Legislature(1999 - 2000)
03/19/1999 03:30 PM House L&C
| Audio | Topic |
|---|
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
HB 121 - DENTAL CARE INSURANCE
Number 1318
CHAIRMAN ROKEBERG announced the committee's next order of business
is HB 121, "An Act relating to patients' rights under a health care
insurance plan or contract providing coverage for dental care, and
prohibiting certain practices by health care insurers relating to
dental care." The chairman noted in the meeting's opening
statements that the committee would take public testimony on HB 121
at this hearing, discuss a future hearing, but not move the
legislation at this time. Chairman Rokeberg invited the bill
sponsor forward.
Number 1326
REPRESENTATIVE CON BUNDE, Alaska State Legislature, came forward.
He noted the short title of HB 121 would be "Dental Patients' Bill
of Rights." This legislation is about allowing Alaskans the right
to maintain a high level of dental care. It is about allowing
Alaskans the options and flexibility in their dental care. It is
about continued access to the best care the patients and their
dentists think is appropriate. At root, he thinks it is about
quality versus quantity. It allows consumers to choose any dentist
they wish to see, including specialists. It prohibits insurers
from reimbursing a covered person at a different rate because of
the person's choice of dentist. It gives covered people the right
to receive full information regarding their care options, without
fear of adverse actions from insurance companies. It allows
patients to take civil action against health care insurers to
enforce their rights and requires any dental treatment plan review
or utilization review to be conducted by a dentist. While it is a
dental patient bill of rights, Representative Bunde commented it is
also a small business bill of rights.
REPRESENTATIVE BUNDE noted the vast majority of dental practices
are small businesses. He indicated Alaska is, and ought to be,
somewhat protective of its small businesses. Alaskans should have
some concerns about what large out-of-state corporations might do
to reduce Alaskan small businesses' opportunity to make productive
livings and contributions to Alaskans. Representative Bunde said
he is presenting the bill from both the patients' point of view and
the rights of small businesses in Alaska. He commented on a common
tendency to elevate health care professionals to a pedestal, not
recognizing they have basic human needs. He noted one of dentists'
needs are to have successful and profitable businesses. With that,
Representative Bunde commended HB 121 to the committee. It
protects average Alaskans and their rights to quality dental care
and it protects the Alaskan small business.
Number 1485
REPRESENTATIVE HALCRO asked if there is a problem with the current
level of care.
REPRESENTATIVE BUNDE replied there is a problem with the quality of
care, noting he had indicated the quantity/quality concerns. He
mentioned the possibility of problems with quality care if
patients' access and amount of time with their dentist is limited,
if the bottom line and the impact on large corporations are the
only concerns. Representative Bunde indicated this is being looked
at as preventative legislation, drawing the analogy to dentistry's
common focus on preventative rather than restorative.
REPRESENTATIVE HALCRO mentioned the committee's previous hearing of
the Mental Health Parity Task Force Report [February 22, 1999]
which recommended that the state mandate mental health care.
Representative Halcro said the report had statistics showing a
current problem existed with people not getting covered and the
associated costs, albeit the supporting numbers were from
out-of-state. He commented the supporting letters in the bill
packet are all from dentists and he questioned if there has been
any correspondence or outcry for this to be changed.
Number 1568
REPRESENTATIVE BUNDE replied it is more preventative than
restorative, as he had said, but he noted Dr. Logan [President,
Alaska Dental Society] could give more direct information.
Representative Bunde said there is also a patient online to
testify.
CHAIRMAN ROKEBERG commented on the sponsor's point that the
legislation may be the small business bill of rights. The chairman
noted the first goal of the Labor and Commerce Committee [House
Labor and Commerce Standing Committee] is the protection of small
business. He said a 180 degree shift could be made; small business
could be negatively impacted by this bill because of an inability
to get cheaper health care. The chairman indicated this is not
necessarily his belief but he thinks the sponsor will receive that
argument.
Number 1615
REPRESENTATIVE BUNDE replied it is a matter of quality or quantity.
