Legislature(2001 - 2002)
02/01/2001 01:30 AM Senate L&C
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
SB 38-MEDICAL ASSISTANCE:BREAST/CERVICAL CANCER
CHAIRMAN RANDY PHILLIPS called the Senate Labor & Commerce
Committee meeting to order at 1:30 p.m. and announced SB 38 to be
up for consideration.
COMMISSIONER KAREN PERDUE, Department of Health and Social Services
(DHSS), said that Congress recently passed legislation to improve
health care for women by extending Medicaid coverage for treatment
of breast and cervical cancer. This bill allows Alaska to take
advantage of this option. By opting into this program, uninsured
women who have been diagnosed with breast or cervical cancer under
the federally financed screening program would be eligible for
treatment of those conditions. Last year in Alaska it would have
meant about 40 women who could not otherwise afford cancer
treatment would have received this care.
COMMISSIONER PERDUE explained that a large number of these women do
get care, but they are saddled with a large number or bills and
there is evidence that women delay care because they are concerned
about financing the care. She did not mean to imply that
physicians are not treating these women.
The screening program began in 1990 when Congress passed the Breast
and Cervical Cancer Mortality Prevention Act (BCCMPA), she said. It
was passed with broad bi-partisan support. There are four grantees
currently operating under this program for women who meet certain
eligibility guidelines, but the federal money did not provide the
follow-up treatment.
MS. CATHY FEASTER, Alaska Nurses Association, supported SB 38. In
FY00, the Breast and Cervical Cancer Early Detection Program
provided screening services for more than 15,000 women. Thirty-
nine of them were diagnosed with breast cancer and 33 were
diagnosed with cervical cancer. This legislation would allow those
women with no other resources to obtain treatment for these
cancers. "Early detection and treatment can cure these conditions,
thereby reducing the long-term socio-economic drain on the state
and increasing the woman's ability to be a contributing member of
her community," Ms. Feaster said.
Number 437
MS. SUE CICCONE, breast cancer survivor, said she has had many
financial problems and she has not completed treatment, yet. She
had insurance, but as of October 1, the company decided not to
carry the State of Alaska any longer. This is the middle of her
reconstruction. The cheapest insurance she could find is $600 -
$800 per month with a minimum of a $3,000 deductible which is
completely unaffordable.
SENATOR LEMAN asked if she had discussed her situation with the
Division of Insurance.
MS. CICCONE answered that she had and had also written to Senator
Murkowski who turned her letter over to the Insurance
Commissioner's office. She could buy a high risk insurance policy,
but it would cost $800 per month which is totally unaffordable to
her.
SENATOR LEMAN said that it seemed to him if she is terminated in
the middle of coverage of her treatment and her premiums were paid,
that she has a legitimate complaint which she should pursue.
MS. CICCONE said she also thinks she has a legitimate complaint,
but according to the Division of Insurance, the company met lawful
notification requirements. She added that she was insured through
her employer and one month prior to renewal of her policy, August
1, 2000, the rate was increase by 135 percent.
CHAIRMAN PHILLIPS asked which insurance company she dealt with.
MS. CICCONE answered, "Humana."
Number 578
MS. BERNICE STARKEY, representing herself, said that she had been
screened and found to have breast cancer and didn't have insurance.
The hospital treated her as an outpatient giving her surgery and
sending her home the same day. The surgery cost $10,000. If she
would have had radiation, that would have been another $10,000.
Chemotherapy would have been twice that much. Ms. Starkey said she
is 62 years old and self-employed. She lost her home and elected
not to have radiation or chemotherapy because of the money. She
has tried to rehabilitate herself, but has declared bankruptcy and
now lives on $1,200 per month.
SENATOR LEMAN asked if she didn't carry insurance when she was
self-employed by choice or was she identified as uninsurable.
MS. STARKEY replied that it was a choice she made, but the
insurance would have cost $320 per month and she couldn't afford it
in addition to all her other responsibilities. Now she is
uninsurable.
