Legislature(2003 - 2004)
02/25/2003 03:02 PM HES
* first hearing in first committee of referral
= bill was previously heard/scheduled
= bill was previously heard/scheduled
HB 21 - MEDICAID FOR BREAST & CERVICAL CANCER HB 107 - MEDICAID FOR BREAST & CERVICAL CANCER Number 0311 CHAIR WILSON announced that the committee will take up HOUSE BILL 21 "An Act relating to an optional group of persons eligible for medical assistance who require treatment for breast or cervical cancer," and SPONSOR SUBSTITUTE FOR HOUSE BILL NO. 107 "An Act relating to an optional group of persons eligible for medical assistance who require treatment for breast or cervical cancer; relating to cost sharing by those recipients under the medical assistance program; and providing for an effective date." Number 0344 CHAIR WILSON told the members it is her intention to hear testimony on both HB 21 and SSHB 107, address any policy issues, and then pass the bills from committee. Chair Wilson said the only difference in the bills is the funding mechanism, and since the next committee of referral is the House Finance Committee, the fiscal impacts will be addressed in that committee. Number 0419 REPRESENTATIVE KAPSNER, cosponsor of HB 21, told the committee she would be presenting the bill because the sponsor, Representative Kerttula was unavailable. Representative Kapsner read a letter to the committee from Representative Kerttula, which stated: Thank you for the opportunity to present House Bill 21, Medicaid for Breast and Cervical Cancer, to the House Health, Education & Social Services Committee. It is with deepest regrets that I am not able to present the bill in person. However, my father has been ill and I am traveling to be with him while he undergoes medical testing. I apologize again for not being present on this important day and appreciate your understanding. REPRESENTATIVE KAPSNER provided the committee with background information on HB 21. She said it makes the treatment for breast and cervical cancer permanent. If the legislature does not do anything, this program will end in June of this year. She said she was excited to sign on as a cosponsor of the bill because it is a lifesaving program. She told the committee there are so few things the legislature can do that can save lives, and this is one of the few things. Number 0511 REPRESENTATIVE KAPSNER said HB 21 provides treatment for those who are screened through the Alaska Breast and Cervical Health Check program and are uninsured or underinsured [meaning their insurance doesn't cover what they need to pay for treatment]. This health check program has been in place since 1995, and more that 100 cases of cancer and 602 precancerous conditions have been diagnosed. However, until 2000, if an individual went through screening and found out she has cancer, there was no program in place to help her pay for treatment of the disease. In fiscal year 2002, in large part due to Governor Murkowski [then United States Senator] and his wife, Nancy Murkowski, the federal government approved a Medicaid expansion to cover treatment for these women. Alaska opted into the program in 2001, but the legislation sunsets this year. In fiscal year 2002, 44 Alaskan women received treatment, with the federal government paying 70 percent of the costs; Alaska paid $172,982, which is less than 30 cents per resident or less than one-one hundredth of a percent of the total general expenditures for that fiscal year. Representative Kapsner said it is very minimal in terms of the overall budget. To date, 94 women have been treated; the total paid is $1,100,000, 70 percent paid by the federal government, and 30 percent paid by the state. As of January 2003, 49 states and the District of Columbia participate; however, Alaska is the only state that has a sunset provision on the program. Number 0645 REPRESENTATIVE KAPSNER brought attention to an amendment, and explained that after the bill had been drafted it was noted that there was not an effective date. The amendment includes the effective date in the title. CHAIR WILSON labeled the foregoing Amendment 1. REPRESENTATIVE KAPSNER moved to adopt Amendment 1, labeled 23- LS0131\D.1, Lauterbach, 1/22/03, which read: Page 1, line 2, following "cancer": Insert "; and providing for an effective date" Page 2, following line 10: Insert a new bill section to read: "Sec. 5. This Act takes effect immediately under AS 01.10.070(c)." Number 0669 CHAIR WILSON asked if there were any objections. Since there were no objections, Amendment 1 was adopted. Number 0700 CHAIR WILSON asked if there is copay language in the bill. REPRESENTATIVE KAPSNER replied that there is no copay language in the bill. She said Representative Kerttula thought long and hard about the differences between the bills. She said not having the copay language in the bill does not disqualify the state from federal funding. She said it would make the bill [or program] confusing because the language does not necessarily match up with the federal program. Number 0730 REPRESENTATIVE SEATON said that even though the Medicaid program includes a cost-sharing requirement from the U. S. Department of Health and Human Services mentioned in question number 45, page 13. He asked if a cost-sharing requirement would apply under this bill. Number 0792 REPRESENTATIVE KAPSNER told the committee that from her discussions