Legislature(2017 - 2018)CAPITOL 106
03/29/2018 03:00 PM House HEALTH & SOCIAL SERVICES
Note: the audio ![]()
and video ![]()
recordings are distinct records and are obtained from different sources. As such there may be key differences between the two. The audio recordings are captured by our records offices as the official record of the meeting and will have more accurate timestamps. Use the icons to switch between them.
| Audio | Topic |
|---|---|
| Start | |
| HB193 | |
| SB174 | |
| SB108 | |
| Confirmation Hearing(s) | |
| HB358 | |
| HJR32 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| += | SB 174 | TELECONFERENCED | |
| += | SB 108 | TELECONFERENCED | |
| += | HB 358 | TELECONFERENCED | |
| *+ | HJR 32 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 193 | TELECONFERENCED | |
HB 193-HEALTH CARE; BALANCE BILLING
3:08:40 PM
CHAIR SPOHNHOLZ announced that the next order of business would
be HOUSE BILL NO. 193, "An Act relating to insurance trade
practices and frauds; and relating to emergency services and
balance billing." [In front of the committee was Version T,
adopted as the working draft on March 8, 2018]
3:09:06 PM
RYAN JOHNSTON, Staff, Representative Jason Grenn, Alaska State
Legislature, offered a brief recap of the proposed bill, HB 193,
stating that the bill was effectively a ban on balance billing
for medical providers, while also instituting a hold harmless
clause for insurance providers. He explained that the bill
would only remove a patient from this billing situation in
emergency situations.
3:09:38 PM
CHAIR SPOHNHOLZ opened invited testimony on HB 193.
3:09:57 PM
ANNE ZINK, MD, Alaska American College of Emergency Physicians,
paraphrased from a letter of support, dated March 28, 2018,
which read: [included in members' packets]:
3:10:35 PM
Representing more than 80% of the emergency physicians providing
emergency medical care to the people of our state, the Alaska
Chapter of the American College of Emergency Physicians writes
today to support HB193.
HB 193 will protect patients and families across the
state from the high costs and sticker shock that can
come from "surprise medical bills." Both doctors and
patients support this important measure, which will
provide consumer protections for patients, strengthen
access to care, and put an end once and for all to
surprise bills.
As emergency physicians in Alaska, we know firsthand
about the gaps in patient healthcare coverage that can
cause patients to postpone or avoid treatment until
it's too late. According to a national survey, 44% of
people reported that they didn't seek treatment when
they were sick or injured because of costs. At the
same time, 35% of Americans would have trouble paying
their regular bills if faced with a $400 health
emergency. This is alarming, but not surprising, and
we must work together to ensure that patients can
safely access emergency care without worrying about
going bankrupt.
What good is insurance if it fails us in an emergency?
Insurance companies are shifting hundreds of millions
of dollars in costs to patients and doctors each year
through higher premiums, deductibles and cost-sharing
requirements. At the same time, Alaska insurance
companies are narrowing their networks making them
smaller through limiting access to doctors and care,
which means fewer options and choices for patients and
creating large coverage gaps where care patients
thought would be covered, turns out not to be. These
gaps are leading to surprise bills, adding even more
costs for patients.
Alaska patients and families deserve better. Right
now, the state has a regulation in place that requires
insurance companies to cover these unexpected out of
network costs during emergencies through fair and
appropriate payments to doctors. But, Alaska insurance
companies are working to undermine this regulation
and we need your help to ensure patients are protected
in the long run. We're working to support a new bill,
HB 193, that will end surprise billing altogether and
provide the protection patients need.
HB 193 is a comprehensive solution that protects
patients and ends surprise bills by requiring insurers
to cover unexpected, emergency out of network care,
and limiting patient financial exposure. HB 193 will
protect patients from receiving large bills that their
insurance companies have refused to pay. By
establishing an appropriate and fair reimbursement
standard between insurers and doctors, the bill takes
patients out of the middle and improves access to
care.
HB 193 sets a fair minimum standard, the 80th
percentile rule that has been working in Alaska since
2004, which insurers use as a benchmark to pay out-of-
network physicians, providers or facilities for
unexpected care. HB 193 bans balance billing, meaning
no further bills would go to patients in these
situations. Because doctors will be payed fairly,
there is no need for additional bills.
Despite negative attention created by misleading
information by insurance companies, patients support
the 80th percentile rule, and want their insurance
plans to fairly cover out-of-network emergency care.