He noted a person could get some very inexpensive dental care if he
or she did not want to have access to specialists, spend more than
two minutes with the dentists, and have accountants in Milwaukee
making decisions about his or her care. Representative Bunde said
he thinks the compromise lies in the middle.
CHAIRMAN ROKEBERG asked if he knew from discussions with the dental
society how many people in the state have dental care, whether
ERISA [federal Employee Retirement and Income Security Act],
non-ERISA or total.
REPRESENTATIVE BUNDE pointed out HB 121 would not cover anyone with
an ERISA policy. He indicated he would refer the question to Dr.
Logan.
CHAIRMAN ROKEBERG announced that for four years the committee has
been trying unsuccessfully to find out how many people in Alaska
are either insured or non-insured, and what type of insurance they
are covered under. The chairman mentioned concerns with specific
issues that have negative impacts, and problems with legislation
that creates an insurance mandate. He asked, however, if it would
be a fair characterization that this is a bill of choice rather
than a mandate.
Number 1694
REPRESENTATIVE BUNDE agreed. Regarding the chairman's comment
about numbers, Representative Bunde noted the numbers are difficult
to get from various sources. He stated he believes all businesses
have a right to make a profit, indicating he does not wish economic
harm to either an insurance company or to a dentist. Most
importantly, he doesn't want the patient to be negatively impacted.
Using the 'no such thing as a free lunch' analogy, Representative
Bunde commented he is not coming before the committee with the idea
he is going to create the expectations in Alaskans seeking dental
care that there is a free lunch.
CHAIRMAN ROKEBERG thanked both the sponsor and his staff member,
Patti Swenson, for their presence. The chairman said the committee
would next take teleconference testimony from Anchorage.
Number 1775
JANET OATES, Director of Government Relations, Providence Health
System, testified via teleconference from Anchorage in opposition
to HB 121. Ms. Oates spoke from a prepared statement:
"Providence expresses concern about HB 121. We certainly
understand that dentists are worried about protecting
their incomes. But at the same time we urge you to
consider the needs of many Alaskan businesses who are
doing their best to provide health and dental benefits to
their employees.
"Contracting for preferred provider relationships has
been a significant factor in keeping insurance and health
industry rates from spiraling out of control in Alaska.
And those of you who've heard us testify in the past know
how it works: it's basically a negotiated discount
pricing in exchange for patient volume. This bill would
eliminate the possibility of that approach in dental
coverage.
"We've also commented in the past about the issue of
choice. And this bill talks about the covered person's
choice. But it doesn't address the choice of an employer
who offers a dental benefit and may well be covering a
significant portion of the cost. When it comes to
choosing no dental benefit or a benefit with a certain
list of preferred providers, we suspect that many
employers - and employees - would go with the latter.
This bill interferes with an employer's opportunity to
choose and manage affordable benefit package[s] which
then in turn reduces access to care for many Alaskans.
"Providence isn't in the dental business, but as one of
the state's largest employers we know a lot about the
cost of providing health and dental benefits to our own
employees. And as a health care provider, we know the
number of uninsured adults in Alaska remains high, and we
would concur with reports we've seen that that number is
about 80,000 or more Alaskans. And from both
perspectives - as an employer and as a health care
provider - we really caution you against taking actions
that discourage employers from offering decent health and
dental plans. And we humbly suggest that Representative
Bunde's bill would have exactly ... an opposite effect
from that which he's seeking. In health care, quantity
equals experience, and experience equals quality.
"Last year we saw the chiropractors carve out their own
protection in SB 197. This bill carves out special
protection for dentists. This isn't the path to greater
health access for Alaskans and we urge you not to pass
this bill."
Number 1903
CHAIRMAN ROKEBERG asked about the 80,000 figure Ms. Oates used.
MS. OATES indicated the figure of 80,000 uninsured adults came out
of state and Medicaid figures and percentages of Providence's
patients. Providence feels that figure is pretty accurate.