with Juli Lucky [Representative Kerttula's aide], who is very knowledgeable on this issue, her understanding is that cost sharing is Medicaid-wide, and not program specific. Representative Kapsner asked Chair Wilson if she would like Juli Lucky to join the discussion. CHAIR WILSON replied that this is really a financial issue and she would prefer not to do that. But her understanding is that this is a Medicaid-wide, not program-specific issue. CHAIR WILSON said she would like to have the sponsor of HB 107, present her bill. The committee will then take testimony from the public on both bills. Number 888 REPRESENTATIVE DAHLSTROM, sponsor of SSHB 107, thanked the committee and members of the public who have taken the time to testify on this important piece of legislation. She thanked Representative Beth Kerttula for her diligent work on this issue. Representative Dahlstrom said Representative Kerttula is dedicated to helping all the women in Alaska and her colleagues are thinking of her and her family today. REPRESENTATIVE DAHLSTROM shared events in her own family when her sister had just been diagnosed with invasive breast cancer. She said she will never forget the devastation in her voice, and the concerns she expressed about what was going to happen to her 14-year-old son, her husband, and just her life in general. She told the committee she had the opportunity to be with her during her first chemotherapy. Her sister had three chemotherapies and then she had a complete radical mastectomy. Representative Dahlstrom said she was able to be with her sister as she was wheeled into the operating room for the surgery, and was able to be there after the surgery to take care of her for the weeks that followed. Her sister had eight more chemotherapies after that, and at this point she hopes that her sister is in remission. Representative Dahlstrom said she is grateful that her sister was able to receive the care that she did. Representative Dahlstrom said this, in part, is why she is a strong advocate for breast cancer awareness. Number 1001 REPRESENTATIVE DAHLSTROM told the committee that one in eight women in Alaska will be diagnosed with breast cancer. Imagine: 250 new cases of breast cancer are diagnosed in Alaska each year. National statistics are no better; one woman every 12 minutes is diagnosed with breast cancer, for which the mortality rate is unacceptable. That is just part of the picture; statistics alone do not reveal the impact on a personal level that this disease causes. The number of people impacted by this dreadful disease is much larger. Imagine the emotional stress in a family when a mother, diagnosed with breast or cervical cancer, has to go through the everyday living when this takes place. She said she knows many of the members have watched as a family member has experienced such an impact. Number 1034 REPRESENTATIVE DAHLSTROM said both HB 21 and SSHB 107 cover a vital service to Alaskan women. Like HB 21, SSHB 107 will continue the treatment services to women who were diagnosed for breast and cervical cancer under the Breast and Cervical Cancer Mortality Prevention Act. In 2001 legislation was passed that extended Medicaid coverage to women diagnosed with cancer by federally funded screening programs. That legislation included a two-year sunset clause that will terminate medical treatment for all women on June 30, 2003. SSHB 107 will remove the sunset provision and ensure that treatment continues for women diagnosed with breast or cervical cancer while under the 2001 legislation. Number 1074 REPRESENTATIVE DAHLSTROM said the major difference between SSHB 107 and HB 21 is the cost-sharing provision. SSHB 107 addresses those who qualify for treatment, but are not covered by Medicare. This bill directs the Department of Health and Social Services to adopt a sliding scale for premiums or contributions in the same way the Denali KidCare program does. This would allow women whose household income falls between 150 percent of the poverty guidelines, which is $34,500, and 250 percent, which is the equivalent of $57,500 of the poverty guidelines in Alaska, to receive needed relief. Representative Dahlstrom urged the committee to pass this legislation out of committee today. Number 1135 CHAIR WILSON asked if members have any questions before the committee takes testimony from the public. Number 1139 REPRESENTATIVE HEINZE asked, of the 92 or 94 women treated, how many survived. She said the department seems to know the cost of what was spent by the federal and state government, but not if they lived or died. REPRESENTATIVE DAHLSTROM responded that she would provide that information to the committee. Number 1185 REPRESENTATIVE CISSNA remarked that she knows the chair does not want to discuss the financing aspects of the bills; however, that is the only difference between the bills. Number 1198 CHAIR WILSON agreed and reiterated her intention to discuss the policy of the bills, and pass the bills from committee if the members feel this is the policy they wish to follow. The financing mechanism will be discussed in the House Finance Committee. CHAIR WILSON opened the meeting to public testimony. Number 1258 MARY KVALHEIM testified that she is a mother of a daughter who died from cervical cancer. She told the committee her daughter was an alcoholic and due to the practice of her disease, she