Legislature(2011 - 2012)CAPITOL 120
04/04/2011 01:00 PM House JUDICIARY
| Audio | Topic |
|---|---|
| Start | |
| HB168 | |
| HB1 | |
| HB6 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 161 | TELECONFERENCED | |
| += | HB 168 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 1 | TELECONFERENCED | |
| += | HB 6 | TELECONFERENCED | |
HB 1 - POLICY FOR SECURING HEALTH CARE SERVICES
1:40:07 PM
VICE CHAIR THOMPSON announced that the next order of business
would be HOUSE BILL NO. 1, "An Act stating a public policy that
allows a person to choose or decline any mode of securing health
care services." [Before the committee was CSHB 1(HSS), as
amended on 4/1/11.]
1:40:17 PM
REPRESENTATIVE PRUITT moved to adopt the proposed committee
substitute (CS) for HB 1, Version 227-LS0006\B, Bailey, 4/1/11,
as the working document.
REPRESENTATIVE GRUENBERG objected.
1:40:46 PM
KAREN SAWYER, Staff, Representative Carl Gatto, Alaska State
Legislature, on behalf of Representative Gatto, one of the
bill's joint prime sponsors, explained that Version B
incorporates an amendment made to CSHB 1(HSS) during the bill's
last hearing. Under that amendment - which altered both
proposed AS 44.99.130(a) and the title - the word, "choose" was
replaced with the word, "accept", and the word, "offered" was
added. The proposed state policy under Version B now says in
part, "a person has the right to accept or decline any offered
mode of obtaining health care services".
REPRESENTATIVE GRUENBERG removed his objection.
VICE CHAIR THOMPSON, noting that there were no further
objections, announced that Version B was before the committee.
MS. SAWYER, to briefly recap, explained that HB 1 pertains to
the federal Patient Protection and Affordable Care Act (PPACA),
and offered her belief that the PPACA is going to mandate that
all individuals have qualifying healthcare insurance or pay a
tax penalty. Specifically, HB 1 is proposing to establish a
state policy that a person has the right to accept or decline
any offered mode of obtaining healthcare services without
penalty or threat of penalty. She also noted that a change made
in a prior committee specifies that as used in proposed
AS 44.99.130, the term, "penalty" does not mean liability for
the cost of healthcare services.
VICE CHAIR THOMPSON, offering his understanding that the bill is
intended to address the issue of [healthcare] insurance,
expressed dissatisfaction that the bill's language instead
focuses on healthcare services, and characterized this
discrepancy as confusing.
MS. SAWYER indicated that the bill was written as it was in
order to specifically address provisions of the PPACA.
REPRESENTATIVE HOLMES, offering her understanding that the
stated goal of the bill is to ensure that no one be required to
have healthcare insurance, pointed out that that's not what the
language of the bill actually says. Unintended consequences,
therefore, could result from passage of HB 1.
MS. SAWYER, relaying that HB 1 is based on model legislation
produced by the American Legislative Exchange Council (ALEC) and
being used by other states, agreed to research the issue
further. In response to a question, she said HB 1 was written
as if the PPACA is going to be found to be constitutional.
REPRESENTATIVE HOLMES pointed out, though, that if the PPACA is
found to be constitutional, HB 1 would be preempted, and if the
PPACA is found to be unconstitutional, then HB 1 won't be
necessary. Either way, isn't it that the bill will have no
actual effect?
MS. SAWYER offered her understanding that over 40 other states
thus far have either passed or are considering passing similar
legislation. The hope is that "all off this" will illustrate
that a number of states disagree that the federal government has
the right to mandate that a person either have healthcare
insurance or pay a tax penalty.
1:48:44 PM
SIGNE ANDERSON, Chief Assistant Attorney General - Statewide
Section Supervisor, Commercial/Fair Business Section, Civil
Division (Anchorage), Department of Law (DOL), concurred that if
the PPACA is found to be constitutional, federal preemption
would be an issue, but relayed that she was not prepared at this
point in time to say that the bill would have no effect at all.
