03/25/2014 03:00 PM House HEALTH & SOCIAL SERVICES

        SB 169-IMMUNIZATION PROGRAM; VACCINE ASSESSMENTS                                                                    
                                                                                                                                
4:35:14 PM                                                                                                                    
                                                                                                                                
CHAIR HIGGINS announced that the  next order of business would be                                                               
CS  FOR SENATE  BILL NO.  169(FIN), "An  Act establishing  in the                                                               
Department   of   Health   and  Social   Services   a   statewide                                                               
immunization program  and the  State Vaccine  Assessment Council;                                                               
creating  a  vaccine  assessment  account;  requiring  a  vaccine                                                               
assessment   from   assessable   entities   and   other   program                                                               
participants for statewide  immunization purchases; repealing the                                                               
temporary  child and  adult immunization  program; and  providing                                                               
for an effective date."                                                                                                         
                                                                                                                                
4:35:38 PM                                                                                                                    
                                                                                                                                
SENATOR  CATHY GIESSEL,  Alaska  State  Legislature, referred  to                                                               
earlier  testimony  regarding  HB   376,  for  extension  of  the                                                               
termination  date for  the Alaska  Health Care  Commission.   She                                                               
noted that the  commission reviewed the high cost  of health care                                                               
in Alaska,  and, as revenue  was declining  in the state,  it was                                                               
necessary to be very attentive to  the budget.  She declared that                                                               
"vaccines reduce  the cost  of health  care," and  that it  was a                                                               
recommendation  of  the  Alaska  Health  Care  Commission.    She                                                               
reported  that  SB  169   created  a  private/public  partnership                                                               
between the insurance companies  and self-insured groups with the                                                               
State of Alaska to address  vaccine costs through a state vaccine                                                               
assessment  council,  which  would  oversee  a  reinstatement  of                                                               
universal  vaccines in  Alaska through  the Department  of Health                                                               
and Social  Services (DHSS).   She reflected  on the  concerns of                                                               
health  care in  Alaska by  Senator  Ted Stevens,  and shared  an                                                               
anecdote  about the  generous funding  for  vaccines he  secured.                                                               
She  reminded  the committee  about  the  earlier high  rates  of                                                               
polio, as  well as Hepatitis  A & B,  and pointed out  that, with                                                               
vaccines, these had  almost been eradicated.  She  noted that the                                                               
last outbreak of measles in  Alaska, in 2000, had been introduced                                                               
by a  young unvaccinated child  arriving from South  Korea, which                                                               
resulted in  the understanding  for a need  of a  second measles,                                                               
mumps,  and  rubella  vaccine.    She  reported  that  there  was                                                               
currently an outbreak of chicken  pox in the Kenai/Soldotna area,                                                               
which was dangerous  for adult men, pregnant  women, and infants.                                                               
She  declared  that vaccines  could  prevent  chicken pox.    She                                                               
pointed out  that earlier  federal funding  of $4.3  million each                                                               
year to Alaska for vaccines was  now only $700,000.  She reported                                                               
on  a bill  that  had  been introduced  in  2012  as a  temporary                                                               
solution, Senate Bill  140, which had passed  unanimously in both                                                               
the House  and the Senate  to use  $4.3 million of  state funding                                                               
for three  years of  vaccines.   During this  time, the  DHSS had                                                               
been directed  to find a  funding solution other than  the state,                                                               
resulting in proposed  SB 169.  The proposed bill  would create a                                                               
council, page  2, line 19 through  page [4], line 8,  which would                                                               
operate  under  DHSS and  its  staff.    She explained  that  the                                                               
council would determine assessments  for the insurance companies,                                                               
and  then  use  that  money  to  buy  low  cost  vaccines  to  be                                                               
distributed   around  the   state.     She   allowed  that   this                                                               
public/private  partnership was  working  in  nine other  states,                                                               
resulting in substantial savings.   She referred to 24 letters of                                                               
support  [Included in  members' packets],  including a  letter of                                                               
support from Premera Blue Cross.                                                                                                
                                                                                                                                
