Legislature(2025 - 2026)BARNES 124
02/04/2026 03:15 PM House LABOR & COMMERCE
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| Audio | Topic |
|---|---|
| Start | |
| Presentation(s): Licensing for Genetic Counselors | |
| Presentation(s): the Rising Cost of Health Care (part 2) | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| + | TELECONFERENCED |
[Includes discussion of HB 293.]
3:19:40 PM
CO-CHAIR HALL announced that the first order of business would
be the Licensing for Genetic Counselors presentation.
3:20:04 PM
MONTY WORTHINGTON, Certified Genetic Counselor, Providence
Cancer Center, noted that he was a lifelong Alaskan and
certified genetic counselor who holds a master's in genetic
counseling from Stanford University. He noted that he was
speaking on behalf of himself as well as his colleagues at the
Providence Cancer Center. He appreciated the opportunity to
speak about genetic counseling and licensing.
MR. WORTHINGTON noted that Alaska was one of twelve states that
has not passed legislation to establish licensure for genetic
counselors. He said that there are several reasons that
licensure for genetic counselors would be valuable. He said
these include reduction in harm to patients due to services
being provided by unqualified individuals, increasing access to
genetic counselling services for Alaskans, and economic benefits
that licensure would bring.
MR. WORTHINGTON said that before speaking about licensure, he
wanted to speak about what genetic counselors do. He said that
he provides care to individuals with personal or family
histories of cancer. He said that with these patients, he
gathers a detailed family history as it relates to cancer and
assesses the likelihood of there being an inheritable component
of the cancer. He provides education on familial and hereditary
risks of cancer and then enters a shared decision-making process
with his patients to determine if genetic testing is warranted.
He said that this involves discussing what types of genetic
testing would be most appropriate. He discloses and interprets
genetic test results and provides up-to-date risk assessment and
cancer screening guidelines for patients and their family
members. Furthermore, counseling and psychosocial support are
provided to patients during their visits, particularly as it
pertains to genetic tests and their impact on patients and
families. He remarked that he sits on multi-disciplinary tumor
boards to provide input on appropriate genetic testing matching
to patients and its utility. He noted that in some cases,
results of genetic testing can provide information to
proactively manage cancer risk for patients and their families.
He said in other cases it can open treatment modalities that are
more appropriate than standard treatment types.
MR. WORTHINGTON remarked that genetic counselors are employed by
a wide range of institutions including clinical care, academic
institutions, laboratories, research, and biotechnology
("biotech") settings. He stated that genetic counselors are
health care providers with significant training and expertise in
human and medical genetics, patient education, psychosocial
counseling, which is obtained in a two-year master's program.
In a clinical care setting, genetic counselors are found in
health care specialties that include prenatal, pediatrics,
oncology, cardiology, neurology, and many other specialties.
Genetic counselors are key players in appropriately applying
genetics into health care, they provide expertise in genetics to
patients and provide expertise to their other clinical
providers. He said that genetic counselors work "hand in hand"
with physicians and other clinical providers to identify
individuals most appropriate for consideration for genetic
testing or hereditary conditions and to provide interpretations
of test results to help guide providers in managing identifiable
genetic conditions.
MR. WORTHINGTON noted that there are currently seven genetic
counselors who work and live in Alaska. He said that at least
one genetic counselor provides services to patients living in
other states. He noted that these counselors work by providing
specialty care in a variety of other instances. He said that
there are several genetic counselors who work for testing labs
or consultancies and provide care to patients in Alaska but
reside in other states. He said that a single hereditary cancer
testing lab has at least sixty genetic counselors who provide
these types of services.
MR. WORTHINGTON explained that Alaska currently has no legal
standard for anyone who can represent themselves as a genetic
counselor. He said that licensure would provide a standard for
practice and by doing so it would provide value in a variety of
ways. This includes protection of patients from harm by
ensuring minimum standards for practice. He said that as the
field of medical genetics grows, there is and will be a need to
provide the residents of Alaska with accurate information
regarding genetic risk. He said that a few decades ago genetic
information was utilized in only a few clinical specialties;
today it is hard to find an area of medicine where genetics does
not have a role to play. Furthermore, the complexity of genetic
tests has continued to increase. He said that genetic
counselling fills this space in the medical field.
