Legislature(2009 - 2010)CAPITOL 106
04/06/2010 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB126 | |
| Confirmation to State Medical Board | |
| HB423 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| *+ | HB 423 | TELECONFERENCED | |
| + | SB 10 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 126 | TELECONFERENCED | |
HB 423-POLICY FOR SECURING HEALTH CARE SERVICES
3:22:39 PM
CO-CHAIR KELLER announced that the next order of business would
be HOUSE BILL NO. 423, "An Act stating a public policy that
allows a person to choose or decline any mode of securing health
care services, and providing for enforcement of that policy by
the attorney general."
3:23:25 PM
REPRESENTATIVE CARL GATTO, Alaska State Legislature, offered his
belief that the passage of the federal health care reform was
unconstitutional. He explained that HB 423 was a means to have
the U.S. Supreme Court determine whether the federal health care
reform act was a violation of the Tenth Amendment. He declared
that he was a believer in freedom, and he opined that the Tenth
Amendment was written to respect the rights of each state. He
shared his belief of various states rights issues in Alaska. He
said that an infringement on state rights by the federal
government was a violation. He stated that the Tenth Amendment
enumerated that whatever was not declared a right by the federal
government, became a state's right. He listed 14 states which
were requesting the states' attorneys general to pursue this to
the Supreme Court. He noted that 5 other states had expressed
they would not go to the Supreme Court. He opined that it was
beneficial for Alaska to pursue its own interest, by joining the
other 14 states. He stated his desire to have the Supreme Court
clearly define the relationship of the Tenth Amendment to the
federal health care reform.
3:30:28 PM
REPRESENTATIVE T. WILSON asked what would be the cost to Alaska.
3:30:37 PM
REPRESENTATIVE GATTO replied that the Goldwater Institute had
offered to "defend the constitutionality of the Health Care
Freedom Act [HB 423] at no cost to the state."
3:31:31 PM
REPRESENTATIVE T. WILSON asked if the lawsuit would prohibit a
choice for government insurance.
3:31:50 PM
THOMAS REIKER, Staff to Representative Carl Gatto, Alaska State
Legislature, in response to Representative T. Wilson, said that
HB 423 did not preclude people from accepting health care, but
it barred the federal government from compelling someone to join
a health care system which they did not want to join.
3:32:17 PM
CO-CHAIR HERRON asked the reason for using the Goldwater
Institute.
3:32:37 PM
REPRESENTATIVE GATTO said that it was just one option. He
pointed to the analysis of the fiscal note, which stated that
the fiscal impact was indeterminate. He opined that the "cost
of not doing something can far exceed the cost of doing
something."
3:33:34 PM
REPRESENTATIVE CISSNA asked if the passage of HB 423 was a
choice for health care, or was it removing the option for the
state to be a part of the health care plan.
3:34:31 PM
REPRESENTATIVE GATTO replied that the federal plan was now in
place until the Supreme Court ruled otherwise.
3:34:38 PM
REPRESENTATIVE CISSNA asked if this decision would affect
contagious diseases and quarantines.
3:35:40 PM
MR. REIKER replied that HB 423 gave an individual the right to
determine their health care service.
3:36:22 PM
REPRESENTATIVE CISSNA stated that her constituents wanted health
care help, and she asked what the motivation was for HB 423.
3:37:11 PM
REPRESENTATIVE GATTO, in response, replied that his district was
overwhelmingly against the federal health care bill. He asked
if individuals should be allowed to choose their health care
option. He opined that it was not the responsibility of the
federal government to change the health care system.
3:40:47 PM
REPRESENTATIVE HOLMES pointed to page 2, line 7, and asked about
the "injunctive and other appropriate relief" that HB 423 was
asking the attorney general to seek.
3:41:22 PM
REPRESENTATIVE GATTO replied that the attorney general was
directed "to pursue, in court, whether or not the Tenth
Amendment has been violated. And if so, since there's
severability in the law, then he may have to deal with which
parts are in violation."
3:41:45 PM
REPRESENTATIVE HOLMES asked what exactly was being protested.
3:42:23 PM
MR. REIKER, on behalf of Representative Gatto, said that the
Tenth Amendment related to mandate provisions, and that the
federal health care reform created unfunded mandates to the
states as part of the Medicaid program.
3:42:53 PM
CO-CHAIR KELLER said that the committee questioning was moving
"outside of the scope of the bill." He directed attention to
Section 2 and Section 3, and opined that HB 423 was not
challenging the entire federal health care reform, but it was
challenging the right to choose any mode of health care.
