04/25/2006 03:00 PM House HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB322 | |
| HJR30 | |
| HB452 | |
| Overview(s) || American Heart Association – Obesity and Health | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 322 | TELECONFERENCED | |
| *+ | HB 452 | TELECONFERENCED | |
| *+ | HB 396 | TELECONFERENCED | |
| *+ | HCR 31 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| + | TELECONFERENCED | ||
| += | HJR 30 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE
April 25, 2006
3:03 p.m.
MEMBERS PRESENT
Representative Peggy Wilson, Chair
Representative Paul Seaton, Vice Chair
Representative Carl Gatto
Representative Sharon Cissna
Representative Berta Gardner
MEMBERS ABSENT
Representative Tom Anderson
Representative Vic Kohring
COMMITTEE CALENDAR
HOUSE BILL NO. 322
"An Act relating to infants who are safely surrendered by a
parent shortly after birth."
- MOVED CSHB 322(HES) OUT OF COMMITTEE
HOUSE JOINT RESOLUTION NO. 30
Relating to public health and a prevention compact.
- HEARD AND HELD
HOUSE BILL NO. 452
"An Act establishing the Alaska Prescription Drug Task Force;
and providing for an effective date."
- HEARD AND HELD
OVERVIEW(S): AMERICAN HEART ASSOCIATION - OBESITY AND HEALTH
- HEARD
HOUSE BILL NO. 396
"An Act establishing the Alaska Commission on Health Care; and
providing for an effective date."
- SCHEDULED BUT NOT HEARD
HOUSE CONCURRENT RESOLUTION NO. 31
Relating to an integrated statewide information and referral
system.
- SCHEDULED BUT NOT HEARD
PREVIOUS COMMITTEE ACTION
BILL: HB 322
SHORT TITLE: SAFE SURRENDER OF BABIES
SPONSOR(s): REPRESENTATIVE(s) LEDOUX, GRUENBERG
01/09/06 (H) PREFILE RELEASED 12/30/05
01/09/06 (H) READ THE FIRST TIME - REFERRALS
01/09/06 (H) HES, JUD
04/25/06 (H) HES AT 3:00 PM CAPITOL 106
BILL: HJR 30
SHORT TITLE: PUBLIC HEALTH COMPACT
SPONSOR(s): REPRESENTATIVE(s) CISSNA
02/06/06 (H) READ THE FIRST TIME - REFERRALS
02/06/06 (H) HES, L&C
03/30/06 (H) HES AT 3:00 PM CAPITOL 106
03/30/06 (H) -- Meeting Canceled --
04/04/06 (H) HES AT 3:00 PM CAPITOL 106
04/04/06 (H) <Bill Hearing Postponed to 04/06/06>
04/06/06 (H) HES AT 3:00 PM CAPITOL 106
04/06/06 (H) -- Rescheduled from 04/04/06 --
04/13/06 (H) HES AT 3:00 PM CAPITOL 106
04/13/06 (H) -- Meeting Canceled --
04/20/06 (H) HES AT 3:00 PM CAPITOL 106
04/20/06 (H) Scheduled But Not Heard
04/25/06 (H) HES AT 3:00 PM CAPITOL 106
BILL: HB 452
SHORT TITLE: ALASKA PRESCRIPTION DRUG TASK FORCE
SPONSOR(s): REPRESENTATIVE(s) GUTTENBERG
02/13/06 (H) READ THE FIRST TIME - REFERRALS
02/13/06 (H) HES, FIN
04/25/06 (H) HES AT 3:00 PM CAPITOL 106
WITNESS REGISTER
CHRISTINE MARASIGAN, Staff
to Representative Gabrielle LeDoux
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented HB 322 on behalf of
Representative LeDoux, sponsor.
TAMMY SANDOVAL, Deputy Commissioner
Office of Children's Services (OCS)
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: During hearing of HB 322, answered
questions.
CINDY FOLSOM, Staff
to Representative Sharon Cissna
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented HJR 30 on behalf of the sponsor,
Representative Cissna.
TAMMY GREEN, Section Chief
Chronic Disease Prevention and Health Promotion
Division of Public Health
Department of Health and Social Services
Anchorage, Alaska
POSITION STATEMENT: During hearing of HJR 30, stated that
Alaska can no longer afford to ignore the power of prevention
and during the overview regarding obesity, answered questions.
REPRESENTATIVE DAVID GUTTENBERG
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Testified as the sponsor of HB 452.
SHARON TREAT, Executive Director
National Legislative Association on Prescription Drug Prices
Hallowell, Maine
POSITION STATEMENT: During hearing of HB 452, discussed the
purchasing pool with which Maine is involved.
PAUL RICHARDS, Lobbyist
Pharmaceutical Research and Manufacturers of America Inc.
Juneau, Alaska
POSITION STATEMENT: Testified in opposition to HB 452.
DWAYNE PEEPLES, Director
Division of Health Care Services
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: During hearing of HB 452, answered
questions.
SUZANNE MEUNIER, Director
Alaska Advocacy
American Heart Association
Juneau, Alaska
POSITION STATEMENT: Provided information relating to the
overview regarding obesity.
BOB URATA, MD, President-Elect
Pacific Mountain Affiliate
American Heart Association
Juneau, Alaska
POSITION STATEMENT: Provided an overview regarding obesity.
ROSIE FLETCHER, Member
Municipality of Anchorage Obesity and Health Task Force;
Community Volunteer, Girdwood, Olympic Medal Winner
Girdwood, Alaska
POSITION STATEMENT: Related her involvement with the task
force.