3:26:05 PM
MR. WORTHINGTON explained that without a standard that qualifies
who can practice, significant harm can occur. He remarked that
residents of Alaska deserve access to professionals who have
been qualified by the state to help understand the potential and
actual impact of genetic information on their health. He noted
that licensure requirements would provide this qualification.
Furthermore, licensure for genetic counselors would make
services more easily billable and reimbursable from both private
payers and Medicaid. He said that the states lacking licensing
standards have challenges regarding what procedures can and
cannot be billed. This makes many services not worth the effort
for reimbursement. He said that states without licensure do not
qualify genetic counselors as rolling providers with Medicaid.
He said that licensure in Alaska would facilitate Medicaid
recognition and facilitate access to health care for Medicaid
beneficiaries. He reiterated that licensing would facilitate
access for counseling services.
MR. WORTHINGTON noted that recent changes to billing codes for
genetic counselors and ongoing efforts at the federal level with
the Access to Genetic Counselor Services Act of 2025, efforts
have been made to facilitate Medicare access to these services.
He said that state licensing would enhance opportunities for
reimbursement and increase access for patients in Alaska.
MR. WORTHINGTON said that this bill would enable genetic
counselors to order genetic tests. He said that genetic
counselors refer to physician referrals and other licensed
advanced practice providers and orders are placed under those
providers names. He said that licensure would allow counselors
to fully perform the scope of practice by eliminating barriers.
This legislation is important to Alaska for maintaining a high-
quality genetic testing workforce. He raised concern about
genetic counselors looking for other opportunities in other
states due to licensing complications and the difficulty in
attracting genetic counselors from other states. He urged the
committee to consider legislation to create licensing
requirements for this profession.
3:30:21 PM
CO-CHAIR HALL mentioned that the committee would hear an
introductory hearing of HB 293 in an upcoming meeting. The bill
would install licensing requirements for genetic counselors in
Alaska and was the bill of reference during Mr. Worthington's
presentation.
3:30:56 PM
REPRESENTATIVE SADDLER said that he had never heard of genetic
counselling prior to seeing the bill in development. He asked
what credentials were in the field of genetic counselling and
how many counselors were practicing in Alaska.
MR. WORTHINGTON responded that at a national level there is
certification process for genetic counsellors.
3:31:32 PM
APRIL O'CONNOR, Certified Genetic Counselor, Providence Cancer
Center, noted that the national certifying body for genetic
counselors was the American Board of Genetic Counselling.
MR. WORTHINGTON noted that currently thirty-five states have
licensures in place for genetic counselors. Furthermore, two
other states have passed legislation that would establish
licensing.
3:31:57 PM
REPRESENTATIVE SADDLER asked how many genetic counselors were
practicing in Alaska.
MR. WORTHINGTON responded that there were seven who work and
live in Alaska and one who lives in Alaska and provides care to
patients living in other states.
3:32:13 PM
REPRESENTATIVE CARRICK noted that she also had not heard about
genetic counselling before today and appreciated the
introduction. She asked whether all seven genetic counselors
were working in Anchorage or were spread to other parts of the
state.
MR. WORTHINGTON responded that three work at Providence Cancer
Center, three provide care through the Southcentral Foundation
and the Alaska Native Medical Center (ANMC), and one works in
Juneau and provides care for people in other states. He was
unsure about the placement of one other genetic counsellor.
REPRESENTATIVE CARRICK said that generally when licensing a
profession, it is common to assay any issues with people
operating outside the scope of licensing. She asked whether
people were calling themselves genetic counsellors without
credentials.
MR. WORTHINGTON responded that Ms. O'Connor had more experience
working in other states and working with licensing credentials.
3:34:26 PM
CO-CHAIR HALL asked Mr. Worthington to follow testimony
protocol.
