04/16/2024 03:00 PM House HEALTH & SOCIAL SERVICES

             HB 285-MAMMOGRAMS:  INSURANCE COVERAGE                                                                         
                                                                                                                                
3:06:22 PM                                                                                                                    
                                                                                                                                
CHAIR PRAX  announced that the  first order of business  would be                                                               
HOUSE BILL  NO. 285, "An  Act relating to insurance;  relating to                                                               
mammograms; and providing for an effective date."                                                                               
                                                                                                                                
3:06:43 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE ZACK  FIELDS, Alaska  State Legislature,  as prime                                                               
sponsor, introduced  HB 285.   He noted that  the bill came  as a                                                               
suggestion from  Susan G. Komen,   the organization that  did the                                                               
research on  the bill.  He  stressed that of the  different types                                                               
of  mammograms,  many  Alaskan  women  cannot  afford  diagnostic                                                               
imaging exams.   He said that the Affordable Care  Act (ACA) does                                                               
not cover  diagnostic screenings; therefore, high  risk women who                                                               
are not  wealthy struggle to pay  for these mammograms.   He said                                                               
that  when cancer  is detected  early,  it is  less expensive  to                                                               
treat; the  bill would  require an up-front  cost which  pales in                                                               
comparison to  the cost of  delaying detection.  He  went through                                                               
the number  of detections in  Alaska as well  as the rest  of the                                                               
U.S.   He further  related impacts  in detection  in regard  to a                                                               
woman's race.   He drew attention to a slide  [hard copy included                                                               
in the committee  packet], which went over cost  comparisons.  He                                                               
noted many  states have enacted  this type of legislation  and he                                                               
welcomed questions from committee members.                                                                                      
                                                                                                                                
3:12:05 PM                                                                                                                    
                                                                                                                                
COURTNEY OWENS,  Staff, Representative Zack Fields,  Alaska State                                                               
Legislature, on  behalf of Representative Fields,  prime sponsor,                                                               
gave  the  sectional  analysis  for   HB  285  [included  in  the                                                               
committee packet],  which read  as follows  [original punctuation                                                               
provided]:                                                                                                                      
                                                                                                                                
     Section   1:   Amends   AS   21.42.375(e)   to   define                                                                  
     "diagnostic   breast  examination"   and  "supplemental                                                                    
     breast  examination"  and  offers  guidelines  for  the                                                                    
     basis of additional testing.                                                                                               
                                                                                                                                
     Section  2:  Adds  a new  subsection  to  AS  21.42.375                                                                  
     guaranteeing  that  mammography  screening,  diagnostic                                                                    
     breast    examinations,    and   supplemental    breast                                                                    
     examinations  are   covered  by   applicable  insurance                                                                    
     plans,  with the  exception of  high deductible  health                                                                    
     plans that  are eligible  for a health  savings account                                                                    
     tax deduction.                                                                                                             
                                                                                                                                
     Section 3:  Amends the  law of the  State of  Alaska by                                                                  
     applying Sec.  1 and Sec.  2 to an insurance  policy or                                                                    
     contract on or after the effective date of the law.                                                                        
                                                                                                                                
     Section 4:  Amends the  law of the  State of  Alaska to                                                                  
     allow the  Division of  Insurance to  adopt regulations                                                                    
     necessary to implement this act under AS 44.62.                                                                            
                                                                                                                                
     Section 5:  Section 4 take effect  immediately under AS                                                                  
     01.10.070(c).                                                                                                              
                                                                                                                                
     Section 6: This Act takes effect January 1, 2025.                                                                        
                                                                                                                                
3:13:08 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  MINA  asked  what   the  average  cost  share  of                                                               
diagnostic imaging was.                                                                                                         
                                                                                                                                
REPRESENTATIVE FIELDS answered that  he heard in public testimony                                                               
there was a range of rates  including hundreds of dollars, but he                                                               
did not know if that was the average.                                                                                           
                                                                                                                                
3:13:54 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE PRAX offered his  belief that diagnostic screening                                                               
followed the regular screening.                                                                                                 
                                                                                                                                
REPRESENTATIVE FIELDS confirmed that was  correct.  For the high-                                                               
risk group,  which he noted  in Alaska  is 12,000 people,  it was                                                               
recommended by doctors that they have the diagnostic screening.                                                                 
                                                                                                                                
REPRESENTATIVE PRAX  questioned whether the  diagnostic screening                                                               
would  need  pre-authorization  and  why  the  insurance  company                                                               
wouldn't pay it.                                                                                                                
                                                                                                                                
REPRESENTATIVE  FIELDS  answered  that  the  issue  is  that  ACA                                                               
required  no  cost  share  for  a  standard  mammogram,  but  the                                                               
diagnostic would  need a  co-pay.  He  went over  scenarios where                                                               
people may not be able to pay the costs.                                                                                        
                                                                                                                                