ROBB BOYER, Ph.D., Member
Municipality of Anchorage Obesity and Health Task Force
Anchorage, Alaska
POSITION STATEMENT: Related his involvement with the task
force.
ACTION NARRATIVE
CHAIR PEGGY WILSON called the House Health, Education and Social
Services Standing Committee meeting to order at 3:03:26 PM.
Representatives Wilson, Seaton, Gatto, and Cissna were present
at the call to order. Representative Gardner arrived as the
meeting was in progress.
HB 322-SAFE SURRENDER OF BABIES
3:04:16 PM
CHAIR WILSON announced that the first order of business would be
HOUSE BILL NO. 322, "An Act relating to infants who are safely
surrendered by a parent shortly after birth."
3:04:35 PM
REPRESENTATIVE SEATON moved to adopt Version 24-LS1110\F,
Mischel, 4/19/06. There being no objection, Version F was
before the committee.
3:05:30 PM
CHRISTINE MARASIGAN, Staff to Representative Gabrielle LeDoux,
Alaska State Legislature, introduced HB 322 on behalf of
Representative LeDoux, sponsor. She paraphrased from the
following statement, which read [original punctuation provided]:
Thank you for the opportunity to testify, I am here
today to introduce the Safe Surrender of Infants Act,
HB 322.
HB 322 has the potential to save an infant's life.
This is a bill that will allow parents to safely
surrender an infant up to three days after birth
without fear of being criminally prosecuted.
There are 46 states that have enacted safe haven laws.
Alaska, Hawaii, Nebraska and Vermont are the only
states that have not passed this type of legislation.
In Texas, this legislation was known as the "Baby
Moses Law" in other states this is known as "Save
Haven Law."
The intent of this bill is to deter typically young
and unmarried women who are concealing their
pregnancies, giving birth in private and then
disposing their newborn's bodies. This bill would
save an infant in imminent danger and enable a parent
to avoid prosecution if they leave an infant at a
designated safe location.
Representative LeDoux's office has worked with the
Office of Children's Services in working on the draft
before you.
3:06:38 PM
REPRESENTATIVE GATTO inquired as to how the father fits into
this legislation. He asked if the father can surrender his
infant or object to the surrender of his infant.
MS. MARASIGAN pointed out that the language in the legislation
refers to "parent". She noted that some states require that
only the mother can surrender an infant. However, under the
current legislation, either parent could surrender the infant.
3:07:05 PM
REPRESENTATIVE GATTO posed a situation in which the father
objects to the surrender of the infant, and asked if the infant
would have to be surrendered to the father. Or, can the
privileges of the father be usurped and the infant be
surrendered to a hospital even if the father objects.
MS. MARASIGAN related her understanding that the intent is to
address an infant in imminent danger and thus the infant would
be in the charge of the authorities to whom the infant was
surrendered to until any issues were addressed.
CHAIR WILSON surmised, "So, in other words, ... if someone
objected, they would want the baby and we're talking about
babies that aren't wanted."
MS. MARASIGAN agreed.
3:08:00 PM
REPRESENTATIVE CISSNA inquired as to how this legislation fits
into current child welfare laws. She asked if the legislation
provides for the infant temporarily after which the infant moves
through the regular termination of parental rights.
MS. MARASIGAN deferred to department representatives.
3:08:53 PM
TAMMY SANDOVAL, Deputy Commissioner, Office of Children's
Services (OCS), Department of Health and Social Services (DHSS),
explained that under the legislation if a child is safely
surrendered, the department would be notified and all of the
same procedures currently in practice would apply. With regard
to the father's role, Ms. Sandoval specified that as is
currently the case, the department would attempt to locate the
father. In further response to Representative Cissna, Ms.
Sandoval specified that HB 53 indicates that when there is the
need for a placement decision, the preference list specifies the
following people in the following order: a relative, family
friend, licensed foster care, and then a facility. Therefore,
all the laws that currently apply would continue to apply with
these cases.
3:10:38 PM
REPRESENTATIVE GATTO posed a scenario in which the mother
surrenders the infant and the father arrives a day later to take
his infant. He asked what happens in such a case.
MS. SANDOVAL said that once custody is assumed, the state is
obligated to go to court for probable cause. The father could
engage in the process, but ultimately the judge determines what
happens at that point.
3:11:30 PM
REPRESENTATIVE GATTO asked whether the father could surrender
the infant without the mother's knowledge. Once the mother
receives a call that [the infant was abandoned], would the
mother have to go through court proceedings, he asked.
MS. SANDOVAL replied yes. She explained that once the
department assumes custody, the normal procedures apply.
However, the process could be cut short because the other parent
enters the scene. Ms. Sandoval emphasized that although the
[surrender of an infant] is a very rare occurrence because other
avenues for a parent to have someone else care for an infant are
well known, having the statute is important. In response to
Chair Wilson, Ms. Sandoval assured the committee that the
department does check to determine whether an individual [has
the wherewithal] to [care for the child]. However, she said
that the aforementioned is highly controversial when the parent
for whom there are no allegations comes forward and wants
custody of the child, but the case has entered the civil
process.
3:14:31 PM
REPRESENTATIVE SEATON referred to the language of Section 3(c)
on page 2, line 2, which says "the parent's legal duty to
support the infant is extinguished after 28 days". He asked if
the aforementioned language removes the requirement for any
legal duty to support an infant after 28 days, if the parent
"brings somebody in".
