Legislature(2005 - 2006)CAPITOL 106
03/29/2005 03:00 PM House HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB128 | |
| HB13 | |
| HB31 | |
| HB186 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 128 | TELECONFERENCED | |
| += | HB 13 | TELECONFERENCED | |
| + | HB 31 | TELECONFERENCED | |
| + | HB 186 | TELECONFERENCED | |
HB 31 - WORKERS' COMP: DISEASE PRESUMPTION CHAIR WILSON announced that the next order of business would be SPONSOR SUBSTITUTE FOR HOUSE BILL NO. 31, "An Act relating to the presumption of coverage for a workers' compensation claim for disability as a result of certain diseases for certain occupations." REPRESENTATIVE ANDERSON, speaking as the sponsor, relayed that his staff would be presenting SSHB 31, that the Alaska Municipal League (AML) has come out in opposition to the bill, and that other states have passed similar legislation and not experienced negative economic consequences. 5:13:09 PM JON BITTNER, Staff to Representative Anderson, Alaska State Legislature, sponsor, relayed on behalf of Representative Anderson that there has been a growing recognition, both nationally and worldwide, regarding the hazards of being a "first responder." Scientific studies have shown that certain cancers and bloodborne diseases occur at significantly higher rates in first responders. Brain cancer and leukemia are two to four times more likely to occur in fire fighters; non-Hodgkin's lymphoma is twice as likely, and skin cancer is three times as likely. The scientific correlation between being a fire fighter or first responder and having an increased likelihood of contracting certain cancers is well documented. MR. BITTNER relayed that studies from all across America, Canada, and abroad have consistently shown that cancer occurs in fire fighters more often than in the public at large, and some studies compare fire fighters to police, thus eliminating the "healthy-worker bias," because of the top physical condition required to be either a fire fighter or a police officer. He explained that SSHB 31 attempts to afford first responders with protections they deserve, providing a presumption of coverage for fire fighters and first responders if they contract the cancers or bloodborne diseases listed in proposed AS 23.30.121(b)(1), which is located in Section 1 of the bill. Furthermore, SSHB 31 will shift the burden of proof off of the aforementioned individuals and onto their employers. MR. BITTNER said that there are those who are concerned that passage of SSHB 31 will result in a significant fiscal burden for some communities, but added that he disagrees. He mentioned that members' packets contain testimony from the International Association of Fire Fighters (IAFF) that outlines studies done in various states that have adopted "presumptive illness" legislation and which indicate that there has been no significant fiscal impact in those states even though they have fire fighter populations ranging from 3,700 to 63,000. Furthermore, some form of [presumptive coverage] legislation has been adopted in approximately 38 other states, and none of those states have been bankrupted by such legislation. MR. BITTNER assured the committee that SSHB 31 does not expand workers' compensation coverage for first responders; instead, it merely protects their right to coverage. A provider will still be able to appeal the worker's claim for coverage and the current burden of proof would apply. He relayed that the sponsor feels that SSHB 31 provides a good balance between what is necessary and what is reasonable for first responders and their employers. In conclusion, he urged the committee to support SSHB 31 and the brave men and women on whose behalf it was introduced. MR. BITTNER, in response to questions, said that the language in SSHB 31 was taken directly from Washington statutes, and indicated that proposed AS 23.30.121(b)(3) says: (3) the presumption established in (1)(C) of this subsection applies only to an active or former fire fighter who has cancer that develops or manifests itself after the fire fighter has served at least 10 years and who was given a qualifying medical examination upon becoming a fire fighter or during employment as a fire fighter that did not show evidence of cancer. CHAIR WILSON surmised, then, that the reason the states have yet to feel a fiscal impact from this type of legislation is that employees won't be eligible for any benefits for 10 years. MR. BITTNER mentioned that the 10-year provision is specific to Washington, that other states have earlier thresholds, that some of the states have had "presumptive coverage" legislation since 1986, that there has been a slight increase in the number of claims - roughly .034 percent - and that the threshold in SSHB 31 does not