Legislature(2019 - 2020)ADAMS ROOM 519
04/30/2019 01:30 PM House FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| SB36 | |
| SB37 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | SB 36 | TELECONFERENCED | |
| + | SB 37 | TELECONFERENCED | |
| += | HB 49 | TELECONFERENCED | |
| += | HB 145 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 20 | TELECONFERENCED | |
CS FOR SENATE BILL NO. 37(FIN)
"An Act relating to the statewide immunization
program; and providing for an effective date."
1:55:14 PM
JANE CONWAY, STAFF, SENATOR CATHY GIESSEL, reviewed the
legislation. She read from the sponsor statement:
CS for Senate Bill 37(FIN)reauthorizes the statewide
immunization program in the Department of Health and
Social Services, which is scheduled for repeal January
1, 2021. Established in 2014, via Senate Bill169, the
program monitors, purchases and distributes all
childhood vaccines and select adult vaccines to
providers, making access to vaccines universal for all
Alaskans. By 2018, the program covered more than
333,000 Alaskans, 45% of the total population. Next to
clean drinking water and good nutrition, vaccines have
saved more lives than any other public health
intervention.
The statewide immunization program is fully funded by
the state Vaccine Assessment Account through
assessments (upfront fees) from health plans and
insurers and other fees. There are no undesignated
general funds needed for this program. The state
leverages its buying power to purchase vaccines in
bulk using the fees collected from healthcare payers.
The state distributes that vaccine to providers who
then administer them at no charge, improving health
and wellbeing while lowering overall vaccine costs by
20 -30%.
CSSB37(FIN) creates the vaccine assessment fund as an
account in the general fund and will allow the
Commissioner of the Department of Health and Social
Services to administer the program and react more
nimbly in the event of an outbreak without first
seeking legislative approval. Alaska's immunization
program is an example of a successful public-private
partnership that ensures Alaskans a healthier future
at the lowest possible cost. The department reduces
vaccine -preventable diseases, and providers have
improved health outcomes for their patients and easier
vaccine stock management. The insurers pay less to
vaccinate individuals; we all save more money in the
long run due to decreased medical costs from vaccine-
preventable diseases.
Ms. Conway detailed that the state could purchase vaccines
in bulk, the providers could administer more vaccines and
have greater access with no waste. She relayed a number of
benefits to the program. Waste was eliminated, and patients
paid less for their vaccines. She concluded her portion of
the presentation. She conveyed the names of those available
for questions.
Co-Chair Wilson invited Ms. Lewis to the table.
2:00:39 PM
JILL LEWIS, DEPUTY DIRECTOR, DIVISION OF PUBLIC HEALTH,
DEPARTMENT OF HEALTH AND SOCIAL SERVICES, relayed that the
chief Medical Officer would begin testimony.
LILY LOU, ALASKA STATE MEDICAL OFFICER, DEPARTMENT OF
HEALTH AND SOCIAL SERVICES, introduced herself and relayed
she had served on the Council for the Alaska Vaccine
Assessment Program (AVAP) and was President of the American
Academy of Pediatrics Alaska Chapter. She noted there was a
letter (copy on file) authored in her capacity as chapter
president. She discussed the vaccine program, noting that
the program made access to vaccines universal, and did
include uninsured adults. Alaska was the only state that
provided the coverage for uninsured adults.
Ms. Lou continued her remarks. She discussed the cost of
the program. She discussed the discount in vaccine pricing
and the bulk purchasing benefits. The program was created
in January 15 and should sunset in 2021. In 2008, the
program had covered 50 percent of Alaskans. The department
had seen a significant improvement in vaccination rate. She
discussed national recognition for the state's increased
vaccination rates.
2:03:46 PM
Ms. Lou directed attention to a slide in member packets
[She pointed to the AVAP Handout - SB 37 Renewal of Vaccine
Assessment Program] (copy on file). She referenced a mumps
outbreak the previous year. The bill reauthorized the
program, removed the phase-in language, and removed the
sunset language. She emphasized that the bill did not
change or impact any regulations regarding vaccine
exemptions. She discussed the advantages of the program.
She discussed the advantage of a unified and effective
inventory system.
Mr. Lou shared an estimate that for every dollar spent on
vaccine programs, it saved $10 in medical costs. She
asserted that the program had proven itself. She thanked
members for the opportunity to speak.
2:07:11 PM
Vice-Chair Ortiz spoke to the issue of what the department
oversaw. He had gleaned that the bill would help improve
access to vaccinations. He mentioned diminished services in
public health clinics and rural areas. He wondered if
public health clinics were the best access to vaccinations
and he wondered about access if a public health clinic
closed.
Dr. Lou responded that the department was aware that public
health clinics provided an important service. She clarified
that the program provided vaccines to any provider that
administered vaccinations.