did not amass any property, nor was she able to hold a job that provided benefits. Because of this, she was afforded the best medical care available in the state of Alaska. She told the committee as a mother she is grateful that things worked out for her that way. But as a woman who did work all her life, sometimes in positions which had no health care, she urged the members to support this bill. She said she left a job in 1980 that paid $1,000 more per month for a job with insurance benefits. This bill will help people who are employed in positions that are unable to do what she did, by leaving one job for another, because they would be unqualified, or because of the pre-existing condition clause. She went on to tell the committee that during her time working for the Legislative Information Office, there was a woman living in Wasilla who would have benefited from this bill, but due to her employment she could not qualify for assistance. She could either make her house payment or pay for her breast cancer treatment, amounting to $600 monthly. She chose the house to have a place to die in. Please support this legislation, she asked members. Number 1338 KATIE HURLEY testified that she is a breast cancer survivor and is in her 14th year. She told the committee she knows the importance of early detection. Having the chance to have mammograms will save money with early detection. She said her cancer was caught before it was invasive. She had a mastectomy, but did not have to have any follow-up treatment because it had not spread into the nodes. She said she cannot tell the members how important it is for women to have good medical care. Number 1391 EMILY NENON testified on behalf of the American Cancer Society, saying that the members probably already know many stories about women who have breast and cervical cancer. She said the policy issue is pretty straightforward: women are getting screened, and they need to be treated. It is unconscionable to screen individuals that do not have the means to get treatment, to tell them that they have cancer and then not provide treatment. The incentive of the 70 percent federal match is a pretty strong message from the federal government on the importance of this issue. In looking at the two bills, she referred to the later bill [SSHB 107] which deals with cost sharing. She said her concern is that there would be undue burden on people that have already established that they do not have the means to cover their own medical care. That is her concern and she wants to make sure it is very clear that the fees that are established are nominal and fair. She said the American Cancer Society supports legislation to remove the sunset provision that is provided by both bills. Number 1503 JOAN DIAMOND testified on behalf of the Department of Health and Human Services, Municipality of Anchorage, in support of HB 21 and SSHB 107. She said the municipality supports both bills as long as they remove the sunset clause and establishes reasonable cost sharing. She pointed out that her department does screen many women who would be potentially eligible if they were diagnosed with cervical or breast cancer. Ms. Diamond told the committee she is hopeful this legislation will pass. Number 1572 HELEN SOARES testified that she is a nurse and long-time breast cancer survivor. She asked the committee to please continue funding the breast and cervical treatment program. She told the committee when she was first diagnosed with breast cancer, she felt really scared because it was a diagnosis of aggressive breast cancer, but she was relieved that she had a second opinion. Ms. Soares said she felt really ignorant about breast cancer because she had worked in pediatrics. She said she got support and knowledge from her support group, family, friends, books, and prayer lists. When the huge tumor had shrunk after weekly chemotherapy [for approximately three months], she had a mastectomy. She said 16 of the 22 nodes were positive, and she felt despair because she could not get the rest of her treatments because her husband's insurance denied treatment and appeals. She said they considered selling their house, but she was fortunate to get into a research program, under the United States Department of Defense and that is how she got treatment several years ago. She urged the committee to pass this legislation, because women who are diagnosed with cancer need treatment to save their lives. Number 1692 MARY LOU BARKS provided the following testimony which was read into the record by Carla Williams in support of HB 21 and SSHB 107. Ms. Williams said she will be testifying in the Finance Committee on the funding aspects of the bills. Hello, my name is Mary Lou Barks. I live in Eagle River, Alaska. Since I am very uneasy about speaking in front of people, I am hoping this will be allowed to be read to the legislation on keeping the funding for Medicaid on Alaska's Breast and Cervical Cancer Program going. Right now I am being helped through this program with breast cancer and can concentrate on getting well. I cannot imagine what it would have been like not to be in the program. Since I have no income except for the PFD [permanent fund dividend], I would not have known about the breast cancer if it were not for this program that is offered to women like myself. As I type this, I am wondering how many