3:34:52 PM
MR. O'CONNOR responded that she has been a genetic counselor for
21 years and in the 4 years that she has practiced in Alaska,
she has come across a scenario where a patient has been
misinformed of the inheritance pattern with test results and
this misinformation may have been provided by a provider who was
not trained in genetics. She said that she also practices
cardiology for a hospital in Tennessee and said that this type
of misinterpretation happens there as well. She said that this
creates problems with treatment options. Overall, she said that
she has seen problems associated with genetic care by
individuals without appropriate credentials.
3:36:30 PM
REPRESENTATIVE COULOMBE asked why someone would get a genetic
counselor and asked what types of conditions would warrant this
type of counselling.
MR. WORTHINGTON responded that the way that the medical systems
work is typically a provider or specialist evaluates somebody
with a condition such as cancer or cardiac condition, and they
would recognize that there may be a heritable component. At
this point they would refer to genetic counsellors. He noted
that oncologists would send patients to a genetic counselor
specializing in cancer risk whereas a cardiologist may refer a
patient to a genetic counselor specializing in cardiology. He
said a counselor's role is to step in and assay the family
history and the likelihood or a heritable component to the
condition.
REPRESENTATIVE COULOMBE asked about the error rate associated
with testing and asked whether there was a percentage error
rate.
MR. WORTHINGTON responded that as far as the tests themselves
operate, they are highly accurate and the only way to receive
errors from the actual test is that there is a classification of
genetic variance and it ranges from pathogenic to benign. He
said that genetic tests themselves, counsellors look at this
type of variance and make determinations. He said that the
actual DNA test is around 100 percent accurate but how it is
interpreted requires training and evaluation.
REPRESENTATIVE COULOMBE said that there is an interpretation
level associated with it much like x-rays and sometimes it can
be misinterpreted.
MR. WORTHINGTON responded that there is a level of
interpretation involved.
3:39:57 PM
REPRESENTATIVE FIELDS asked Mr. Worthington whether the absence
of a sustainable billing model due to lack of licensure would
cause complications for genetic counselors operating in smaller
clinical organizations that cannot pay the costs.
MR. WORTHINGTON responded that licensing would increase
employment opportunities and said that Ms. O'Connor could
comment as well.
3:40:39 PM
MR. O'CONNOR added that currently not having licensure there was
complications with downstream revenue. She noted that if
services could get billed at a professional level, then that
could open the doors. She said that states that contained
licensing had more billable operations and more businesses could
employ genetic counsellors.
REPRESENTATIVE FIELDS asked whether Ms. O'Connor could comment
on the technological advancements regarding people's genetic
information and how it generates more efficient patient care.
3:42:06 PM
MS. O'CONNOR responded that much of the field is evolving into
targeted therapies. She said this has opened a large role for
genetic counsellors to provide counseling for patients.
Depending on the results of the gene screening, it can assist
with driving care and targeted therapeutics. She described the
process of isolating a gene factor and specific patient focused
care.
3:42:59 PM
MR. WORTHINGTON added that in terms of genetic testing
technology, there is a wide array of different ways to test the
genome. He said that knowing which test is appropriate is a
constant learning curve and ensuring that appropriate test
deployment is a matter of continuing education.
3:43:42 PM
REPRESENTATIVE SADDLER said that he was hung-up on the counselor
aspect of things and was curious to what degree genetic
considerations are made during a routine physical check-up when
patients are seeing a physician. He said that he still would
like to hear the case for why genetic counselling needs its own
practice.
MR. WORTHINGTON responded that the title of genetic counselor
has been established for more than 50 years, it occurred when
genetic specialists working in the medical field were termed
"genetic counselors." He said that they provide counselling
primarily to their patients. He noted that the work is complex
and it does not simply involve individuals but often patient
families. He reiterated that psychosocial concerns were common
and they were trained to address these.
3:45:15 PM
REPRESENTATIVE COULOMBE asked whether most people getting
genetic counselling were adults and whether the practice was
common with children.
MR. WORTHINGTON responded that there are specialists who work in
pediatrics. He said that when there are complicated health
conditions in children, genetic counsellors can be part of the
diagnostic process. He said that it is also important to
recognize when counselling would be appropriate. He said that
most conditions he works with lead to adult onset of cancer risk
as opposed to child onset of cancer risk. He said that
sometimes family members are keen to test their children for
things that would not change health care until adulthood. He
said that genetic counsellors try to counsel parents that
autonomy might be a better approach. He said that families are
families and make their own decisions, but counsellors try to
guide them through pitfalls and benefits.
