Legislature(2017 - 2018)BELTZ 105 (TSBldg)
04/20/2018 01:30 PM Senate JUDICIARY
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| Audio | Topic |
|---|---|
| Start | |
| HB355 | |
| HB123 | |
| HB259 | |
| HB336 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 355 | TELECONFERENCED | |
| += | HB 208 | TELECONFERENCED | |
| += | HB 123 | TELECONFERENCED | |
| + | HB 259 | TELECONFERENCED | |
| + | HB 336 | TELECONFERENCED | |
| + | TELECONFERENCED |
HB 123-DISCLOSURE OF HEALTH CARE COSTS
1:51:32 PM
CHAIR COGHILL announced the consideration of HB 123 and noted
the proposed committee substitute (CS).
1:52:11 PM
SENATOR COSTELLO moved to adopt the work draft Senate CS for
CSHB [123], version 30-LS0380\Q, as the working document.
CHAIR COGHILL objected for an explanation.
1:52:45 PM
JORDAN SHILLING, Staff, Senator John Coghill, Alaska State
Legislature, Juneau, Alaska, reviewed the following substantive
changes between version B and version Q of HB 123:
Page 2, the disclosed price information that is
required to be posted no longer reflects the Medicaid
price. It will reflect the undiscounted price.
Also on page 2, the requirement for a health care
facility to post the 50 most common procedures is
changed to the 25 most common procedures.
Page 4, line 22, insurers were removed from the
requirements under subsection (h). They will no longer
have to comply with the components of (h) that are a
part of the good faith estimate.
MR. SHILLING explained that insurers indicated they would not be
able to comply with a few elements of subsection (h). They would
have difficulty providing the procedure code unless the provider
or patient supplied it. Further, Primera said they could not
provide, as part of a good faith estimate, the information
required under subsection (h)(5). This information is the
identity or suspected identity of any other person who "may
charge the patient for a service, product, procedure, or supply
in connection with the health care services included in the
estimate,".
Page 6, line 26, under subsection (n)(3), a facility
operated by an Alaska tribal health organization is
exempted from the definition thereby exempting them
from the requirements of the bill.
CHAIR COGHILL said it was a federal preemption issue.
1:55:52 PM
REPRESENTATIVE IVY SPOHNHOLZ, Alaska State Legislature, Juneau,
Alaska, sponsor of HB 123, said her minor concern about reducing
the number of prices a facility is required to post from 50 to
[25] is ameliorated by a forthcoming amendment.
CHAIR COGHILL advised that the amendment he had drafted would
take 10 common health care services from each of the six
sections of Category I, Current Procedural Terminology. The idea
is to provide patients with the most relevant information.
REPRESENTATIVE SPONHOLHLZ clarified that she supports the CS
with the forthcoming amendment.
1:57:51 PM
CHAIR COGHILL opened public testimony on HB 123.
1:58:34 PM
GINA BOSNAKIS, representing self, Anchorage, Alaska, said she is
a small business owner and has worked in the Alaska employee
benefits industry for over 30 years. Outside of a death claim,
the most difficult part of her job is receiving a call from a
patient who thought they'd done everything they were supposed to
do to make sure they were getting their procedure from the right
doctor or facility, but they did not ask if the provider was a
preferred provider or in-network with their insurance company.
If they aren't, it changes the whole dynamic for the patient.
She said HB 123 will make it easier for the patient to find out
approximately what their out-of-pocket expenses will be if the
provider is in-network with their insurance company and what the
procedure code for the recommended treatment will be. If the
provider is not in-network, the patient will know their out-of-
pocket expenses will almost certainly be much more than
anticipated. At that point they can and probably should consider
other options such as traveling outside of the state for their
care. Most insurance companies in Alaska offer that option.
If HB 123 becomes law as written, it will absolutely save a lot
of Alaskans from unnecessary debt and potentially curb the high
cost of health care and therefore health insurance in Alaska.
She said she believes with all her heart that the positive
impacts of HB 123 will be felt in every city, borough, and
village in Alaska.
2:02:03 PM
JENNIFER MEYHOFF, representing self, Anchorage, Alaska, said she
is a principal with Marsh & McLennan Agency which is part of the
worldwide consulting firm, Marsh & McLennan Company. She has
over 25 years of experience working with employers on their
employee benefits and what can be affordable. She asked members
to think about the economic decisions they make in an average
day about purchasing various goods and services in the market.
She also asked them to think about the complexity of exploring
for oil and getting it to market and that the company can tell
you to the penny what the price will be before you buy it. She
pointed out that throughout the day and in virtually all aspects
of life, consumers are participants in the market and the
exchange of goods and services. The price of the good or service
is known and communicated before every transaction, except when
you go to the doctor or the hospital.
Medical providers have said they can't disclose prices because
it's just too complicated, but there are a lot of complicated
goods and services in the marketplace and somehow consumers
figure it out. She said a lot needs to be done to help rebalance
the health care marketplace and HB 123 is an important part.