women have died or will because there was not a program to help them in finding out through the screening and diagnosis of cancer. The cost is overwhelming. How can a person be able to recover if they have this cost facing them? So I am asking you to please keep the Medicaid funding for the Alaska's Breast and Cervical Cancer Treatment Program going to help women like myself because unless you have been in our shoes, you will never know how it feels to cope with the cost and getting better. I give my permission to put my testimony into the public record. Number 1787 MARIE DARLIN, Coordinator, Capitol City Task Force, AARP, testified in support of HB 21 and SSHB 107. She said the program is established now and she urges the committee to remove the sunset clause and keep the program going because it has proven its worth. Number 1834 CHERYL MANN told the committee she was not sure she wanted to speak, but then heard the statistics in the committee room "that three of us will have breast cancer." She said only two in the room have to worry, because she has it. She said she is blessed because she has two health insurance policies that cover her and she is getting treatment. She said she is there to ask the committee to support HB 21 because the women who do not have the resources she does, cannot get treatment. The anti-nausea pill she takes after treatment is $75 for one pill. Women without resources could not have that and could not access any of the treatment. She urged the committee to even the playing field and make treatment accessible to poor women as well as those with resources. She urged the committee to support the bill. Number 2007 ELMER LINDSTROM, Special Assistant, Office of the Commissioner, Department of Health and Social Services, provided the department's position on HB 21 and SSHB 107. He said that he knows the committee is aware of the governor's interest in this legislation. As a member of the United States Senate, Governor Murkowski was instrumental in seeing that the federal authorizing legislation became law at the federal level. Mr. Lindstrom told members that Commissioner Gilbertson and Governor Murkowski's message to the committee is to urge passage of a bill that extends the program as quickly as possible. Mr. Lindstrom said he appreciates the bi-partisan support on this legislation. Number 1997 REPRESENTATIVE GATTO asked Mr. Lindstrom if he has read both bills and asked if he sees something in one bill that is not in the other, with the exception of the fiscal aspects of the bill. MR. LINDSTROM replied that the administration finds both bills absolutely acceptable. He told the committee that the governor and the department do support cost sharing for the Medicaid program, particularly in instances when income eligibility for Medicaid is greater than the historical norm. This program and a previous program that everyone is familiar with, the Denali KidCare program, have income levels that are greater than what has historically been the case. So, in principle, the governor and the department endorse this, as did the previous administration. Having reasonable cost-sharing provisions on a sliding fee scale for people who can afford to pay something for their care as their income increases is the right thing to do. He said the practical application of both of these bills is the same. Number 2067 CAREN ROBINSON, Lobbyist for the Alaska Women's Lobby, told the committee the Alaska Women's Lobby has been in Alaska since the mid-1980s and has a membership of around 3,000 men and women from across the state. She told the members the Alaska Women's Lobby supports both bills and urges the committee to pass this legislation as quickly as possible. Ms. Robinson said she believes it is essential to assist people who are having a battle with a disease. These women need a lot of love and patience. She said on a personal note, she is fortunate because her husband works for the state and she would be covered. She shared with the committee that Ruth Lister, who was the chair of the Alaska Women's Lobby for many years, lost her battle to cancer on December 10 of this year . She said her last words to Ms. Lister were that she would do what she could to get this bill through this year. Number 2131 REPRESENTATIVE HEINZE asked about Ruth Lister. MS. ROBINSON told the committee that Ms. Lister lived in Juneau, but was originally from Fairbanks, where she was the dean of women [at the university] in Fairbanks. At one time she was the director of the Women's Commission, and was one of the original directors of the women's shelter in Fairbanks. Ms. Robinson told the committee Ms. Lister had a 15-year battle with cancer, and she testified on this bill last year about this time. CHAIR WILSON asked if anyone else wanted to testify or if the members had further questions. Number 2196 REPRESENTATIVE GATTO moved to report HB 21 [as amended] out of committee with individual recommendations and the accompanying fiscal note. There being no objection, CSHB 21(HES) was reported from the House Health, Education and Social Services Standing Committee. Number 2215 REPRESENTATIVE HEINZE moved to report SSHB 107 out of committee with individual recommendations and the accompanying fiscal note. There being no objection, SSHB 107 was reported from the House Health, Education and Social Services Standing Committee.