Legislature(2005 - 2006)CAPITOL 106
04/27/2006 03:00 PM HEALTH, EDUCATION & SOCIAL SERVICES
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HB 396-ALASKA COMMISSION ON HEALTH CARE 3:24:33 PM CHAIR WILSON announced that the next order of business would be HOUSE BILL NO. 396, "An Act establishing the Alaska Commission on Health Care; and providing for an effective date." 3:24:55 PM REPRESENTATIVE GARDNER moved to adopt HB 396, Version 24- LS1266\Y. There being no objection, HB 396 was before the committee. 3:25:11 PM REPRESENTATIVE ETHAN BERKOWITZ, Alaska State Legislature, sponsor of HB 396, said that he introduced HB 396 because although there has been much discussion about health care, nothing has been done directly about what can be done to decrease the cost of medical care in the state. Alaska has one of the highest cost and the poorest rates of public participation with insurance. This legislation attempts to bring together the various interest groups to develop an action plan. He noted that he did a lot of work with Representative Cissna, who has been a champion of health care in this state. Representative Berkowitz pointed out that included in HB 396 are a couple of his own pet projects, including improving access to health care cost information, doing more with information technology, and moving from the tort reform [perspective] to the health care court. He explained that a health care court would have trained judges and experts who would act quickly in resolving health care issues. The aforementioned will allow the legal system to help the medical system identify issues, resolve issues quickly, and ensure that injured parties receive quick compensation. 3:28:59 PM CHAIR WILSON requested more detailed information on the health care court. REPRESENTATIVE BERKOWITZ pointed out that the following website www.cgood.org provides much good information, including information for health care courts. 3:29:56 PM CHAIR WILSON asked if the judges would be appointed or would sitting judges be trained to do this work. REPRESENTATIVE BERKOWITZ said that it's similar to the workers' compensation system. However, there would be a different level and qualification for these judges. Ideally, the judge would be legally and medically trained. Furthermore, there would be a reservoir of experts that the court could rely upon in order to avoid the current situation in which there are dueling experts. He informed the committee that only about 4 percent of negligence cases end up in the court system because most people don't pursue a remedy for the injury they've suffered. Due to the aforementioned, the medical profession isn't as quick in spotting and resolving problems that might be occurring. The aforementioned places everyone in a reactive mode rather than a proactive mode that could reduce costs. 3:31:28 PM REPRESENTATIVE GARDNER referred to page 4, line 1, which specifies that the commission should address the public availability of health care cost information. She asked if that language is the beginning of the debate of hospitals reporting and posting their charges. REPRESENTATIVE BERKOWITZ replied yes, and opined that the more informed the consumer is the better. 3:32:09 PM REPRESENTATIVE CISSNA opined that having the proper information about what is available can result in a well-made decision for which one can spend his/her money wisely. However, currently the consumer doesn't have that information. REPRESENTATIVE BERKOWITZ said that one of the predicates for the capitalist system is for the consumer to have perfect knowledge and help consumers hold down unnecessary costs. 3:33:28 PM REPRESENTATIVE GATTO turned attention to the fiscal note and highlighted that it calls for an executive director at a Range 22, which earns about $96,000. REPRESENTATIVE BERKOWITZ stated, "This fiscal note is clearly the result of an administration that's not anxious to move one of my bills, and so I think that's what it reflects." He said he expected that if the legislation were ever to move that the fiscal note would be brought down to a more manageable level. He noted that he wasn't consulted with regard to how the fiscal note was drafted. However, he further noted that the salaries specified include the benefits. In further response to Representative Gatto, Representative Berkowitz said it would depend on who is hired as to what benefits would attach. 3:34:58 PM REPRESENTATIVE CISSNA pointed out that one issue is that different groups have reviewed the problem and developed different solutions. However, when groups have come together at the various conferences, everyone has agreed that all parts of the system have to be included in order to develop a compromise and solution. REPRESENTATIVE BERKOWITZ highlighted that almost 125,000 Alaskans don't have health care insurance, which is unacceptable. He then highlighted the situation in Massachusetts where the problem is being aggressively addressed. The fact that a bipartisan solution arose seems to indicate that where there is the will to address the problem, it can be done. Massachusetts used largely a free market solution. The Massachusetts governor has pointed out that "we" pay for the uninsured whether it's in the emergency room or through [higher] insurance costs. Therefore, the Massachusetts governor opined that there needs to be a better way of allocating the same dollars. Representative Berkowitz said that as long as Alaska is trapped in these high costs of medical care, insurance and medical care can't be provided. He stressed the need for legislators to do what they can to ensure that as many Alaskans as possible have access to health care. 3:38:23 PM CHAIR WILSON opined that one of the largest challenges in Alaska is the size of the state and the logistics involved in providing health care to its population. The aforementioned contributes to health care costs in Alaska. REPRESENTATIVE BERKOWITZ highlighted that Alaska's telemedicine capabilities allow a medical professional with a particular expertise to review cases in rural areas. He stressed that there is economic potential in telemedicine because it can be used worldwide for analysis and consultation. He emphasized the need for Alaska to take advantage of its position on the globe and the technology already utilized and that can be further utilized. CHAIR WILSON noted that she has requested $1 million for radiology technology for 12 hospitals that are located throughout the state. 