Legislature(2011 - 2012)BELTZ 105 (TSBldg)
02/15/2011 01:30 PM Senate LABOR & COMMERCE
| Audio | Topic |
|---|---|
| Start | |
| SB38 | |
| SB67 | |
| SB70 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| += | SB 70 | TELECONFERENCED | |
| += | SB 38 | TELECONFERENCED | |
| += | SB 67 | TELECONFERENCED | |
SB 70-ALASKA HEALTH BENEFIT EXCHANGE
1:57:42 PM
CHAIR EGAN announced SB 70 to be up for consideration.
ANDY MODEROW, staff to Senator Hollis French, sponsor of SB 70,
showed the front page of the "Massachusetts Health Connector"
website at www.mahealthconnector.org that he would refer to
during his presentation. It was established in 2006 as a part of
their reform effort and it would give the committee some insight
into how an exchange could function in Alaska.
MR. MODEROW explained at first there are different categories to
click on depending on whether one is an individual, an employee
or an employer. He clicked on the individual and family button,
and noted that "exemptions from the mandate option" was a choice
and explained that although Massachusetts established its
exchange before federal health care reform, they did have a
requirement to obtain coverage. Just like the Massachusetts
Connector, SB 70 sets up the mechanism which would exempt
individuals from the federal requirement to have coverage if an
affordable product is not available to them.
2:01:05 PM
The "start now" button brings up the question: How big is the
group you are applying with? For the purpose of this experiment
he said he would use the size of three and that page informs you
that in Massachusetts if you have household income below $54,936
you might be eligible for subsidized health care. The
Massachusetts reform offers subsidies up to about 300 percent of
the federal poverty level, but under federal reform, subsidies
will be offered up to 400 percent. These will be in the form of
tax credits. So the household income which would qualify for the
subsidies (for a family of three) would be $74,000. For today's
purpose he assumed the test family does not qualify.
The website says that the open enrollment period is closing
today. These are the windows of times for people to enroll in a
health insurance policy within the connector. They open and
close so that people don't wait until they get sick to purchase
coverage. SB 70 has the same provision. The next page asks for
zip code, the type of coverage, and birth dates for purposes of
calculating premiums.
2:02:48 PM
Once those are entered, three broad categories of policies
appear for review. After choosing the "view all plans" option,
one sees the lowest cost up to the highest cost premiums within
the chosen category. The low cost plan is $680 per month for
three people. You can further narrow down your search and choose
what premium costs you want to pay. If you are concerned about
your deductible, you can choose between none, $250, and $500 or
$2-4000. A grid across the top shows things like annual
deductible, the price of a doctor visit, and emergency room
visits. He pointed out that like SB 70, Massachusetts also has a
telephone call center if someone needs help.
MR. MODEROW then selected three plans from three different
private health insurers to compare, and that went on for a
number of pages. Enrollees can find out if a certain doctor is
provided within an insurer's network, for instance. In
particular, he pointed out the "special considerations" box
that, for example, lets one see if the plan provides limited
doctors and limited hospitals. This page had a little warning
for a consumer to make him aware that money is saved by
selecting this plan. He emphasized that the purpose of this
legislation and this effort is not to choose plans for people,
but to help them be aware of what they are choosing.
2:07:25 PM
He pointed out the extensive details of plans that are available
for side-by-side comparison. The "NCQA rating" [National
Committee for Quality Assurance] is an insurance report card,
which lets the consumer know how the carrier has been
performing. After choosing a plan, (he chose the bronze medium
plan), the next page provides a summary of the selection. Next
one can confirm their choices.
MR. MODEROW explained in SB 70, section (a) 11 (page 4, lines
18-24) determines eligibility for state and local medical
assistance programs such as Medicaid and Denali Kid Care.
Section (a) 12 provides for a calculator which tells someone how
much they are eligible for in benefits.
The legislative also provides for free choice vouchers for
employers to provide payment assistance to an employee without
sponsoring an entire plan. They can offer their employees $100
towards the premiums of a plan and give it to them in this form
which will then be spent within the connector.
This bill also sets up the "SHOP" program which would help
create a new pool for small employers and connects small
businesses with large tax incentives to sponsor a plan of their
own. For those wanting to do their own experimenting on the
website, Mr. Moderow included the zip code he used of 02043.