CHAIRMAN ROKEBERG confirmed Ms. Oates agreed one of the Alaska's
biggest problems is the state's large uninsured population. He
asked if Providence is the state's largest employer.
MS. OATES indicated she believes they are the second largest
private employer after Carr-Gottstein Foods Company/Safeway
Incorporated. In response to the chairman's further questions
about the benefits Providence provides to its employees, Ms. Oates
explained employees can choose from several plans, and they do
offer comprehensive dental benefits at three levels. She noted
Marci Burton could probably describe those levels better. Ms.
Oates said Ms. Burton is in charge of Providence's benefit and
coordinated care plans.
Number 1975
MARCI BURTON, Regional Director for Managed Care and Physician
Integration, Providence Health System, testified next via
teleconference from Anchorage. Providence currently offers its
employees four plans. One is a coordinated care plan which
functions much like a point-of-service plan. Employees can choose
to go to a primary care provider and have their care directed by
that provider. If the employees go through that provider and use
the referrals directed by the provider, care is covered at 80
percent, a larger percentage. However, the employees can also go
to any provider of the employees' choice. Benefit coverage still
exists but is provided at a lesser rate. Providence's other three
plans are straight indemnity plans with varying degrees of
deductibles.
REPRESENTATIVE BUNDE noted, in regards to the 80,000-plus figure
given for Alaskans without health insurance, that many Alaskans may
have chosen a self-reliant lifestyle, away from government, which
makes them unlikely to be involved in any business that would
provide any health coverage. He indicated care must be taken not
to deny this reality, and commented he thinks there will always be
a large percentage of Alaskans who are not in any insurance pool.
Representative Bunde noted this unfortunately causes those who are
in the insurance pool to pay more, but this freedom of choice
exists. Representative Bunde reiterated that although health care
might have a revered status, it is still a business and health care
will not exist if practitioners and providers do not stay in
business. He indicated small providers in many communities go out
of business when large entities begin competing; he doesn't know
that encouraging this situation produces better dental care.
Number 2080
REPRESENTATIVE HALCRO asked Ms. Oates if Providence's dental care
is in the form of a PPO [preferred provider organization].
MS. OATES replied it is not, and she is not aware of any plan in
the state that has a preferred provider relationship for dentists.
She indicated she understands this legislation is concerned with
future possibilities in regards to dentists.
CHAIRMAN ROKEBERG asked Ms. Burton to send the committee a copy of
Providence's employee dental coverage, thanking both Ms. Oates and
Ms. Burton for their participation.
Number 2143
WILLIAM FELL, DDS, testified next via teleconference from Anchorage
in support of HB 121. He is an Anchorage dentist and belongs to a
national board, Alliance for Dental Reimbursement Plans, which is
mainly a patients' rights organization. Dr. Fell indicated he has
been working on this issue for many years. For years the providers
have (indisc.) law that they cannot charge a different fee for
patients in an insurance system compared to a non-insurance system.
They are mandated to charge the same fee. House Bill 121 mandates
the insurance companies to reimburse at the same fee, making a fair
playing field. Dr. Fell refuted Ms. Oates' analogy that quantity
equals experience and experience equals quality. He noted it
certainly does not work that way in dentistry.
DR. FELL described that to make a profit under a low fee system, a
dentist has to see a lot of patients and spend a very short time to
accomplish things. The dentist can either speed up his/her work
which often puts the dentist beyond his/her highest quality levels,
or delegate some of the procedures to incompletely-trained
ancillary personnel. As a result, if the dentist performs this
kind of service day in and day out, he/she loses proficiency at the
more difficult tasks. Therefore, in dentistry quantity does not
always result in experience that allows a dentist to improve
his/her quality. His experience is that most practitioners working
in these facilities become disgusted with their competency level.
DR. FELL indicated this practice may work in an emergency room, but
not in dentistry if it is necessary to generate income from every
procedure. Time is needed to do it correctly. Dr. Fell noted it
would be an unfair situation, and would not be tolerated in the
state, if a person receives $1,000 for his/her Permanent Fund
Dividend if it is spent at a state store but only $800 if it is
spent at COSTCO [COSTCO Wholesale Corporation]. He commented this
legislation is just making it a fair relationship for the patient.