4:43:38 PM                                                                                                                    
                                                                                                                                
ROSALYN  SINGLETON, MD,  Alaska Native  Tribal Health  Consortium                                                               
(ANTHC)  Immunization   Program,  stated  her  support   for  the                                                               
proposed  bill  to  improve  access  to  vaccines  for  Alaskans,                                                               
streamline  distribution, and  reduce  the administrative  burden                                                               
for providers, and she directed  attention to a PowerPoint titled                                                               
"Alaska  - What  have vaccines  done  for you."  She referred  to                                                               
slide  2, "Vaccination:  an ounce  of prevention  saves a  ton of                                                               
lives,"   which  offered   a  brief   summary  of   the  dramatic                                                               
improvement  in disease  control because  of universal  access to                                                               
vaccines  in  Alaska.   She  moved  on  to  slide 3,  "Vaccine  -                                                               
Preventable  Disease  Success,  Alaska,"   and  stated  that  Hib                                                               
meningitis,  measles, and  Hepatitis  A  outbreaks had  virtually                                                               
disappeared.    She pointed  out  that  measles were  most  often                                                               
brought in from  other countries, and in Alaska, this  was only a                                                               
plane  flight away.    She  declared that  it  was imperative  to                                                               
maintain  a high  rate of  vaccination  in children  in order  to                                                               
control  the  disease.    She discussed  slide  4,  "Polio,"  and                                                               
explained  that it  attacked the  nervous system,  causing muscle                                                               
weakness, paralysis, or  death.  She reported that  the last case                                                               
of polio  in the United States  had been in 1979,  although polio                                                               
was  still endemic  in  other parts  of the  world  and could  be                                                               
brought  into   the  country.     She  moved   on  to   slide  5,                                                               
"Diphtheria,"  and shared  an anecdote  of an  epidemic in  Nome,                                                               
which was  today highlighted by  the Iditarod Race.   She relayed                                                               
that  diphtheria was  also  a disease  of the  past  in the  U.S.                                                               
because of  vaccines.  Discussing slide  7, Hepatitis A and  B in                                                               
Alaska," she relayed that there  had been almost total control of                                                               
Hepatitis A  in Alaska since the  vaccine.  She pointed  to slide                                                               
6,  "Hib disease,"  and explained  that  it had  decreased.   She                                                               
concluded with  slide 8,  "Measles," and  stated that  Alaska had                                                               
not  had measles  since 2000.   She  emphasized that  since 2009,                                                               
providers had fronted  the cost of vaccine  for insured patients,                                                               
while separately  stocking private and state  purchased vaccines.                                                               
She relayed  that SB 169  would re-establish universal  access to                                                               
vaccines  through the  self-sustaining,  cost effective  private-                                                               
public partnership.                                                                                                             
                                                                                                                                
REPRESENTATIVE  REINBOLD  opined  that this  was  leveraging  the                                                               
state's buying power  to reduce the cost and  increase access for                                                               
vaccines.   She  asked if  there  were any  adverse reactions  or                                                               
concerns for vaccinations and immunizations on a larger scale.                                                                  
                                                                                                                                
DR. SINGLETON replied that all  vaccines could have adverse side-                                                               
effects.   She  stated that  vaccines  were the  most tested  and                                                               
regulated health care  benefit that we have.  She  said there was                                                               
not  any evidence  for significant  side effects  from the  newer                                                               
vaccines, as they  had been extensively tested  with post vaccine                                                               
testing and evaluation.                                                                                                         
                                                                                                                                