REPRESENTATIVE HOLMES pointed out that regardless of whether the
PPACA is found to be unconstitutional, if passed, HB 1 would
still be in effect and therefore could still have unintended
consequences, particularly given that its language broadly
refers to healthcare services in general. If the bill is
intended as a statement of disagreement over provisions of the
PPACA, Alaska is already a party in the federal lawsuit, Florida
et al v. United States Department of Health and Human Services,
and so what more of a statement of disagreement than that is
necessary?
REPRESENTATIVE GRUENBERG asked why the bill, via Section 1, is
proposing to add a short title to uncodified law. He offered
his understanding that except in situations involving interstate
compacts and uniform Acts, providing for a short title was just
not done. He asked whether the [joint prime sponsors] would
object to deleting Section 1 of HB 1.
MS. SAWYER, noting [the joint prime sponsors'] absence, relayed
that she would be unable to speak for [them] on this issue at
this time.
REPRESENTATIVE GRUENBERG expressed a preference for not
including a short-title provision. Observing, then, that
proposed AS 44.99.130(b)(2) says that the proposed state policy
may not impair a contract right that provides healthcare
services, he asked whether any federal law requiring a person to
have or purchase healthcare insurance would simply become part
of [employment] contracts as an "implied-in-law" provision,
thereby rendering HB 1's proposed state policy inapplicable.
MS. ANDERSON - noting that under Alaska's insurance laws, such a
requirement by the state would be implied in [employment]
contracts - relayed that due to her nescience regarding federal
jurisprudence, she is unable to say whether such would also be
the case with federal law.
REPRESENTATIVE GRUENBERG surmised, then, that that issue still
needs clarification, particularly if the PPACA does contain such
a requirement.
REPRESENTATIVE HOLMES asked whether the Department of Health and
Social Services has any concerns that HB 1 would have a negative
impact on other federal programs such as Medicaid or Medicare.
1:57:07 PM
JON SHERWOOD, Medicaid Special Projects, Medicaid and Health
Care Policy, Division of Health Care Services, Department of
Health and Social Services (DHSS), said he is unable to speak to
the question of whether Medicare would be impacted, because it's
a federal program that the DHSS is not involved in the
administration of, but with regard to the question of whether
the bill would impact other state, and state and federal
programs - such as Medicaid - he said he'd specifically asked
the Department of Law (DOL) whether the exemption provided for
via proposed AS 44.99.130(b)(1) would be adequate for the DHSS's
purposes, including its child support enforcement efforts - a
linked requirement for certain assistance programs - and the
DOL assured him that the exemption was adequate for the purpose
of allowing the DHSS to continue administering its programs. In
response to another question, he said it was his understanding
that the PPACA's tax penalty would apply to someone who doesn't
have health insurance or some other means of obtaining
healthcare - such as through the Indian Health Service (IHS),
for example - and that that's why the bill uses [the phrase,
"mode of obtaining health care services"].
REPRESENTATIVE HOLMES shared her concern that regardless of the
joint prime sponsors' intent, the language of the proposed state
policy could be interpreted as allowing for something that's
contrary to public policy or current law.
VICE CHAIR THOMPSON, reiterating his concern that the proposed
state policy doesn't specifically reference healthcare
insurance, again characterized this lack as confusing.
REPRESENTATIVE GRUENBERG questioned whether the bill isn't
simply stating legislative intent.
MS. SAWYER said she is unable to speak to whether that's what
the drafter intended when he chose to address [the joint prime
sponsors' concerns about the PPACA] via the proposed state
policy.
REPRESENTATIVE GRUENBERG said that's how he is interpreting the
bill, and is therefore questioning how, as a practical matter,
[the proposed state policy] would be applied and whether it
establishes a statutory right.
MR. SHERWOOD indicated that because of the exemption laid out in
proposed AS 44.99.130(b)(1) and because the programs offered by
[the DHSS] are generally authorized via statute, the DHSS would
not be bound by HB 1's proposed state policy, and this is why
the DHSS submitted a zero fiscal note for HB 1.
2:07:01 PM
REPRESENTATIVE GRUENBERG asked what the joint prime sponsors
intend for the bill to actually do.