The patient would be receiving equitable treatment from not only
the provider but also from the insurer.
Number 2268
REPRESENTATIVE HALCRO asked if Dr. Fell had lost any patients due
to this.
DR. FELL replied patients usually feel the insurance company
represents and protects them, but the reality of the relationship
is that it is profit-driven from the insurance company's side. He
indicated he thinks an unfair relationship exists and it probably
does have adverse effects on dentists' patients. He described that
an insurance company practice is to send patients letters telling
them the services rendered are above normal and customary fees
without any justification in terms of [the fees of] corresponding
other dentists in the specific area. This puts the dentists into
an adversarial role with their patients - the patients are being
told the dentists are somehow untruthful or unjust with regards to
the patients' treatment. Dr. Fell indicated this misunderstanding
is usually resolved but it still puts a strain on the
dentist-patient relationship. He is sure that over 30 years of
practice some patients, who had trusted him previously, have not
returned because of a letter from an insurance company.
CHAIRMAN ROKEBERG asked, in the way dental coverage is usually
written, does the patient usually seek preapproval or does Dr.
Fell's office contact the insurer. He noted his cost concern about
the bill's current language regarding the utilization review
approval in the first instance by a peer-level dentist.
Number 2361
DR. FELL responded his office tries to provide that service for
each patient who wants it done. As a courtesy and good business
policy, his office submits the proposed procedure(s) to the insurer
and the insurer sends back an estimate of coverage. He noted
sometimes a patient knows his/her coverage for a specific procedure
from past experience, so a predetermination is not necessary before
treatment. Dr. Fell described his frustration with an out-of-state
reviewer in one situation. He had performed a particular procedure
and corrected the problem for less than the allowed amount but the
insurer refused to pay. Dr. Fell indicated he had performed
appropriate care for the patient and the patient was satisfied, but
the reviewer said the insurer would not cover the procedure. Dr.
Fell said the reviewer refused to reveal whether or not he was
actually a dentist and became angry when asked how many years he
had been in practice. Dr. Fell indicated review by an experienced
dentist is sometimes appropriate; he expressed his amazement the
insurer would refuse to pay for something that cost less money and
solved the problem.
CHAIRMAN ROKEBERG asked, "Correct me if I'm wrong, but you're
saying that when you got preapproval, authorization, and (indisc.)
estimate - and in this instance, the refusal to pay and you made an
inquiry - you talked to a person at the end of the phone ... And
so you weren't sure what level of competency they had?"
Number 2451
DR. FELL agreed he had spoken by phone; he indicated one has no
ability to determine the reviewers' competency levels. In a recent
incident a particular carrier had hired an outside dentist as an
independent adviser. Dr. Fell noted that relationship was very
good: the other dentist was open about his experience, listened to
Dr. Fell, and agreed he had performed the correct procedure.
However, a number of times they speak with people who may not be
dentists or who refuse to reveal it if they are.
CHAIRMAN ROKEBERG asked if there is any utilization review done in
Alaska rather than somewhere in the Lower 48.
Number 2489
DR. FELL replied, "I used to be a Blue Cross representative for a
period of time and I think Blue Cross still has -- and some of the
other carriers may have up here, but what's the amazing thing that
a lot of people don't know is most..." [TESTIMONY INTERRUPTED BY
TAPE CHANGE]
TAPE 99-27, SIDE B
Number 0001
DR. FELL continued, "... dentists in terms of quality of work or
whether it was appropriate work, it really comes down to peer
review which is a voluntary organization made up of Alaska
dentists. And we solve those problems and do not assess the
patient the fee for it. And it's always been that way. And so the
real protector -- and on our board, we have a lay person that
represents non-dental interests, and it's amazing, many times the
lay person (indisc.) partisan to this is the one that tells the
reviewing dentist to back off. ... In grade school they ask you to
pass your paper to the left, you usually got a tougher grading job
from your peers than you did from the instructor." Dr. Fell thinks
the dentists belonging to the peer review system are doing their
very best to assure quality of care. He indicated the attempt is
always made to be fair on both sides and the presence of a lay
person assures that it will be a fair judgement.