3:44:16 PM
REPRESENTATIVE HOLMES replied that she had asked the sponsor to
explain the bill and that her questions were within those
parameters. She strongly stated her opinion that the focus of
the bill was not clear. She emphasized that HB 423 did not
specifically reference federal health care reform, yet it asked
for specific action from the attorney general. She asked what
specific action HB 423 was asking.
3:45:48 PM
MR. REIKER, in response to Representative Holmes, said that HB
423 discussed choice and mode of health care. He pointed to the
mandate within the federal health care reform as the target of
HB 423. He explained that this affected people who did not have
health care and would be forced into buying health care.
Secondly, he noted that Medicaid had enforcement provisions
which were now the responsibility of the states. Finally, he
shared the concern of whether the federal government could force
states to impose state level regulations. He opined that
Alaskans should have the choice to participate.
3:47:33 PM
REPRESENTATIVE SEATON reported that some people were unhappy
with Medicare, yet were required to pay for that. Pointing to
page 1, line 14, he opined that HB 423 was targeted toward
Medicare, and he asked the sponsor where the bill specifically
directed the attorney general not to seek liberation from
Medicare participation.
3:48:51 PM
MR. REIKER opined that you have the right to supplemental
private insurance, but that you did not have to receive
Medicare, even if you pay for it.
3:49:16 PM
REPRESENTATIVE SEATON, addressing payment for Medicare, asked
whether an individual should have to pay, whether they used it
or not. He asked if HB 423 would allow individuals to decline
the charge for any mode of health insurance.
3:50:21 PM
REPRESENTATIVE GATTO said that you may have to pay for Medicare,
but you don't have to use it. He pointed to the restrictions
imposed by Medicare. He opined that individuals had the right
to go to any medical facility and to pay for that service.
3:51:24 PM
REPRESENTATIVE SEATON, in response to Representative Gatto, said
that the mandate of the federal health care reform was for an
individual to have insurance or pay a fine, but that it did not
enforce use of the insurance. He asked how that was any
different than Medicare.
3:52:20 PM
REPRESENTATIVE GATTO said that individuals pay for many services
that were not used. He said that HB 423 was a bill about
states' rights, and the right of refusal as opposed to the right
of acceptance.
3:53:29 PM
REPRESENTATIVE SEATON replied that Medicare was a federal
program, with a federal mandate that an employee pay into the
medical system. He asked to clarify that HB 423 required the
attorney general to challenge a federal insurance program. He
asked about the difference between Medicare and this federal
health care program.
3:54:28 PM
MR. REIKER said that the federal health care program required
states to implement state level regulations, although these came
from the federal government. He stated that it also set minimum
standards for the mandated insurance and care, which was a
violation of the Tenth Amendment. He stressed that this was
different from Medicare.
3:55:13 PM
REPRESENTATIVE CISSNA, in response to Representative Gatto,
pointed out that Alaskans do not pay state income tax, hence, do
not pay for roads, but instead receive money from the state.
She opined that there was not a state health plan, but that
Medicaid was a payment source for a great deal of the health
care in Alaska. She suggested discussions with professionals
who understand the new federal program to better understand the
costs to Alaska.
3:57:28 PM
REPRESENTATIVE GATTO replied that there was a state plan [for
employees of the state], and that there were private plans. He
stated that an individual could decline to be in the state
health plan. He admitted that there were many people who did
not have coverage. He declared that in his 25 years [working as
a paramedic] of transporting patients to emergency rooms, he had
never known of a person who was not transported because they
could not pay. He declared that the issue of payment was
between the patient and the hospital. He said that "we don't
have people dying on the streets, we don't have people starving
in corners, we don't have people begging up and down the halls,
we have plans, we do things." He stated that the [federal]
government did not have any money, that all the money sent to
Alaska, came from Alaskans. He declared that "we keep sending
them money and they send us a smaller percent of it, over and
over and over again." He opined that it was better for the
state to keep state money and institute its own Medicare plan.
He opined that the federal government was forcing Alaska into a
plan that was not wanted. He expressed, "I don't want it." He
stated "I think I have rights but the federal government is
saying I don't." He declared that this was the intent of HB
423. He explained that HB 423 requested the attorney general to
represent similar thinking Alaskans in asking if the Tenth
Amendment had been violated. "It's not about bills, it's not
about health care, it's about the Tenth Amendment." He stated
that to not address this on the federal level was tantamount to
giving up. He opined that it was an overwhelming precedent for
the federal government to determine that an individual must buy
a product.
4:01:49 PM
CO-CHAIR KELLER clarified that the bill would go to House
Judiciary Standing Committee for a legal determination.
4:02:26 PM
REPRESENTATIVE T. WILSON asked if HB 423 was focused on those
individuals who were now required to purchase health care.