MS. SANDOVAL opined that it's inconsistent to allow a parent to
safely surrender his/her child at 3 days, but not extinguish the
parent's financial care and support until after 28 days. She
requested further clarity of Representative Seaton's example.
REPRESENTATIVE SEATON clarified his example by specifying that
it's a father who doesn't want a child and doesn't want to pay
child support and who safely surrenders the child within three
days. He asked if after 28 days, the father's legal duty to
support the child is extinguished.
MS. SANDOVAL said she believes that is what the legislation
states.
3:16:45 PM
REPRESENTATIVE SEATON asked if under current law the parents are
absolved from any future financial support, if the department
has to take custody of a child due to unsafe conditions.
MS. SANDOVAL answered that the department attempts to recoup any
care and support funds that it can when the department has
custody of the child until the rights of the parent are legally
terminated. Ms. Sandoval clarified that after the parent's
legal rights are terminated, he/she no longer has to pay child
support.
3:17:49 PM
CHAIR WILSON posed a situation in which the mother surrenders
the child and the unknowing father is found afterwards, and
asked if the department could seek support from the father at
that point.
MS. SANDOVAL offered to obtain the technical answer for the
committee.
3:18:21 PM
CHAIR WILSON, referring to page 1, lines 10-11, inquired as to
whether it would be illegal to surrender a child that is older
than three days old.
MS. SANDOVAL commented that the aforementioned is a good
question.
REPRESENTATIVE LEDOUX interjected that the line has to be drawn
somewhere. She recalled that originally the legislation allowed
legal surrender of an infant are six months to a year. She
informed the committee that the group being targeted are young,
single women, often teenagers, who attempt to conceal the
pregnancy and deliver in private. The desire was to provide
another choice for the mother.
3:19:56 PM
CHAIR WILSON related a personal story of a teen who concealed a
pregnancy.
3:20:40 PM
REPRESENTATIVE CISSNA inquired as to how often a child is left
in a dumpster.
MS. MARASIGAN, recalling her research, related that [in the year
prior] to the 1999 enactment of the Baby Moses Laws in Texas, in
a 10-month period there were about 13 abandoned babies found
dead. She further recalled from her research that in the year
2001 in California 38 abandoned infants were found. In fact,
this past year in Venezuela there was a highly publicized case
in which a fisherman found and saved an infant in a plastic bag
that was tossed into a lake by its mother. In 2001-2002, the
federal government recommended [that states] track and follow up
cases of abandonment, which led to a task force on the matter.
3:23:32 PM
REPRESENTATIVE LEDOUX opined that the purpose of HB 322 is to be
proactive rather than reactive.
3:23:48 PM
MS. MARASIGAN, in response to Representative Seaton, explained
that allowing the infant to be safely surrendered within the
first three days of its life was chosen for the following
reasons. In the 46 other states that have passed similar
legislation, over 12 states chose to allow the safe surrender of
an infant who is less than 3 days old. The remaining states
range from a week to a year. Ms. Marasigan reminded the
committee that this legislation addresses the infant that's in
imminent danger. She informed the committee that in a study of
women who committed infanticide, the majority of the research
indicated the need to address the immediacy of the situation.
Originally, the legislation allowed safe surrender of a child up
to a year in age, but discussions with agency staff pointed out
that timeframes longer than a few days are really abusive
situations.
CHAIR WILSON indicated her agreement that allowing safe
surrender of a child up to age one isn't appropriate.
3:26:09 PM
REPRESENTATIVE GATTO referred to page 9 of the National
Conference of State Legislatures (NCSL) update on safe havens
for abandoned infants dated October 21, 2003. Under the heading
Father's Rights, the update says: "Critics contend that denying
notification unfairly presumes that these fathers do not want to
care for their children. Utah's legislation addresses this
concern by requiring a search of the confidential registry for
unmarried biological parents and requiring that notice be sent
to each potential father identified in the registry." The
aforementioned seems complicated and almost unworkable, but
seems to illustrate the difficulty in including the father.
REPRESENTATIVE LEDOUX opined that such is the situation with any
termination of parental rights. For example, the situation in
which a mother living alone decides to place her child for
adoption and says that she doesn't know who the father is could
occur now. With regard to the registers, Representative LeDoux
suggested that those could be the subject of legislation next
year.
3:28:40 PM
REPRESENTATIVE SEATON commented that he would like to change the
legislation such that a parent can safely surrender a baby
without fear of prosecution for an infant up to eight days old
rather than three days old.
3:29:21 PM
REPRESENTATIVE GARDNER related her understanding that a parent
can't relinquish his/her parental rights for a specified amount
of time, which she understood to be about 48 hours.
MS. SANDOVAL said that she isn't familiar with the
aforementioned, but indicated that someone from the Department
of Law should be able to answer.
3:30:09 PM
REPRESENTATIVE GARDNER referred to page 2, lines 18-21, and
inquired as to what occurs if the parent, upon taking a child to
the appropriate authorities, doesn't say that he/she wants to
relinquish his/her parental rights or expresses the need for
time and leaves.
MS. MARASIGAN said that the reason it takes 28 days before the
parent's legal duty to support the infant is extinguished is in
order to sort out all the possibilities with regard to the
[absent] parent and whether there is an understanding as to what
it means to relinquish parental rights as well as other matters.
The legislation focuses on the safety of the infant in the
immediate future, she reminded the committee. As far as testing
[and the specified timelines], Ms. Marasigan said that she would
have to get back to the committee on that matter.
3:32:33 PM
REPRESENTATIVE SEATON related his understanding of the
legislation, which is that a parent who abandons his/her infant
can be criminally prosecuted if the parent doesn't relinquish
parental rights.
