Legislature(1993 - 1994)
02/10/1994 03:00 PM House HES
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* first hearing in first committee of referral
+ teleconferenced
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+ teleconferenced
= bill was previously heard/scheduled
HB 332 - PUBLIC HEALTH COMMISSION Number 996 (See Attachment 1 for prepared statement from Rep. Sitton.) REP. JOE SITTON, Prime Sponsor of HB 332, stated that the bill establishes a public health commission that would develop a comprehensive public health plan for Alaska. He said that the plan must be established regardless of other health care reform measures because no plan is going to succeed in the area of cost containment unless public health and prevention are the cornerstones of the plan. He said the legislation would define what public health is and what the priorities should be. He said without the definition, prioritizing would be impossible and funding would be haphazard. REP. SITTON explained that the legislation would require the compilation of comprehensive statewide data that would help to prioritize resources. He said a comprehensive information system is an integral part of health care reform. He said a central data base on all Alaskan children and on patterns of Alaskans' usage of resources was needed. He asserted that substance abuse was Alaska's number one health problem. Rep. Sitton continued on to list percentages of alcohol related problems in Alaska. He stated that there are few indicators of the nature and prevalence of alcohol and drug usage among youth. He said, as stated in Healthy Alaskans 2000, that "without a continuing mechanism to track changes in the behavior of youth, there will be no way of measuring progress toward reducing the use of alcohol and other drugs among youth." REP. SITTON further stated that a comprehensive public health plan can reduce health care costs by focusing on how to finance medical treatment and health care delivery systems. He also said it was necessary to focus on the underlying factors which contribute to rising medical expenditures. He parenthetically stated that last year the total cost for health care for the 500,000 people in Alaska was over $1.3 billion. REP. SITTON referred to the 1993 U.S. Public Health Service report that indicated dramatic health gains which could be obtained if resources were applied to public health services. TAPE 94-14, SIDE B Number 000 REP. SITTON stated there would be a fiscal impact in developing a comprehensive public health plan, but stressed that prevention was far more cost-effective than treatment. He said that $240 million would be saved annually by preventing 3% of coronary by-pass operations. He said hospital costs for low birth rate babies could range between $30,000 and $70,000 and perhaps five to ten times that for long-term care, and prevention would have cost approximately $700. He further stated that lifetime expenditures of over $354,000 for an infant with congenital rubella syndrome would be preventable with immunization. He said $10 million would be saved annually by preventing the outbreak of only two communicable diseases. Also, he explained that prevention of one new HIV infection for every five person identified as HIV positive would save $15 to $25 for every $1 spent in counseling, testing, referral and partner notification and counseling. He continued on to say that the estimated cost of water fluoridation for on individual's lifetime equals or is less than the cost for treatment of one cavity. REP. SITTON told the committee that a choice needs to be made. He felt money should be spent on prevention to save costs in the long-term and to save lives or be prepared for ever escalating costs of treatment. REP. SITTON stated that what he was proposing to do was to establish a limited lifetime commission that would last six years and subsequently be able to report its recommendations to the legislature. He stressed that there were Alaskans dying needlessly because there is no comprehensive public health policy. Number 165 REP. TOOHEY referred to the 59% of children under the age of two who are not immunized and asked if immunization was not available to them. Number 180 DR. PETER NAKAMURA, Director, Division of Public Health, Department of Health and Social Services (DHSS), answered that the statistics indicate children who were not fully immunized for their age. Number 190 CHAIR BUNDE interjected that children are not allowed into the school system unless they are fully immunized. Number 196 DR. NAKAMURA responded by saying that many diseases affect children before school age. He stressed the importance of immunizing at the appropriate age. Number 240 REP. KOTT asked why the commission would have ten members versus a less "unwieldy" number. Number 250 REP. SITTON said that the decision for ten members was projected from the scope of the work involved. Number 269 REP. KOTT said if HB 332 were to become law, the earliest effective date would be implemented sometime in August. He felt that with the requirement for the commission to report to the legislature, January 1, 1995, was too optimistic. Number 300 REP. SITTON said the date was for the initial assessment of the plan. He further stated that he was open for any suggested amendments. REP. KOTT suggested that whoever drafted the DHSS fiscal note consider that the plan would not be implemented until August, and that it would not be a full year of travel and personal expenses therefore, indicating a possible decrease in the fiscal note. REP. SITTON said that the fiscal note would be worked on further. He urged the committee to take the long view and said he was convinced that millions of dollars could be saved. He said he felt his proposal was the least expensive of all other proposed bills. Number 363 CHAIR BUNDE said he was not optimistic that