if the  previous  chair has  a role  with                                                               
AGDC.                                                                                                                           
                                                                                                                                
MR. CRUZ replied he is general counsel.                                                                                         
                                                                                                                                
SENATOR GIESSEL asked how the search for a president is going.                                                                  
                                                                                                                                
MR. CRUZ said  it's going well and the board  is interviewing the                                                               
top two candidates. The legislature will  have a say prior to the                                                               
hire.                                                                                                                           
                                                                                                                                
1:42:51 PM                                                                                                                    
SENATOR STEVENS asked when gas will flow.                                                                                       
                                                                                                                                
MR.  CRUZ said  the target  has always  been 2025.  Both projects                                                               
have  had steady  progress and  AGDC will  hold the  permits this                                                               
year,  which  is monumental.  The  rights-of-way  permits can  be                                                               
handed over to AKLNG to facilitate the project.                                                                                 
                                                                                                                                
1:44:38 PM                                                                                                                    
CHAIR  COSTELLO asked  if the  board has  any concerns  about the                                                               
progress  of   the  AKLNG  project  or   current  state  policies                                                               
regarding it.                                                                                                                   
                                                                                                                                
MR. CRUZ  said no; AGDC  is well  engaged with the  state gasline                                                               
team and has good working relationships with all the entities.                                                                  
                                                                                                                                
CHAIR  COSTELLO  asked   if  the  board  has   a  diverse  enough                                                               
membership to tackle this project.                                                                                              
                                                                                                                                
MR. CRUZ said yes; the board works well together.                                                                               
                                                                                                                                
SENATOR  GIESSEL  asked if  he  feels  the  board has  the  right                                                               
qualifications.                                                                                                                 
                                                                                                                                
MR. CRUZ said he does at this point.                                                                                            
                                                                                                                                
1:47:56 PM                                                                                                                    
SENATOR MEYER joined the committee.                                                                                             
                                                                                                                                
SENATOR GIESSEL  noted he is  distinguishing between  the current                                                               
board and the previous board.                                                                                                   
                                                                                                                                
MR. CRUZ  said that's correct.  Today's requirements  differ from                                                               
those of previous boards.                                                                                                       
                                                                                                                                
CHAIR COSTELLO thanked Mr. Cruz  for his dedication to the state.                                                               
She noted that she will forward all the names in one batch.                                                                     
                                                                                                                                
1:50:40 PM                                                                                                                    
At ease                                                                                                                         
                                                                                                                                
1:51:08 PM                                                                                                                    
CHAIR COSTELLO  reconvened the meeting  and asked Mr.  Hopkins to                                                               
tell the committee his interest  in serving on the Alaska Gasline                                                               
Development Corporation Board of Directors.                                                                                     
                                                                                                                                
1:51:47 PM                                                                                                                    
LUKE  THOMAS  HOPKINS,   Appointee,  Alaska  Gasline  Development                                                               
Corporation  Board  of  Directors,   reviewed  his  personal  and                                                               
professional  history  in  Alaska.  Most  recently  he  has  been                                                               
involved with  organizing and  moving forward  on building  a new                                                               
gas utility  in Fairbanks. He is  pleased to be part  of the AGDC                                                               
board and chair  of the Communications Committee and  a member of                                                               
the Governance Committee.                                                                                                       
                                                                                                                                
CHAIR COSTELLO  asked what he is  doing to ensure the  success of                                                               
AKLNG.                                                                                                                          
                                                                                                                                
MR. HOPKINS mentioned approving  actions on receiving funding for                                                               
the  buyout  of  TransCanada  that   included  acquiring  all  of                                                               
TransCanada's  data.  Also, he  helped  with  the work  plan  and                                                               
budget to get to a decisional point.                                                                                            
                                                                                                                                
CHAIR COSTELLO asked if his role is reactive or proactive.                                                                      
                                                                                                                                
MR. HOPKINS said he sees his  role as proactive. He discussed the                                                               
board meetings and interactions to keep on a timeline.                                                                          
                                                                                                                                
CHAIR  COSTELLO   asked  if  he  had   signed  a  confidentiality                                                               
agreement.                                                                                                                      
                                                                                                                                
MR. HOPKINS said  he has never been presented with  a document to                                                               
sign, but is aware of the process and procedure.                                                                                
                                                                                                                                