MS. MARASIGAN clarified that a parent who surrenders his/her
infant can do so without expressing whether he/she will return
for the infant. The idea behind the legislation is to not
prosecute the parent for abandonment when he/she leaves the
infant [in the care of the individuals specified in the
legislation]. She highlighted that the parent may or may not
provide information, but if information is provided it may be
utilized.
3:35:21 PM
CHAIR WILSON determined that no one else wished to testify.
3:35:31 PM
REPRESENTATIVE GARDNER inquired as to how many infants are
abandoned in Alaska; and of which, how many are abandoned within
the first three to eight days.
MS. MARASIGAN deferred to OCS.
MS. SANDOVAL said that OCS doesn't know of any children that
would come under HB 322 within the last three years.
CHAIR WILSON noted that if the abandoned child isn't discovered,
there would be no knowledge of the abandonment.
3:36:56 PM
REPRESENTATIVE SEATON moved Amendment 1, as follows:
Page 1, line 10;
Delete "three"
Insert "eight"
Page 3, line 19;
Delete "three"
Insert "eight"
There being no objection, Amendment 1 was adopted.
3:38:00 PM
REPRESENTATIVE GARDNER expressed that in certain circumstances
HB 322 could be great, but she noted concern with regard to the
secure and stable placement of a child when the father isn't
identified earlier on in the process. She pointed out that the
legislation doesn't include a mechanism for the aforementioned.
3:38:33 PM
CHAIR WILSON inquired as to how long it takes to contact the
second parent.
MS. SANDOVAL answered that it depends upon how much information
the division can garner on the [absent parent]. However, the
division attempts to locate absent parents and relatives
immediately upon the abandonment. The intent, as specified in
HB 53, is for the division to place children with relatives. In
further response to Chair Wilson, Ms. Sandoval said that the 28-
day provision is confusing because she didn't know the technical
[requirements] to obtain support for the child within the
remaining 20 days.
CHAIR WILSON posed a scenario in which a child is placed with
his/her grandmother and no other individual is found, and asked
what happens at that point.
MS. SANDOVAL reiterated that she would have to obtain an answer
for the committee. In such a situation, if the grandmother
decides to become licensed or not, relatives have the option to
become licensed. If the grandmother becomes licensed, the state
pays her the foster care stipend. If the grandmother isn't
licensed, then the grandmother would have the ability to support
the child or apply for public assistance. Again, she expressed
that she didn't know the behind-the-scenes process for recouping
the funds to support these children.
3:41:58 PM
REPRESENTATIVE SEATON opined that if someone follows the
procedures, surrenders the child without abuse, it would seem
that there would be no need for the 28-day [wait before support
begins]. Therefore, he questioned whether the elimination of
the 28-day period would satisfy the department's criteria.
MS. SANDOVAL said that it would make it clearer for the
department and its duties, although she didn't think the 28-day
wait is a problem.
REPRESENTATIVE SEATON inquired as to the sponsor's thoughts on
eliminating the 28-day wait.
REPRESENTATIVE LEDOUX said that it would be appropriate.
3:44:14 PM
REPRESENTATIVE SEATON moved Amendment 2, as follows:
Page 2 line 3;
Delete "after 28 days"
There being no objection, Amendment 2 was adopted.
CHAIR WILSON opined that she feels it's most appropriate that
the parent's legal duties won't be extinguished until after a
thorough investigation.
REPRESENTATIVE SEATON commented that this sends a clearer
message to a parent who is abandoning his/her child safely.
REPRESENTATIVE SEATON moved to report Version 24-LS1110\F,
Mischel, 4/19/06, as amended, out of committee with individual
recommendations and the accompanying fiscal notes. There being
no objection, CSHB 322(HES) was reported from the House Health,
Education and Social Services Standing Committee.
HJR 30-PUBLIC HEALTH COMPACT
3:49:55 PM
CHAIR WILSON announced that the next order of business would be
HOUSE JOINT RESOLUTION NO. 30, Relating to public health and a
prevention compact.
3:50:21 PM
REPRESENTATIVE GARDNER moved to adopt CSHJR 30, Version 24-
LS1557\F, Mischel, 4/4/06. There being no objection, Version F
was before the committee.
3:50:46 PM
CINDY FOLSOM, Staff to Representative Sharon Cissna, Alaska
State Legislature, stated the following:
This is really a very simple bill that encourages a
dialogue between people. The aim is to get groups of
people to focus on prevention as a way to improve
personal help and to address the spiraling cost of
health care. This proposed legislation encourages a
statewide discussion of lessons learned in preventing
the increase of health risks and would greatly expand
the personal promotion of health strategies and
knowledge in every Alaskan community.
3:51:40 PM
MS. FOLSOM then turned the committee's attention to a PowerPoint
presentation entitled "It's all about Prevention!", the slides
of which are included in the committee packet. The
aforementioned PowerPoint reviewed the importance of eye care
exams, dental exams, and exercise for prevention and management
of chronic illness and maintaining good bone structure. The
presentation emphasized that "Bad habits are making Alaskans
sick..." and related the behavioral health risks for Alaskan
adults in 2003, including being overweight, smoking, obesity,
engaging in no physical activity, and binge drinking. All of
the aforementioned can be changed and are preventable. She
related that in Alaska in 2002, 485 deaths were due to tobacco
use and 122 deaths due to second-hand smoke. Also, alcohol
abuse impacts every Alaskan and it costs. In fact, the total
outpatient cost for [alcohol abuse] was $25 million in 2003.