4:02:57 PM
MR. REIKER agreed.
4:04:16 PM
REPRESENTATIVE T. WILSON declared that there was a misconception
that people without health insurance had others pay for their
health care.
4:04:48 PM
REPRESENTATIVE GATTO replied that 30 million people did not have
[health] insurance, and he opined that 10 million of these
people were illegally in the United States. He offered his
belief that many people considered it improper to pay health
insurance for illegal residents.
4:05:45 PM
CO-CHAIR HERRON asked if the Department of Law (DOL) had been
asked to testify.
4:06:09 PM
MR. REIKER said that DOL had not been asked.
4:06:18 PM
MR. REIKER, in response, said that Department of Health and
Social Services (DHSS) was not asked to testify.
4:06:34 PM
CO-CHAIR HERRON asked why other states had filed lawsuits.
4:06:48 PM
MR. REIKER replied that a group of states had filed the lawsuit
together, with the focus on the mandate to buy a private good
with private funds. He continued, and explained that this was a
violation of the Tenth Amendment and the Commerce Clause of the
U.S. Constitution. He added that there were significant
portions of the lawsuit which pertained to the unfunded mandate
for Medicaid. He pointed out that there were also state level
regulations which were imposed by the federal government. He
opined that the only option given to the states was to opt out
of Medicaid.
4:08:04 PM
CO-CHAIR HERRON asked to clarify that the complaint focused on
the financial burden of expanded Medicaid. He asked the sponsor
if he suggested opting out of Medicaid.
4:08:21 PM
REPRESENTATIVE GATTO said that the lawsuits run parallel
courses, and they all dealt with the Tenth Amendment and the
Commerce Clause. He asked for clarification of the question.
4:09:03 PM
CO-CHAIR HERRON asked if the reason for HB 423 was the
additional financial burden from the expansion of Medicaid.
4:09:45 PM
REPRESENTATIVE GATTO replied that the primary issue was the
mandate, but that Medicaid, the Commerce Clause, and the Tenth
Amendment were all part of the lawsuit. He opined that it was
incumbent on Alaska to do its share, and be in the forefront for
states' rights. He offered his belief that this was "the time,
the place, and the moment in history to address that question
because never in history have we had such an enormous impact on
our economy." He opined that the federal health care reform
would increase the national debt.
4:11:49 PM
CO-CHAIR HERRON asked to clarify that the attorney general
should consider whether the U.S. Congress had the power to
regulate health insurance, and commerce in Alaska.
4:12:18 PM
REPRESENTATIVE GATTO replied that the federal government did
regulate commerce. He expressed disagreement with a mandate to
purchase a specific product. He stated that Alaska, alone,
could not nullify a federal law.
4:14:00 PM
CO-CHAIR HERRON asked to clarify whether this was an issue of
states' rights, or a violation of individual rights.
4:14:27 PM
MR. REIKER replied that it was both. He offered his belief that
the Tenth Amendment guaranteed individual and states' rights.
He opined that the right to regulate insurance was reserved,
under the Tenth Amendment, to the states, as it was not
specifically enumerated to the federal government. He opined
that purchasing the mandated insurance was a violation of
individuals' rights to control their own property. He offered
his belief that the Alaskan constitution guaranteed Alaskans the
right to "fruits of their own labor."
4:15:43 PM
REPRESENTATIVE SEATON stated that the bill limited what the
state was able to do. He offered quarantine as an example and
asked if this bill, which would allow the option for health
care, would supersede any prior legislation that allowed for
quarantine.
4:16:44 PM
REPRESENTATIVE GATTO replied that, in the interest of protecting
the public, quarantine would happen. He said that HB 423 did
not address the right to enforce quarantine if an individual
declined.
4:17:38 PM
MR. REIKER said that the actual quarantine would not be health
care, but that only the services received afterward were health
care. He stated that HB 423 would allow a person the right to
refuse health care services and choose death from a quarantined
disease, but not to violate the quarantine.
4:18:04 PM
REPRESENTATIVE SEATON referenced Alaskan legislation which
allowed the state to quarantine for health care services, and he
questioned if HB 423 would supersede that. He also asked if HB
423 would supersede involuntary commitment for mental health
services.
4:18:56 PM
CO-CHAIR KELLER reflected that these questions were best
answered by the House Judiciary Standing Committee. He opined
that the central statement of HB 423 was the right for Alaskans
to choose whether or not to have health care, and not to be
penalized if they choose not to have it. He stated that 41
states had legislation against this penalty. He opined that
quarantine was not a health care issue, but instead a disease
control issue.