money would be saved because people continue to do unhealthy things knowing that it is unhealthy. He felt that the people of Alaska are not ill-informed and that Rep. Sitton was trying to "lead a horse to water." Number 392 REP. SITTON said that a person's behavior does not shield them from some public health threats. He said that a very health conscious, responsible person could get on a plane and contract Tuberculosis (T.B.) from someone who was not identified with having T.B. and was not being tracked by the state. He said that innocent bystanders are able to contract T.B. for which there is no cure. Number 427 CHAIR BUNDE asked how Rep. Sitton thought his proposal would "mesh" with Governor Hickel's proposal. Number 441 REP. SITTON said "the bill in the Senate...first had a vague reference to public health." He said that the Senate had looked at HB 332 and incorporated it into SB 270/HB 414. Number 480 CHAIR BUNDE asked how Rep. Sitton's proposal related to SB 270/HB 414. Number 485 REP. SITTON said the Senate has shown an interest in public health. He stressed that as long as the "function" was carried out that he did not care whose bill it was. Number 497 CHAIR BUNDE asked for teleconference testimony. Number 534 DEBORAH SMITH, Executive Director, Alaska Mental Health Board, testified in support of HB 332. She said it was very important that public health issues be coordinated around the state. She suggested an additional provision under Section 3 requesting that the Alaska Mental Health Board be added to the list that the commission would consult with. She said frequently public health views an individual "from the neck down and we want to make sure the whole individual is considered in that plan." CHAIR BUNDE asked for testimony from Fairbanks. Number 583 TERESA LYONS, Director, Alaska Nurses Association, testified in support of HB 332. She stated that the mission of the Alaska Nurses Association is to work for the improvement of high health standards and the availability of health care services for all people. She wanted to address health care reform issues. She stated that a universal health care program should be available and accessible in regards to insurance. She said there must be access to not only universal insurance, but also to health care provisions. She explained that there was a difference between public health services and cadillac health care coverage available to most Alaskans and Americans. She asserted that cadillac coverage is coverage for catastrophic care. Public health services are founded on prevention services and result in savings. MS. LYONS stated that for $1 spent on prevention of premature births, $10 is saved for neonatal care. She felt that health care coverage should be a basic human privilege for every American and that primary health care and preventative services could be a strong tool for social intervention. Number 706 CHAIR BUNDE referred to Mr. Aaron Katz, on-line from Seattle for testimony. Mr. Katz informed Chair Bunde that he was not prepared for testimony but would be happy to answer any questions on public health issues. Number 717 CHAIR BUNDE continued with testimony in Juneau. Number 725 ELMER LINDSTROM, Special Assistant, Department of Health and Social Services, testified in support of HB 332. He stated that SB 270/HB 414 was drafted with a provision that would allow for the creation of subcommittees under the health authority, which he felt implied a public health role. Number 766 CHAIR BUNDE thanked Mr. Lindstrom for his testimony and stated that it was a concern to the committee as to how "we mesh services, particularly in challenging budgetary times." Number 783 SHERRIE GOLL, Alaska Women's Lobby, testified in support of HB 332. She felt it was important to create a commission to focus on the health care issue. She stated that "the "incredibly high cost of health care is of great concern to women and families; and in fact, is the underlying problem that we're trying to address with other legislation to reform our welfare system and our system of torts." MS. GOLL asserted that the issue is the cost of health care and the purpose of public health service delivery is to promote healthy people. She felt that in the long-term society would save considerable amounts of money by promoting prevention. She said that, as women, they were concerned about communicable and preventable diseases and immunization, citing that China, Bulgaria and Hungary are more successful than the United States for fully immunizing children. She said that woman in Alaska face a higher risk of homicide than women nationwide. She explained that for every 1000 births in Alaska 60 are teen births compared to four of every 1000 births in Japan. She further stated that teen mothers are less likely to get prenatal care, resulting in more low birth weight babies. She said a total of 5% of all Alaskan babies are low birth weight babies. She also mentioned that, as a nation, our infant mortality rate was higher than South Korea and Singapore. She continued on to say that substance abuse, mental health, and environmental health problems abound in Alaska. MS. GOLL stated that a strong and comprehensive health care system will help to control the overall cost of medical care. She said, although preventive care does cost something, it costs less than the "actual treatment." She urged the committee not to delay in the process of developing a public health plan for the state. Number 867 CHAIR BUNDE asked for further testimony. Number 874 HARLIN KNUDSON, President, Alaska Hospital and Nursing Association, testified in support of HB 332. He said the foremost reason he supports the legislation is that there is a need to support public health systems. He urged the committee to keep public health issues in the forefront. He noted that Section 4 of HB 332 is duplicated in