Legislature(2017 - 2018)GRUENBERG 120
03/29/2017 01:00 PM House JUDICIARY
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| Audio | Topic |
|---|---|
| Start | |
| HB43 | |
| HB108 | |
| HB42 | |
| HB123 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 43 | TELECONFERENCED | |
| += | HB 108 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 123 | TELECONFERENCED | |
| += | HB 42 | TELECONFERENCED | |
HB 123-DISCLOSURE OF HEALTH CARE COSTS
2:04:48 PM
CHAIR CLAMAN announced that the final order of business would be
HOUSE BILL NO. 123, "An Act relating to disclosure of health
care services and price information; and providing for an
effective date." [Before the committee was CSHB 123, Version D.]
2:05:27 PM
REPRESENTATIVE KREISS-TOMKINS requested that Amendment 1 be
moved to the bottom of the amendments stack because he recently
received "fresh data" he would like to circulate amongst the
committee members and the bill sponsor.
2:05:48 PM
REPRESENTATIVE REINBOLD moved to adopt Amendment 2, Version 30-
LS0380\I.3, which read as follows:
Page 3, line 18, following "municipal,":
Insert "federal,"
Page 3, line 24:
Delete ""health care facility" does not include"
Page 3, line 25, through page 4, line 3:
Delete all material.
REPRESENTATIVE FANSLER objected.
2:06:16 PM
REPRESENTATIVE REINBOLD noted that during her discussion with
the sponsor she mentioned this amendment and the sponsor did not
offer opposition. This amendment, she explained, removes the
federal exemption and keeps everyone on the same page.
2:06:41 PM
The committee took a brief at-ease.
2:09:13 PM
CHAIR CLAMAN noted that the initial question of Representative
Reinbold was whether the bill sponsor supported or did not
support Amendment 2.
2:09:51 PM
REPRESENTATIVE IVY SPONHOLTZ, Alaska State Legislature, said she
does not support Amendment 2 because it is in conflict with the
Supremacy Clause of the United States Constitution [Article VI,
Clause 2], which read as follows:
This Constitution, and the laws of the United States
which shall be made in pursuance thereof; and all
treaties made, or which shall be made, under the
authority of the United States, shall be the supreme
law of the land; and the judges in every state shall
be bound thereby, anything in the Constitution or laws
of any State to the contrary notwithstanding.
REPRESENTATIVE SPOHNHOLZ continued that there is not a bright
line separating government institutions from private
institutions in this bill, but rather it separates out federally
funded organizations. She opined it would put the state in the
position of defending costly lawsuits which is not in the best
interests of the state.
2:10:48 PM
REPRESENTATIVE REINBOLD said that her impression, during their
discussion on this bill, was that Representative Spohnholz did
not have any strong feelings one way or another. She stressed
that federal dollars are private tax dollars; therefore, the
private sector dollars would fund public facilities, and this
amendment eliminates exemptions for public facilities funded by
private dollars. Also, she commented, sometimes with state
facilities there are matches, such as Medicaid dollars, which is
also the peoples' money. She opined that, at a minimum, it is
only fair that public facilities be on the same playing field as
the private sector.
2:12:12 PM
REPRESENTATIVE LEDOUX related that she understands page 3, line
18, and inserting federal, but she doesn't follow when it comes
to [Section 1, AS 18.15.360(h)], page 3, lines 24-25, and page
4, lines 1-3, which read as follows:
(A) the Alaska Pioneers' Home and the
Alaska Veterans' Home administered by the department
under AS 47.55;
(B) an assisted living home as defined
in AS 47.33.l990;
(C) a nursing facility licensed by the
department to provide long-term care;
(D) a facility operated by an Alaska
tribal health organization; and
(E) a hospital operated by the United
States Department of Veterans Affairs or the United
States Department of Defense, or any other federally
operated hospital or institution;
REPRESENTATIVE LEDOUX asked how a nursing facility licensed by
the department to provide long-term care would be federal.
2:12:59 PM
REPRESENTATIVE SPOHNHOLZ answered "that it is not," and
clarified that she was speaking to the first section of which
inserts "federal." The second section would delete out the
Pioneers' Homes, Veterans' Homes, assisted living homes, and
nursing facilities, in particular. She said she chose not to
include those facilities because everyone living in those
facilities knew exactly what their stay would cost, no one goes
into a long term care facility or the Pioneers' Home without
knowing the exact daily cost. Therefore, having it posted on
the wall was not additional information. In the case of the
tribal health organizations and subparagraph (E), it was her
understanding that the tribal health organizations were largely
federally funded, and she actually received verbal feedback that
a lawsuit would probably ensue because it viewed itself as part
of a federal entity. She said she chose not to take that on
because her primary focus was on the individual marketplace and
having the most opportunity to make a big difference.