4:20:05 PM
REPRESENTATIVE SEATON replied that several bills had been passed
which were based on health care. He pointed out that HB 423
specifically stated that an individual could decline those
services. He asked if HB 423 would supersede those earlier
bills and allow individuals to "decline any mode of health care
service." He asked for an opinion from Legislative Legal and
Research Services as to the effect of HB 423.
4:22:00 PM
REPRESENTATIVE SEATON directed a question to Dennis Bailey, and
asked if HB 423 would supersede previous legislation, which
allowed quarantine for health reasons, and "that a person has
the right and is free to choose or decline any mode of securing
health care services."
4:22:50 PM
DENNIS BAILEY, Attorney, Legislative Legal Counsel, Legislative
Legal and Research Services, replied that the bill was not clear
on that issue. He opined that securing health care services
could include the quarantine services.
4:23:20 PM
CO-CHAIR KELLER asked to clarify that securing health care
services was an umbrella which included quarantine.
4:23:38 PM
MR. BAILEY replied that HB 423 was unclear as to a distinction
between quarantine and the health care services during the
quarantine. He suggested that this be clarified.
4:24:07 PM
CO-CHAIR KELLER replied that securing health care services
implied volition and individual choice, whereas quarantine was
for the greater good of the community.
4:24:36 PM
REPRESENTATIVE HOLMES asked if the bill language would also
conflict with the requirement of immunizations for kids when
attending school.
4:25:11 PM
REPRESENTATIVE GATTO replied that immunizations were not
required unless you wanted to enroll your children in school.
He said that a variety of laws declared that an individual may
not harm another, and he declared that contagious diseases were
included under these laws.
4:26:45 PM
MR. BAILEY directed attention to page 2, Section 3(e)(1), and
stated that immunization would fall under health care services.
4:28:05 PM
CO-CHAIR KELLER asked if quarantine would also be included in
this definition.
MR. BAILEY replied that it was not addressed directly in the
bill, and he was not able to determine whether quarantine was a
health care service.
4:28:37 PM
REPRESENTATIVE SEATON asked if involuntary psychiatric
commitment would also be included in health care services.
MR. BAILEY replied that mental health care was included in the
definition of health care service; therefore involuntary
psychiatric commitment could not be excluded from the meaning in
the bill.
4:30:26 PM
MR. REIKER said that this was statute, and could be amended now
or in future legislation.
4:30:52 PM
REPRESENTATIVE T. WILSON asked if this bill language was copied
from existing statute in another state.
MR. REIKER replied that the bill language was from an Idaho
statute.
4:31:11 PM
REPRESENTATIVE GATTO read from AS 18.15.385 which was entitled
"Isolation and quarantine." He opined that the statute dealt
with quarantine, and that HB 423 did not void state statutes.
4:32:06 PM
REPRESENTATIVE SEATON pointed out that a subsequent statute did
modify previous statutes, so that HB 423 would indeed supersede
the earlier statutes.
4:32:46 PM
REPRESENTATIVE CISSNA remarked that not having representatives
from the departments and from health administration to answer
questions made it difficult for any responsible decisions to be
made. She asked if department representatives had reviewed the
bill and commented on the possible outcome.
4:35:09 PM
MR. REIKER, in response to Representative Cissna, said that
currently under Alaska law, HB 423 has been the de facto policy.
He explained that the federal health care reform mandate had
changed Alaska law, therefore HB 423 was challenging it.
4:36:04 PM
REPRESENTATIVE CISSNA asked if they had worked with DHSS to
determine any effects to the state. She pointed out that HB 423
was copied from another state's legislation.
4:36:30 PM
REPRESENTATIVE GATTO replied that the level of health care in
Alaska "is what it is" until the federal mandate to purchase a
specific product. He declared that it was not necessary to
contact DHSS, as the statute model addressed the Tenth
Amendment, not health care.
4:37:43 PM
CO-CHAIR HERRON asked if the attorney general or the governor
had indicated they were going to move forward with action
against the federal government, regardless of the outcome of HB
423.
4:38:14 PM
REPRESENTATIVE GATTO replied that he had talked with the
attorney general, who "was notably quiet." He opined that the
attorney general was not at liberty to disclose anything about
his investigation.
4:39:19 PM
CO-CHAIR KELLER closed public testimony.
4:39:47 PM
CO-CHAIR KELLER opined that HB 423 was not a health and social
services bill, but was a bill about the freedom to choose where
an individual received health care service.
4:40:27 PM
REPRESENTATIVE CISSNA expressed her concern, especially as she
had not heard from DHSS. She declared that she still had
questions.