refer to 10 years after passage but rather to 10 years of total fire fighting experience. REPRESENTATIVE ANDERSON commented on the low percentage of additional claims experienced by Washington, and characterized this as illustrative of what Alaska could expect. MR. BITTNER concurred, adding that Nevada experienced an average increase of only one case per year. 5:17:59 PM CHAIR WILSON asked who would be paying for the qualifying medical examinations referred to in the bill. MR. BITTNER said that those tests are part of a yearly physical, which fire fighters currently have to endure for employment. In response to a further question, he said he doesn't know who is financially responsible for those exams, but added that others might be better able to address that issue. CHAIR WILSON offered her understanding that the municipalities are currently responsible for paying for the exams. REPRESENTATIVE ANDERSON surmised that that might be one reason for municipalities to oppose the legislation. 5:19:43 PM ERIK TUOTT, Anchorage Local Representative, Alaska Professional Fire Fighters, International Association of Fire Fighters (IAFF), American Federation of Labor and Congress of Industrial Organizations (AFL-CIO) Central Labor Council (CLC), after noting that he's been serving on the Anchorage Fire Department (AFD) for the last three years as a fire fighter and emergency medical technician (EMT), concurred with points made by Mr. Bittner regarding the ten-year provision; relayed that since the adoption of Washington's legislation in 2003, there have only been six claims from a population of over 6,800 fire fighters; and explained that the AFD requires annual health physicals and an initial medical examination, and provides cancer screenings. 5:21:32 PM REBECCA BOLLING, R.N., B.S.N., President, Alaska Nurses Association (AaNA), said that the AaNA is in support of HB 31 - the original legislation. With regard to SSHB 31, she said: The specific aspect of the new section that I would like to speak to with regard to the workers' [compensation] Act is the part that refers to the exposure to bloodborne pathogens such as [human immunodeficiency virus (HIV)] and hepatitis C. These are acquired bloodborne diseases that healthcare workers are continuously exposed to in the course of their employment, through their daily exposure to blood and body fluids. These diseases are devastating and disabling, and healthcare workers such as nurses operating room personnel, fire fighters, first responders, emergency staff, et cetera, are all, ... equally, at risk for exposure. And it's important [to] provide all healthcare workers this presumptive coverage, and not just fire fighters, first responders, and peace officers, because it's not uncommon for workers' [compensation] claims to be pending for very long periods of time; ... during an investigation, they can take a long time to determine whether these diseases are actually a result of their employment or if in fact they are a result of their lifestyle. So healthcare workers' medical insurances may also refuse to pay the medical bills while they are off with these diseases, because they contend that the bloodborne disease is obviously a workers' [compensation] claim. And ... workers' compensation may delay or deny benefits because they contend that it was the healthcare worker's lifestyle that caused the illness and not their exposure at work. So if the committee is concerned about the potential increase in cost to workers' [compensation] ..., a preliminary investigation of states such as Nevada, Idaho, Arizona, Washington, et cetera, who've passed similar legislation, has also shown minimal impact on premiums. So I do urge [you] to enact this bill, but I urge you to enact this bill with all persons [included] who are exposed to human blood an body fluids on a regular basis, and not just limit it to ... fire fighters and first responders and peace officers. This is good legislation and it is good policy for the state of Alaska. 5:24:28 PM REPRESENTATIVE ANDERSON explained that in the original version of HB 13, he'd inadvertently included nurses in the first responder category, and so he's since introduced the sponsor substitute so that the bill only pertains to fire fighters and ambulance personnel who are acting as first responders. He suggested that the AaNA should consider having someone sponsor similar, separate legislation that would pertain to nurses. CHAIR WILSON said that there are healthcare workers who face the aforementioned situations every single day and currently there is nothing in statute that protects them. REPRESENTATIVE GARDNER said she agrees that any healthcare workers or service workers who are at risk should have some sort of [presumptive] coverage, but is of the belief that nurses should not be included in this bill because fire fighters have a unique set of risk factors with regard to smoke inhalation. CHAIR WILSON clarified that the situations she is referring to are those wherein a person is at risk of contracting a bloodborne disease. 