3:46:45 PM
REPRESENTATIVE SADDLER said that he was still trying to
understand the practice, he asked where in the medical chain
genetic counsellors operate and who pays for their services.
MR. WORTHINGTON responded that he works for the Providence
medical system and is paid through the Providence Cancer Center.
He reiterated that since many of the genetic counselling
services were not billable, it is one of the reasons that
licensure is important. He said that this creates challenges in
recouping costs from unbillable services. He said that genetic
counsellors sit in the overhead of the cancer center. He said
that one reason Providence does this is that it allows
credentialing as a comprehensive cancer care center. This
certification requires genetic counsellors working at an
institution. He reiterated that they were paid by the overhead.
3:48:02 PM
REPRESENTATIVE CARRICK asked whether there was a demand for
prenatal genetic counselling so potential parents can understand
risk factors. Furthermore, she asked whether there was an
understanding of what volume of counsellors work in oncology as
opposed to another field.
MR. WORTHINGTON deferred the question to Ms. O'Connor.
3:49:08 PM
MS. O'CONNOR said that she has worked as a prenatal genetic
counselor for the entirety of her career. She said that she is
currently working remotely as a maternal fetal medicine
specialist in Arizona. She said that when she graduated in
2005, most genetic counsellors were in prenatal space, or around
60-70 percent of counsellors at the time. She noted that
genetic screening in oncology is still in its infancy. She said
today things have shifted and most genetic counsellors practice
oncology and make-up over half of the workspace. She reiterated
that there is a role of prenatal genetic counselling that
involves meeting with families to discuss prenatal conditions
that could affect an unborn challenge. She said work is closely
conducted with prenatal medicine specialists.
3:50:46 PM
REPRESENTATIVE FIELDS said that his understanding is that
sometimes an older couple may worry that they have a heritable
condition and could talk with a genetic counselor to determine
risk. He asked whether Ms. O'Connor could elaborate on this.
MS. O'CONNOR responded that in states with licensure, maternal
fetal medicine specialists have determined that patients in a
high-risk group should be referred to genetic counselling. She
described instances in which couples might get referred to
genetic counsellors.
REPRESENTATIVE FIELDS commented that one of his motivations in
introducing the bill is to provide consulting services for
couples engaged in family planning.
3:53:17 PM
The committee took an at-ease from 3:53 P.M. to 4:10 P.M.
^PRESENTATION(S): THE RISING COST OF HEALTH CARE (PART 2)
PRESENTATION(S): THE RISING COST OF HEALTH CARE (PART 2)
4:10:05 PM
CO-CHAIR HALL announced that the final order of business would
be The Rising Cost of Health Care (Part 2) presentation.
4:10:46 PM
GARY STRANNIGAN, Vice President, Congressional and Legislative
Affairs, Premera Blue Cross Blue Sheild of Alaska ("Premera"),
began the Rising Cost of Health Care (Part 2) presentation via
PowerPoint [hard copy included in committee file]. He noted
that Premera is a not-for-profit institution that has operated
in Alaska prior to the establishment of statehood. He said the
aim of Premera is to make health care work better by placing the
customer at the forefront of everything the company does. He
noted that insurance is a heavily regulated business and the
products are reviewed and prices are approved before plans can
be sold. He noted that Premera is subject to financial and
regulatory supervision and accountability in the marketplace.
MR. STRANNIGAN explained that insurance commissioners were
created to address a problem where unscrupulous operators would
come into a town and sell different types of insurance at low
cost and were never seen again. He said that because of this,
insurance commissions were put into place to provide market
supervision. In essence, insurance commissioners were created
to be sure that insurers were charging enough. He said that it
is often not possible to do business in a successful way in an
environment that is prone to legislative and public input.