2:15:04 PM
REPRESENTATIVE LEDOUX referred to a nursing facility licensed by
the department to provide long term care, and opined that with
some of these facilities possibly basic "stuff" was provided,
but there's the "other stuff" that's provided upon request for
necessity. She said she was thinking of her folks in
California, when her father broke his hip he went into a long
term care facility and was billed for specific services. It
wasn't just that he had to pay "X" amount of dollars in order to
enter the place, and she asked how the facilities are run in
Alaska.
REPRESENTATIVE SPOHNHOLZ opined that the facilities tend to be
that the patient pays for the level of care they need, there may
be some individual distinctions, but the pricing tends to be
based on the level of care for the patient. She explained there
are different pricings for different levels of care, and
generally speaking, the patient knows the cost, and their bill
doesn't change dramatically from one month to another, unless
there was a major medical event. She explained that she was not
discussing that level of care, but rather care such as, routine
and/or elective care when going to the traditional health care
provider. It was her intent, she said, to focus in on that
routine and/or elective care, of which makes up the bulk of the
particular kind of marketplace this bill could influence.
2:18:06 PM
REPRESENTATIVE KOPP referred to Amendment 2 and inserting the
word "federal," and noted that any person or provider eligible
under the federally funded Indian Health Service program does
not compete in the marketplace with respect to price
transparency. Also, with respect to the word "federal," how
would this impact military hospitals, such as the hospital on
Joint Base Elmendorf-Richardson (JBER). He said he was not
familiar with how TRICARE works currently, and opined that with
the intent being marketplace transparency he was unsure how it
aligned with a military hospital posting a price disclosure.
2:19:26 PM
REPRESENTATIVE SPOHNHOLZ remarked that they were discussing two
distinct elements when talking about this one specific
population served through TRICARE, the Veterans Affairs, or the
United States Department of Defense (DoD) delivered health care
services. In the case of the federal facilities operated on
bases, or just outside of the military bases in the case of the
Department of Veterans Affairs, those are excluded on page 4,
lines 1-3, [subparagraph (E)], which read as follows:
(E) a hospital operated by the United States
Department of Veterans Affairs or the United States
Department of Defense, or any other federally operated
hospital or institution;
REPRESENTATIVE SPOHNHOLZ pointed out that those were treated as
separate because they are federal institutions. Although, in
the event a veteran with TRICARE received approval for some sort
of care outside of the military system and visited a private
provider in the marketplace, the veteran should be able to see
that information. TRICARE can be used within the private
market, with some restrictions outside of military
installations, but she said she did not know all of the details.
2:20:51 PM
REPRESENTATIVE KOPP referred to Amendment 2, page 1, lines 4-5,
deleting subparagraphs (D) and (E), and asked whether there
would be a problem leaving subparagraphs (A), (B), and (C).
REPRESENTATIVE SPOHNHOLZ advised that the way the bill was
drafted was actually the inverse because ...
REPRESENTATIVE KOPP clarified that he asked the question
backwards.
REPRESENTATIVE SPOHNHOLZ responded that she did not object to
his suggestion, although she did not believe anyone moves into
an assisted living home without first receiving the exact cost,
how they are charged for services, and how the services will be
paid. Therefore, she remarked, the need for transparency was
not the same when compared to the needs at the Pioneers' Home or
an assisted living home, and walking into an emergency room at
the hospital and considering an MRI, or to the local doctor for
additional bloodwork.
2:23:01 PM
CHAIR CLAMAN explained that when his family had to determine
which assisted living community center would be best for his
parents, his siblings talked to approximately four and six
different assisted living centers, and they knew the exact price
for each center.