CHAIR COSTELLO asked if he would sign one if presented.                                                                         
                                                                                                                                
MR. HOPKINS said he'd need to  read it before signing, but he has                                                               
no problem with confidentiality.                                                                                                
                                                                                                                                
2:00:47 PM                                                                                                                    
SENATOR MEYER asked who the legal counsel is for AGDC.                                                                          
                                                                                                                                
MR. HOPKINS said it's John Burns.                                                                                               
                                                                                                                                
SENATOR MEYER asked if Mr. Burns was a previous board member.                                                                   
                                                                                                                                
MR.  HOPKINS  answered  yes;  he  was on  the  board  until  mid-                                                               
November.                                                                                                                       
                                                                                                                                
SENATOR MEYER asked Mr. Hopkins  for examples of his gas pipeline                                                               
experience.                                                                                                                     
                                                                                                                                
MR.  HOPKINS  mentioned  working  with the  Alaska  Gasline  Port                                                               
Authority projects as  a board member from 2006 to  2010. He said                                                               
he also worked on the AGIA project  as one of the options for the                                                               
APP project.  He expanded on  his work  with the buildout  of the                                                               
Fairbanks  Gas  Authority.   He  also  worked  on   the  size  of                                                               
transmission lines for the Fairbanks municipal utility.                                                                         
                                                                                                                                
SENATOR  MEYER  asked  if  he  supports  having  two  legislative                                                               
members on the AGDC board.                                                                                                      
                                                                                                                                
MR.  HOPKINS  said  what's  important   is  that  everyone  works                                                               
together and communication is open.                                                                                             
                                                                                                                                
SENATOR  MEYER said  he hopes  he  understands the  legislature's                                                               
frustration  being asked  to appropriate  money when  they aren't                                                               
part of the executive discussion.                                                                                               
                                                                                                                                
2:07:44 PM                                                                                                                    
MR. HOPKINS  said having  the two  funds already  appropriated is                                                               
important to people  outside of the board, such  as producers. He                                                               
voiced appreciation for legislative funding.                                                                                    
                                                                                                                                
SENATOR GIESSEL  asked what undergraduate  degree he  received at                                                               
the University of Alaska - Fairbanks.                                                                                           
                                                                                                                                
MR. HOPKINS said he doesn't have  a degree, just four years' work                                                               
starting   in  wildlife   management  and   ending  in   physical                                                               
anthropology.  From  there  he   started  a  small  manufacturing                                                               
business.                                                                                                                       
                                                                                                                                
CHAIR  COSTELLO  thanked  Mr.   Hopkins  for  coming  before  the                                                               
committee.                                                                                                                      
                                                                                                                                
2:10:15 PM                                                                                                                    
At ease                                                                                                                         
                                                                                                                                
        SB 206-REINSURANCE PROGRAM; HEALTH INS. WAIVERS                                                                     
                                                                                                                                
2:11:18 PM                                                                                                                    
CHAIR  COSTELLO   reconvened  the   meeting  and   announced  the                                                               
consideration of SB 206.                                                                                                        
                                                                                                                                
2:12:00 PM                                                                                                                    
LORI WING-HEIER  Director, Division  of Insurance,  Department of                                                               
Commerce, Community  and Economic Development  (DCCED), discussed                                                               
the  two parts  of SB  206.  The bill  is designed  to allow  the                                                               
director  of  insurance to  establish  a  reinsurance program  to                                                               
address the high-cost  claims that were once  part, or considered                                                               
part, of  the Alaska  Comprehensive Health  Insurance Association                                                               
(ACHIA). This  was prior to  the Affordable Care Act  (ACA) being                                                               
implemented. The  bill expressly  establishes a  reinsurance pool                                                               
for high-risk  claims to go  into ACHIA and be  reinsured through                                                               
ACHIA -  Chapter 55 of  Title 21. It  will operate much  like the                                                               
Children's Reinsurance Pool of 2013.                                                                                            
                                                                                                                                
MS. WING-HEIER  continued to say that  SB 206 also says  that the                                                               
50  percent  tax credit  would  no  longer  be allowed  for  this                                                               
particular insurance program.                                                                                                   
                                                                                                                                