SENATOR LEMAN said that several years ago the legislature asked the
insurance industry to design a plan for people like her so that the
permanent fund dividend would pay for it. It would be a
catastrophic care plan, but they came back with a design that
worked. He asked her if she would have been interested in
something like that in 1997.
MS. STARKEY replied, "Sure."
MS. SHELLEY COLLIDGE, Anchorage resident, deferred her time so that
other women could speak.
MS. JANA JOSEY related how her mother-in-law had cervical cancer
that totally used up her savings of $8,000. All of the doctors
have dropped her because she could no longer pay for their
services. A year ago she could take care of herself, but now she
has to depend on the state to do it.
MS. DONNA JOSEY, the mother-in-law, added, "The State really don't
give you a lot. I mean it helps. Then I have my kids who support
me." She explained that she didn't have time to recover from the
procedure or the radiation which takes two to three years.
MS. MARIE LAVIGHE, Executive Director, National Association of
Social Workers, Alaska Chapter, said they strongly supported SB 38.
She said they, " …support efforts to extend health care coverage to
the uninsured and underinsured, including the expansion of Medicaid
coverage to women diagnosed with breast and cervical cancer. It has
been estimated that 70 women annually in Alaska who could not
otherwise afford treatment may be able to receive payment for care
under this plan.
MS. ANNE HARRISON, Planned Parenthood, said she is also a friend
and relative of too many women who have had breast cancer. She
said that passing SB 38 should be done without any second thoughts.
Not funding it would be like having a fire department come to a
fire and sit there and watch the house burn.
MS. CHERYL KILGORE, Executive Director, Interior Neighborhood
Health Clinic, said their mission is to provide universal access to
primary health care. Out of the 10,500 patients they had last
year, 50 percent of those visits were people who live at or below
200 percent of the federal poverty level of Alaska. About half of
them had no health insurance at all. Two thirds of their patients
are women and they are one of the first sites to use the Breast and
Cervical Cancer Early Detection Program. Her clinic is currently
one of the grantees to provide door-to-door outreach for women
between ages 50 - 64. There is a need for women to come in for
early screening, particularly for breast cancer, because if
detected early, the outcome is much better than if detected later.
She said they have diagnosed a small number of women with breast
and cervical cancer and all of them were uninsured. They were
working, but in occupations that provided a bare minimum wage and
the employers had no health insurance coverage. Those women had
extreme difficulties and required a lot of support from her site to
help them get the resources once their cancer was detected so it
could be treated.
MS. JOSEPHINE RYAN testified that she is a breast cancer survivor.
She had a lumpectomy and radiation which cost about $50,000. The
radiation alone was $40,000. She has always been a very healthy
person, eating well and exercising every day. It was a real shock
to have cancer. The cost was phenomenal and it was very stressful.
She thought that 60 - 70 percent of women don't get checked because
of the financial situation that could happen [if they were
diagnosed] and said, "Something should be done about that."
Number 1787
MS. POLLY HESSING said she had been working seasonally and going to
school and didn't have health insurance, because she didn't have
quite enough money to pay for it. She put off getting her annual
exams and dental checkups and thought that once she was done with
school, she would work and have insurance again. She was very
healthy. When she got married several years later, she had
insurance and caught up with health screening. She was then
diagnosed with breast cancer. If she had not had insurance, it
would have been very difficult for her to become insured again.
It's expected that one of every two men and one of every three
women will have some type of cancer in their lifetime. "Until
you're the one who is sick, it's impossible to describe how it
feels to fall through that safety net."
MS. KATE COLEMAN testified that when she left state service in 1998
an abnormality was detected on her mammogram and the radiologist
said that no additional action was required, but that she should
continue to get mammograms every six months. When she left the
state service, she took a different insurance policy. When the new
policy arrived, it had a rider saying the policy would never cover
any breast issues. In the summer of 2000, under the Alaska Breast
and Cervical Cancer Early Detection Program, she was diagnosed with
breast cancer. Without insurance, she was not referred anywhere.