2:23:54 PM
REPRESENTATIVE EASTMAN referred to federal jurisdiction and
opined that it made sense for the Department of Veterans Affairs
to determine what goes on in its facilities, and to keep those
standards consistent state-to-state. Which, he commented, is
different from the federal medical facilities not competing with
the private sector in the marketplace because they absolutely do
compete in this state. For example, he said, the Alaska Native
Medical Center (ANMC) provides treatment for federally eligible
beneficiaries and also any number of different people. It is
the only hospital in Anchorage with the ability to serve
multiple trauma cases simultaneously, and it can compete with
other aspects of the private sector. He offered concern with
the idea that transparency was needed for all of the various
facilities covered under this bill because transparency was
already working well, such as with a senior center. He said he
hoped for consistency and equity in applying these requirements
to everyone in Alaska, and if the legislature made the
requirement to post prices, that requirement should be made for
everyone regardless of the facility. In the event the word
"federal" was not inserted at line 18, he said, there would be
no need for any of the federal references in subparagraphs (D)
or (E.
2:31:21 PM
REPRESENTATIVE FANSLER related that he could see a difference
between subparagraphs (A), (B), and (C), and what this bill was
attempting to provide in that he could not walk into an assisted
living facility and have his broken arm examined unless he lived
there. The bill encourages transparency in the situation of an
elective surgery and the patient would know where they would
want to go based on that transparency. As for subparagraphs (D)
and (C), he could see their complete difference, obviously, with
the Supremacy Clause. Perhaps, he suggested, when facilities
are required to post fees, if the federal facilities suddenly
were no longer taking in the patients they once did because it
didn't have that transparency, he pointed out, that chances are
that the free market would pull them into the transparency on
its own.
2:33:10 PM
REPRESENTATIVE REINBOLD offered that she was open to a friendly
amendment, but in reviewing the Supremacy Clause she would like
the Department of Law to weigh in. She opined that the
Supremacy Clause had nothing to do with this and that it was an
overuse of that clause. However, she said she would go to the
United States Constitution, Amendment IX and X, which read as
follows:
Amendment IX
The enumeration in the Constitution, of certain
rights, shall not be construed to deny or disparage
others retained by the people.
Amendment X
The powers not delegated to the United States by the
Constitution, nor prohibited by it to the states, are
reserved to the states respectively, or to the people.
REPRESENTATIVE REINBOLD asked whether it was the sponsor's
intention that the private sector be required to publically post
their CPT codes and fees, while the public sector, using private
sector dollars, would not be required to post those codes and
fees.
2:34:23 PM
REPRESENTATIVE SPOHNHOLZ pointed out that page 3, lines 18-24,
read as follows:
(2) "health care facility" means
private, municipal, or state hospital, psychiatric
hospital, independent diagnostic testing facility,
residential psychiatric treatment center ...
REPRESENTATIVE SPOHNHOLZ continued that it is a long list,
several of which include public entities. She pointed out that
she had said several times that the distinction was not between
public and private institutions. She reiterated that the only
entities carved out, specifically due to the Supremacy Clause,
are federal in nature, and she stressed that was the only
distinction.
REPRESENTATIVE REINBOLD asked that the Department of Law weigh
in on the Supremacy Clause because she believed it was a misuse
of the Supremacy Clause.
2:35:09 PM
REPRESENTATIVE LEDOUX pointed out that she did not pretend to be
an expert in the Supremacy Clause, but there is a long line of
judicial precedent stating that the state can't make the federal
government do things. For example, she said, the state cannot
tax the federal government, and while the states do not always
have to adhere to what the federal government tells them what to
do, the state cannot make the federal government do things.
2:35:53 PM
CHAIR CLAMAN commented that he completely agrees with
Representative LeDoux about the Supremacy Clause, and as he
offered during the last hearing, he intends to move this bill
out of committee today. He pointed out that the question of the
Supremacy Clause came up during the last hearing on this bill
and Representative Reinbold could have followed up with the
Department of Law or Legislative Legal and Research Services
before today. He stated that there was no reason to call
Legislative Legal and Research Services during this hearing
because the courts have consistently ruled, again and again,
exactly as Representative LeDoux described.
REPRESENTATIVE REINBOLD argued that it is important for the
Department of Law or Legislative Legal and Research Services to
weigh in on the Supremacy Clause, and the committee needs to
discuss the Constitution of the United States, Amendments IX and
X. She then described herself as a federalist "and I do believe
that the -- the rights that are not absolutely specifically ...
and I see nothing in the constitution that says that -- that
they can't, you know, post, or they shouldn't be transparent
with -- with public dollars. It just -- it just seems to me
outlandish to be using that Supremacy Clause in this case." She
said the committee needs [this bill] to be on a fair playing
field.
