Legislature(2011 - 2012)CAPITOL 106
02/14/2012 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB209 | |
| HB310 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 310 | TELECONFERENCED | |
| += | HB 209 | TELECONFERENCED | |
HB 310-STATE IMMUNIZATION PROGRAM
3:50:48 PM
CHAIR KELLER announced that the final order of business would be
HOUSE BILL NO. 310, "An Act temporarily reinstating the child
and adult immunization program in the Department of Health and
Social Services; and providing for an effective date."
3:51:04 PM
REPRESENTATIVE HERRON, introducing HB 310 as the prime sponsor
of the bill, said that the Alaska immunization program had
benefited from federal grant money for vaccines to underinsured
children and adults who would not, otherwise, have had access.
He pointed out that recent reductions to federal grants had
resulted in an 84 percent loss of funding. He reported that,
thanks to the vaccines, many common, life threatening diseases
were now virtually unheard of. He confirmed that, although the
Alaska Health Care Commission did not specifically endorse
legislation, its report encouraged the State of Alaska to
"adequately support a program that improves immunization rates
in order to protect Alaskans from serious, preventable diseases
and their complications." He opined that this legislation would
benefit all Alaskans.
3:53:57 PM
CHAIR KELLER confirmed that, as a member of the health
commission, he had "become painfully aware of the dangers of
continually expanding health care coverage, but this particular
one is probably a cost savings measure. I think I'm probably
convinced." He allowed that immunizations costs had been paid
for many years, but that $4.9 million of federal money was no
longer available for immunizations. He offered his belief that
similar situations would be forthcoming unless health care costs
were managed.
3:56:10 PM
REPRESENTATIVE MILLER expressed his concern with page 3, lines
3-7 of the proposed bill, and asked about the uses of
"recommended" and "approved." He asked for discussion to the
exclusion of approval for two specific vaccines.
REPRESENTATIVE HERRON replied that testimony would be
forthcoming on that section of proposed HB 310. He suggested
not precluding the commissioner from making the determination of
approval for the two specific vaccines, meningococcal and human
papillomavirus vaccines. He affirmed that testimony would
discuss the advantages and disadvantages for the State of Alaska
to make the determination for these vaccines.
3:58:01 PM
CHAIR KELLER, referring to the recommended immunizations, asked
if the Department of Health and Social Services would determine
the provider.
REPRESENTATIVE HERRON agreed with a need for further discussion
to this.
3:59:12 PM
CHAIR KELLER opened public testimony.
3:59:43 PM
GEORGE BROWN, MD, Glacier Pediatrics, read from a letter from
Glacier Pediatrics [Included in members' packets]:
Please support HB 310. It is critical that children
and families in our great state receive and have
access to vaccinations, not only to ensure the overall
health of our youngest members but also to lessen the
possibility of dangerous infections ravishing our
state. As a state that is working on improving our
vaccine rates (we have been in the lowest 10 percent
for the past several years), it can only happen if we
continue to have vaccines available for all of our
citizens. As pediatric health care providers, we know
that if the Alaska vaccine program decreases or ends
its' subsidy, the people who will suffer are the
working underinsured. We urge you to support House
Bill 310.
4:01:32 PM
DR. BROWN agreed that it was necessary to have concern for cost,
but he emphasized that providing vaccines saved money. He
stated that in the past decade it had been shown that every
dollar spent for measles, mumps, and rubella vaccines had saved
$16. He referred to a recent whooping cough outbreak in Juneau,
and pointed out that these bacterial infections, including
diphtheria and tetanus, required boosters. He allowed that
without the vaccines, this outbreak would have been far worse.
At that time, the vaccine cost $3 or less per person, and the
average cost of treatment was several thousand per
hospitalization. He emphasized that this bill would save a lot
of money, and "some major catastrophes."
4:04:40 PM
DR. BROWN, in response to Representative Miller, said that the
Tdap vaccine was for tetanus, diphtheria, and pertussis.
4:05:41 PM
ROSALYN SINGLETON, MD, Alaska Native Tribal Health Consortium
(ANTHC) Immunization Program, shared some background information
on the use of vaccines in Alaska. She declared that vaccines
were critical to the health of Alaskans. Speaking about
Hepatitis A, she reported that before vaccines there had been
massive epidemics every seven to ten years which had cost
hundreds of thousands of dollars in health response. Since
effective Hepatitis A vaccines were developed in 1995,
infections had dramatically declined, and Alaska now had one of
the lowest rates in the U.S., with the resultant savings of
public health dollars. She reported that in the 1960s, five
percent of the infants in Southwest Alaska, one to eleven months
of age, died, with half of these deaths secondary to measles or
pertussis. Since 1997, Alaska has been free of outbreaks from
measles because of vaccines. She reminded that, because of the
staged federal funding decreases in 2011, Alaska no longer
provided adult vaccines; and, in 2012, Alaska would no longer
provide vaccines to children who were not eligible for federally
funded vaccinations. She pointed out that proposed HB 310 would
reinstate these vaccines until there was a longer term solution.