The other  part of the bill  allows the director of  insurance to                                                               
apply  to the  Centers for  Medicare  and Medicaid  (CMS) for  an                                                               
innovation  waiver. This  is  a Section  1332  waiver to  provide                                                               
insurance   under   ACA   in  individual,   small   group,   and,                                                               
potentially,  the   large  group  markets  in   Alaska.  Enabling                                                               
legislation is required to begin the process.                                                                                   
                                                                                                                                
She provided background  on why this is needed.  She stressed the                                                               
high cost of the individual market  in Alaska which has seen a 40                                                               
percent increase  in the  past two years  from Premera  and Moda.                                                               
Early indications  are that rate  increases will be more  than 25                                                               
percent. In addition,  the risk assessment and  the risk corridor                                                               
will sunset in 2016 under  the federal program. Reinsurance alone                                                               
paid over $19  million to Premera and $13 million  to Moda. Those                                                               
costs need to be reabsorbed somehow.                                                                                            
                                                                                                                                
She  provided  examples  of  the 40  percent  rate  increases  to                                                               
consumers. In 2014,  a 45-year-old was paying about  $486 a month                                                               
for  a gold  plan;  the same  membership in  2017  will be  about                                                               
$1,300 a month.                                                                                                                 
                                                                                                                                
2:16:36 PM                                                                                                                    
CHAIR COSTELLO  asked if the federal  reinsurance program expires                                                               
or sunsets.                                                                                                                     
                                                                                                                                
MS. WING-HEIER  said it expires  at the  end of 2016.  ACHIA will                                                               
replace it in  some way. It won't reduce rates,  but will provide                                                               
stability. Provider losses are substantial  and the rates must be                                                               
adequate.                                                                                                                       
                                                                                                                                
CHAIR  COSTELLO  asked her  to  explain  the higher-risk  medical                                                               
conditions.                                                                                                                     
                                                                                                                                
MS. WING-HEIER  said they would  take the most  costly conditions                                                               
out of  the individual market  and spread  them out to  ACHIA. It                                                               
will be a reinsurance pool.                                                                                                     
                                                                                                                                
2:19:09 PM                                                                                                                    
SENATOR ELLIS asked,  should this legislation pass, will  it be a                                                               
negotiation  point, or  will  the state  just  hope that  private                                                               
insurers don't  increase rates  as much as  25 percent.  He asked                                                               
what the terms of negotiation might be.                                                                                         
                                                                                                                                
MS.  WING-HEIER said  she could  not  make commitments  regarding                                                               
rates, but  the state  will always negotiate  and the  rates will                                                               
still not  be enough to cover  all the claims in  the pool. There                                                               
is a lot of uncertainty in the markets.                                                                                         
                                                                                                                                
SENATOR ELLIS  commented that he  doesn't know what the  state is                                                               
getting for  this kind  of cost, even  though he  understands the                                                               
administration's need to take action to protect consumers.                                                                      
                                                                                                                                
MS. WING-HEIER  explained if the  state continues on  the current                                                               
path, the  rates will likely  increase and the  individual market                                                               
will  go into  a death  spiral.  The intent  of the  ACA was  for                                                               
people  to be  able to  afford  insurance. Alaska  is faced  with                                                               
incredibly high  costs for  health care  resulting in  high costs                                                               
for insurance. The idea is to  spread the top 10 percent of high-                                                               
cost claims over the reinsurance pool.                                                                                          
                                                                                                                                
She pointed  out that the  state could also consider  the Chapter                                                               
1332 waiver for a long-term  solution. The reinsurance plan is an                                                               
immediate answer.                                                                                                               
                                                                                                                                
SENATOR ELLIS said "or a portion thereof."                                                                                      
                                                                                                                                
CHAIR COSTELLO  said her  understanding is  this bill  would make                                                               
the rate increase less egregious.                                                                                               
                                                                                                                                
MS. WING-HEIER said that's correct.                                                                                             
                                                                                                                                
CHAIR COSTELLO offered her understanding  that the second part of                                                               
the  bill  provides a  longer-term  solution.  She asked  if  the                                                               
division would return  to the legislature in order  to pursue the                                                               
waiver.                                                                                                                         
                                                                                                                                
MS. WING-HEIER said yes.                                                                                                        
                                                                                                                                