5:28:32 PM KEVIN SMITH, Executive Director, Joint Insurance Association, Inc. (JIA), Alaska Municipal League (AML), explained that the JIA is a self-insurance pool for cities, boroughs, and school districts in Alaska, and that currently about 140 such entities have joined this pool in order to obtain various forms of insurance including workers' compensation coverage, general liability coverage, and property coverage. He went on to say: Certainly, I don't want anybody to take my testimony as though we don't like fire fighters or that we don't like police officers ... - we like our employees. But this proposal is, I think, ... the wrong bill at the wrong time. ... Imagine that we were to suggest that everybody retire in 15 years under the PERS system right now. That's absurd - we've got a problem with the PERS system, we need to get control of the PERS system. The workers' compensation is also in crisis at the moment. ... I think it's fair to say that Alaska has the second highest workers' [compensation] rates in the country, behind California; the rates have been increasing for Alaska's local governments and our businesses, in double digits and sometimes triple-digit situations, over the last several years. Now is not a good time to expand benefits. Now is a time to try to get a handle on the workers' compensation problem, before we expand benefits. The bill, I think, is unnecessary. ... It is difficult with the cancers ... to point to a single fire and say ..., "I got this here," or "I got this there," ... [but] for the communicable diseases, when we certainly know what day ... [you] gave mouth-to-mouth resuscitation ... or the day ... you got needle-stuck, there's incident reports that you fill out, send into the "comp" system, [and] we can test to see whether or not you got the disease. And ... we've paid claims for communicable diseases ... particularly with our clinics and with our hospitals when it's clear that the needle-stick [occurred] or the communicable disease was contracted as part of your job. I guess the biggest problem, in my mind, with [SSHB 31] is the expense. I heard a figure of 1,000 fire fighters, [but] I did some ... calculations of my own and I called the Division of Fire Prevention, tried to subtract out the State's fire fighters and the fed fire fighters - those that are registered in Alaska - and I came up with a number of volunteers and paid [personnel] somewhere more in the neighborhood of about 9,000 when you add in the EMTs. So the first responder pool - exclusive of police - [is] about 9,000. I called the Fairbanks Fire Department and [asked] how much [it costs] for one of these screenings ... [and] they said they cost ... [between] $750 and ... $1,100 depending on age. ... Let's say that it was $900 times 9,000 - you're looking at close to $8 million just in screening costs alone which is not ... really contemplated. ... It's a big cost, and then there'll be recurring costs over time as some retire and some more come on, [since] ... you're going [to] pretty much want to do [screening] annually. So I'm real concerned about the medical screening costs. The cost of treatment is undetermined. There are a small number of incidents, as we've heard [in] testimony earlier, but these incidents are very expensive. Short of premature babies, the cancer incidents are probably the most expensive sort of diseases that you can ... work on [and] not necessarily cure. This is in part, I think, why [the National Council on Compensation Insurance, Inc. (NCCI)] has estimated the increase in costs for these particular class codes to be 10 to 20 percent ... for each of these job classes. In addition, the retroactive nature of the bill is such that all the rates that have been collected to date really haven't contemplated that there would be [a] long-term tail for cancers and communicable diseases. ... MR. SMITH then suggested that the bill also has some potential legal problems, and that research has indicated to him that in a large number of the 38 states that have "these sort of presumptions," they are merely presumptions in pension plans, not presumptions in workers' compensation plans. Additionally, several of those 38 states have found that the legislation could be unconstitutional; states such as Connecticut, New Hampshire - in part because of funding stipulations in its state constitution - and Nevada - based on discrimination between classes of employees. In conclusion, he opined that the bill comes at a bad time for municipalities because of the potential expense. 