Vice-Chair Ortiz asked if the department had seen any
increase in outbreaks of disease that could be affected by
not having access to vaccines.
Dr. Lou appreciated the challenges when a health facility
closed.
Representative Sullivan-Leonard asked about
reauthorizations for the program. She wondered if other
diseases were coming to the forefront such as measles.
Dr. Lou responded that measles was the primary national
issue, although it had not been seen in Alaska yet. There
was a recent outbreak of measles in the State of
Washington. There were no current vaccine-preventable
outbreaks in Alaska. There were other outbreaks such as
tuberculosis.
2:10:47 PM
Ms. Lewis introduced the PowerPoint presentation: "SB 37
Renewal of Vaccine Assessment Program" (copy on file). She
began with slide 2, "SB 37":
?Reauthorizes the statewide Alaska Vaccine Assessment
Program in the Department of Health and Social
Services, scheduled for sunset January 1, 2021.
?Eliminates a temporary phase-in period that ended in
2017.
?Uses the state Vaccine Assessment Account to fully
fund the program.
o No unrestricted general funds are involved.
Ms. Lewis turned to slide 3, "What is the Alaska Vaccine
Assessment Program?":
Established in 2014, AVAP is a public-private
partnership making access to vaccines universal for
all Alaskans at no cost to the state.
?Provides all childhood and certain adult vaccines for
privately insured children and some adults.
?Covers vaccine costs through assessments collected
from private health insurers, third party
administrators, and other program participants.
?Purchases vaccines at discounted rates off a bulk
contract.
?Distributes vaccine directly to healthcare providers
at no charge who administer the vaccines to their
patients.
Ms. Lewis detailed that providers could still bill for an
office visit or to administer the vaccines.
Ms. Lewis continued to slide 4: "What is the Alaska Vaccine
Assessment Program.":
? Through AVAP, Alaska continues to demonstrate
leadership in creating innovative solutions for
difficult public health issues.
? Alaska is one of only 11 states that has a universal
childhood vaccine program and one of only 3 states
that offers adult vaccines.
? Alaska is the only state that offers healthcare
providers the option of purchasing state-supplied
vaccine to serve uninsured adults.
2:14:10 PM
Ms. Lewis reviewed the flow chart on slide 5. She began at
the top of the slide with Alaska Vaccine Assessment Council
which set the annual assessment rate based on historical
information. To the right showed the payers who paid into
the assessment quarterly based on their reported covered
lives. The Division of Public Health purchased the vaccine
off a discounted bulk contract. The Division of Public
Health then distributed the vaccine at no cost to providers
or through the Vaccine Depot. Providers vaccinated covered
patients, only billing payers for office visits. Providers
then reported administered vaccines to the Division of
Public Health, and then provided data to the council for
rate setting. She remarked on the streamlined process
provided by the program.
2:17:40 PM
Vice-Chair Johnston understood that the program had gone on
for almost 5 years. She asked if the department had a good
idea of the amount of vaccines that were needed after
collecting data over time.
Ms. Lewis thought Vice-Chair Johnston was asking about the
department's ability to forecast the number of vaccines
needed. She thought the council was good at forecasting and
had been operating a central vaccine depot for more than 30
years. Previously the depot was federally funded until the
funds were lost when the former United States Senator Ted
Stevens left office. She asserted that the department was
very accurate with its data, and actively worked to manage
waste.
Representative Tilton referenced the flow chart on slide 5.
She asked if the "payers" referenced on the chart was
referencing insurance companies.
Ms. Lewis responded that the health plans and the insurers
were required to pay the assessment. In order to cover the
uninsured adult population, the program allowed providers
to opt into the program. If the providers had a large
community to serve, such as a community health clinic, the
providers could get the same price break by voluntarily
participating. Without participation, providers would have
to pay the retail cost and would not be able to avail
themselves of the 20 to 30 percent discount.
Representative Tilton asked how providers could participate
in the program.
Ms. Lewis responded that providers had to agree to certain
conditions in order to participate and provided information
about how many patients were in the caseload. The cost was
the same rate that health plans paid per member per month.
Co-Chair Wilson asked if the program required parents to
immunize their children.
Ms. Lewis stated that in Alaska there was the option to
decline vaccination due to medical or religious reasons,
and the bill did not affect the option. She returned to
speaking to the flow chart on slide 5.
2:22:55 PM
Ms. Lewis explained slide 6: "Vaccine Cost," which showed a
bar graph depicting the cost to vaccinate a person through
18 years of age for the AVAP program versus the private
sector. The overall vaccine costs were lowered 20-30
percent by the program and showed a savings of almost
$1,000 per child.