2:23:18 PM                                                                                                                    
CHAIR COSTELLO opened public testimony.                                                                                         
                                                                                                                                
2:23:30 PM                                                                                                                    
SHEELA TALLMAN,  Legislative Policy  Manager, Premera  Blue Cross                                                               
Blue  Shield of  Alaska,  testified  in support  of  SB 206.  She                                                               
provided  the history  of Premera  in Alaska  since 1952  and its                                                               
coverage. She  commented on  the changes in  the market  that are                                                               
impacting  Premera's individual  plan  premiums.  She noted  that                                                               
Premera  has  experienced a  number  of  new high-cost  enrollees                                                               
after the health  reform in 2014. In 2014, Premera  had losses of                                                               
about  $13  million in  the  individual  market and  sought  rate                                                               
increases of almost  40 percent for 2015 and 2016  to account for                                                               
the high risk individuals.                                                                                                      
                                                                                                                                
Premera is  taking in, on average,  $713 per member per  month in                                                               
premium and  paying out $913  per member per month.  There aren't                                                               
enough  ratepayers  to  offset  the   high  costs,  nor  are  the                                                               
subsidies some receive.                                                                                                         
                                                                                                                                
MS. TALLMAN stated that Premera  supports the reinsurance program                                                               
and  the innovation  waiver. The  program  helps address  premium                                                               
increases, but  also helps provide  some stability to  the market                                                               
and may attract new competitors.                                                                                                
                                                                                                                                
2:29:27 PM                                                                                                                    
SENATOR  ELLIS asked  about  the timeframe  on  the waiver  going                                                               
forward.                                                                                                                        
                                                                                                                                
MS. TALLMAN said the states can  begin applying for the waiver in                                                               
2017.                                                                                                                           
                                                                                                                                
SENATOR ELLIS  asked what  other states have  a similar  issue of                                                               
rising healthcare costs and setting up a reinsurance approach.                                                                  
                                                                                                                                
MS.  TALLMAN  said Oregon  has  addressed  the matter  and  other                                                               
states will follow.                                                                                                             
                                                                                                                                
SENATOR ELLIS  asked if  Premera will  commit to  an amount  of a                                                               
less-than-40-percent  increase in  premiums  if this  legislation                                                               
passes.                                                                                                                         
                                                                                                                                
MS. TALLMAN said  she can't make a  specific commitment regarding                                                               
rates, but  would be committed  to working  on rule making  for a                                                               
balanced assessment across the market.                                                                                          
                                                                                                                                
2:32:57 PM                                                                                                                    
SENATOR  ELLIS said  the state  is  being asked  in a  relatively                                                               
short timeframe to  take an affirmative action. He  is willing to                                                               
entertain  the request,  but would  like  insurance companies  to                                                               
commit as well and form a partnership.                                                                                          
                                                                                                                                
CHAIR COSTELLO said  she appreciates the remarks and  is aware of                                                               
the situation that it brings.                                                                                                   
                                                                                                                                
MS.  TALLMAN  said  Premera  is committed  to  working  with  the                                                               
division on the actual program  that would be implemented via the                                                               
rule making and has  been doing so for the last  year. There is a                                                               
lot of uncertainty now regarding the market.                                                                                    
                                                                                                                                
2:35:16 PM                                                                                                                    
ALBERT   FOGLE,  Alaska   Association  of   Health  Underwriters,                                                               
testified in support  of SB 206. He described the  bill as a tool                                                               
to help with the survival  of the individual marketplace. It will                                                               
help   stabilize  the   market  and   smooth  out   premiums  for                                                               
individuals and  families going  forward. It  isn't the  fault of                                                               
the carriers, but the geography of Alaska and its unique market.                                                                
                                                                                                                                
He  highlighted  that  ACA limits  premiums  a  health  insurance                                                               
carrier  can  charge.  They  are  allowed  just  20  percent  for                                                               
administrative costs.                                                                                                           
                                                                                                                                
2:38:27 PM                                                                                                                    
KRAIG ANDERSON,  Senior Vice President and  Actuary, Moda Health,                                                               
testified in support  of SB 206. He described  Moda's business in                                                               
Alaska  since 2007.  Moda offers  policies  both on  and off  the                                                               
exchanges  and is  one of  two providers.  They are  committed to                                                               
policyholders in Alaska.  He echoed comments made  by Ms. Tallman                                                               
regarding the market  and how the bill would help.  He noted they                                                               
have submitted  detailed claims data  to model the impact  of the                                                               
ACHIA program.                                                                                                                  
                                                                                                                                