The 80th percentile rule relies on transparent market-
based information that takes into account local market
prices for services. They are based in market costs
and not set by government or manipulated by insurance
companies.
Although critics have claimed that providers with
extremely large market share can impact prices under
this standard, there's no evidence or report of foul
play. ISER (UAA's Institute of Social and Economic
Research) is currently looking at this issue for
Alaska. Research in New York State has shown that a
similar standard did not increase cost after its
implementation there.
Without the 80th percentile rule in HB193, patients
will be left unprotected as insurance companies shirk
their responsibility to pay. In fact, insurance
companies would be allowed to set any rates they
wanted with no regard for costs or impact on
emergency room staffing or services.
Alaska patients and families need this full protection
from surprise bills. This bill with strengthen the
healthcare system, offering protection first and
foremost to patients, and ensuring the doctors and
emergency rooms can keep their doors open and keep
staffed with needed specialists and providers to best
treat patients in emergencies.
We hope we can count on your support for HB 193.
3:12:28 PM
REPRESENTATIVE JOHNSTON, noting that there were two major
insurance providers in Alaska, asked if her business was
currently in-network for either of those providers.
DR. ZINK expressed agreement that her group was in-network.
REPRESENTATIVE JOHNSTON asked if her group contracted with out
of network physicians.
DR. ZINK replied that her group covered the emergency department
at the Mat-Su Regional Medical Center, and, as they billed as a
unified group, they were in-network with all the major
providers. She explained that most providers wanted to be in-
network and did not want to shift that burden to patients. She
stated that they did not have any contract negotiations, and, as
they were busy with patients, they "just take what the insurance
companies give us." She declared "that's the reason why this
legislation is really important."
DR. ZINK expressed her agreement with Representative Johnston,
that the bulk of their emergency room visits, if insured, were
in-network.
3:14:00 PM
REPRESENTATIVE JOHNSTON asked about the operations in other
emergency room facilities in Alaska.
DR. ZINK replied that there was a similar model throughout the
state for emergency providers, that most were independent groups
contracted with a hospital. She pointed out that the networks
were shrinking in the Lower 48, resulting in larger insurance
gaps. She expressed her hope that this proposed legislation
would get in front of that. She declared that her group did not
send many balance bills, although this was a huge issue in the
Lower 48.
3:15:04 PM
CHAIR SPOHNHOLZ opened public testimony on HB 193.
3:15:33 PM
SAMI ALI, MD, Alaska Emergency Medicine Associates, explained
that her group of physicians staffed the emergency room at the
Providence Alaska Medical Center and provided care to all
patients who came through the emergency room. She pointed out
that the facility did not use mid-level providers. She asked
that the 80th percentile rule be preserved to prevent any
reduction in quality care or to accessibility for medical care
for patients in Alaska. She declared support for proposed HB
193 as it would enable physician groups in Alaska to recruit and
retain high quality physicians, as this was a difficulty in
Alaska.
3:18:38 PM
STEVEN COMPTON, MD, President, Alaska Heart and Vascular
Institute, stated that practicing cardiology in Anchorage was a
challenge, as it was difficult to recruit physicians to come to
Alaska. He reported that to attain the same ratio of
cardiologists to population as the Lower 48, it would be
necessary to more than double the number of cardiologists in the
state. He noted that, as the Baby Boomer demographic was
entering the age for needing more cardiology care, the demand
for services had "accelerated tremendously in the last decade
and will continue to do so," and that the state was already
underserved. He stated that it was a fundamental commitment of
his organization to provide care to anyone who walked through
the door. He reported that his group served 30 percent of the
state Medicare population, and noted that all Medicare clinics
lost money and were heavily subsidized by the hospitals. He
said that the "way we keep the lights on is by cost shifting."
He explained that the Medicare charges were paid with funds from
private payers, allowing them to maintain access to care. He
declared support for the proposed bill.
3:23:10 PM
CHAIR SPOHNHOLZ closed public testimony on HB 193.
3:23:28 PM
REPRESENTATIVE ZULKOSKY moved to report CSHB 193, Version 30-
LS0466\T, Wallace, 3/6/18, out committee with individual
recommendations and the accompanying fiscal notes. There being
no objection, CSHB 193(HSS) was moved from the House Health and
Social Services Standing Committee.