It's time to empower consumers with information to make good
economic decisions about their health care just like the
information most consumers use to make good economic decisions
throughout their average day. HB 123 provides that opportunity
and will help toward containing the cost of health care.
CHAIR COGHILL noted who was available to answer questions.
2:05:08 PM
SHAUN LEWIS, representing self, Fairbanks, Alaska, said he has
been in the health insurance industry for the last 25 years. He
believes that HB 123 is a good bill because it is good for
businesses to have transparency. It will also make the consumer
responsible for looking at why doctor XYZ charges more than
doctor ABC. He said he believes posting the 25 most common
procedures is a step in the right direction. HB 123 is not a
silver bullet that will magically drive costs down, but it's a
good start in the marathon.
2:08:04 PM
TERRY ALLARD, representing the Alaska Association of Health
Underwriters, said she is a Senior Benefits Advisor with The
Wilson Agency in Anchorage, Alaska. She has been in the industry
for over 25 years and is testifying in support of HB 123. The
very high cost of health insurance is an issue the state has
been dealing with for some time. Some might say we've reached a
crisis point. Her clients have asked why expenses are so high
and what can be done about it/ There isn't a single solution,
but HB 123 is a starting point. It gives consumers the tools
they need to access information from their providers so they can
make informed decisions about when to get services, who to get
services from, and how to deal with that in their own personal
budgets. There is no silver bullet, but passage of HB 123 will,
over time, help bring health care costs down.
2:11:25 PM
ELIZABETH WARLICK, Advocacy Coordinator, Greater Fairbanks
Chamber of Commerce, Fairbanks, Alaska, said the more than 700
businesses they represent absolutely support market
transparency, information availability, and the role in
government to bring the cost of health care into balance.
2:12:13 PM
DR. THOMAS KOBYLARZ, representing self, Soldotna, Alaska, said
he appreciates the legislative efforts to control costs health
care costs. He related a personal experience of trying to get
quotes from five clinics on the cost of getting a physical
examination. He was given five different quotes over the phone.
The only issue was the lab tests were different. The exam he
chose to have took about one hour, whereas other exams he's had
lasted about 10 minutes. That illustrates a difference in the
equality of health care.
He said the biggest problem he has in his private practice is
with insurance companies. Preauthorized services are often not
paid as promised. This is frustrating to both providers and
consumers. He believes in health care transparency and
disclosure of health care costs. However, he does not want to
post a menu in his office to describe the cost of each
procedure. That won't lower prices but will make his office look
different.
2:14:28 PM
DR. HEATHER WILLIS, Governmental Affairs Chair, Alaska Dental
Society (ADS), Fairbanks, Alaska, said ADS appreciates the
intent of HB 123 to increase transparency. She highlighted that
in the dental industry it is not difficult to get accurate
estimates for a service. They have no issues with that part of
the bill. However, they do have concerns with posting the top 25
procedures and the fees. The highest fees consumers will see
will be from specialists but they won't necessarily know it is
for specialty care. Based on the fee alone, patients may go to
the wrong or an unqualified provider. She opined that posting
the fees for services tells consumers that health care is a
commodity, but it is not gas or oil. She concluded that the bill
is a step in the right directions for consumers overall, but it
will have unintended consequences as currently drafted.
2:17:24 PM
DR. GRAHAM GLASS, representing self, Anchorage, Alaska, said he
is a neurologist and past president of the Alaska State Medical
Association/ He applauds the sponsor for pushing for
transparency in health care. He referenced his practice and
noted that it can be particularly difficult for patients to ask
the right questions and get needed information about health care
costs when they've just been told they have something like
Parkinson's or ALS. He said he strongly supports good-faith
estimates and his office has been proactive in doing this. It is
appreciated and also helps the office because patients do not
like to pay surprise bills.
He said his concern with the bill relates to listing rack rates
for services because those rates almost never reflect what the
patient will actually pay for their contracted rates. It's a
little misleading on the transparency scale. He said contracted
rates would be the most valuable but that's difficult to do. He
supports good faith estimates and believes the bill could be
amended to say that "no contracts with providers are allowed to
have nondisclosure clauses." Consumers should know basically
what they're going to pay and some of that burden should be on
insurance companies, he said.
2:21:25 PM
RHONDA PROWELL-KITTER, Chief Financial Officer, Public Education
Health Trust, Anchorage, Alaska, said she is testifying as the
president of Alaskans for Sustainable Healthcare Costs. This is
a group of Alaskan employers who are working to find solutions
to the rising health care costs. They fully support HB 123 and
urge its passage. Their employees are being asked to contribute
more out-of-pocket, increase their deductibles, and to be
informed consumers. Part of being an informed consumer is
knowing the cost of services, starting with the rack rate. She
said HB 123 is not the silver bullet to bring down health care
costs, but it is the silver BB that is needed in the market.