Moreover, poor nutrition accounts for 20-30 percent of
cardiovascular heart disease and obesity is becoming the state's
largest health risk factor, which is preventable. A recent
Institute of Social and Economic Research (ISER) study relates
that the state has improved in others areas of health, except
obesity, which has increased from 11 percent to 23 percent.
Physical inactivity, she reported, accounts for about 35 percent
of all cardiovascular health disease. In conclusion, Ms. Folsom
opined that "Wishful thinking is not enough ... prevention
involves action." Therefore, this prevention compact encourages
individuals to take personal responsibility for their good
health care. The goal is to promote a paradigm shift and foster
an awareness that health care is a choice and that prevention
can result in a difference in every Alaskan community.
3:57:57 PM
REPRESENTATIVE CISSNA highlighted that choices individuals make
impact the lifestyle people lead. In order to change the
choices, she indicated the need to change the conversation to
create a message of interest in changing health habits.
3:59:51 PM
TAMMY GREEN, Section Chief, Chronic Disease Prevention and
Health Promotion (CDP/HP), Division of Public Health, Department
of Health and Social Services (DHSS), paraphrased from the
following written statement [original punctuation provided]:
I am here to provide support for the concept of
prevention as a major strategy to promote and sustain
the public's health within the State of Alaska.
Chronic Diseases are among the most common and costly
of all health problems and they are also among the
most preventable. Prevention and health promotion
efforts directed at the most common risk factors can
improve not only the quality of life but can also
impact the growing cost of health care.
Approximately 60% of the top 10 causes of death in
Alaska are attributed to Chronic Diseases such as
Cancer, Heart Disease, Stroke and Diabetes and these
Chronic Diseases are greatly impacted by 4 risk
factors or lifestyle choices that people make. The 4
risk factors are:
Tobacco use
Lack of adequate physical activity
Poor nutritional habits (not consuming the daily
recommended 5 or more servings of fruits and
vegetables)
Being overweight or obese
To get a grasp of the magnitude of how Alaskans stack
up on these risk factors I give the following:
63% are overweight or obese
1 in 4 smoke 25%
1 in 5 are sedentary; many more don't meet the minimum
recommendations for physical activity (20%)
3 of 4 are not eating the daily recommended amounts of
fruits and vegetables (75%)
Additionally only 5% of Alaskans meet the positive
side of these risk factors - in other words only 5% of
Alaskans don't smoke, get adequate physical activity,
eat the recommended 5 or more servings of fruits and
vegetables and are not overweight. That is something
we in Public Health find quite distressing.
Not only are there health consequences for these risk
factors but there are also significant economic
consequences as well.
Tobacco (annually):
$135 million in direct medical expenditures
$160 million in lost productivity related to death
$??? In lost productivity from tobacco-related
illnesses
$292 million each year
Obesity (annually):
$195 million in direct medical expenditures
$17 million of this is Medicare (9%)
$29 million of this is Medicaid (15%)
Almost every Alaskan is adversely affected by chronic
disease in one way or another-through the death of a
loved one; a family member's struggle with lifelong
illness, disability, or compromised quality of life;
or the huge personal and societal financial burden
wrought by chronic disease.
In Summary:
Although chronic diseases are among the most common
and costly of all health problems, they are also among
the most preventable, however the focus of our health
care system over the past century has not been on
prevention of chronic disease, but on treatment of
short-term, acute health problems. As a nation, we
have emphasized expensive cures for disease rather
than cost-effective prevention.
If we are serious about improving the health and
quality of life of all Alaskans AND keeping our health
care budget under control ... we can no longer afford
to ignore the power of prevention.
4:04:06 PM
CHAIR WILSON stressed the need for personal healthy lifestyles.
She then requested that the committee view future health care
issues with prevention in mind as a possible way to decrease
health care costs in Alaska.
[HJR 30 was held over.]
HB 452-ALASKA PRESCRIPTION DRUG TASK FORCE
4:06:27 PM
CHAIR WILSON announced that the next order of business would be
HOUSE BILL NO. 452, "An Act establishing the Alaska Prescription
Drug Task Force; and providing for an effective date."
REPRESENTATIVE SEATON moved to adopt HB 452, Version A, as the
working document. There being no objection, HB 452 was before
the committee.
4:06:43 PM
REPRESENTATIVE DAVID GUTTENBERG, Alaska State Legislature,
sponsor of HB 452, reminded the committee that the legislature
has recently addressed the Public Employees' Retirement System
(PERS) and Teachers' Retirement System (TRS) and workers'
compensation, all of which are related to rising health care
costs. He related the following: pharmaceuticals are the
fastest growing segment of Alaska's rising health care costs,
one of four of Alaska's seniors choose between taking medication
and purchasing food, an average American consumes about 3
billion prescriptions a year. In fact, between 1995 and 2003,
the average increase for prescription drug expenditures was 15
percent higher than any other health expenditure. He pointed
out that the committee packet should include a chart that
illustrates that prescription drug expenditures are about triple
that of other health care costs. Representative Guttenberg then
related that the March 2006 research survey of the Institute of
Social and Economic Research (ISER) found that the average price
for retail prescriptions was 25 percent higher in Alaska than in
other states. He noted that there are many issues on the table
that address more than the cost of the drug. With regard to the
proposed task force, Representative Guttenberg said that it
doesn't restrict or limit the many options that are available to
reduce the cost of prescription drugs.