MR. STRANNIGAN noted that one key role of insurers in the
construct of the United States health care marketplace is to put
downward pressure on health care costs. He said that without a
doubt, this puts insurers at odds with some provider partners.
MR. STRANNIGAN, on slide 2, pointed to a pie chart that
illustrated Premera dollars in the small and large group
marketplace. He said that what is interesting is that the
insurance side is small, about 8 percent. He noted other data
points pertaining to commission, taxes, and other factors. He
said that there was a "little sliver" on the pie chart
pertaining to profits. He continued to elaborate on the various
points on the pie chart. He said that the reason the pie chart
was important was that for decades lawmakers have focused the
bulk of their attention on the 8 percent of the pie chart. He
said that given that Premera was 8 percent of the overall
picture, there is not a lot of "fruit left on the tree." He
said the American health care system is about twice as costly as
most other industrialized nations, with outcomes that are not
better, and often worse. He said that it seems to him that
there would be better service regarding innovation to improve
the pre-existing health care system. He acknowledged that
tremendous investments have been made and successes have been
made in health improvement despite this. He remarked that the
pie chart underscores where opportunities lie.
4:16:43 PM
MR. STRANNIGAN proceeded to slide 3 of the presentation, which
displays a few common procedures and cost differentials between
Washington and Alaska. He said that Primera does business
exclusively in both these states. He said that they are
licensed with the Blue Cross Blue Sheild Association (BCBSA).
He said that these comparisons were good since the data was
readily available and costs for in-network and out-of-network
care are available. He said that the chart on the slide has
been similar for quite some time.
MR. STRANNIGAN proceeded to slide 4, which showed a chart of
"new" information from the U.S. Bureau of Economic Analysis
(BEA). He explained that it was a 2024 report on the cost of
living in every state. He said that several states have
exceeded Alaska regarding the cost of living. He pointed out
that Washington has a 6 percent higher cost of living than
Alaska. He said that a few years ago he could eat at a nice
dining area in Alaska for less money than the same type of
establishment in Washington. The factors pushing cost of living
higher than Alaska are taxes, cost of housing, childcare, and
restaurants. He said it is interesting how cost of living has
flipped and it is important to make these considerations when
thinking about the cost of health care. People often conflate
health insurance and health care and the costs of each. He said
that health insurance is primarily driven by the cost of health
care but there is a fine distinction. In Alaska, the
affordability is driven by the cost of care.
4:20:12 PM
MR. STRANNIGAN proceeded to slide 5, the final slide of the
presentation which provided information on recommendations for
sustainable affordability. He said there are not a lot of
proactive things listed but, rather, cautions. He said that the
repeal of the eightieth percentile from a few years ago had some
positive impacts on the individual market in the state of
Washington, meaning reductions in premiums. He said that these
were mostly concealed by increases in the cost of care which
outpaced reductions. He said that this year, apart from the
expiration of the advanced premium tax credits, the individual
market premiums went down 3 percent. Consumers are seeing
higher prices due to the expiration of the credits. He said
that Premera was a strong supporter of continuation of the tax
credits and was disappointed to see their expiration, especially
considering the market in Alaska. He said that customers need
help since the insurance has become costly.
MR. STRANNIGAN pointed out that the slide listed a few other
pieces of legislation that pertain to health insurance premiums.
He described a few of the pieces of legislation and cautioned
against specific legislative approaches to change reimbursements
and the floor. He noted that last year a bill was passed that
Premera and Jared Kosin with the Alaska Hospital and Healthcare
Association (AHHA)supported, and it was a great example of
health insurance and health associations working together to
support Alaskans. He recommended that it could be modeled by
other states.
MR. STRANNIGAN noted that the final recommendation on the slide
pertains to value-based care arrangements to provide provider
incentives with good patient outcomes. He noted that people are
paid to "pull a crank" and this does not always align with good
patient outcomes. He noted that care arrangements are intended
to address the wellness of the patient and not just the symptoms
of a current condition. He stated that there is difficulty in
convincing providers to sign up for this for a variety of
reasons, but it is something that warrants more exploration. He
concluded the presentation and noted that he was happy to listen
to additional testimonies and answer any potential questions.
