SB 169-STATEWIDE IMMUNIZATION PROGRAM  1:32:41 PM CHAIR STEDMAN announced that the first order of business would be SB 169. He said it is the first hearing on the bill. The intent is to adopt a new Committee Substitute, have the sponsor introduce the bill, take public testimony, and then set the bill aside for further review. 1:32:47 PM SENATOR MEYER moved to adopt the CS for SB 169, labeled 28- LS1219\P, as the working document. CHAIR STEDMAN objected for discussion purposes. SENATOR CATHY GIESSEL, Alaska State Legislature, Juneau, Alaska, sponsor of SB 169, introduced the bill. She stated that SB 169 would permanently put the state vaccine program in place with monies other than the state's money. She related that after Senator Stevens left the U.S. Senate, the Center for Disease Control changed how they viewed Alaska. Alaska had been getting $4.3 million per year to provide vaccines for all residents. That funding decreased to $700,000. The state's vaccination program was greatly curtailed. She recalled the vaccine- preventable diseases that the program targeted. SENATOR GIESSEL related that two years ago, after hearing this same bill, the state funded the program for $4 million per year for 3 years. At the end of 3 years, the Department of Health and Social Services (DHSS) was charged with finding a way to fund the program, in collaboration with the state's insurance companies. She said that is what this bill does. 1:35:45 PM JANE CONWAY, Staff, Senator Cathy Giessel, Alaska State Legislature, Juneau, Alaska, described the changes in SB 169 on behalf of the sponsor. She said changes were made from version O to version P, the current CS. She noted the original bill used the name "State Vaccine Assessment Commission" for the group being set up to administer the vaccine program. That name was changed to the "State Vaccine Assessment Council" so it would not be confused with the current "State Health Care Commission." All throughout the bill the term was changed. Another term was changed in version P; "health care insurer" was changed to "an assessable entity" for a broader usage. It is a term used by other states for their vaccine assessment programs. MS. CONWAY referred to page 5, line 18; the manner in which the definition "assessable entity" is written is different than version O, but is using the same reference by definition and it encompasses the detail list from version O. This language recommended by legislative legal services. CHAIR STEDMAN removed his objection to adopting version P. There being no objection, version P was before the committee. 1:38:10 PM At ease 1:39:42 PM SENATOR MEYER inquired about the change in wording from "commission" to "council." He asked if the council would be treated like a commission in the sense that people from all over the state make up the members, they meet on a regular basis, and are subject to an audit. MS. CONWAY explained that the council is a group that is appointed by the commissioner of Public Health; it is not a board. The council will meet throughout the year to set up the program and assess the entities. They will work under the auspices of DHSS and they will serve without compensation or reimbursement. SENATOR MEYER asked if they would serve at the pleasure of the commissioner. MS. CONWAY said the commissioner of DHSS would appoint an 8- member board. 1:42:04 PM WARD HURLBERT, Chief Medical Officer, Division of Public Health, Department of Health and Social Services (DHSS), Juneau, Alaska, provided information related to SB 169. He shared a story to highlight the vast changes from vaccinations in Alaska. He said in 1953 in Ketchikan there were 93 cases of polio, 83 of which were paralytic. Today, a woman came in and was resistant to having her child immunized because she did not know what polio was. He told a story about a measles outbreak in Dillingham in 1961 when children died from the disease. He said it has been a long time since an Alaskan has been lost to measles, due to vaccinations. DR. HURLBERT shared data about the effectiveness of vaccinations. The flu vaccine is only about 50 percent to 60 percent effective for those over 65 years old. Worldwide, smallpox no longer exists. It is nearly the same with polio. He concluded that immunizations have made a big difference. 