In Juneau, many women with breast cancer choose a mastectomy
whether or not the severity of their disease warrants it, because
it's much less expensive and radiation therapy is not available.
MS. COLEMAN chose a lumpectomy and six weeks of radiation therapy
to be performed in Anchorage. In addition to financial
arrangements for the hospital, she said, arrangements needed to be
made for the surgeon, a radiation oncologist, a medical oncologist,
x-ray, nuclear medicine, pathologist, housing, and transportation.
She finished her radiation last Tuesday and believed this incidence
of cancer was over for her. While concentrating on healing, it is
a heavy burden to put on a patient. "While the cancer is over, it
will be many, many years before I have paid all these bills."
MS. JANIE WILSON strongly supported SB 38. She is a breast cancer
survivor and knows it is an emotional and lengthy process to go
through. The federal government has already agreed to support this
monetarily if the state will agree to spending approximately
$175,000. After being diagnosed with breast cancer, money was not
an issue, because she had insurance. She cannot imagine having to
make a treatment plan without money with which to cover the plan.
It would be simple to just do nothing. She said she is here nine
years later as living proof that treatment helped.
MS. RUTH LISTER said she is a breast cancer survivor and supported
SB 38. Over the years, the cancer has come back several times. She
has always been fortunate enough to work where there is insurance
and has had her treatments covered. If she didn't, she wouldn't be
here today. Her daughter was 10-years old when she was first
diagnosed and she wanted to live long enough to see her grow up.
She now has two grandchildren and it's her goal to see them grow
up, also. With treatment, these women can keep living and being
part of their families and part of the community.
MS. CAREN ROBINSON, Alaska Women's Lobby, supported SB 38. She
reiterated testimony saying that it is important to diagnose cancer
early and to get treatment that is needed. A person can recover
and have a productive life and spend the precious times with family
and children. She said that it's a small price to pay, only
$175,000. She asked them to look at each individual woman and
imagine the cost it would be those families and to society if those
mothers were no longer here to care for their children.
MS. ROBINSON said she is also one of those people who has to get
mammograms every six months. When she was no longer a state
legislator getting the wonderful state insurance and went back into
the private sector she got Blue Cross/Blue Shield and because of
the fact she was on the six months mammogram system, she was
perceived as a person who was high risk and was not able to get the
insurance she needed. She actually had a rider on her policy that
any future breast cancer would not be covered. She fought it and
got the disclaimer removed, but it cost her another $350 per month.
She now pays $650 per month to have nothing but catastrophic
insurance coverage. She can't imagine what it would be like to be
diagnosed and have to make those kinds of decisions on whether she
fed her children or got treatment. She has seven friends who have
been diagnosed with cancer this year and has lost two friends in
the last five years.
SENATOR LEMAN asked what her definition of catastrophic is.
MS. ROBINSON explained that she had to pretty much be on her death
bed before any one was going to assist her on anything. She
thought it was $5,000 to $10,000 deductible and offered to get him
that information.
SENATOR LEMAN said he was trying to rationalize the fiscal note
with the testimony. If it cost her $8,000 per year to avoid on
average of about $17,500 per treatment, "Something isn't right."
MS. NANCY WELLER, Division of Medical Assistance, said that SB 38
is a new option that was added by Congress that allows women who
are screened through the BCCMPP to be eligible for Medicaid except
for women who have creditable coverage. Anyone who has any kind of
coverage, including Alaska Native and American Indian women who are
eligible for IHS Services, would not be eligible. She said this
year it would affect about 40 women.
TAPE 01-2, SIDE B
Number 2400
She explained that the fiscal note was based on actual expenditures
for women with breast and cervical cancer diagnoses for last year.
Medicaid does not pay the full cost of services. Providers enroll
in the program and agree to accept their payment as payment in full
except for the cost sharing that is required under state law. Her
division does not pay the full cost for people who are paying
privately.