She stated that many small medical practices would stop
providing vaccines, and that many parents were deferring them
until the vaccine was necessary for school attendance. She
opined that a decrease in coverage could lead to an increased
risk of outbreaks, and it would also leave Alaska without an
adequate vaccine supply to respond to outbreaks.
4:10:44 PM
DR. SINGLETON explained that meningococcal and human
papillomavirus vaccines were not included in proposed HB 310
because of cost. She said they were important vaccines, but as
they were costly, they were left out of the proposed bill.
4:11:20 PM
CHAIR KELLER directed attention to the fiscal note, which
confirmed the cost benefit ratio for these vaccines.
4:12:00 PM
REPRESENTATIVE DICK asked if Hepatitis A existed in Alaska
before contact with Europeans.
4:12:31 PM
DR. SINGLETON replied that testing for Hepatitis A had only
begun about 30 years ago, but that "people have had hepatitis
and yellow jaundice for many years." She spoke about the
successes for eliminating chronic Hepatitis B, with Alaska
Natives now having the lowest rate for any racial or ethnic
group in the U.S.
4:14:54 PM
RANDI SWEET, Director, Community Action, United Way of
Anchorage, expressed support for proposed HB 310, and its
stopgap funding for the Alaska immunization program through
2015. She lauded the framing and analysis for development of a
long term funding resolution so that vulnerable children and
adults would receive needed vaccines. She stated that access to
vaccines was necessary for quality health care. She remarked on
the economic attraction of a healthy Alaska to businesses. She
pointed to the Alaska Constitution, which stated that the
legislature shall "provide for the promotion and protection of
public health." She stated that through this temporary
solution, the legislature would "promote prevention of illness
and protect the public health of Alaskans from unnecessary
exposure to and spreading of disease and associated illness or
death."
4:16:14 PM
MARY SULLIVAN, Alaska Primary Care Association (APCA), confirmed
that APCA represented the 143 community health centers in
Alaska. She reported that these mostly small clinics would be
severely impacted with this loss of funding. She announced that
some clinics had already overspent their immunization budget,
with an expectation of zero compliance and an increase to
serious public health risk from measles, mumps, rubella, and
pertussis. She reported that many of the APCA providers were
less concerned with the language about meningococcal. She
suggested that a better funding stream could include more
expensive serums, as some providers had suggested that increased
funding could free up money in immunization budgets to purchase
the more expensive vaccines.
4:20:12 PM
REPRESENTATIVE MILLETT asked if shingles was recognized as an
adult vaccination.
MS. SULLIVAN offered her belief that shingles was covered by
Medicare.
4:21:07 PM
CARL ROSE, Executive Director, Association of Alaska School
Boards (AASB), submitted a letter in support of proposed HB 310.
Chair Keller read the letter from Mr. Rose:
AASB supports HB 310/SB 144. AASB believes that the
health, welfare, safety and education of Alaska's
children and youth are our highest priority. As such,
AASB supports the establishment of a child and adult
immunization program in the Department of Health and
Social Services. Thank you for reading my statement
of support to the House Health and Social Services
Standing Committee.
4:22:11 PM
CHAIR KELLER declared that he would leave public testimony open.
4:22:50 PM
WARD HURLBURT, M.D., Chief Medical Officer/Director, Division of
Public Health, Central Office, Department of Health and Social
Services, mentioned that Hepatitis B had resulted in a huge
number of liver cancer cases, but that vaccines had reduced it
to an uncommon cancer. He pointed out that measles, pneumonia
and encephalitis no longer threatened the lives of infants. He
reported that the Centers for Disease Control and Prevention
(CDC) offered statistics for immunizations which showed that
every $1 spent would save $16 in overall direct health care
costs and time lost from work. He stated that although vaccines
were not 100 percent effective, they provided herd immunity,
which meant that the whole population was protected if about 80
percent of the population were vaccinated. He noted that the
American Committee on Immunization Practices (ACIP) and the
American Academy of Pediatrics (AAP) both made regular
recommendations about new vaccines. He noted that most states,
including Alaska, mandated certain vaccines for school
attendance, although these were fewer than on the recommended
list. He explained that therapeutic and preventative
interventions were often determined by a quality adjusted life
year (QALY), which involved input from statisticians and
clinicians, and required a philosophical decision. He referred
to the proposed bill, which would provide vaccinations to the 25
percent of kids in Alaska who were under insured. He noted that
currently almost half the kids in Alaska received vaccines paid
by the federal government under the Vaccines for Children
program, but there were still 25 percent of the kids who were
not covered. He addressed the ACIP list of recommended
vaccines, which was used to determine the Alaska vaccine list.