1:44:56 PM He explained that the proposed methodology in the bill is used by 9 other states. He called it a "win/win" because the payers have to pay less because the state will buy vaccinations at wholesale rates. The modest surcharge will pay for vaccines for underinsured children. About five years ago Alaska was 49th among states in immunization rates for ages two and under. Currently, Alaska is 37th or 38th and about 65 percent of kids are immunized. He predicted that this legislation would improve these numbers much like New Hampshire was able to do. 1:46:29 PM ROSALYN SINGLETON, M.D., representing herself, Anchorage, Alaska, testified in support of SB 169. She called the bill a cost-saving model which will improve access to vaccines for all Alaskans, streamline the distribution of vaccines, and reduce the huge administrative burden that health providers currently have. She said vaccinations demonstrated the dramatic effect of reducing Hepatitis A from the highest to the lowest rate in the country. Also, Alaska has been free of measles since 2000. She said Alaska's expanse challenges the ability to provide on- time immunizations, so ready access to vaccines is critical. Due to the administrative burden, some providers in small communities no longer can provide all of the recommended vaccines due to having to front costs and keep separate stocks of vaccine from state and private purchases. She remarked that she has received calls from providers and parents who cannot access vaccines. She said other states have experienced cost savings and streamlined distribution when using the model the bill would create. 1:49:28 PM LILY LOU, M.D., Medical Director, Newborn Intensive Care Unit, Providence Children's Hospital, Anchorage, Alaska, testified in support of SB 169. She shared that she is the president of the Alaska Chapter of the American Academy of Pediatrics (AAP) and the District 8 representative, for the Western United States and Canada, to the executive committee of the AAP section on perinatal pediatrics. She said she is speaking as an individual in favor of the bill for four reasons. First, is the effectiveness of vaccines, second, is good stewardship, third, is access to care, and fourth, is the future. DR. LOU related that the prevention of infectious diseases by immunization has been one of the most significant advances in health care in human history. She shared statistics related to 16 measles outbreaks in 2011, the cost of which was estimated to be $5.3 million. She maintained that vaccinations will protect everyone and a universal purchase program will likely lead to savings. She said a vaccine assessment account will allow the state to benefit from volume purchasing at discounted federal rates. Other states have shown significant savings and have streamlined the process. The new system will provide more access to care, especially in small communities. It will also have a positive effect on the future. 1:54:04 PM PATRICIA SENNER, Director, Professional Practices, Alaska Nurses Association, Anchorage, Alaska, testified in support of SB 169. She spoke of frustrations she has experience as a nurse practitioner providing immunizations since the state moved away from universal coverage. She said she had to keep separate sets of vaccines for those eligible and not eligible for vaccines through the state. That made for increased costs and increased administrative difficulties, as well as for waste. 1:55:54 PM RANDI SWEET, representing herself, Anchorage, Alaska, testified in support of SB 169. 1:56:37 PM AMY DRESSEL, Pediatrician, Juneau, Alaska, testified in support of SB 169. She listed many reasons for supporting the bill. She said vaccines are very expensive and there are problems with access. The bill helps all vaccine-eligible children in Alaska. Alaska is lowest on the national vaccine record. The bill would help all Alaskans, provide favorable rates, and universal access, decrease the administrative burden, and make for a more efficient system. 1:59:06 PM CHAIR STEDMAN closed public testimony. CHAIR STEDMAN detailed five fiscal notes: one fiscal note that reflects the fund transfer to the new vaccine assessment account in the amount of $4,496,000 from an appropriation in the Governor's current FY 15 budget; one net zero fiscal note from the Department of Health and Social Services (DHSS), Public Health Division, showing the program's expenses of $26,950,000 and the same amount in program revenue; and one indeterminate fiscal note from the Department of Health and Social Services (DHSS), Medicaid Service Division; one zero fiscal note from the Department of Commerce, Community and Economic Development (DCCED); and one indeterminate fiscal note from the Department of Administration. 2:00:34 PM SENATOR MICCICHE asked if it was an initial $4.4 million to fund the program and then about $33,000 in fees to make it sustainable. MS. CONWAY clarified that $4 million is left over in the vaccine program now and will be transferred to the new model. That amount will help to purchase the initial vaccine for the next year. The department will then use a formula to assess how many vaccines will be needed statewide and purchase them in bulk with money from the assessable entities. After the initial $4 million the program becomes funded by insurance payers. SENATOR MICCICHE stated that $4.4 million is leftover previous funding. MS. CONWAY said correct. CHAIR STEDMAN held SB 169 in committee.