SENATOR PASKVAN asked if he had compared the cost of these plans
with any available in Alaska.
MR. MODEROW answered no, and that Massachusetts has a very
different set up for the price of premiums than Alaska does. So,
he didn't do a side-by-side on that front, but other websites in
Alaska sponsored by private insurers do that - usually with
their own options.
2:10:54 PM
MR. MODEROW continued with an overview of the fiscal notes
attached to SB 70. There is a $5-million set-up cost for the
exchange and a $2.1-million annual operating cost. He said the
state is eligible to receive federal grants to set up the health
exchange program. A $1-million dollar planning grant is
available to the state until Friday. After that there are two
additional levels of grants that pay for the set up costs.
As far as operating costs, SB 70 allows for grants from state,
local or other entities, and also allows the exchange to charge
assessments or user fees to health care insurers or otherwise
generate funding necessary to support its operations. The fiscal
note at this time assumes the operation costs will come out of
the general fund, but that language could be changed by the
committee.
MR. MODEROW emphasized that Senator French would be pleased to
work with the committee on amendments.
CHAIR EGAN turned the gavel over to Senator Paskvan.
2:13:15 PM
RON KREHER, Acting Director, Division of Public Assistance,
Department of Health and Social Services (DHSS), said he wanted
to address the fiscal note that is based on an assumption that
the health information exchange will be passing information to
the Division of Public Assistance after it does an initial
determination of eligibility for Medicaid and Denali Kid Care
recipients. The fiscal note is intended to provide the funding
necessary to build the interface required for this exchange of
information. The assumption is that this will be a straight-
forward file exchange and developers of the health information
exchange have make sure that the business requirements they
recover are transferable to the division's eligibility
information system so a case can be set up in their system. He
also noted that an on-line form could be developed, but this
would have additional costs.
SENATOR PASKVAN asked if it would be useful for Alaskans to have
the system in place.
MR. KREHER replied that it would be another access point for low
income Alaskans, people who might not know they are even
eligible for Medicaid or Denali Kid Care, until they go through
the Exchange.
SENATOR GIESSEL asked if the fiscal note is $460,000.
MR. KREHER confirmed that it is.
SENATOR GIESSEL asked if the data would download into the DHSS
data system, which is called MMIS.
MR. KREHER responded that they are referring to the Division of
Public Assistance Eligibility Information System, which is the
platform they use to determine elegibility for specific public
assistance cases such as Medicaid and DKC. But the MMIS is a
larger data base that tracks coverage that is outside the
Division of Public Assistance. It is currently being enhanced.
He assumed that MMIS would drive off of their eligibility
information system and should track information - amounts or
payments, coverage and costs - about Medicaid DKC-eligible
folks.
SENATOR GIESSEL said she knows that MMIS needs to be made more
robust, and asked how more data would be manageable within this
system.
MR. KREHER replied he is not the right person to answer that
question.
2:17:58 PM
LINDA HALL, Director, Division of Insurance, Department of
Commerce, Community and Economic Development (DCCED), said the
exchange would be housed in the DCCED.
SENATOR MENARD joined the committee.
MS. HALL said there are two fiscal notes; because the exchange
language is in Title 21, which is the Insurance Code, there is a
zero fiscal note from her and the commissioner to describe what
the bill does and why the fiscal note is zero, which is because
they don't really have any involvement in the actual exchange
itself. Since the exchanged will be is housed in the DCCED there
is another fiscal note of roughly $1.6 million from the
department. That is the estimate for the required resources to
meet the core functions of the exchange including a staff of 12
people - an executive director and assistants, web people, and
costs for board meetings. They estimated monthly two-day
meetings, at least originally, to get an exchange up and
running, up to and including a grant to navigators which is
provided in the bill itself. Program receipts are the funding
source. The federal bill contains a provision that the exchange
be self-funding by January 1, 2015. It can charge insurers user
fees that she assumed could then be passed on to consumers as
part of premiums.
SENATOR DAVIS asked if the state is applying for the federal $1-
million grant for start-up costs of the exchange.
MS. HALL answered the planning grant can't be used for the
operation of the exchange, and once it is up and running it
would become self funding.