4:10:33 PM
SHARON TREAT, Executive Director, National Legislative
Association on Prescription Drug Prices (the Association), began
by relating that the Association is a group of legislators who
came together back in 2000. The Association has grown and
researches ways in which to reduce prescription drug prices.
The legislation before the committee provides the committee with
the opportunity to coordinate the various agencies that have a
piece of the prescription drug and health care issue as well as
experts throughout the state in order to ensure that affordable
prescription drugs can be accessed by as many people as possible
within the budget constraints of the state. Ms. Treat related
that HB 452 is very similar to legislation passed in West
Virginia in 2004 and in Maine in 2005. Such legislation is
pending in several other states as well.
MS. TREAT explained that the legislation in both West Virginia
and Maine established a task force to review bulk purchasing and
pooling of prescription drugs within the state as well as with
other states, as is proposed in HB 452. [Bulk
purchasing/pooling of prescription drugs] is a way to leverage a
good price when negotiating for Medicaid programs. One of the
big issues being faced by many states, including Alaska, is that
all those Medicaid recipients who have been moved to Medicare
Part D are now not in the purchasing pool. The aforementioned
makes it more difficult to negotiate a good price and thus [HB
452] is a way of "beefing that up." In Maine there's a three-
state purchasing pool that has already saved $1 million in the
Medicaid program over the last year. The aforementioned
purchasing pool has benefited Maine's program that helps provide
access to [prescription] drugs to the elderly, which is similar
to Alaska's program. Ms. Treat noted that her written
testimony, included in the committee packet, provides more
information. She then informed the committee that Colorado is
considering a purchasing pool for which the savings have been
projected to be about $3 million. Furthermore, the proposed
task force would review other ways to provide information to
physicians and other health care practitioners in order to
reduce the cost of prescription drugs. She then informed the
committee that Pennsylvania is providing independent, objective
information that Alaska could utilize to its benefit. The task
force would review various other ideas. She highlighted that HB
452 suggests that Alaska join the Association, which the
Association certainly supports.
4:16:27 PM
CHAIR WILSON asked if there are other western states besides
Colorado that are interested in joining the purchasing pool.
MS. TREAT opined that Utah is possibly addressing this matter.
She indicated that perhaps similar size states would come
together, particularly those with smaller populations. There
has been much review in the states of Washington and Oregon with
regard to evidence-based medicine and providing information to
physicians with regard to alternatives. In fact, Washington has
a purchasing pool that, even with a limited preferred drug list
(PDL), has saved money.
4:18:22 PM
MS. TREAT commented that it's not the easiest thing for several
states to come together [for a purchasing pool] because every
state has a slightly different Medicaid program. In fact, the
sovereign states group hired a nonprofit organization that was
adept at working with various [groups] to help them [leverage
purchasing drugs]. In a slightly different fashion, West
Virginia and other states attempted to do joint purchases.
REPRESENTATIVE GUTTENBERG indicated that the state is in a
multi-state pool for Medicare with states similar in size, such
as West Virginia, Maine, and Vermont.
4:20:24 PM
REPRESENTATIVE SEATON inquired as to how this ties in with
state's that have different preferred drug lists.
MS. TREAT said that it may complicate things. However, the
states that have entered into the earlier mentioned purchasing
pool have a memorandum of understanding that specifies that each
state will plan its own Medicaid programs but that they will
work together. This is just one opportunity to save money, she
said. Ms. Treat commented that she didn't know the extent to
which Alaska utilizes programs that promote the purchase of
generic brands. This task force, she opined, allows experts to
come together and review a number of opportunities with the goal
of determining what works best for Alaska.
4:22:32 PM
REPRESENTATIVE SEATON expressed interest in the relationship of
the claw back and Medicare Part D. He recalled that at one
point the states may pay more than 100 percent of the federal
obligation under Medicare Part D; he asked if that's correct.
MS. TREAT answered that it depends upon the state. She offered
to research it for Alaska. Ms. Treat then explained that the
claw back was based on the formula, which was based on the
increase of drug prices and state Medicaid prices over a
specified period of time. States that had been utilizing
programs such as preferred drug lists and purchasing pools and
kept their costs down are penalized under the formula because it
assumes that the Medicaid costs were much higher than they
actually were. However, other states that had not implemented
cost saving measures benefited. For example, Maryland received
more funds than it was able to utilize for various wrap-around
prescription drug services for those who applied for Medicare
Part D. However, Maine had implemented so many cost saving
measures that the level of inflation was well below that of
other states and thus Maine will have to pay more than it
actually cost to provide the Medicare benefit.
MS. TREAT explained that with regard to the purchasing pool, the
states that are negotiating with drug companies to obtain a good
Medicaid price, part of that ability to negotiate was tied to
the people tied to the purchasing pool. However, now that
people have been moved to Medicare Part D, those individuals are
out of the state purchasing pool, which leaves the states with
much less leverage and control over the health of those
individuals.
4:26:06 PM
PAUL RICHARDS, Lobbyist, Pharmaceutical Research and
Manufacturers of America (PhRMA) Incorporated, testified in
opposition to HB 452, which PhRMA believes "would establish a
process to control prescription drug prices, regulate
advertising and marketing, determine what information health
care practitioners provide to patients, and essentially regulate
a private sector industry." He noted that the committee packet
should include a written statement from PhRMA. He then informed
the committee that PhRMA has worked to educate and reduce costs.
In fact, PhRMA has worked in each state in patient prescription
drug programs to identify and involve seniors in the state with
patient programs for each pharmaceutical company represented by
PhRMA. Over 14,000 Alaskans are signed up for patient
prescription assistance programs in the state due to PhRMA's
efforts.