4:24:41 PM
JOSEPH FONG, Administrator, Medical Park Family Care, gave
testimony during the Rising Cost of Health Care (Part 2)
presentation. He noted that Medical Park Family Care is a
physician owned and locally owned primary care practice located
in Anchorage. It has been operating for around 52 years, and
the current owners are all long-time Alaskans. He said that the
organization has cared for Alaska residents for years and wants
to continue to do so. He said that pressures on both cost and
reimbursement are making it challenging to provide services. He
said that the clinic is in the process of renewing its health
insurance plan, and the 2026 prices were increased by 37
percent. He noted that it was not reasonable, and he does not
understand the price increases. He said that Medical Park
Family Clinic pays most of the costs for health insurance and,
in prior years, it has paid 82 percent of the total cost of
health care. He noted that if the cost of insurance for the
year was $10,000, then the organization paid for $8,200 of the
employee health insurance costs. He said that the 37 percent
increase translates to an additional $340,000 that needs to be
covered by the organization to continue providing health
insurance for the employees. He said that the employees would
experience price increases as well. He discussed the payments
and changes the clinic made to accommodate price increases and
noted that employees were still seeing double the cost than that
of previous years. He said that price increases are hard to
understand and justify.
MR. FONG said that being a health care provider allows the
clinic to get perspectives from the patients as a recipient of
payments from insurance companies. He said that over the last
several years, more patients are coming in and asking for
services that are 100 percent covered by their health insurance
provider. He said that this is not a good way to provide health
care, and others could testify to this. Not only is it not a
good way to approach health care but it is something that is
challenging since patients' health insurance coverage varies.
He said it can be challenging for the clinic to understand what
insurance plans cover what services for what patients. He said
that the clinic asks patients to determine what is and what is
not covered, it is something that the clinic is unable to do.
He said that in 2025 the clinic saw 13,000 individual patients
and it is not possible to keep track of this type of
information. He noted that it was challenging to provide care
rather than deal with an "administrative burden."
MR. FONG noted an additional observation in 2026 is that a lot
of patients are opting not to carry health insurance. He said
that the clinic conducts health insurance verification prior to
visits, and the clinic has found an increased number of patients
who no longer carry health insurance. Furthermore, even if the
patients do have insurance, they are asking whether they can pay
for health care services in cash. He said that the clinic
offers uninsured patients a cash pay discount and, in some
instances, this can be less than what the insurance
reimbursement is with patient deductibles. He said that it is
hard to understand and navigate this.
MR. FONG noted that another factor for consideration is the
reimbursement side. He explained that all the costs continue to
rise with insurance but as a provider that bills insurance and
gets reimbursed, the reimbursements have not increased. He said
that reimbursement rates have not changed in almost 10 years.
He said that given these pressures, it is becoming harder to
provide good quality care from a clinical perspective as well as
being able to have a viable business.
4:32:45 PM
MR. FONG said that the clinic participates in a few value-based
care projects, and it requires careful design to ensure the
value of that care. He also mentioned that the clinic is part
of an integrated network comprising over thirty practices. He
noted that the clinic has spoken with Premera regarding
expansion of the value-based care program, but there has been no
movement in that direction after two years of conversation. He
reiterated that it was hard to understand how the health care
billing was a sustainable model and the clinics' opinion is that
it was not.
4:34:28 PM
JILL GASKILL, MD, Medical Park Family Care, gave testimony
during the Rising Cost of Health Care (Part 2) presentation.
She said that she has been concerned regarding the decision-
making for employee health insurance. The clinic has realized
that the health insurance bill has gone from around $1 million
to approximately $1.35 million. She pointed out that this is
for a business that covers 48 employees and their families,
which she said is not a "huge" number of people. She related
that $1 million dollars just gets premiums and not necessarily
health care. She raised concern that small businesses in
Anchorage working in the private sector are struggling with
recruitment and as a health care provider she needs nurses and
other clinicians to provide care.
4:40:55 PM
DR. GASKILL asked the committee to consider the way small
businesses are being taken advantage of by private insurance
companies to provide meaningful health care to employees. She
said that people in the private sector need access to health
insurance and for businesses to remain in place.