2:38:27 PM
A roll call vote was taken. Representatives Eastman and
Reinbold voted in favor of adopting Amendment 2.
Representatives Fansler, Kopp, Kreiss-Tomkins, LeDoux, and
Claman voted against it. Therefore, Amendment 2 failed to be
adopted by a vote of 2-5.
2:39:07 PM
REPRESENTATIVE REINBOLD moved to adopt Amendment 3, Version 30-
LS0380\I.4, which read as follows:
Page 1, line 1, following "information;":
Insert "relating to health care insurers;"
Page 2, line 1, following "AS 18.23.400":
Insert "and AS 21.96.125"
Page 4, following line 21:
Insert a new bill section to read:
"* Sec. 3. AS 21.96 is amended by adding a new
section to read:
Sec. 21.96.125. Disclosure of health care
services and price information by health care
insurers. (a) A health care insurer shall annually
(1) compile a list describing, by procedure
code, including a brief description in plain language
that an individual with no medical training can
understand, the 50 most common health care services
covered by the insurer in this state in the previous
calendar year and the total cost to the insurer for
each of those health care services during that period;
(2) publish and update the list on the
insurer's Internet website by January 31 each year;
and
(3) submit the list by January 31 each year
to the Department of Health and Social Services for
entry in the database under AS 18.15.360(a).
(b) The Department of Commerce, Community, and
Economic Development may adopt regulations under
AS 44.62 (Administrative Procedure Act) to implement
this section.
(c) A health care insurer that fails to comply
with the requirements of this section is liable for a
civil penalty. The Department of Health and Social
Services may impose a civil penalty of not more than
$150 for each day after March 31 that a health care
insurer fails to provide and post information as
required under (a) of this section. The total penalty
may not exceed $2,500. A person penalized under this
subsection is entitled to a hearing conducted by the
office of administrative hearings under AS 44.64.
(d) In this section,
(1) "health care insurer" has the meaning
given in AS 21.54.500;
(2) "health care service" has the meaning
given in AS 18.23.400;
(3) "insured" means an individual covered
by a health care insurance policy."
Renumber the following bill section accordingly.
REPRESENTATIVE FANSLER objected
2:39:25 PM
REPRESENTATIVE REINBOLD explained that Amendment 3, requires a
posting of the prices paid by the insurance companies.
2:39:52 PM
REPRESENTATIVE SPOHNHOLZ offered that while she appreciates the
intent of expanding price transparency, unfortunately, in
looking at Amendment 3, she could not support it at this time.
She noted that lines 15-16 ask for the total cost to the insurer
for each of those health care services during that period, and
she was unsure what that meant because there are a variety of
definitions of health care costs are out there. She asked
whether Amendment 3 referenced the total amount they've paid
out, in which case that would be getting into a totally
different issue than under HB 123, because it is about informing
consumer price transparency. She noted that it could also mean
what the insurers are paying to different providers, and that
would vary depending upon whether or not that providers was
within a preferred provider network or out of the provider
network. She related that a lot of time was spent in
determining how to have a clean, clear bill that was
understandable by the end user, and Amendment 3 muddies the
water.
2:41:20 PM
REPRESENTATIVE LEDOUX asked Representative Reinbold to explain
Amendment 3 because she was unsure whether the amendment was so
doctors could see what the insurance companies were going to
pay, or whether the consumer would see what the insurance
company pays.
REPRESENTATIVE REINBOLD explained that doctors will post their
rack rate fee, the CPT codes, except doctors receive different
reimbursements from insurers for their different types of
insurance patients. Unfortunately, she said, patient's will
"freak out" over the posted charge, not understanding that is
not the amount the doctor is actually reimbursed, and it becomes
more complicated under managed care. For example, while working
in a doctor's business office in Texas, the office was only
allowed to charge $400 and the rack rate fee may have been
$10,000 because it had negotiated a low price. The amendment
allows that the reimbursable price the insurance companies pay
be transparent, she said.
2:43:50 PM
REPRESENTATIVE LEDOUX offered that while she was sympathetic to
what this amendment was trying to do, but was complicated in its
manner because around here things are sometimes accomplished
through baby steps. She remarked that she will not support this
amendment because, in the context of this bill, it would not
work.
2:44:51 PM
REPRESENTATIVE EASTMAN referred to page 2, line 3, wherein the
fine appears to have tripled and asked why it went from $50 per
day to $150 per day.