CHAIR  COSTELLO  closed  public  testimony and  held  SB  206  in                                                               
committee.                                                                                                                      
                                                                                                                                
                 SB 55-OPTOMETRY & OPTOMETRISTS                                                                             
                                                                                                                                
2:42:01 PM                                                                                                                    
CHAIR COSTELLO  announced the consideration  of SB 55.  She noted                                                               
this is the  second hearing and the intent is  to continue public                                                               
testimony.                                                                                                                      
                                                                                                                                
2:42:55 PM                                                                                                                    
DR.  MIKE  BENNETT,  OD,  Alaska  Optometric  Association  (AOA),                                                               
testified  in support  of SB  55. He  provided his  education and                                                               
work history. He said there have  been a lot of fairy tales about                                                               
what the  bill would do and  they are not accurate.  He countered                                                               
the  notion   that  the  AOA  board   would  authorize  untrained                                                               
procedures  should  the bill  pass.  He  pointed out  that  self-                                                               
regulating  boards  have a  long  history  of success  and  their                                                               
primary  charge is  to protect  the  public. There  is no  hidden                                                               
agenda.                                                                                                                         
                                                                                                                                
2:45:46 PM                                                                                                                    
BOB PALMER,  State Affairs Policy  Director, American  Academy of                                                               
Ophthalmology, testified  in opposition to  SB 55. He  focused on                                                               
policy  issues, especially  the  language in  the bill  regarding                                                               
surgery,  which  leaves  open what  is  acceptable.  He  believes                                                               
optometrists would be able to  perform several hundred additional                                                               
surgical   procedures,  which   is  unacceptable.   He  suggested                                                               
defining what constitutes  surgery and then back  out what should                                                               
not be included.                                                                                                                
                                                                                                                                
He  discussed how  other  states have  addressed  this issue.  He                                                               
concluded that defining surgery protects the patient.                                                                           
                                                                                                                                
2:50:27 PM                                                                                                                    
SENATOR GIESSEL asked where he is from.                                                                                         
                                                                                                                                
MR. PALMER said Washington D.C.                                                                                                 
                                                                                                                                
SENATOR GIESSEL asked if his  organization paid for movie, radio,                                                               
and TV ads, robocalls, and mailings.                                                                                            
                                                                                                                                
MR.  PALMER  said  no.  They  gave  the  Alaska  Society  of  Eye                                                               
Physicians and Surgeons a grant of about $50,000.                                                                               
                                                                                                                                
CHAIR COSTELLO asked  him to provide the  specific information to                                                               
the committee.                                                                                                                  
                                                                                                                                
2:51:55 PM                                                                                                                    
PAUL MARKS,  representing himself, testified in  opposition to SB
55. He  shared a personal  experience with optometrists  and said                                                               
he doesn't  support an  optometrist doing  surgery when  he isn't                                                               
qualified to do so.                                                                                                             
                                                                                                                                
SENATOR GIESSEL asked if an optometrist did surgery on his eye.                                                                 
                                                                                                                                
MR. MARKS answered no; he went to Anchorage.                                                                                    
                                                                                                                                
SENATOR  GIESSEL restated  that the  optometrist did  not perform                                                               
surgery.                                                                                                                        
                                                                                                                                
2:55:53 PM                                                                                                                    
DR. GRIFFITH  STEINER, MD, testified  in opposition to SB  55. He                                                               
provided  his  professional  education  and practice  as  an  eye                                                               
surgeon.  He  described this  bill  as  specifically designed  to                                                               
expand  the scope  of practice  for optometrists.  It allows  for                                                               
injections around the  eye and the right to do  laser surgery. He                                                               
maintained that  they will not  have enough training to  do those                                                               
procedures.                                                                                                                     
                                                                                                                                
SENATOR GIESSEL  asked if the State  Medical Board has a  list of                                                               
surgeries that he can perform.                                                                                                  
                                                                                                                                
DR. STEINER said no, because physicians have medical training.                                                                  
                                                                                                                                