SB 284. Number 931 REP. TOOHEY stated that Mr. Knudson made the third reference to the Senate bill and asked if it was SB 270 (Senator Duncan's bill). MR. KNUDSON said "no, this is the workgroup bill. This is the compromise bill." Number 938 MR. KNUDSON stated that he hoped the legislation will address the issue of health reform and cited that Section 4 would be a "charge" to whatever commission is created. Number 958 DENNY DEGROSS, Former President, Alaska Public Health Association, testified in support of HB 332. He agreed with Rep. Toohey that America has the greatest health care system in the world, but America also has the poorest health. He felt that it was due to the lack of understanding between the medical care system and public health care. He explained that services are provided to an individual through doctor, hospital, or clinic care as opposed to the care that is provided as protection for large populations. He mentioned the various systems of cultural, state, and military systems that provide health care. MR. DEGROSS offered the metaphor that "we are on a $2 billion truck careening down a hill...and we've got all these groups in the front seat and everyone is trying to stay away from the steering wheel. We have nobody in charge of this 18 wheeler." MR. DEGROSS asserted that health care cost is now $2 billion and is projected to be approximately $6 billion by the year 2003. He said the state desperately needs to get health care reform under control. He said that "someone has to know what the whole picture looks like, and we have nobody who has that capacity." MR. DEGROSS said the legislation would cause all those involved to discuss and develop the core functions of state government in regards to public health care. TAPE 94-15, SIDE A Number 000 CHAIR BUNDE stated that we would be gathering information that the state is already aware of and then disseminating it to people who would continue to engage in self-destructive habits. He said if a successful goal could be achieved, he would not be opposed to the legislation, but he felt people would not take personal responsibility to protect themselves regardless of the information and resources provided by the state. Number 065 REP. SITTON said that he agreed with most of what Chair Bunde had expressed. He said it was his feeling that there is a lot of information and resources in the state, but much of it is not utilized because of organizational problems. He further explained that 25% of people with "full blown" AIDS contracted the disease between the ages of ten and 19. He asserted that a ten year old child did not have the acumen to protect him/herself from such diseases. Rep. Sitton mentioned again the threat of contracting T.B. as an innocent bystander. Number 167 CHAIR BUNDE contended that if a commission was in place, he still could not protect himself against T.B. Number 171 REP. SITTON said, "well, I don't know that." Number 179 CHAIR BUNDE reiterated that he agreed on the goals of the legislation, but he felt there would be difficulty making the public comply with what the state asks them to do. Number 190 REP. TOOHEY said that at the very least the legislation makes the state aware of the importance of health care issues. She felt that a commission would be destructive and redundant and urged everyone in the room to attend every meeting held that pertains to public health care. Number 231 REP. SITTON said that he was prepared to propose amendments on Governor Hickel's bill. Number 238 DR. NAKAMURA told the committee that public health is the state of health of the public and is also a system that will assure that the gains that have been made will be retained. He felt that a public health improvement plan was needed for the state that would identify all core functions and essential services that have to be in place to preserve health gains. He said the proposal was an infrastructure for a health care system that must be developed. He said the Clinton administration health care reform plan uses the words simplicity, security, savings, quality, and responsibility. Dr. Nakamura referred to the definitions of these terms in the hand out titled "President Clinton's Health Care Reform Plan: Health Security act of 1993." (See Attachment 2.) DR. NAKAMURA reiterated that there is a definitely defined service and process to health care. He thanked the committee. Number 428 REP. B. DAVIS stated that many bills are addressing the issue of public health. She said that money will not be saved in the short-term but will be in the long-term. She stressed cost containment. She felt there must be other components along with the commission to deal with public health. She also stated that she had valuable knowledge and input to help craft a successful bill. She stressed that changes had to be made regardless of what is decided in Washington, D.C. Number 555 CHAIR BUNDE said he agreed with Rep. B. Davis and said, "if we want something done right, we ought to do it ourselves." He thanked Rep. Sitton for his efforts. Number 595 REP. SITTON commented that he wanted specific provisions and said he did not care who's legislation it was in. Number 609 REP. G. DAVIS referred to the fiscal notes and then to the words in constitution provided in the bill files and said, "...the legislature shall provide for the promotion and protection of public health." He felt the sentence was vague and perhaps needed work. He said public health was the core of health and social services and it was given very little recognition in regards to a $600 million state budget. He further stated that prevention was the core issue that needed to be addressed to save catastrophic care costs in the future. Number 669 CHAIR BUNDE, seeing no further business before the committee, ADJOURNED the meeting at 4:45 p.m.
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