MS. MARY DIVEN, Division of Public Health, said some women may have
been talking about their total costs, not their annual costs. It
may take more than one year to go through treatment.
Number 2341
SENATOR LEMAN asked why Ms. Weller said this would affect 40 women
per year and the Governor's letter said it affects 70.
MS. WELLER replied that there were over 70 women who were diagnosed
under the Breast and Cervical Cancer Detection Program. However,
this Medicaid option excludes American Indian and Alaska Native
women. Sixty-one percent of the women who were diagnosed with
breast cancer and 18 percent diagnosed with cervical cancer were
Alaska Natives. She assumed they would not be eligible for
purposes of preparing the fiscal note.
SENATOR LEMAN said he assumed they would be adding new people to
the group every year and the cost is $15,000 per person. He asked
if they pay about 30 percent of the costs.
MS. WELLER answered that it depended on the facility they went to.
SENATOR LEMAN asked if 30 percent was a reasonable average.
MS. WELLER answered that it's closer to 70 percent for physicians'
services and that hospitals would vary depending on their cost
reports.
SENATOR LEMAN asked how much they would vary.
MS. WELLER answered that the lowest percentage they were paying was
36 percent and it goes up to 100 percent. A lot of facilities
don't offer cancer treatment.
SENATOR LEMAN said he wanted to know the exact costs. He asked if
it was reasonable to pay $8,000 per year to avoid $20,000 in
expenses (as he figured it).
MS. WELLER said it didn't make sense, but that is the cost of
insurance. Medicaid is different than insurance in that there is
no premium cost for the people who are receiving it. The estimates
are based on their actual expenditures in 2000.
SENATOR TORGERSON added that you couldn't get diagnosed and then go
and buy insurance.
SENATOR LEMAN agreed. He asked what would a fair amount be.
MS. WELLER responded that she thought the Division of Insurance
might be able to address the cost of the private insurance market
in the state.
SENATOR DAVIS said she didn't think Ms. Weller could answer that,
because each individual would require a different amount of money
for any treatment they might have. Most of the women SB 38 applies
to don't have any insurance. She said, "They don't pay anything,
because they don't have the money to pay."
SENATOR LEMAN said he was trying to get at the amount people could
afford to pay and come up with a mechanism so they can afford to
have it.
Number 2100
SENATOR TORGERSON asked if any part of the legislation was
retroactive.
MS. WELLER replied that they are prohibited under the
Administrative Procedures Act from any action in that regard. If
the legislation passed, the Department would have to adopt
regulations and that would take a considerable amount of time.
SENATOR TORGERSON asked if having four grantees in Alaska meant
that only four areas in Alaska have the detection program that's
funded by Disease Control.
MS. WELLER answered that the State of Alaska is a grantee and the
other three grantees are Native corporations - the North Slope
Borough, SEARCH, and South Central Foundation. The State of Alaska
covers all the areas the others don't cover.
SENATOR TORGERSON asked what the chance is of someone being
diagnosed who isn't covered under the Disease Control regulations.
MS. DIVEN answered that she thought there would be some women who
would not be diagnosed under the program. The intent of the
program is to reach high-risk women who are delaying early
screening to catch cancers early, because they either have high
deductibles or no insurance.
SENATOR TORGERSON asked if most of our hospitals were covered by
the Center for Disease Control funding.
MS. DIVEN replied that that is the trigger. There are screening
providers in 12 communities and many hospitals in those communities
are diagnostic providers under the program. Not all hospitals in
the state are diagnostic providers.
SENATOR TORGERSON asked what happens if some one is diagnosed in
some area where there isn't a provider.
MS. DIVEN replied that that person is in the position that women
everywhere in the state are now. They are working on having a
broad screening program and having referrals into the program as
early as possible at the screening level.
SENATOR TORGERSON asked if this would be funded through the Center
for Disease Control.
MS. DIVEN answered that was correct.