REPRESENTATIVE REINBOLD noted that she had not requested that
language and asked that the drafter explain the difference.
2:45:28 PM
REPRESENTATIVE SPOHNHOLZ pointed out that this amendment
requires the health care insurer to post information allowing
patients to see what the insurer would charge for the service.
In that manner, a person would have to review the doctor's rack
rates and then review their insurer's website to determine what
the insurer would pay. Essentially, she related, her source at
the Department of Health and Social Services advised that an all
payor claims database would be required to mesh this amendment
with the bill.
2:46:49 PM
REPRESENTATIVE REINBOLD advised that her intention is to include
insurers because the third party insurance company pays the
bills. She commented that the amendment is fair if the goal is
to get true transparency and make this a consumer friendly bill.
2:48:26 PM
REPRESENTATIVE EASTMAN commented that Amendments 1 and 3 appear
to be going in the same direction, yet applying different
language to get there.
CHAIR CLAMAN interjected that Amendment 1 has nothing to do with
information from insurance carriers, and Amendment 3 is all
about information from insurance carriers. He pointed out that
Representative Eastman cannot claim they address the same issue
as they are completely different.
REPRESENTATIVE EASTMAN opined that they do, and that obtaining
information from insurers appears to be a fairly important part
of this whole equation. He related that when he visits a
doctor's office, that office queries his insurance company for
information and relays that information to him. He said, "I
work with them on whether or not I'm gonna actually contract
with them for the services." His concern with the bill,
unamended, is that it runs into the "bridge too far problem."
He explained that there was an idea to go straight from Britain
to Berlin, during World War II, by way of several bridges.
Unfortunately, the forces were unable to reach the last bridge,
and; therefore, the whole idea and effort crumbled because they
never got there. He related that if the legislature doesn't
actually get to the point of an Alaska resident receiving
helpful information, then it appears like a lot of effort and it
doesn't get the legislature where it needs to be.
2:50:50 PM
REPRESENTATIVE KOPP suggested that this amendment raises
questions in that the health care insurance market negotiates
rates for procedures individually with health care facilities
and employers. Certainly, he commented, those rates are
different depending upon volume, how well the health care
program is managed, history with the insurer, and a host of
issues. He suggested getting an insurance expert online and ask
whether the legislature can do this because it will get into
market proprietary information between insurance companies.
Also, he said, possibly the committee would be interfering with
insurers as to the market by requiring them to disclose their
negotiated rates for a whole host of entities, such as health
care facilities or employers.
2:52:24 PM
CHAIR CLAMAN commented that the House Health and Social Services
Standing Committee heard this bill and the insurance companies
said little, but they did say there were significant privacy
issues between commercial relationships, the insurance
companies, and their insured.
He commented that he recognizes the sponsor's intent for more
transparency as to health care costs and insurance costs, and
rather than try to globally fix everything, the sponsor prefers
to take baby steps toward improved transparency. He related
that the [amendment] requires Premera, Blue Cross Blue Shield of
Alaska to voice how much it paid in the state last year for all
of the completed blood counts, and to give a total number. He
suggested this amendment asks that, instead of letting the
consumer know the average price for a complete blood count paid
by insurance company "X," it would provide the total number of
the many hundreds of thousands of people they provide insurance
for, and the consumer would not be helped.
CHAIR CLAMAN advised that Ms. Glover was online regarding the
$150 penalty. He said he believes the committee could agree to
change the figure to $50 consistent with the bill, and treat it
as an informal amendment.
2:55:50 PM
CHAIR CLAMAN asked the committee to agree that on page 2, line
3, delete "$150" and insert "$50." There being no objection,
the informal amendment was adopted.
2:56:28 PM
REPRESENTATIVE REINBOLD opined that Chair Claman said something
about insurance companies not wanting to disclose their
information due to it being proprietary information, even though
a lot of doctors don't want to do that either due to sticker
shock. She commented that people believe the rate posted is the
amount the doctor receives and it turns the patient against the
doctor. Unfortunately, she said, the patient doesn't know their
doctor has far more specialties, went through 10-20 more years
of schooling with loans, or that the doctor may take a Medicare
patient and only receive 10 percent of the rack rate posted.