2:23:09 PM
NIBERT LUJAN, Alaska Association of School Business Officials
(ALASBO), Juneau, Alaska, said there is a recognition in the
capitol that there are lots of cost pressures on school
districts. Flat funding results in a cut to education services.
The high cost of health care is one of those cost pressures that
school districts and all employers face. HB 123 is a bill that
can help school districts that are struggling with costs. It
won't solve the problem, but it will help health care consumers
become better consumers and hopefully bend the cost curve. She
urged passage of HB 123.
2:24:53 PM
JEANNIE MONK, Alaska State Hospital and Nursing Association
(ASHNA), Juneau, Alaska, thanked the sponsor for working with
stakeholders in the development of HB 123. She said ASHNA
supports price transparency and believes that this legislation
is a reasonable first step. They appreciate that the CS removes
the posting of Medicaid prices. Medicaid payment rates are
negotiated between the state and provider and are already
published. ASHNA also supports good faith price estimates.
Hospitals have existing systems to help patients get estimates
for planned procedures and ASHNA members believe they will be
able to comply with this legislation. She said insurers often
have access to the best data on prices and that is who consumers
should work with to get accurate information on the cost of
services, out-of-pocket expenses, and to make sure the provider
is part of the insurer's network. HB 123 is a first step toward
transparency and ASHNA looks forward to continuing to work with
the legislature on this initiative and others to help consumers.
She highlighted the fairhealthconsumer.org website as an example
of what can be done to make price transparency meaningful.
2:28:06 PM
DR. JOSEPH ROTH, MD and President elect Alaska State Medical
Association (ASMA), Juneau, Alaska, stated that ASMA supports
transparency in medicine, ongoing work on improving health care
and its costs, and good faith estimates by physicians and
insurers. However, ASMA does not support the requirement for
providers to list undiscounted charges. These charges do not
reflect what a patient will actually pay. What they pay is based
on the patient's type of insurance and whether their provider is
in-network or out-of-network. Most procedural charges cannot be
listed accurately because changes in the description of the
procedure can lead to marked changes in charges. For example,
there can be a wide disparity in cost to treat an ankle fracture
because it depends on what is done to the ankle. Another problem
is that studies show that the posting of prices by physicians
leads to increased overall health care costs. They are able to
see what other providers charge and price discrepancies narrow
in an upward fashion. Also, medical billing is a complicated
process. His office of 15 providers has 3.5 billers who are
always available to discuss the cost of a patient's medical care
based on their insurance type.
DR. ROTH advised that both he and ASMA support good faith
estimates from providers and insurers, but they believe that an
all-claims database would serve patients more fully. This means
that both insurers and providers would fully disclosure their
prices. He cautioned members against using information from an
undisclosed cost list to determine health care costs, and
encouraged them to talk to their providers and insurance
companies to get accurate information.
CHAIR COGHILL said he's been working with the sponsor to make
the information a little more valuable, but having the rack
price will be a big part of having one end of the
conversation."
DR ROTH replied the concern is that patient won't get the
information they want if insurers aren't also involved. It
shouldn't be any more difficult for insurers to provide that
information than it is for providers.
CHAIR COGHILL noted that they learned that the insurers wouldn't
be able to provide some of the information that was originally
required.
CHAIR COGHILL asked Mr. Shilling the substance of the proposed
amendment that seeks to make the price information more
valuable.
2:34:04 PM
MR. SHILLING explained that an ongoing concern has been that
listing the 25 most common procedures could result in a list of
admission or diagnostic and admission codes that are not
relevant to some consumers. To make the data more relevant, the
amendment models a bill in the Senate that provides for the
posting of the most common procedures and services within the
six different Current Procedural Terminology (CPT) categories.
CHAIR COGHILL asked the sponsor to comment on the proposed
amendment.
2:35:42 PM
REPRESENTATIVE SPOHNHOLZ said the amendment works conceptually
and it makes sense for hospitals, but the applicability may be
problematic in the various health care settings. The legal
definition of health care facility is any practice that has more
than one health care provider, which encompasses the many
facilities that do not provide services such as radiology,
anesthesiology, or surgery. She said finding something that
works for everybody has been very complicated and that is why
she and the other sponsors decided on the 50 most offered
services. That is simple enough to implement in any health care
setting.
2:37:35 PM
SENATOR WIELECHOWSKI asked for an explanation of the six
sections of Category I, Current Procedural Terminology.
REPRESENTATIVE SPOHNHOLZ listed evaluation and management,
anesthesia, surgery, radiology, pathology labs, and medicine.
The idea is to serve patients who go to a hospital as well as
the patients who only visit their local provider.
CHAIR COGHILL said he wouldn't offer the amendment today but
would bring it up again when the bill is heard on Monday. He
reiterated his concern about providing relevant information.
REPRESENTATIVE SPOHNHOLZ noted she had samples from members of
ASHNA that show the top 50 procedures in several health care
facilities in the state.
CHAIR COGHILL removed his objection and version Q was adopted.
2:40:15 PM
CHAIR COGHILL held HB 123 in committee for further
consideration.