4:41:33 PM
CO-CHAIR FIELDS said that one of his concerns when Congress
gutted Medicaid and the enhanced premium tax credits is that it
would end access to affordable private insurance, and the
effects were already observed. He asked Dr. Gaskill to keep the
committee in the loop as she sees the downstream impacts.
4:42:09 PM
DR. GASKILL, in response to Representative Saddler, confirmed
that medical assistants are called MAs and perform a variety of
clinical tasks.
4:42:24 PM
MR. FONG, in response to Representative Saddler, explained that
value-based programs utilize payments based on the value of care
received. He discussed the incentives to provide this type of
care and some programs on the backend; if savings are
demonstrated, then savings can be shared between insurance and
the provider. In response to a follow-up question, he clarified
that rather than paying for results or service, value-based
programs focus on "paying for outcomes."
4:43:56 PM
DR. GASKILL, in response to Co-Chair Fields, replied that she
did not know the exact number of local, family-oriented
facilities like Medical Park Family Care, but estimated there
may be around 10. She noted that most people in Anchorage would
likely be seeing a clinician in private practice. She described
a few examples of private practice providers. She said that the
ones that are not private tend to serve a niche group of
patients.
4:45:37 PM
REPRESENTATIVE SADDLER referred to the pie chart slide of Mr.
Strannigan's presentation and asked if he could clarify the
numbers associated with it.
MR. STRANNIGAN responded that he could not expand on the pie
chart at this time, but he could follow up with an answer. He
asked if there was a specific service he was interested in.
REPRESENTATIVE SADDLER said that he was trying to understand the
net amount of premium dollars associated with the chart. He
asked whether Premera was only operating with a .9 percent
profit and if that's what the chart suggested.
MR. STRANNIGAN, in response to a query from Representative
Saddler regarding a pie chart on a previous slide, confirmed
that it represents the insured group business. He said that
this is the data that he can send with follow up. He noted that
it is not the entire amount of revenue from the State of Alaska.
REPRESENTATIVE SADDLER asked for a layman's understanding of the
chart.
MR. STRANNIGAN responded that the State of Alaska does not
regulate self-insured business since that is not actually
insurance and those businesses operate their health plans for
companies themselves and pay the claims themselves. They do so
under the federal Employee Retirement Income Security Act of
1974 (ERISA) laws. He said that they are governed by the U.S.
Department of Labor.
REPRESENTATIVE SADDLER asked again for the clarification of the
chart and how it ties into discussions.
MR. STRANNIGAN responded that the state-regulated business is
fully insured and Premera assumes the risk of the claims that
the employees bring for the large group and small group.
4:49:10 PM
REPRESENTATIVE COULOMBE, referring to previous testimony, asked
Mr. Strannigan to respond to the claims of premiums going up to
the point of unaffordability. She noted that there was not much
mention of the cost of care going up but the premiums have.
MR. STRANNIGAN responded that it is not uncommon and is part of
why Premera advocated so aggressively for the extension of the
premium tax credits. He said that this is especially important
when considering the small business and individual markets. He
confirmed that the premiums were "sky high" and affirmed that 85
percent of the premium cost is from health care and the cost of
health care is "sky high."
MR. STRANNIGAN noted that GLP-1s were referenced and most
Premera plans for businesses do not cover this type of
medication. He said Premera was aware of only one small
business member that opted for coverage for GLP-1s. He said
that the per member per month cost is over $50. He said these
costs were spread amongst the group. For context, around half
of this was paid for through primary care. He said that it is a
"big" expense to opt into this kind of coverage. He noted that
most plans do not cover weight loss medications. He said there
are lot of unknowns for GLP-1s from a clinical and actuarial
perspective.
4:52:58 PM
REPRESENTATIVE COULOMBE said that the termination of tax credits
could be blamed but she believed that there is a bigger problem
with this. She said the problem was just being masked by the
tax credits. She said that if her premium is $100 and she had
the tax credits and was able to pay $50, the insurance company
would still get $100 for the premium. She wanted to determine
what is driving the premiums up "so high" and why they are
staying so high. She noted that high premiums have been
unmasked since the government is not helping. She asked whether
Mr. Strannigan had any thoughts on this.