CHAIRMAN PHILLIPS asked how many states were participating in this.
MS. DIVEN answered that all fifty states and the territories are
participating in the screening and diagnosis program. The federal
program just passed this fall and several states have legislation
pending.
CHAIRMAN PHILLIPS asked if the other states have basically the same
structure that this bill entails.
MS. DIVEN replied yes, because that's the way the federal
legislation was written. The federal law was very specific.
CHAIRMAN PHILLIPS asked her to provide the committee with a list of
costs and hospital payment structures.
CHAIRMAN PHILLIPS asked if the state is currently funding the 14
programs under AS 47.07.
MS. WELLER explained that AS 47.07.035 addresses what should be
eliminated from the program if the funding is insufficient to cover
the program. It starts with services and goes to optional groups.
CHAIRMAN PHILLIPS asked if there's a shortage of money, what other
factors are thrown in.
MS. WELLER answered that the legislature instructed them only one
time in 1994 to go through the list and eliminate services. The
first 10 services on the list were eliminated for adults only.
(They are mandatory for children.) They were not available for two
years 1994 - 1996 when the legislature instructed them to reinstate
the services without funding.
MS. DIVEN explained that the services are such that a lot would
have to be done before they started to eliminate the groups. If
the Medicaid program were cut in half, they might get to the
groups.
COMMISSIONER PERDUE said that the nation doesn't have a perfect
health care system and absent our ability to figure out coverage
systems, this is the way she thought it would happen. Congress has
given the states this opportunity. It is a disease that can be
dealt with early on and there are good recovery rates for it.
CHAIRMAN PHILLIPS asked if Congress was mandating coverage for any
other diseases.
MS. DIVEN answered this is the only one.
MS. RUTH LISTER, speaking as the Grant Administrator for a grant
from the Department of Labor held by the Alaska Hospital and
Nursing Home Association (ASHNHA), said that two consortia had
applied for the grant and the two groups are Williams Alaska Energy
Corporation and the Alaska Process Industry Career Consortium. The
two consortia have been working together since November. They both
have a very clear and critical problem which is a shortage of
people with the skills needed to fill the job openings in Alaska.
This is a critical issue for a lot of industries in Alaska. Jobs
should go to Alaskans, but they need to receive the training, too.
MS. LISTER said the industry got involved because it wanted a more
skilled labor pool and by working with government and the education
system, they are able to impact the training that happens to make
sure it meets industry standards. They are involved with post-
secondary and with k-12 education levels and work with the Alaska
Human Resource Investment Center (AHRIC) within the Department of
Labor. They also work with the job centers and the Alaska Native
Centers for Employment and Training.
When they have brought in people from the National Skills Standards
Board to work with them in Alaska, they have found that Alaskans
are in the lead among the states in terms of industry getting
involved with work force development.
MS. LISTER focused specifically on the health industry and nursing,
the area with the highest need. Currently, the UAA is graduating
60 registered nurses (RN) per year and they just expanded into
Fairbanks and Kodiak. This will add another 24. At the same time,
according to a recent snapshot survey they did for ASHNHA, there
were 276 nursing vacancies, extrapolated that means about 400. The
Department of Labor shows over the next 10 years there will be 150
new nursing jobs a year opening up. This doesn't include jobs that
people will be leaving because of the aging work force. They
figure there are at least a couple of hundred job openings a year
in nursing and less than 100 graduates being produced. This is a
good example of where that skill need is not being met in Alaska
and where the training possibilities need to be expanded -
particularly into smaller regional areas where they are often
hiring as many as 60 percent of their work force from out of state.
Right now, Providence Hospital goes to the Philippines and other
countries to recruit nurses. Ms. Lister explained:
There are a number of different areas the University is
looking at funding which they hope the legislature will
consider funding such as radiography tech where there's a
strong demand, but there's no training in this state.
There are enough positions coming up in areas such as
mammography to CT scans where we could very well do the
training. This is one of their big pushes - that you will
support post-secondary budgets, particularly the
University, where they are putting in new initiatives for
both the health and process industries.