3:16:08 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   RUFFRIDGE  asked   for   clarity  whether   high                                                               
deductible plans would be exempt under the proposed legislation.                                                                
                                                                                                                                
REPRESENTATIVE   FIELDS   explained   the   differences   between                                                               
deductibles and delays in care.                                                                                                 
                                                                                                                                
REPRESENTATIVE RUFFRIDGE sought confirmation  that the bill would                                                               
cover  people  covered  under private  insurance  and  would  not                                                               
affect  Medicaid or  Medicare.   Further, he  inquired whether  a                                                               
person  with a  high deductible  plan  would not  be mandated  to                                                               
cost-share under the bill.                                                                                                      
                                                                                                                                
REPRESENTATIVE FIELDS responded that's correct.                                                                                 
                                                                                                                                
3:17:47 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE PRAX welcomed invited testifiers.                                                                                
                                                                                                                                
3:17:59 PM                                                                                                                    
                                                                                                                                
REBECCA  BIRCH,  Director,  State  Policy &  Advocacy,  Susan  G.                                                               
Komen,  said  she strongly  supported HB 285  and shared  a story                                                               
about a  patient who  was "barely  making ends  meet" who  had to                                                               
take out  a loan to take  the diagnostic test and  the costs that                                                               
ensued because  of late detection.   She commented about  a study                                                               
on cost  averages and said  high deductible plans  are eliminated                                                               
with the health savings accounts.                                                                                               
                                                                                                                                
3:21:29 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE PRAX opened public testimony on HB 285.                                                                          
                                                                                                                                
3:22:11 PM                                                                                                                    
                                                                                                                                
BEVERLY  WOOLEY, representing  self, testified  in support  of HB
.   She described her history  with breast cancer and  how her                                                               
ultrasound finally  found a tumor.   She said she was  an example                                                               
of how the cost savings  can be realized through early detection,                                                               
and the  bill would  provide an increase  to much  needed access.                                                               
She  noted because  of delayed  diagnosis, 20  years out  she was                                                               
still paying  for follow-up care.   She opined that HB  285 would                                                               
save  lives  and encouraged  the  committee  to pass  it  without                                                               
delay.                                                                                                                          
                                                                                                                                
3:25:13 PM                                                                                                                    
                                                                                                                                
LISA PEABODY, FORCE - Facing  Our Risk of Cancer Empowered, Inc.,                                                               
said  she  represented a  high-risk  community  and testified  in                                                               
support of HB  285.  She further discussed  high risk individuals                                                               
with  a predisposition  that the  average person  does not  have.                                                               
This  high-risk  community,  according  to  national  guidelines,                                                               
needed  their mammograms  to start  at age  25.   In addition  to                                                               
mammograms, this group  may also need a breast  ultrasound or MRI                                                               
every  year, even  when it  costs  hundreds of  dollars, and  she                                                               
opined that the  proposed bill would close the gap  for the high-                                                               
risk individuals.                                                                                                               
                                                                                                                                
3:27:57 PM                                                                                                                    
                                                                                                                                
KELLEY MARRE, representing  self, testified in support  of HB 285                                                               
and shared that  she was an oncology social worker.   She offered                                                               
statistics  on  annual diagnoses  and  noted  that men  also  get                                                               
breast cancer.   She discussed costs and delays  in diagnosis due                                                               
to the  lack of affordability.   She stressed that no  one should                                                               
have to choose  between basic needs or health care  and asked the                                                               
committee to pass HB 285 so  individuals would not be charged for                                                               
high-risk screening and diagnostic imaging.                                                                                     
                                                                                                                                
3:29:53 PM                                                                                                                    
                                                                                                                                
EMILY  NENON,  Alaska  Government  Relations  Director,  American                                                               
Cancer Society Cancer Action Network,  testified in support of HB
 and   gave a history of coverage for  cancer screenings.  She                                                               
spoke to  state-regulated plans and  how they set  the precedence                                                               
for what other  plans do and opined that the  bill would be about                                                               
setting  precedence for  every plan  offered in  the state.   She                                                               
shared a  story of a  woman who  needed follow up  treatment, who                                                               
had to set aside  money each month for over a year  to be able to                                                               
afford the  treatment, and  she said the  bill would  help people                                                               
like  her.   She  offered  to  address deductibles  and  [health]                                                               
savings  accounts,  the  latter   which  are  specific  kinds  of                                                               
accounts  that have  federal law  issues.   She  said she  looked                                                               
forward to progressing and that she was available for questions.                                                                
                                                                                                                                
3:33:43 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE PRAX,  after ascertaining that no  one else wished                                                               
to testify, closed public testimony on HB 285.                                                                                  
                                                                                                                                
3:34:29 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE RUFFRIDGE moved to report  HB 285 out of committee                                                               
with  individual  recommendations  and  the  accompanying  fiscal                                                               
notes.  There being no objection,  HB 285 was reported out of the                                                               
House Health and Social Services Standing Committee.