5:37:12 PM CHAIR WILSON asked whether all fire fighters in Anchorage are paid personnel. REPRESENTATIVE ANDERSON surmised that there are both paid fire fighters and volunteer fire fighters in the Anchorage area. CHAIR WILSON asked whether municipalities currently pay for screenings. MR. SMITH said that the larger fire departments with paid personnel currently pay for screening, but whether fire departments that use volunteers pay for such screening is decided on a department-by-department basis. He suggested that most municipalities that are not at least mid size use only volunteer personnel and don't currently pay for any screenings. Thus, if the bill passes, the volunteers in those municipalities would expect the communities to pick up the additional expense of the screenings. REPRESENTATIVE ANDERSON acknowledged that the bill would affect "the bottom line" of the AML's JIA, and that the cost of treating any cancer covered under the bill would be expensive, but characterized the argument that the [costs of screening] could be as much as $8 million as ridiculous. He posited that passage of the bill will assist in the recruitment and retention of fire fighting personnel. 5:41:01 PM JEFF BUSH, Executive Director, Alaska Public Entity Insurance (APEI), said he is not in favor of [SSHB 31] and would be speaking in opposition to it. He said that the APEI is the "other pool," in addition to the AML's JIA, that insures Alaska municipalities and school districts, and is concerned about the costs that the bill could engender, particularly because those costs are not something that the APEI, as a pool, can control. This is because the rate settings are recommended by the NCCI, and it is those recommendations that the big, international insurance companies - which the APEI turns to for reinsurance and excess insurance - listens to. So even if the APEI is able to demonstrate that there are very few claims or that there is an unlikelihood of a claim, such a showing would not carry much weight with the aforementioned excess insurance carriers. MR. BUSH predicted that such carriers will look at the legislation and say that there is a higher risk for workers' compensation losses in Alaska and will therefore raise rates 10 to 20 percent for the aforementioned classes of people. The problem with this is that although from a statewide perspective such a job class is fairly small, for municipalities it is not - it represents the largest single job classification for municipalities. So not only will such municipalities have to pay for the aforementioned screenings, but their workers' compensation rates will be affected by the NCCI's recommendations. CHAIR WILSON noted that members' packets contain a letter from the NCCI, and that the letter does warn that the costs for claims covered by the bill could increase by 10 to 20 percent or more, particularly given the bill's retroactive nature. She surmised that this cost increase could be significant for municipalities. REPRESENTATIVE ANDERSON remarked on the committee process and potential deadlines, and recommended that the bill be moved on to its next committee of referral, the House Finance Committee. 5:45:52 PM CHAIR WILSON said she feels that the legislature would be making a policy shift via SSHB 31, because it would no longer be up to the worker to prove where he/she contracted a communicable disease. She said that she has had conversations with representatives from the NCCI who've informed her that including healthcare workers - nurses - in the bill would not increase workers' compensation costs. She characterized it as unfair not to provide [nurses], who come in contact with communicable diseases every day, with the same presumption that is being proposed for other types of [first responder] personnel. CHAIR WILSON made a motion to adopt Conceptual Amendment 1, to include nurses in [proposed AS 23.30.121(c)]. 5:48:03 PM REPRESENTATIVE ANDERSON objected, and suggested that nurses don't need to be included in the bill because they work in controlled environments. CHAIR WILSON pointed out that she is a registered nurse and was a first responder on an ambulance squad for four years. A roll call vote was taken. Representative Wilson voted in favor of Conceptual Amendment 1. Representatives Kohring, McGuire, and Anderson voted against it. Therefore, Conceptual Amendment 1 failed by a vote of 1-3. 5:51:05 PM REPRESENTATIVE McGUIRE moved to report SSHB 31 out of committee with individual recommendations and the accompanying fiscal notes. There being no objection, SSHB 31 was reported from the House Health, Education and Social Services Standing Committee.
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