SENATOR DAVIS asked if she feels comfortable that the state has
the money available to establish the exchange without getting
the $1 million grant from the federal government.
MS. HALL replied that review is still going on as to whether
Alaska will apply for the planning grant.
SENATOR PASKVAN asked if there are other monies at risk if the
$1 million is not applied for by Friday.
MS. HALL answered yes; establishment grants are available to
establish the exchange, not to fund the board and employees,
which would be an ongoing expense.
SENATOR PASKVAN asked how much in grant funds are at risk if
planning funds are not applied for.
MS. HALL answered no dollar amount is put on those. States can
apply for funds in two stages, one is the early stage where
planning hasn't been done and those can only be applied for
every six months. Phase two is more like a three-year funding
that would allow the exchange to be up and running; when and how
much depends on where one is in the planning process. She was
not aware of any maximum limits set on those funds and explained
that they are dependent upon the type of exchange the state
decides to develop, the government structure that exists, and
what the governing body thinks the exchange should do.
SENATOR PASKVAN asked who would best be able to advise this
committee by Friday what the risk is if the initial application
isn't in by then.
2:26:01 PM
MS. HALL answered she didn't think anyone else was in a better
position to advise the committee. She suggested contacting the
Department of Law or the Governor's Office.
2:26:47 PM
SENATOR GIESSEL said she added up the four fiscal notes attached
to SB 70 and that they totaled $5 million.
SENATOR PASKVAN asked if those are the state monies at risk if
the federal monies are not applied for and received.
MS. HALL responded that the Department of Administration's $3
million fiscal note is for hardware, software and bandwidth
development and that would be an implementation cost potentially
covered by an establishment grant. She wouldn't speak to the
Division of Public Assistance note, but she thought it was an
implementation grant also. The DCCED fiscal note is ongoing, and
by federal law that is supposed to become self supporting
through user fees.
SENATOR PASKVAN reiterated that if the state does not apply for
the $1 million grant funds by Friday, then another potential $5
million in development money is at risk?
MS. HALL answered that she wasn't sure that the DCCED would have
development costs, because those are considered operational
fees. What is potentially at risk is the hardware and software
development. But without applying for the grant, she could not
be certain.
SENATOR PASKVAN asked if it is fair to say it is closer to $3
million than $5 million, based on the information she now knows.
MS. HALL answered yes.
2:30:11 PM
SENATOR DAVIS asked Ms. Hall what would be her recommendation at
this time, or if has she made a recommendation, as to the $1
million if the deadline is Friday.
MS. HALL replied that is a policy decision that is being
reviewed. Her department has not taken a position on this bill.
They still have concerns and are willing to work with the
sponsor on this version of an exchange. She is not making a
recommendation of any kind. Policy is made by the governor.
CHAIR EGAN asked if the policy decision would be made before
Friday.
MS. HALL answered that was her understanding.
2:32:03 PM
SENATOR GIESSEL said she enjoyed poking around on an actual
exchange website. She noted this exchange is not about health
care, but about buying an insurance product. But the composition
of the board that the bill proposes has a lot of emphasis on
health care providers. That got her wondering where the
actuarial expertise would be, and she looked at the Alaska
Comprehensive Health Insurance Association (ACHIA) that
currently provides health care insurance for high risk people
who don't qualify for other types of insurance. That board's
composition is much more focused on finance and insurance
expertise. She wondered if Ms. Hall could comment on the analogy
between this proposed insurance exchange and the ACHIA board
that has been functioning effectively for quite a while.
MS. HALL responded that ACHIA is under Title 21 and operates
differently than the exchange under this bill. Her division
approves AHCIA's plan of operation and the board members. She
agreed with Senator Giessel about the exchange being an
Amazon.com of the health insurance world. Ms. Hall stated that
she has looked at legislation being proposed in a number of
states, and there are more people on this board than most. She
didn't think health care providers necessarily understand health
care insurance. Consumers would be purchasing a product that is
not significantly different from what is available today; it's
just a different place to buy it.