She argued that if the legislature doesn't require government
facilities to meet the same standards as the private sector,
they don't have to comply. The fact that these doctors may post
a $500 fee, they may only receive $50 for their service because
the insurance company negotiated a deal where it racks in
hundreds of millions of dollars and takes no risk. Yet, she
pointed out, it is the doctors seeing the patients, the doctors
have the insurance, the doctors have to deal with the follow up,
and now the insurance companies "get scot-free clean." She
stressed that it would be completely misguided if the insurance
companies were not included in this bill.
2:58:59 PM
A roll call vote was taken. Representatives Eastman, Reinbold,
Kopp voted in favor of adopting Amendment 3. Representatives
LeDoux, Fansler, Kreiss-Tomkins, and Claman voted against it.
Therefore, Amendment 3 failed to be adopted by a vote of 3-4.
2:59:31 PM
REPRESENTATIVE REINBOLD moved to adopt Amendment 4, Version 30-
LS0380\I.5, which read as follows:
Page 2, line 11, following "charged":
Insert "and the amount the provider actually
received"
Page 2, line 16, following "charged":
Insert "and the amount the provider actually
received"
REPRESENTATIVE FANSLER objected.
2:59:35 PM
REPRESENTATIVE REINBOLD referred to her comments regarding a
posted fee of $500, and explained that the doctor may only
receive $50 or write off the entire fee, and Amendment 4
requires "the amount the provider actually received" because
that information is important for the patients. Some patients
may believe their doctors are millionaires, not knowing they may
have extensive education loans, and insurance costs to pay. She
related that the insurance companies treat doctors
"horrendously," the sticker shock can be high, and the amendment
requires the amount the providers actually received for their
services to be posted.
3:00:52 PM
REPRESENTATIVE EASTMAN commented that Amendment 4 moves the
committee closer to actual transparency by requiring all doctors
to post the actual amount they receive from the insurer, thereby
allowing an even playing field.
3:02:34 PM
REPRESENTATIVE LEDOUX said she was sympathetic to what this
amendment was trying to do, but if the committee was really
concerned about the impact on the private sector, she was
hesitant to ask doctors to post the amount they actually receive
from insurers, Medicaid, Medicare, or workers' compensation
insurance. In response to Representative Eastman's argument
that doctors certainly have the opportunity to explain their
rack rates during the patient's visit, she pointed out that
there is nothing in the bill prohibiting physicians from posting
all of those rates.
3:03:59 PM
REPRESENTATIVE KREISS-TOMKINS noted that Amendments 3 and 4,
appear to approach health care price transparency from the
insurance side of the equation, as opposed to the provider side,
and agreed that it was important to approach it in both
directions. Amendment 4 is elegant in its simplicity, he
described, but the element he struggles with was what
Represented LeDoux pointed out, that different insurers have
different rates and no one has any idea how much anything costs.
He commented that he was unsure this bill was the correct
vehicle because it was more of a provider based bill. He then
read the language in the amendment "and the amount the provider
actually received," and asked how Representative Reinbold saw
that being implemented and practiced.
REPRESENTATIVE REINBOLD responded that if this was a provider
based bill, because most providers hate this bill, and it will
make patients "freak out" at the sticker shock. In response to
Representative LeDoux comment that nothing prohibits the doctor
from discussing their rates, she answered that some doctors may
not want to tell their patients they receive $50 for a Medicare
patient, $55 for a veteran, and $200 for a lawyer. She opined
that doctors want to discuss the patient's medical and emotional
issues, and not get into this "price fixing, this anti-trust,
this movement toward -- I think this is a much bigger issue,
like with stark laws and anti-trust laws, and all sorts of other
things." She said she believes that even with this amendment,
"it's none of our business."
3:07:52 PM
REPRESENTATIVE EASTMAN surmised that, currently the bill states
the discounted price charged, and this amendment would then add
the amount the provider received, and commented that he hoped
the committee was not worried about having too much
transparency. There is a medical facility in his district with
a history of "being on the high side," but with that information
available it would give patients the opportunity to ask why the
prices are high. He described the bill as helpful in starting
conversations so that 10 years from now the population would not
be looking at the same problem.
3:09:41 PM
REPRESENTATIVE KOPP commented that a couple of years ago he
threw his lower back out, and the chiropractor advised it would
be $80 if he self-paid, or $260 would be billed to the insurance
company. He commented that Amendment 4 gets right at this issue
because if the committee was really looking at transparency in
the marketplace, at some point it must be recognized there is a
business relationship, which is not inherently evil or
nefarious, with third party payor insurance companies.