Ms. Lewis reported on slide 7: "Vaccine Coverage":
2018
? 366,000 Alaskans covered
? 50% of the population
? 86,000 children
? 44% of all children
? 280,000 adults
? 52% of all adults
Vaccination Coverage Awards
?Most improved among adolescents for HPV
?Most improved among adults aged 65+ for pneumonia
Ms. Lewis noted that Alaska was improving its vaccination
rates, which were lower than the rest of the country.
Ms. Lewis discussed slide 8: "Successes":
Win-Win-Win-Win
? The Division of Public Health reduces vaccine
preventable diseases.
? Providers have improved health outcomes for
vaccinated individuals and easier vaccine stock
management.
? The health insurance industry pays less to vaccinate
individuals.
? All Alaskans save more money in the long run due to
fewer medical costs from vaccine-preventable diseases.
Ms. Lewis reviewed the benefits of the program on slide 9:
"Return on Health":
Lowers direct and long-term healthcare costs and yields
numerous public health benefits:
? Ensures that every child and some adults who enter a
participating doctor's office or hospital can receive
recommended vaccines at no cost.
? More healthcare providers can offer vaccination
services
? less up-front costs to finance out of their own
pockets for vaccines, and
? reduces staff burdens required to separate
private and public vaccine stock.
? Allows the State to manage the supply of vaccines,
? ensuring that the state can quickly supply
vaccines to vulnerable patient groups during
emergencies or vaccine shortages, and
? reducing waste through centralized inventory
management.
Ms. Lewis discussed the challenges of stocking vaccine
supply before the centralized program.
2:26:45 PM
Ms. Lewis discussed slide 10: "For every $1 spent on a
vaccine in the US?". She noted that the MMR vaccine saved
$26 for every dollar spent.
Vice-Chair Johnston asked if the flu vaccines and shingle
vaccines were covered.
Ms. Lewis responded that the state covered both vaccines.
Vice-Chair Johnston asked if the newer shingles vaccine was
covered.
Ms. Lewis responded that the newer shingles vaccine was
covered. She discussed the restructuring of the Vaccine
Assessment Account. The new vaccine was more expensive and
estimated to cost $1 million more per year. The new vaccine
also applied to a broader age group and thereby required
more vaccines. Under the fund transfer, the program would
be limited to the appropriation amount in a single year.
She noted with the fund capitalization the program was not
as limited and could spend assessments that had been
collected.
Co-Chair Wilson asked if shingles vaccines were available
for retired state employees.
Ms. Lewis believed that the state did provide the vaccine
but was considered in terms of covered lives. She thought
the vaccine coverage for retirees was limited.
Representative Merrick noted Ms. Lewis had mentioned that
unused vaccines were returned. She wondered how ensure to
vaccines had been properly cared for while in other hands.
Ms. Lewis indicated that the quality control was well
managed for vaccines. The depot spent a great deal of its
time on quality assurance including site visits, mandatory
temperature checks, and reports.
2:30:26 PM
Representative LeBon referenced slide 7 and asked about the
44 percent of children covered. He wondered if the number
indicated the number of children vaccinated.
Dr. Lou reported that the 44 percent denoted the children
covered by the AVAP, which was different than vaccine
rates. She noted that 100 percent of Alaskan children were
covered.
Representative LeBon asked about the record of vaccine
participation in the state.
Dr. Lou responded that vaccination rates were tracked by
vaccine at the point of vaccine administration. The state
did not have the best vaccination rates. She mentioned
"herd immunity" and thought the state was close to the
cusp. She mentioned that the percentage required for herd
immunity of the community was different for each disease.
Representative LeBon asked Dr. Lou about measles in Alaska
and if she had concerns.
Dr. Lou replied that as a pediatrician she had concerns
about the trend, and thought the state had a 93 percent to
94 percent vaccination rate for the disease. She expressed
concerns that there were communities where vaccine
hesitancy was at much higher rates and a vaccine-
preventable disease could take hold and spread to the rest
of the state.
Co-Chair Wilson asked if the program sunset was being
removed. She wondered if the legislation allowed for fees
to be adjusted.
Ms. Lewis responded that the AVAP Council had the ability
to adjust the rate if needed.
2:34:05 PM
Vice-Chair Johnston understood that the bill would not have
a sunset date. She asked if the program had ever been
audited.
Ms. Lewis indicated that the program was audited annually
by an independent auditor.
Representative Josephson referenced cuts to public health
nursing. He wondered if the cuts had affected provision of
vaccines.
Dr. Lou responded that Representative Josephson's question
was a separate question from the bill. However, she thought
cutting public health care resources did impact the
provision of vaccines.
2:35:40 PM
Co-Chair Wilson OPENED Public Testimony.