MR. STRANNIGAN responded that Premera would suggest that any
changes in prices of health insurance are not necessarily
associated with insurance but the cost of care. He said that
virtually every hospital system that has been part of
negotiations has requested a 15 percent price increase year
after year. He reiterated that the cost of care and the
hospital side of things is the biggest piece.
4:54:50 PM
CO-CHAIR HALL remarked that she was having a hard time analyzing
this. She asked for clarification that the premium increases
are a result of a cost of care and wished to hear from Family
Park Medical Clinic regarding this. She said that if the
providers are not receiving increases in the reimbursement rates
and if it is flat over years, she is not understanding the what
is being said.
DR. GASKILL responded that when it comes to the reimbursements
for primary care, these have been flat. She has not received
any increase in compensated care over the last decade, and the
dollar amounts are the same. She noted the Premera's
reimbursement has not gone up in 10 years. She said that the
clinic is seeing a similar, if not fewer, number of patients and
there is not another way to do the math. She said that she has
been engaging with value-based contracting through clinically
integrated networks and Premera has not been interested in
participation. The clinic is seeing higher costs, higher plans,
and higher deductions.
4:57:18 PM
CO-CHAIR HALL asked whether Mr. Strannigan had any comments on
this. She asked for insights into why reimbursements for
primary care have remained flat.
MR. STRANNIGAN responded that he did not have any illuminating
information on the flat reimbursements for primary care, and he
agreed with the comments regarding primary care that helps
address health care cost inflation. He said an interesting
study he recently came across indicated that people who have a
relationship with a primary care physician have 30 percent lower
health care costs. He said that primary care is something that
Premera has tried to prioritize and there is a network of
primary care facilities in Washington State. He said that there
is a primary care crisis that has many waiting six months to
meet with a physician. He reiterated that flat line
reimbursements were something that Premera needs to look review.
He suspects that most cost increases have come from private
equity firms buying up clinical practices.
5:00:58 PM
REPRESENTATIVE SADDLER said he has observed what seems to be
finger pointing regarding who is responsible, with the
clinicians pointing at health insurance costs and the insurance
providers pointing at rising health care costs. He questioned
how he could explain this to constituents. He asked for an easy
answer as to why health costs and insurance costs are
increasing, offering his understanding that Mr. Strannigan noted
that it was private equity.
DR. GASKILL said that the question regarding increasing health
care premiums going up was something that she could not answer
easily since these cost increases were not necessarily
associated with the primary care settings. She noted that the
expenses may be associated with other clinical settings that
provide the highest levels of care.
5:02:42 PM
MR. FONG added that he agreed with Dr. Gaskill and that rising
costs were not coming from primary care facilities but specialty
care facilities.
5:03:06 PM
MR. STRANIGGAN said that it is the cost of care, and it is
important to note that insurance companies are regulated and the
books are checked. He said that none of these things are true
for clinical providers.
CO-CHAIR HALL asked if Mr. Strannigan agreed with Mr. Fong's
comments on costs associated with specialty care facilities.
MR. STRANNIGAN responded that he agrees with Mr. Fong regarding
specialty care costs.
5:03:57 PM
REPRESENTATIVE SADDLER asked for clarification of the cost of
care.
MR. STRANNIGAN responded that it runs the gamut and features a
wide range of services. He said the price of these services is
going up.
REPRESENTATIVE SADDLER asked for clarification.
MR. STRANNIGAN responded that the number of widgets and cost of
widgets has gone up.
5:05:27 PM
ADJOURNMENT
There being no further business before the committee, the House
Labor and Commerce Standing Committee meeting was adjourned at
5:05 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| Alaska Affordability Brief White Paper - FINAL.pdf |
HL&C 2/4/2026 3:15:00 PM |
Healthcare Cost Presentation |
| Alaska - House Labor and Commerce - Affordability Work Session - Gary Strannigan - FINAL.pdf |
HL&C 2/4/2026 3:15:00 PM |
Rising Cost of Health Care |