MR. FRED VILLA, Alaska Process Industry Careers Consortium (APICC),
said that he works for Williams Alaska Petroleum Inc. at the North
Pole refinery. He explained that APICC is a newly formed non-
profit organization involved in workforce development and is an
industry led consortium. He explained that process industries
include oil and gas from production and wellhead through
transportation and pipeline systems through petrochemical and
refineries, mining, power generation, waste water and water
treatment systems, and large industrial scale food processing
(Alaska seafood). "It is turning resources for items into
something else that you monitor or control," he said. In the past a
lot of these industries have relied on, at times, going out of
state to bring the workforce in.
In August of 1999, APICC did a snapshot of some of the industry
partners and recognized an attrition level of the employee
population due to retirement in excess of about 500 employees
within the next 10 years. Those are jobs that are required now and
in the future to maintain those industries at those levels. That
wasn't projecting the gas pipeline or future projects, he said.
These are jobs where people will have to be replaced. The state is
losing the experience, the safe workers and safe work practices.
"When APICC formed, they brought together education providers,
industries, unions, and government people to form a consortium to
develop a fast track system to replace those workers or get workers
in those fields," Mr. Villa said. Since August of 1999 they have
developed curriculum to the standards of the front line workers in
the field and overfilled classes at three campuses at UAF, UAA, and
Kenai Peninsula College (KPC). One of the criteria they have in
developing this program is that credits are fully transferable
among the campuses in the UA system.
MR. VILLA said that they view this as a program, not just a
project, and are looking at 20 additional job classes that directly
support process industries. These will be prioritized by
criticality to the industry, the numbers, and the salaries. As
they do that they are going to look at adopting national standards
for each job and survey the current training programs to see if
they meet the standards.
MR. VILLA said that the labor unions are involved and are opening
their doors to best practices and best results in establishing
training programs to put people into the work force. He asked for
the legislature's support in vesting occupational education as
things come across the table and investing in those things that
meet industry based skill standards, especially those incorporating
statewide delivery systems. He also asked them for support of the
career pathways system including ARIC, the one-stop system, ABC,
and others that are providing career opportunities to Alaskans. He
asked for support for vocational education funding, UA and tech
positions for new and expanded programs, especially in the health
and process industries.
MR. VILLA concluded that the legislature should encourage emphasis
on employability standards as well as the academic performance
standards for the high school exit exams. He said, "APICC is
really here as a model for consortium building and how industry can
be involved in everything from k-12 efforts to industry to work
force development. APICC can work with you in work force
development and we're willing to share our best practices for best
results…." He said they want to raise the level of awareness of
what opportunities are here in the state and help guide the
pathways that make education applicable to those areas of interest.
SENATOR DAVIS asked him to explain the grant.
MS. LISTER answered that the two consortia have a grant from the
federal Department of Labor for doing work force development, like
needs assessment and creation of a confidential web-based survey
tool that businesses can use for their job openings.
SENATOR DAVIS asked how long the grant is for.
MS. LISTER answered 18 months.
CHAIRMAN PHILLIPS asked if they were working with institutions
other than the ones she had listed, like private schools.
MS. ANN SPOHNHOLZ, Executive Director, APICC, answered, "Not yet,
but we would be absolutely open to it."
CHAIRMAN PHILLIPS asked if they were waiting to be contacted.
MS. SPOHNHOLZ replied, "There's only one of me and I just started.
So I'm running as fast as I can."
MR. DENNIS MURRAY, ASHNHA, said they have had some initial meetings
with Alaska Pacific University (APU), which has more of a liberal
arts focus and other schools. He said they have just started
assessing who in the education community can fit the needs of
either industry, either APICC or ASHNHA.
CHAIRMAN PHILLIPS thanked everyone for their testimony and said he
would hold the bill for a further hearing and adjourned the meeting
at 2:25 p.m.
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