3:41:29 PM REPRESENTATIVE GATTO informed the committee that Massachusetts recently passed legislation mandating that every private company will provide insurance for its employees. That requirement is a double-edged sword because small businesses may have to decide whether to stay in business, but individuals with insurance usually seek treatment from a physician while the uninsured most often seek treatment in an emergency room. REPRESENTATIVE BERKOWITZ related that Massachusetts is very concerned with the ability of small businesses to come together to find insurance packages that work for everyone. In relation to the Massachusetts situation, it has been noted that not only have the very small businesses had a difficult time acquiring insurance, the insurance companies have a difficult time developing a package that suits small businesses. Representative Berkowitz said that he became frustrated and aggravated to hear only about benefit cuts in relation to health care. Benefit cuts are merely a cost shift because someone will pay for it somewhere and efficiencies and economies of scale are lost when the state is involved. Representative Berkowitz then related a quote from Mario Cuomo, as follows: "It's not government's job to do the job, it's government's job to make sure the job gets done." The legislature, he opined, has the responsibility of ensuring that everyone has access to health care. 3:45:21 PM REPRESENTATIVE KOHRING moved to report HB 396 out of committee with individual recommendations and the accompanying fiscal notes. REPRESENTATIVE GATTO objected due to the fiscal note. REPRESENTATIVE BERKOWITZ reminded the committee that the fiscal note is the responsibility of the House Finance Committee while the House Health, Education and Social Services Standing Committee addresses any of the substantive issues of the legislation. He said that he could accept the committee holding the legislation due to substantive issues, but he indicated his disagreement with holding the legislation because of the fiscal note. CHAIR WILSON reminded the committee of her announcement at an earlier meeting, that the committee would not report out any House legislation, but rather utilize remaining House legislation for ideas for next year. 3:48:14 PM REPRESENTATIVE CISSNA, drawing upon her experience as a Democrat, related that Democrats go to an enormous amount of work on good ideas that would save the state money. However, such legislation is often pushed to the bottom of the list. CHAIR WILSON interjected that the aforementioned is why she chose to make this a working committee to make recommendations. Chair Wilson asked if Representative Kohring would withdraw his motion. 3:49:14 PM REPRESENTATIVE KOHRING sustained his motion. CHAIR WILSON announced that the motion would be left pending while testimony from the department is taken. 3:50:35 PM DWAYNE PEEPLES, Director, Division of Health Care Services (DHCS), Department of Health and Social Services (DHSS), noted that the committee should be in possession of a memorandum dated February 21, 2006, from the department regarding some of the issues that the department is addressing related to health care. He offered to respond to questions. 3:51:15 PM MR. PEEPLES specified that the department has been trying to address various issues, including what is occurring with Medicare, financing, and Medicaid services. The department has also been reviewing the possibility of revising the certificate of need, tweaking Denali KidCare, and trying to bring on more programs. There was also a recent revision of State Public Health laws. Furthermore, the department has worked closely with the Denali Commission in regard to developing health care facilities and health care services. Mr. Peeples highlighted that the largest area of focus is chronic disease management and ways to improve disease prevention and control so as to use it as a reimbursable service. For example, tobacco cessation is a reimbursable service under Medicaid. Moreover, the department is also working to maintain and recruit in the health care positions in which there are shortages. There has also been work to coordinate benefits with health care insurance. The commission as proposed by HB 396 would provide a higher level of interest in trying to resolve some of the health care issues and the associated costs. 3:53:28 PM REPRESENTATIVE CISSNA inquired as to what the state is doing to ensure that the environment is appropriate for the market to do its job. She further inquired as to what the state is doing for the uninsured. She also inquired as to whether the state is doing anything similar to what is proposed in HB 396. MR. PEEPLES replied no. The committee took an at-ease from 3:55:30 PM to 3:56:11 PM. 3:56:13 PM REPRESENTATIVE KOHRING restated his motion to report HB 396 out of committee with individual recommendations and the accompanying fiscal notes. There being no objection, HB 396 was reported out of the House Health, Education and Social Services Standing Committee. [Representative Gatto's earlier objection was treated as withdrawn.] The committee took an at-ease from 3:56:57 PM to 3:56:57 PM.