He shared that the QALY value had to be less than $25,000 each
year for a vaccine to be included. He reported that, for
adults, this list included the flu and pneumococcal vaccines, as
these were especially effective for herd immunity. He offered
his belief that the intent of proposed HB 310 was to leave some
flexibility for vaccine choice to the Department of Health and
Social Services.
4:32:51 PM
REPRESENTATIVE HERRON surmised that Dr. Hurlburt had put
parameters on the use of higher priced vaccines in order to
offer more of the other vaccines to more people.
DR. HURLBURT endorsed this to be the reasonable, prudent
decision when resources were limited.
4:34:45 PM
REPRESENTATIVE MILLER asked if there were any other vaccinations
more specific to Alaska which should be recommended.
4:35:25 PM
DR. HURLBURT replied "basically, our diseases are what are seen
elsewhere." He noted that the some, such as hepatitis A, had
already been addressed in Alaska with dramatic success. He
allowed that regional outbreaks did occur, such as a recent
outbreak of pertussis in California.
4:37:16 PM
REPRESENTATIVE MILLER, directing attention to the fiscal note
which mentioned rotavirus, asked why it was not included in the
proposed bill.
REPRESENTATIVE HERRON replied that he did not know.
DR. HURLBURT, in response to Representative Miller, said that
there were not unlimited dollars for the program, so the cost
benefit ratio was utilized in the decision. He opined that
rotavirus was a more common problem, and that he would suggest
it be added first if more money became available.
4:39:00 PM
REPRESENTATIVE MILLETT, reflecting on the 50 percent success for
shingles vaccine, asked about the success rate for the rotavirus
vaccine.
DR. HURLBURT said that he would find out.
4:39:34 PM
REPRESENTATIVE MILLETT asked about the increase to the fiscal
note if these two vaccines were included.
DR. HURLBURT, in response to Representative Millett, explained
that the equation used for determining vaccines had established
the additional cost to include rotavirus would be $409,000 and
to include the shingles vaccine would cost $980,000 each year.
4:41:23 PM
REPRESENTATIVE MILLETT asked if there were specific problems for
shingles in Alaska.
DR. HURLBURT replied that there was nothing out of the norm in
Alaska.
4:41:48 PM
CHAIR KELLER agreed with the necessity that "following the money
to try to figure these things out [was] a worthwhile thing to
do." He reviewed that proposed HB 310 offered coverage to 25
percent of Alaska children, and he asked to clarify what other
payment coverage, along with private insurance, covered the
remaining 75 percent.
DR. HURLBURT declared that the federal Vaccines for Children
program immunized anyone with Medicaid and all Alaska Native
children. He stated the immunization rates for Alaska Native
children to be "admirable." He pointed out that immunization to
the rest of the state's children only ranked 42nd in the U.S.
CHAIR KELLER asked for more information about the providers.
DR. HURLBURT explained that the vaccine would be significantly
less expensive if the State of Alaska procured the vaccine for
all the providers, and maintained a single stock of each
vaccine. He described that currently each provider had to
maintain separate refrigerators and supplies for the privately
insured patients and for the Medicaid patients. He said that
pediatricians, family medicine physicians, and nurse
practitioners provided vaccines. He noted that the federally
qualified health clinics and public health nurses could give
vaccines to uninsured kids. He emphasized that it was necessary
to find a way to procure vaccines from one source to make the
cost of the process reasonable for private practices, to ensure
they also participate.
4:45:44 PM
CHAIR KELLER asked if there was any danger to a central vaccine
supply.
4:46:36 PM
DR. HURLBURT replied that central procurement for vaccines was
through CDC. He stated that the Division of Public Health
maintained the handling chain for vaccines. He described
parental hesitancy, when parents were reluctant to have their
children immunized, as even a two-year old required 15 shots.
He reported that Alaska had the highest rate, 9 percent, of
parental hesitancy in the U.S. He stressed a need for education
about vaccines and the recommended schedule for shots. As an
example, he pointed to the debunked British physician and
researcher who had published a purported study that measles,
mumps and rubella vaccines lead to autism. He emphasized that
this had been proven to be a deliberate falsification of the
data, and the researcher had since lost his physician's license.
He repeated the need for education for patients and parents.
4:49:47 PM
CHAIR KELLER shared that one community health center in his
constituency had reported never having treated a child who was
up to date on immunizations.
[HB 310 was held over.]