SENATOR GIESSEL also observed that the board has no
representative from the Division of Public Assistance, and she
thought that would be an important addition to it. She also
noted that language on page 12, line 23, says that the exchange
board would also promulgate regulations - pertaining to
insurance - that would be sold through the exchange - and that
seems duplicative of what the Division of Insurance (DOI) does.
MS. HALL said she was surprised at that language as well and
while her division can adopt regulations, she didn't know a lot
about other boards' authority, but ACHIA does not adopt
regulations.
2:37:32 PM
SENATOR GIESSEL said if the committee wanted to follow it
through, language on page 13, line 16, talks about the exchange
adopting regulations and page 15 defines the qualified health
plan that this exchange board would be approving and providing
regulations for. Under SB 70, the exchange board would actually
be certifying health benefit plans - again duplicating what the
Division of Insurance does already.
MS. HALL responded that one of her visions of operating the
exchange would be that the board would use the resources of the
DOI, because that evaluation is best done by insurance experts.
2:39:54 PM
SENATOR DAVIS asked why Ms. Hall had not stated her concerns to
the committee at an earlier meeting.
MS. HALL said she has had one meeting with the sponsor and has
discussed some of her concerns with him, and that she is still
in the process of working him.
SENATOR DAVIS said people with ACHIA are currently providing a
good service, but under the new regulations they might go away.
She asked Ms. Hall if that was true, what department would run
the exchange.
MS. HALL said she believed ACHIA would go away. The federal law
says that as of January 1, 2014, preexisting conditions can no
longer be used to deny coverage. Once that is in place, there
will be no reason to have a high risk pool. She explained that
right now Alaska has two high risk pools - federal money given
to an entity that ACHIA also manages known as ACHIA fed, a
preexisting insurance plan that about half the states have.
Unfortunately, health insurance in Alaska is very expensive and
even though the new ACHIA federal plan is based on the standard
rate, only 28 people in Alaska are in that plan. She stated the
price of insurance in Alaska is still not affordable and the
underlying cause of it is not being tackled. She noted the ACHIA
federal plan has been effective since July 1, 2010.
2:45:27 PM
SENATOR DAVIS asked if the state doesn't establish its own
exchange that the federal government will do it for us.
MS. HALL answered yes.
SENATOR DAVIS responded, "It looks like that is where we're
headed then."
2:46:21 PM
GREG LOUDON, Chairman, Legislative Committee, Alaska Association
of Health Underwriters, said he has been tasked with managing
the association's position regarding an exchange. They had been
working on this issue for about one year already and are aware
that if Alaska doesn't set up an exchange the federal government
will do it. In short, the state has to show substantial progress
in setting up an exchange by January 1, 2013. The million-dollar
grant that has been referred to is for planning. SB 70 appears
to be fully formed and appears to go past planning, already
resembles the Massachusetts exchange. Federal officials in
Washington, D.C. have said that Massachusetts is at one end of
the budget spectrum and Utah is at the other.
MR. LOUDON explained that the Massachusetts exchange employs 45
people with an annual budget of $45 million and Utah has two
employees with a budget of $2 million. Their philosophies are
dramatically different and he hoped to see a detailed work
product about what perspective the state wants to take.
SENATOR PASKVAN asked how many other states have insurance
exchanges in place.
MR. LOUDON replied that 14 or 15 states are in the process, but
only Utah and Massachusetts have them now. California has had
two that failed, but is putting another one together.
SENATOR PASKVAN asked how many people the Alaska exchange would
cover.
MR. LOUDON replied the regulators would like to cover all those
who are not currently covered, which would be about 300,000
individuals.
2:52:07 PM
SENATOR PASKVAN asked if the exchange would cover more people
than are currently covered in Massachusetts.
MR. LOUDON replied that Massachusetts has more people, so that
is not accurate.
2:52:50 PM
SENATOR FRENCH, sponsor of SB 70, said he wants to work with the
committee on this complex legislation, and that he wants an
exchange that works for this unique state.
SENATOR PASKVAN recapped that Ms. Hall had concerns but was in
touch with Senator French's office.
SENATOR MENARD emphasized talking with Ms. Hall should be a
priority for Senator French so that this legislation can be
moved on.
SENATOR FRENCH said he appreciated the comments and would have a
frank dialogue with Ms. Hall.
SB 70 was held in committee.
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