SENATOR GIESSEL emphasized that the  bill does not contain a list                                                               
that defines what the Board  of Medicine can authorize. She asked                                                               
if  his  authorization  is  based  on  his  education,  which  is                                                               
determined by the board.                                                                                                        
                                                                                                                                
DR. STEINER said yes; however,  a medical board is different than                                                               
an optometry  board, because the medical  board represents people                                                               
that are  trained in medicine  and surgery, with many  more years                                                               
of training.                                                                                                                    
                                                                                                                                
SENATOR  GIESSEL   said  optometrists  are  not   asking  for  an                                                               
expansion of practice.                                                                                                          
                                                                                                                                
DR. STEINER disagreed.                                                                                                          
                                                                                                                                
2:59:55 PM                                                                                                                    
MICHEAL GUZMAN, representing himself,  testified in opposition to                                                               
SB 55. He offered his understanding  that the bill would allow an                                                               
optometrist to  perform eye surgery  and prescribe  narcotics and                                                               
he does not support that.                                                                                                       
                                                                                                                                
SENATOR GIESSEL asked who told him those things.                                                                                
                                                                                                                                
MR. GUZMAN said he  read it online and heard it  on the radio. He                                                               
said he also researched the bill.                                                                                               
                                                                                                                                
SENATOR GIESSEL asked if he  is aware that optometrists have been                                                               
allowed to prescribe narcotics for nine years.                                                                                  
                                                                                                                                
MR. GUZMAN  said he wasn't  aware of that.  He asked if  they can                                                               
prescribe to the same degree.                                                                                                   
                                                                                                                                
SENATOR GIESSEL  said it may  help if he  was aware that  many of                                                               
the courses optometrists take are  taught by the same instructors                                                               
as   ophthalmologists  and   they  both   obtain  the   same  DEA                                                               
authorization.                                                                                                                  
                                                                                                                                
3:02:41 PM                                                                                                                    
MATTHEW GLYNN,  representing himself, testified in  opposition to                                                               
SB 55.  He shared  his story  of wanting  laser surgery  and only                                                               
finding   he   wasn't   a   candidate    when   he   visited   an                                                               
ophthalmologist.                                                                                                                
                                                                                                                                
SENATOR  GIESSEL  asked  if any  of  the  optometrists  performed                                                               
surgery.                                                                                                                        
                                                                                                                                
MR. GLYNN answered no.                                                                                                          
                                                                                                                                
3:04:36 PM                                                                                                                    
TIM SMITH,  representing himself,  testified in opposition  to SB
55. He  spoke as a medical  professional who was not  in favor of                                                               
cross training in different modalities for licensure.                                                                           
                                                                                                                                
3:05:38 PM                                                                                                                    
EDDY IVIZARY,  representing himself,  testified in  opposition to                                                               
SB  55. He  said  that he  feels that  only  a qualified  surgeon                                                               
should be able to operate on eyes. He shared his personal story.                                                                
                                                                                                                                
SENATOR GIESSEL  asked who  told him  that optometrists  would be                                                               
doing eye surgery.                                                                                                              
                                                                                                                                
MR. IVIZARY  restated his  personal story  and the  importance of                                                               
being able to see.                                                                                                              
                                                                                                                                
SENATOR GIESSEL asked if an  optometrist had ever done surgery or                                                               
put a needle in his eye.                                                                                                        
                                                                                                                                
MR. IVIZARY said yes and he told him to stop.                                                                                   
                                                                                                                                
3:08:28 PM                                                                                                                    
DR.  MICHAEL   BRENNAN,  Ophthalmologist,   Alaska  Ophthalmology                                                               
Society,  testified  in  opposition  to  SB  55.  He  shared  his                                                               
professional background.  He maintained  that the  bill endangers                                                               
the health of  the citizens of Alaska. The bill  has two inherent                                                               
flaws;  the brevity  in the  education and  training required  to                                                               
manage complex  medical and surgical conditions,  and second, the                                                               
vague language  regarding penetrative surgery. He  also addressed                                                               
the over-prescribing of potent pharmaceuticals.                                                                                 
                                                                                                                                
SENATOR GIESSEL asked how much  money the society has invested in                                                               
ads opposing the bill.                                                                                                          
                                                                                                                                