CHAIR WILSON explained that the drug companies will be called
into testify on this matter.
4:28:27 PM
DWAYNE PEEPLES, Director, Division of Health Care Services
(DHCS), Department of Health and Social Services (DHSS),
informed the committee that the department implemented a
preferred drug list in 2003. Alaska was also one of the first
pool states that was referenced earlier. He recalled that
initially Alaska pooled with five other states. Some of the
states involved in the pool were Nevada, Michigan, Vermont, and
Wisconsin. He noted that Vermont is initiating separation from
the pool in order to create a nonprofit corporation pool.
Originally, Alaska pooled under the state's current fiscal
agent, First Health Services.
CHAIR WILSON asked if the state has realized savings due to the
pool.
MR. PEEPLES replied yes. The pooling of the lives into
purchasing power resulted in a supplemental rebate, which
amounted to about $6-$7 million a year until the state
transitioned to Medicare Part D. Additionally, the state
established a preferred drug list that was operated under the
auspices of the PNT committee. With the supplemental rebate and
moving prescribing behavior to generic and cheaper drugs
contributed $1-$2 million in savings. Therefore, Alaska's
experience was positive until this January when the state
transitioned to Medicare Part D. In further response to Chair
Wilson, Mr. Peeples explained that there are several ways to
implement a PDL. With the cooperation of the vast majority of
the physicians in the state, Alaska requires that if one is
going off of the PDL drug, the prescription must specify
"medically necessary." The medical community has been very
cooperative and supportive. Mr. Peeples related that when
balancing the cost of operating a restrictive program versus how
Alaska has run its program, the state has been reasonably
successful.
[HB 452 was held over.]
^OVERVIEW(S)
^AMERICAN HEART ASSOCIATION - OBESITY AND HEALTH
4:32:31 PM
CHAIR WILSON announced that the final order of business would be
a presentation by the American Heart Association regarding
obesity and health.
4:35:06 PM
SUZANNE MEUNIER, Director, Alaska Advocacy, American Heart
Association, introduced her companions who will provide comments
later in the meeting.
BOB URATA, MD, President-Elect, Pacific Mountain Affiliate,
American Heart Association, presented a slide show entitled,
"American Heart Association Learn and Live". He began by
explaining that obesity is defined as having a very high amount
of body fat in relation to lean body mass, which is referred to
as the body mass index (BMI). Studies have shown that the BMI
is a useful tool for defining obesity, although it doesn't work
very well for very muscular individuals because the soft tissue
is muscle not fat. In children, the term obesity isn't used due
to its negative connotation but rather the term overweight is
used.
4:38:44 PM
DR. URATA, referring to a slide entitled "Trends," then related
that over the past 20 years there has been a dramatic increase
in obesity in the United States. In 1985 only a few states
participated in the Centers for Disease Control and Prevention
(CDC) behavioral risk factor surveillance system (BRFSS) that
provides obesity data. In 1991 four states had obesity
prevalence rates of 15-19 percent and no states had obesity
prevalence above 20 percent. However, by 2004 33 states had
obesity prevalence rates of 20-24 percent and 9 states had rates
more than 25 percent. Dr. Urata then presented a series of
slides that illustrate the [increase] in obesity rates in the
United States. In 1991 Alaska began participating in the BRFSS
and had an obesity prevalence rate of 10-14 percent. As more
years pass, the slides show the increases in obesity in more
states. In fact, in 1997 obesity prevalence reached more than
20 percent in a few states. From 1998 on Alaska has had an
obesity prevalence of more than 20 percent, save a decrease to
15-19 percent in 1999.
4:40:44 PM
DR. URATA then reminded the committee that 63 percent of adults
in Alaska are either overweight or obese. Moreover, of Alaskan
high school students, 22 percent of females and 29 percent of
males are overweight or at risk for being overweight. He then
informed the committee that 8 million children and adolescents
are overweight and over the last two decades the rates for
overweight adolescents have tripled. As expected, the health
consequences for overweight and obese individuals include
premature mortality, including cardiovascular disease, diabetes,
musculoskeletal disorders, sleep apnea, gallbladder disease, and
certain types of cancer. An individual with a BMI over 45 can
expect to have 20 years cut from his/her life. The
aforementioned type of individual would require a medical
procedure to help him/her lose weight.
4:42:11 PM
DR. URATA highlighted the following health consequences of
obesity in youth, including high blood pressure, high
cholesterol, Type 2 diabetes, psychosocial disorders, and an
increased risk of obesity as an adult. The economic costs are
high. In fact, in Alaska $17 million was financed by Medicare
and $29 million by Medicaid for a total of $195 million in
annual direct medical expenditures. Dr. Urata then presented
slides that illustrate things that contribute to this problem,
such as rewarding homework with donuts and super sized meals.
DR. URATA said that obesity is an epidemic that will soon
surpass smoking as the leading preventable cause of death. He
pointed out that obesity has greater morbidity than smoking,
problem drinking, and poverty. "The National Institute of
Health projects that our next generation of children will be the
first in the history of the U.S. whose life expectancy is
shorter than their parents due to the impacts of obesity and
related health consequences," he related.
4:44:09 PM
MS. MEUNIER related that the American Heart Association is
prepared to work with the committee to develop a policy to
address physical activity and nutrition. Information relating
to addressing obesity through public policy is included in the
slides in the committee packet.
4:45:15 PM
REPRESENTATIVE SEATON asked if it's the quantity of the food
consumed or is there something in the food that lowers one's
metabolism rate such that more fat is accumulated.
