Legislature(2003 - 2004)

02/25/2003 03:02 PM HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= 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                                                                    
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                                                               
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                                                               
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                                                               
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                                                               
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                                                               
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 [2002].   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.                                                                 

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