MS. SAWYER, in response, said the joint prime sponsors don't
believe an individual should be mandated by the federal
government to purchase a particular product, and instead believe
that to then penalize that individual for not doing so would be
another error.
REPRESENTATIVE GRUENBERG pointed out, though, that it's the
federal courts that are responsible for addressing the
provisions of the PPACA and any constitutional questions that
arise. Given that under the Supremacy Clause, the state is
required to follow federal mandates, wouldn't the joint prime
sponsors' beliefs regarding the PPACA be better addressed via a
house joint resolution urging the federal government to change
the PPACA, or urging the state to challenge the provisions of
the PPACA? "I don't think that this has any authority -- we
can't ... have the kind of effect on federal law and the federal
Constitution that you're saying you want this bill to have," he
concluded.
MS. SAWYER offered [the joint prime sponsors' belief] that
healthcare insurance isn't something the federal government
should be mandating, that that duty instead lies with the state.
To address the concern about the language of the proposed state
policy possibly being interpreted as allowing for something
that's contrary to public policy or current law, she noted that
proposed AS 44.99.130(c)(2) defines the term, "mode of
obtaining" in part as meaning directly purchasing healthcare
services from a healthcare provider.
2:11:17 PM
PATRICK LUBY, Advocacy Director, AARP Alaska, stated that the
AARP opposes HB 1. He then offered his belief that individuals,
businesses, and government entities/programs that have, offer,
or administer a healthcare insurance plan, end up picking up the
shifted healthcare costs incurred by the uninsured. Not
complying with the provisions of the PPACA will only allow this
practice of cost-shifting to continue, and for this reason, the
AARP is requesting a "No" vote on HB 1. In response to a
question, he offered his belief that the possible benefits
afforded by the provisions of the PPACA won't be realized unless
everyone participates - that's the whole purpose of group
healthcare insurance; the more people who have healthcare
insurance, the less healthcare services and healthcare insurance
will cost everybody. In response to other questions, he said he
agrees that everyone should be mandated to have healthcare
insurance, but acknowledged that to some extent, cost-shifting
also occurs when particular individuals - regardless of whether
they already have healthcare insurance - require
expensive/extensive healthcare services.
REPRESENTATIVE KELLER suggested that because the AARP offers
supplemental Medicare insurance, Mr. Luby has a conflict of
interest.
REPRESENTATIVE HOLMES pointed out, though, that those on
Medicare would be considered to already have healthcare
insurance and thus wouldn't be required under the PPACA to
purchase more healthcare insurance, either through the AARP or
elsewhere.
2:17:32 PM
VICE CHAIR THOMPSON, after ascertaining that no one else wished
to testify, closed public testimony on HB 1, and announced that
HB 1 would be held over.
REPRESENTATIVE KELLER offered his belief that under HB 1's
proposed state policy, a person employed by a company that
provides its employees with healthcare services would have the
right to either accept or decline such services without penalty
or threat of penalty. In conclusion, he said he would like the
legislature to establish the right policy for Alaska and its
citizens.
[HB 1, Version B, was held over.]
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB168 Proposed Amendment B.2 03-29-11.pdf |
HJUD 4/4/2011 1:00:00 PM |
HB 168 |
| HB1 CS Version B 04-01-11.pdf |
HJUD 4/4/2011 1:00:00 PM |
HB 1 |
| HB6 CS Version R WORK DRAFT 03-25-11.pdf |
HJUD 4/4/2011 1:00:00 PM |
HB 6 |
| HB6 Draft Amendment Keller 1 03-21-11.pdf |
HJUD 4/4/2011 1:00:00 PM |
HB 6 |
| HB6 Draft Amendment Keller 2 04-04-11.pdf |
HJUD 4/4/2011 1:00:00 PM |
HB 6 |
| HB6 Draft Amendment Keller 3 04-04-11.pdf |
HJUD 4/4/2011 1:00:00 PM |
HB 6 |
| HB6 Explanation of Changes Version T to R 04-04-11.pdf |
HJUD 4/4/2011 1:00:00 PM |
HB 6 |