4:41:37 PM
CO-CHAIR KELLER asked to clarify that Representative Cissna
would ask DHSS if the attorney general's involvement would
affect health care.
4:41:56 PM
REPRESENTATIVE SEATON said that HB 423 was an Alaskan statute,
not federal, which related to the freedom to choose or decline
health care services in Alaska. He referred to Mr. Bailey's
testimony that it did have interactions with how health care was
practiced. He expressed the need to hear from DHSS. He stated
that he was focused on the impact of HB 423 on Alaska and its
health care.
4:44:05 PM
REPRESENTATIVE SEATON, in response to Co-Chair Keller, said that
the HB 423 language was for both the freedom to choose to secure
or choose to decline health care services.
4:44:24 PM
CO-CHAIR KELLER said that health care services were defined on
page 2. He opined that it not take away the choice of the
individual.
4:44:45 PM
REPRESENTATIVE SEATON emphasized to Co-Chair Keller that Dennis
Bailey, attorney, had stated that was not correct. He pointed
to Mr. Bailey's testimony which stated that involuntary
commitment to a mental health facility, vaccinations, and
immunizations were included in the bill. He opined that the
bill covered all the health care services offered by the state.
4:45:48 PM
CO-CHAIR KELLER said that the health care services definition on
page 2 was for care of physical or mental disease. He opined
that this was the care of society, not the care of a person. He
allowed that he had a different interpretation than
Representative Seaton.
4:46:18 PM
CO-CHAIR HERRON requested to hold HB 423.
4:46:53 PM
CO-CHAIR KELLER requested a vote on HB 423.
4:47:07 PM
REPRESENTATIVE T. WILSON said that HB 423 allowed a person the
right to choose any mode of health care services. She opined
that the bill was about the right to choose whether or not to
have health care coverage. She declared a desire to keep that
option open. She said that HB 423 did not solve the dilemma of
non-payment for emergency room use. She offered her belief that
the attorney general would determine whether or not there was a
case to be made against the federal government. She opined that
HB 423 reflected the concern of Alaskans.
4:49:17 PM
REPRESENTATIVE SEATON, in response, emphasized that nothing in
HB 423 mentioned the federal government. He pointed out that it
stated the attorney general would take the appropriate action to
defend HB 423 against the DHSS. He emphasized that HB 423 did
not mention the Tenth Amendment, or anything against the federal
government. He offered his belief that it was necessary for DOL
and DHSS to testify as to the effect of HB 423 on health care
services in the state of Alaska. He opined that a lawsuit and
the imposition of the Tenth Amendment were solely
interpretations of the bill, and not in the bill language. He
stated that he could not support HB 423 without further
testimony to its implications.
4:51:16 PM
REPRESENTATIVE LYNN said that everyone wanted good health care,
but he opined that the question was to the constitutionality.
He opined that only the US Supreme Court could make that
determination, and it would be necessary for a case to be
brought to the Supreme Court. He urged that HB 423 be forwarded
to the House Judiciary Standing Committee for further
discussion.
4:52:52 PM
CO-CHAIR KELLER opined that HB 423 was a very simple statement
for the attorney general to defend the right to choose.
4:54:00 PM
The committee took a brief at ease.
4:55:39 PM
REPRESENTATIVE LYNN stated a necessity to advise the attorney
general whether to move forward with a lawsuit.
REPRESENTATIVE CISSNA expressed her concern that, as this was
the first hearing for this bill, she had not heard all sides.
She stated the necessity for knowledgeable testimony from DHSS
and she expressed a concern for unintended consequences. She
pointed out that "going slow is a good process in this where
we're actually affecting people's lives."
4:57:56 PM
CO-CHAIR KELLER opined that this was stopping the process, and
he was unwilling to do that.
4:58:41 PM
REPRESENTATIVE T. WILSON offered her belief that it was
necessary to keep the process moving.
4:59:27 PM
REPRESENTATIVE GATTO said that he was trying to be responsible
and he offered that it was appropriate to delay HB 423 for one
more meeting.
5:00:15 PM
REPRESENTATIVE SEATON agreed, but he requested that DHSS be
available for testimony to the health care ramifications of HB
423. He opined that it was not a function of the legislature to
institute a lawsuit. He emphasized that a statute had long term
implications.
5:01:46 PM
CO-CHAIR KELLER asked that Representative Seaton introduce any
amendments to the bill.
5:02:40 PM
[HB 423 was held over.]
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB423pckt.PDF |
HHSS 4/6/2010 3:00:00 PM |
HB 423 |
| SB10pckt.PDF |
HHSS 4/6/2010 3:00:00 PM |
SB 10 |