Currently, patients are not directly paying physicians, and if
the goal is transparency without including the insurer in any
manner, it does make it harder to get there, he commented.
While realizing Amendment 4 was problematic, he said he would
support the amendment.
REPRESENTATIVE REINBOLD commented that she would stick with
Representative Kopp's good comments.
3:11:40 PM
REPRESENTATIVE FANSLER maintained his objection.
3:11:47 PM
A roll call vote was taken. Representatives Eastman, Reinbold,
and Kopp voted in favor of adopting Amendment 4.
Representatives Kreiss-Tomkins, LeDoux, Fansler, and Claman
voted against it. Therefore, Amendment 4 failed to be adopted
by a vote of 3-4.
3:12:46 PM
REPRESENTATIVE KREISS-TOMKINS withdrew Amendment 1, labeled 30-
LS0380\I.2 [prior to offering a motion to adopt the amendment].
REPRESENTATIVE KREISS-TOMKINS commented that after reviewing
actual CPT codes in a facility realized that many of the CPT
codes are diagnostic and testing in nature and that none of the
"meat and potatoes" procedures the committee was interested in
actually made the top 50 CPT codes. After reviewing a workers'
compensation medical fee schedule which included all of the meat
and potatoes procedures, such as MRIs, X-rays, stitches for a
laceration, he drafted an amendment to maintain the simplicity
of the bill and integrates all of that information The Alaska
State Hospital and Nursing Association (ASHNA) worked closely
with his office to provide a list of the top 10 grossing
procedures at a sample facility, and from a different facility,
and there was 100 percent overlap between the top 10 grossing
procedures and the top 50 most common procedures. Therefore,
Amendment 1 is redundant; however, he opined, the way to get
there is using NTCI data which comes from workers' compensation.
It listed the 10 top grossing procedures within different AMA
service categories, and the four largest AMA service categories
in health care include: surgery at 31 percent of all health care
costs; physical medicine at 29 percent; evaluation and
management at 16 percent; and radiology at 13 percent. Those
four AMA service areas account for the preponderance of medical
costs. He summarized that today is not the day, but he felt it
was important to put on the record that possibly there is a way
to get at the meat and potatoes procedures while still working
within the parameters of the simplicity in this legislation.
3:15:59 PM
CHAIR CLAMAN advised that the bill was back before the committee
with no amendments attached, and asked for further comments or
discussion.
3:16:12 PM
REPRESENTATIVE EASTMAN said that Representative Kreiss-Tomkins
solution was not before the committee, and he could not support
the bill. In determining how to get from "where we are" to a
more transparent system and possibly more economical pricing in
dealing with the cost of delivering health care, he said this
bill "gets us somewhere" but was unsure whether it moves the
state closer to where it wants to be and was possibly pulling
the committee farther away. The bill imposes more government
regulations, institutes the threat of fines on health care
facilities, and the problem of the disparity between what is
expected of the state's facilities and state departments and
what is being asked of the private sector hasn't been solved.
For example, the sponsor made an effective date of HB 123 at
January 1, and on that date the requirements would be instituted
for health care facilities with total penalties not to exceed
$2,500, but the fiscal note has a department that will not have
the regulations in place for it to uphold its end of the bargain
until July 1, 2019. He said he will vote against the bill.
3:19:44 PM
REPRESENTATIVE REINBOLD offered that the bill is coming from a
"fabulous place," but her philosophy is that this will have some
negative unintended consequences in patients against their
doctors due to fees. She described it as a double standard when
asking the private sector to post fees without requiring public
facilities to also post fees, and that the is being missed if
the bill doesn't include insurance companies, which are the key
third party payor, as part of this government solution. She
referred to the Constitution of the State of Alaska, Article 1,
Section 22, and commented, "It is the legislature's job to not
infringe on privacy of our citizens" and this may be on the
verge of that infringement.
3:23:22 PM
REPRESENTATIVE FANSLER moved to report CSHB 123(HSSS), Version
30-LS0380\I, out of committee with individual recommendations
and the accompanying fiscal notes.
REPRESENTATIVE EASTMAN objected.
3:23:35 PM
A roll call vote was taken. Representatives Kopp, Kreiss-
Tomkins, LeDoux, Fansler, and Claman voted in favor of CSHB 123.
Representatives Eastman and Reinbold voted against it.
Therefore, CSHB 123(HSS) was reported out of the House Judiciary
Standing Committee by a vote of 5-2.