DR. URATA answered that it is the quantity and the poor quality
of food being eaten. He suggested that people eat five servings
of fruits and vegetables rather than carbohydrates and starches,
reduce meats to lean or low fat meats, and reduce trans fats and
saturated fats. He also recommended that people exercise more,
especially since children are coming home to sit in front of a
computer rather than the physical [chores] of the past.
Furthermore, there needs to be education as to what is healthy
for children. In response to Chair Wilson, Dr. Urata agreed
that it's best and more effective to target younger children.
4:47:23 PM
MS. MEUNIER highlighted the slide specifying that between 70-80
percent of overweight children and adolescents will continue to
be overweight in adulthood and become obese adults.
4:47:49 PM
ROSIE FLETCHER, Member, Municipality of Anchorage Obesity and
Health Task Force; Community Volunteer, Girdwood, Olympic Medal
Winner, related that second only to her passion for sports is
working with children. In fact, over the last 10 years Ms.
Fletcher noted she has been speaking to children throughout the
state in hope of changing one child's life. Over this time, she
said she has noticed a lack of enthusiasm for nutrition,
physical activity, and a rise in obesity. Therefore, when the
opportunity arose to be part of this task force, she said she
jumped at the chance. However, she indicated that it has proven
challenging, especially when using the term obesity. She
explained that her goal has been not to be against obesity but
rather for physical activity and good nutrition, which is
especially effective with children. She provided an account of
a physical activity event in which she participated in at an
Alaskan school, which made her realize the depth of the problem.
ROBB BOYER, Ph.D., Member, Municipality of Anchorage Obesity and
Health Task Force, turned attention to the slide presentation
entitled, "Municipality of Anchorage's Task Force on Obesity and
Health," which is included in the committee packet. A
collaborative effort began to educate [its members] which broke
into subcommittees in order to develop the goals and objectives
of the group. The four goals and objectives are as follows:
1) Ensure plan implementation, oversight, and review.
2) Improve the eating habits of the Municipality of
Anchorage residents through better nutrition.
3) Increase the number of adults, adolescents, and
children who engage in regular physical activity.
4) Create a community environment that supports a more
physically active way of life.
DR. BOYER explained that within the first goal a process by
which the plan can be reviewed has been developed. Furthermore,
umbrella programs that assist in quantifying and rewarding
efforts on a communitywide basis have been identified. With
regard to the second goal, Dr. Boyer said it became
controversial and complex because the solution isn't merely to
eat less. He highlighted the issues related to vending machines
in schools and workplaces. In response to Chair Wilson, Dr.
Boyer related that the Division of Health and Human Services
will ensure that the review occurs but the [task force] can't
require any changes.
4:56:44 PM
DR. BOYER continued with review of the second goal as it relates
to what health care providers are able to assist in encouraging
better eating habits. He acknowledged that the physical
activity goals are quite aggressive. In fact, the Mayor of the
Municipality of Anchorage's task force recommended physical
education every day for all K-12 students. The aforementioned
would require building new buildings, hiring new physical
education teachers, and increasing/decreasing credit
requirements. The fourth goal looked at the broader picture in
regard to ways in which the community can encourage physical
activity such as ensuring that sidewalks and paths are clear for
physical activities.
4:58:13 PM
DR. BOYER, in response to Representative Seaton, pointed out
that within the environment recommendations there were
recommendations with regard to building designs and the location
and signage for stairs.
4:58:46 PM
DR. URATA concluded by relating that the goal of the American
Heart Association is to reduce death and disability from heart
disease and stroke by 25 percent within 10 years, which would be
by 2010. Obesity, he opined, is one of the challenges that will
help reach that goal. Therefore, the national American Heart
Association and the Robert Wood Johnson Foundation have produced
a source book on obesity. Additionally, the national American
Heart Association has joined forces with the Clinton Foundation
to develop a healthy children program. The goal is to work with
the following groups: children in the schools, the restaurant
industry, and the health care industry. The hope, he
emphasized, is to halt the increasing prevalence of childhood
obesity.
5:01:13 PM
REPRESENTATIVE CISSNA described her personal relationship with
the changing face of Alaska and the love of the automobile.
5:02:05 PM
CHAIR WILSON questioned whether restaurants would be willing to
make portions smaller.
5:02:39 PM
REPRESENTATIVE GARDNER opined that restaurants will do whatever
their customers support. Therefore, the problem isn't the
restaurants or the various food manufacturers.
5:03:18 PM
REPRESENTATIVE SEATON suggested that increased gas prices could
promote more physical activity. He asked if the slides account
for the change in definition of "overweight" and "obesity" that
occurred four years ago or so.
DR. URATA said that the slides are based on the current
definition of those terms. The change came about when, upon
review of the BMI and the diseases people had, it was discovered
that at a BMI of about 25 bad things started to occur. In
further response to Representative Seaton, Dr. Urata related his
understanding that the slides with data obtained prior to the
definition change were adjusted to the BMI data.
5:05:37 PM
TAMMY GREEN, Section Chief, Chronic Disease Prevention and
Health Promotion (CDP/HP), Division of Public Health, Department
of Health and Social Services (DHSS), confirmed that the slides
have been adjusted for the new definitions of overweight and
obesity.
5:05:59 PM
CHAIR WILSON thanked the presenters and charged the committee
with providing recommendations to the legislature.
5:10:02 PM
ADJOURNMENT
There being no further business before the committee, the House
Health, Education and Social Services Standing Committee meeting
was adjourned at 5:10 p.m.
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