Legislature(1993 - 1994)

02/10/1994 03:00 PM HES

Audio Topic
* first hearing in first committee of referral
+ 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                        
  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                          
  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                    
  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                      
  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                  
  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                          
  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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