4:50:50 PM                                                                                                                    
                                                                                                                                
DR.  SINGLETON, in  response to  Representative Reinbold,  stated                                                               
that there was  not any link between vaccines and  autism.  There                                                               
had been a 1998 paper published  in Britain, based on research of                                                               
12 children, claiming  a link between vaccines  and autism, which                                                               
had  ultimately been  found  to  be fraudulent.    The paper  was                                                               
disavowed by  the British Medical  Journal, and the data  had not                                                               
been replicated  in subsequent studies.   She declared  that this                                                               
report had  sparked unwarranted concerns,  and she  expressed her                                                               
confidence  that there  was  not any  link  between vaccines  and                                                               
autism.                                                                                                                         
                                                                                                                                
REPRESENTATIVE REINBOLD  said that  the proposed bill  could have                                                               
"a long term, very positive effect on our state budget."                                                                        
                                                                                                                                
CHAIR  HIGGINS   expressed  his  agreement  with   evidence  that                                                               
vaccines were  good.  He  declared that the proposed  bill raised                                                               
the question  for how  to pay  for this.   He stated  his concern                                                               
with third  party payers and  Tricare making these payments.   He                                                               
stated that he wanted to make the program work.                                                                                 
                                                                                                                                
CHAIR HIGGINS  asked for more  information about the  third party                                                               
payer, specifically  Tricare, as the  focus of the  proposed bill                                                               
was for adult  immunizations.  He stated that  federal money paid                                                               
for child  immunizations.   He opined that  the "donut  hole" was                                                               
for adult immunizations, as Medicare  did not offer coverage.  He                                                               
asked how the proposed program would  work for adults.  He stated                                                               
that only  one other state  included adults in  vaccine coverage.                                                               
He  offered his  belief that  Vermont most  closely mirrored  the                                                               
proposed bill.                                                                                                                  
                                                                                                                                
4:56:14 PM                                                                                                                    
                                                                                                                                
JILL LEWIS,  Deputy Director -  Juneau, Central  Office, Division                                                               
of  Public  Health, Department  of  Health  and Social  Services,                                                               
expressed agreement  that Vermont had included  adult vaccines in                                                               
its universal  program since  2009.   She declared  that, without                                                               
the proposed  bill, when the  temporary funding for  vaccines was                                                               
depleted at  the end of  2015, the state  would not have  a state                                                               
supply  for all  children.   She  clarified that  the only  state                                                               
supplied vaccine would be for  the 50 percent of children covered                                                               
by a federal  program, Vaccines for Children.   She reported that                                                               
this  would  only  include   Medicaid,  Alaska  Native,  American                                                               
Indian,  and uninsured  children.   She stated  that anyone  with                                                               
private  pay  insurance  would not  receive  any  state  supplied                                                               
vaccine, as the burden would be  on the providers to purchase and                                                               
pay up front  for vaccines, and then seek  reimbursement from the                                                               
payers.  She  explained that there was no safety  net program for                                                               
adults, and each payer would need  to be assessed funding for its                                                               
patients.  She  noted that Tricare had not  participated and paid                                                               
the  reimbursement  in  other  states.   She  reported  that  the                                                               
proposed  bill had  reviewed  the programs  in  other states  and                                                               
decided  that, should  Tricare not  participate,  then the  state                                                               
would not supply  the vaccine and other payers would  not have to                                                               
pay, so the  providers would continue to purchase  the vaccine on                                                               
the open market and continue  to seek reimbursement from Tricare,                                                               
as was  the current practice.   She said that the  provider could                                                               
continue to  purchase vaccines  privately when  there was  not an                                                               
accessible payer.                                                                                                               
                                                                                                                                
REPRESENTATIVE  NAGEAK asked  that  the vaccine  for shingles  be                                                               
made available for people.                                                                                                      
                                                                                                                                
REPRESENTATIVE  KELLER reflected  that the  proposed bill  was "a                                                               
big issue  and lots of  pitfalls in it."   He requested  that the                                                               
questions  be  answered  before  the  bill  was  moved  from  the                                                               
committee,  that any  unintended consequences  be addressed,  and                                                               
that the costs be closely reviewed.                                                                                             
                                                                                                                                
CHAIR HIGGINS said that [SB 169] would be held over.