DR. BRENNAN  said the organization  invests in a wide  variety of                                                               
advocacy activities in  order to provide patient  safety. He said                                                               
he has  not made a direct  contribution to those ads.  He did not                                                               
know how much the organization spent.                                                                                           
                                                                                                                                
SENATOR  GIESSEL asked  if he  is aware  that optometry  has been                                                               
prescribing controlled substances for nine years.                                                                               
                                                                                                                                
DR. BRENNAN said they don't for  for schedule IA and schedule IIA                                                               
drugs. He said the bill expands the pharmaceutical array.                                                                       
                                                                                                                                
SENATOR GIESSEL said the bill doesn't say that.                                                                                 
                                                                                                                                
3:15:28 PM                                                                                                                    
At ease                                                                                                                         
                                                                                                                                
3:16:08 PM                                                                                                                    
CHAIR COSTELLO reconvened the meeting.                                                                                          
                                                                                                                                
3:16:49 PM                                                                                                                    
LUCRETIA   ANN   DEMIS,   representing  herself,   testified   in                                                               
opposition to SB  55. She doesn't think  that optometrists should                                                               
be  authorized  to   do  the  same  surgical   procedures  as  an                                                               
ophthalmologist.  She said  they don't  have  enough training  or                                                               
background.                                                                                                                     
                                                                                                                                
SENATOR  GIESSEL pointed  out that  an optometrist  refers people                                                               
when they need surgery.                                                                                                         
                                                                                                                                
3:20:29 PM                                                                                                                    
DR. ALFRED  DERAMUS, Ophthalmologist, testified in  opposition to                                                               
SB  55.  He  shared  his professional  background.  He  said  the                                                               
legislation is  poorly written and  will not gather  consensus on                                                               
either side  of the  issue because  of its  content. Some  of the                                                               
language  such   as  "invasive  surgery"  and   "injections"  are                                                               
inflammatory  and don't  adequately address  what is  and is  not                                                               
surgical.                                                                                                                       
                                                                                                                                
3:23:25 PM                                                                                                                    
PAUL  BARNEY,   Chair,  Alaska  Board  of   Optometry  Examiners,                                                               
testified in  support of SB  55. He  said his primary  concern is                                                               
the safety  of the public. In  his four years on  the board there                                                               
have  not  been   complaints  that  rose  to  the   level  of  an                                                               
investigation.  In  general,  optometrists are  conservative  and                                                               
cautious providers.  The bill will  not allow the board  to write                                                               
regulations outside  of optometrists' training. He  mentioned the                                                               
board has  oversight by the  attorney general, the same  as other                                                               
healthcare  providers.  They have  no  intention  of lifting  the                                                               
four-day limit  on prescribing narcotics. SB  55 would modernized                                                               
the definition of optometry and  reflect what is currently taught                                                               
in schools of optometry.                                                                                                        
                                                                                                                                
3:27:21 PM                                                                                                                    
DR. DAVID ZUMBRO, Ophthalmologist,  testified in opposition to SB
55. He said his  primary issue with SB 55 is  that it attempts to                                                               
define   invasive  surgery.   As  written,   the  definition   is                                                               
incomplete and wide open to  interpretation. He suggested that be                                                               
changed.                                                                                                                        
                                                                                                                                
SENATOR GIESSEL asked  if he has had optometrists  do surgery and                                                               
had the patient referred to him afterwards.                                                                                     
                                                                                                                                
DR. ZUMBRO said no.                                                                                                             
                                                                                                                                
3:29:12 PM                                                                                                                    
DR. ROBERT ARNOLD, representing  himself, testified in opposition                                                               
to SB  55. He said,  as a pediatric ophthalmologist,  he performs                                                               
two complex  procedures that are  not described in the  bill. His                                                               
concern is  that the definition  of surgery  is loose and  may be                                                               
open to interpretation. He noted  oversight of safety for surgery                                                               
in Alaska  occurs via licensure  and hospital  privilege surgical                                                               
review.                                                                                                                         
                                                                                                                                
SENATOR  GIESSEL asked  if he's  had  problems with  optometrists                                                               
performing rash interventions.                                                                                                  
                                                                                                                                
