Legislature(2005 - 2006)CAPITOL 106


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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                                                               
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                                                               
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                                                               
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                                                               
3:45:21 PM                                                                                                                    
REPRESENTATIVE KOHRING  moved to report  HB 396 out  of committee                                                               
with  individual  recommendations  and  the  accompanying  fiscal                                                               
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                                                               
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                                                               
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.                                                                

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