KAREN MORTON, ALASKA NURSES ASSOCIATION, SOLDOTNA (via
teleconference), spoke in favor of the bill. She reviewed
the many benefits of the program and urged support of the
bill.
2:36:43 PM
IRINA OBOLENTSEVA, SELF, DELTA JUNCTION (via
teleconference), read a doctor's opinion about autism and
vaccinations. She relayed that certain vaccinations were
unsafe products that she felt the state should not pay for.
She argued that one-shot-fits-all was not a smart thing to
do.
2:39:49 PM
ANNA GONCHAROVA, SELF, DELTA JUNCTION (via teleconference),
spoke in opposition to the bill. She spoke of chronic
symptoms related to vaccinations. She listed a number of
repercussions resulting from vaccinations. She did not
support SB 37 and urged members to vote against the bill.
2:42:05 PM
JOHN ZASADA, AK PRIMARY CARE ASSOCIATION, ANCHORAGE (via
teleconference), reported his members strongly supported
the bill. He discussed health center participation in the
program. The program allowed non-profit practices to
purchase and administer vaccines, and also allowed them to
provide services for infectious diseases. He continued to
discuss the benefit of the vaccination program no matter a
person's ability to pay.
2:44:50 PM
ROSLAYN SINGLETON, SELF, ANC (via teleconference), strongly
supported SB 37. She discussed a time when vaccines were
not available in rural locations. As a pediatrician, she
had seen children die of preventable diseases. She recited
some rates of debilitating infection. She talked about the
importance of vaccinating for measles. She urged support of
the bill.
2:46:46 PM
Co-Chair Wilson CLOSED Public Testimony.
2:47:07 PM
DAVID TEAL, DIRECTOR, LEGISLATIVE FINANCE DIVISION, noted
that the department had testified that the program had
reduced the cost and increased the availability of
vaccines, and the bill would re-establish AVAP as a fund
capitalization rather than as a fund transfer. He used an
example to show the advantages of a fund capitalization. He
referenced the Regional Education Attendance Area (REAA)
School Fund, which was used to build and maintain schools
in the REAAs. The fund was established as a fund transfer,
into which the legislature had appropriated approximately
$40 million per year. Additionally, the legislature
appropriated money to individual school capital projects.
Mr. Teal continued with his example of a fund
capitalization. Three years previously the attorney general
had indicated that the REAA fund transfer was being done
incorrectly, and money should have been put in the fund
without the state choosing projects. The Department of
Education and Early Development should have ranked the
school construction projects, and the funding should be
used in the prioritized order. It used to be a fund
transfer where money was appropriated to the fund then
appropriated from the fund to the capital project. After
the attorney general's ruling the fund was converted to a
fund capitalization; after which monies were appropriated
to the fund and it flowed out without further
appropriations. The same thing would happen with the
vaccination program.
Mr. Teal explained that the fiscal notes would change the
language in both the House and Senate versions of the
operating budget bill. There were 3 fiscal notes. The
fiscal note with OMB component number 296 was no longer
needed due to the change he described. The second note OMB
component 3083 was also no longer needed. The third fiscal
note was a new fiscal note and was a fund capitalization
that would add language to the bill that deposited money to
the fund. The deposit would be an appropriation the program
could immediately spend to purchase vaccines. The fiscal
notes were a net zero.
2:51:42 PM
Mr. Teal further discussed the fiscal notes.
He discussed increased flexibility for using funds for
immediate needs. He suggested that with an open-ended
appropriation from the insurers (and perhaps providers)
into the fund, then AVAP could increase the assessments and
money in the fund, which could be spent with no legislative
action. The change would eliminate double counting with a
single appropriation to the fund. The change made the fund
no longer subject to the annual sweep into to the
Constitutional Budget Reserve. He discussed the conditions
under which funds were swept. He thought the fiscal notes
seemed more complicated than a simple bill should warrant,
but assured that the notes resulted in a net zero to the
state.
2:54:38 PM
Representative LeBon asked if the program went through all
its money every year, or if there was a fund that was
building up.
Mr. Teal informed that the program set its assessment fees.
In years of high outflow, AVAP didn't lose the money. There
was no advantage to building a big fund balance, so the
program should tailor the assessments to the amount of
money expected to be needed.
Representative Tilton had a question for the bill sponsor's
staff. She had heard in public testimony about adverse
reactions to vaccinations. She wondered if there was a
reporting mechanism for adverse reactions.
Dr. Lou responded that there was a very stringent reporting
system for adverse reactions to vaccinations that was
maintained by the Center for Disease Control and was
accessible to anyone any time.
Co-Chair Wilson informed members that amendments were due
by 5:00 P.M. on Wednesday, May 1, 2019.
[Recessed to the Call of the Chair. The meeting never
reconvened.]