DR.  ARNOLD  said  he  has   not  experienced  surgical  care  by                                                               
optometrists, but he has experienced  excellent care by them. His                                                               
partners have  been optometrists. He  said his concern is,  as an                                                               
educator,   that   surgical   oversight  is   not   afforded   to                                                               
optometrists.                                                                                                                   
                                                                                                                                
3:32:09 PM                                                                                                                    
STEVE   DOBSON,   President,   Alaska   Optometric   Association,                                                               
testified  in  support  of  SB 55.  He  shared  his  professional                                                               
background. He  said Alaskans  have benefitted  tremendously from                                                               
the increase  in access  to quality  medical optometric  eye care                                                               
due  to past  legislation.  The  goal of  the  association is  to                                                               
ensure  the  best  practice  of  care and  to  attract  the  best                                                               
graduates  from the  colleges of  optometry. SB  55 is  not about                                                               
allowing eye  surgery, but rather  about board autonomy.  To date                                                               
the  board has  demonstrated  superb  confidence, integrity,  and                                                               
professionalism  protecting  the  interest   of  the  public  and                                                               
passage of the bill would allow continuation of that.                                                                           
                                                                                                                                
CHAIR  COSTELLO  closed  public  testimony  and  held  SB  55  in                                                               
committee.                                                                                                                      
                                                                                                                                
3:36:06 PM                                                                                                                    
There being  no further  business to  come before  the committee,                                                               
Chair Costello  adjourned the Senate Labor  and Commerce Standing                                                               
Committee meeting at 3:36 p.m.                                                                                                  

Document Name Date/Time Subjects
Gasline Development - Cruz #1.pdf SL&C 3/29/2016 1:30:00 PM
Gasline Development- Hopkins #1.pdf SL&C 3/29/2016 1:30:00 PM
Gasline Development- Merrick #1.pdf SL&C 3/29/2016 1:30:00 PM
Alaska Gasline Development Corporation Factsheet.pdf SL&C 3/29/2016 1:30:00 PM
1 - Alaska Gasline Development Corporation Roster.pdf SL&C 3/29/2016 1:30:00 PM
SB 206.PDF SL&C 3/29/2016 1:30:00 PM
SB 206
SB 206 - Fiscal Note.pdf SL&C 3/29/2016 1:30:00 PM
SB 206
2016.03.28 Division of Insurance - Reinsurance White Paper.pdf SL&C 3/29/2016 1:30:00 PM
2016.03.28 - Premera Reinsurance White Paper.pdf SL&C 3/29/2016 1:30:00 PM
SB 55 - Association of Eye Surgeons - SB 55 Surgeries List.pdf SL&C 3/29/2016 1:30:00 PM
SB 55
SB 55 - Opposition Article - Alaska should leave eye surgery to the surgeons.pdf SL&C 3/29/2016 1:30:00 PM
SB 55
SB 55 - Opposition - ASPS Comments - Scope Optometric - AK SB55 - 03-21-16.pdf SL&C 3/29/2016 1:30:00 PM
SB 55
SB 55 - Opposition Letter - Dr. Korshin.pdf SL&C 3/29/2016 1:30:00 PM
SB 55
SB 55 - Support Background Document - AOA Malpractice Fact Sheet.pdf SL&C 3/29/2016 1:30:00 PM
SB 55
SB 55 - Support Letter - AOA.pdf SL&C 3/29/2016 1:30:00 PM
SB 55
SB 55 - Support Letter - Dr. Karpik.pdf SL&C 3/29/2016 1:30:00 PM
SB 55
SB 206 - RWJ Foundation - Innovation Waivers 1.pdf SL&C 3/29/2016 1:30:00 PM
SB 206
SB 206 - RWJ Foundation - Innovation Waivers 2.pdf SL&C 3/29/2016 1:30:00 PM
SB 206
SB 206 - RWJ Foundation - Innovation Waivers 3.pdf SL&C 3/29/2016 1:30:00 PM
SB 206
SB 206 - Hearing Request.pdf SL&C 3/29/2016 1:30:00 PM
SB 206
SB 206 - Sectional Analysis.pdf SL&C 3/29/2016 1:30:00 PM
SB 206
SB 206 - Support Letter - AAHU.pdf SL&C 3/29/2016 1:30:00 PM
SB 206
SB 206.PDF SL&C 3/29/2016 1:30:00 PM
SB 206