Number 0045
CHAIRMAN ROKEBERG asked Dr. Fell if he has ever been approached to
join any kind of a managed care organization, or to provide limited
service, or [service] to a limited group of people.
DR. FELL replied he has a significant file of all the offers. He
always tries to keep an open mind because he has patients who
belong to these groups and he is not opposed to the concept of a
PPO, HMO [health maintenance organization], et cetera. His main
desire is that it be open-ended, which this bill would somewhat
ensure: if someone leaves [the plan] he/she will be reimbursed at
the same level. Unfortunately, he hasn't found one that reimburses
at a rate he could afford for the amount of time the procedures
take him. Dr. Fell noted he accepts the lower Medicaid and
Veterans Administration set reimbursement levels without question
because the patients need the assistance or have served their
country; he does that because he thinks it is part of what is
right.
CHAIRMAN ROKEBERG asked if he knew of panels of dentists working in
Alaska.
DR. FELL replied there are some organizations with a list of
selected dentists that they prefer their employees to use. This
fits his definition of preferred provider organizations. ARCO
[ARCO Alaska, Incorporated] and the Champus program [for military
dependents] have these, and there may be more. Dr. Fell indicated
one argument given is that if these organizations do not have
control over which providers the patient base use, they will not be
able to attract providers. However, as long as these organizations
provide the dentist enough to have an economically positive
relationship with the patient, they will always get their list of
preferred providers. For example, Concordia [United Concordia
Companies, Incorporated] initially offered an amount that would not
allow dentists' to cover their overhead. No one signed up.
Concordia threatened that it would bring its own dentists up, but
soon changed its fee schedule just enough so that a few dentists
joined. He commented the companies did not have to control
people's freedom of choice to get providers. Dr. Fell noted the
environment in Alaska is very competitive for dentists.
Number 0191
MARIANNE BURKE, Director, Division of Insurance, Department of
Commerce and Economic Development, came forward to comment on HB
121. As has been mentioned, HB 121 will not affect federal
programs like Champus or self-insured employers covered by ERISA
like ARCO. House Bill 121 will also not affect state self-insured
plans, any federal plan, or the Indian Health Service (IHS).
Noting that, Ms. Burke pointed out there is already legislation in
place dealing with a number of the bill's provisions; these bill
provision are redundant. No law prohibits choice and the division
has the statutory authority to enforce that. No plan can restrict
a patient's choice of health care provider, but there may be a
difference in reimbursement. No law permits "gag order" or less
than full disclosure. The division has statutory authority under
AS 21.36 to enforce prohibitions against such unfair trade
practices. This law has been in existence for quite a long time.
Ms. Burke noted the division has no record of receiving a complaint
from any Alaskan about a gag order regarding any type of insurance,
not just dental.
Number 0293
MS. BURKE agreed that utilization review should be performed by a
peer. Someone reviewing proposed treatment for a patient's dental
problem should be qualified to make those decisions. Ms. Burke
noted there is sufficient statutory authority currently and the
division has enforced this. In a market conduct examination on
health care providers done by the division about three years
previously, the division found the preliminary utilization review
was being done by registered nurses (RNs). This was corrected.
The division insists on peer-to-peer review. In response to the
chairman's question that the Alaska Statutes contain peer review
mandates for utilization review, Ms. Burke replied that if the
review is not done by a peer, it is an unfair trade practice and
the division would enforce it as such. In response to the
chairman's request, Ms. Burke agreed to provide the committee with
the line of reasoning, statutory reference, supporting case law,
and the specific market conduct examination. Ms. Burke continued
that HB 121, as written, would require the dentist performing the
review to be Alaska-licensed. Nothing currently requires the
person reviewing proposed treatment to have state licensure; she is
not currently aware of any state requiring this.
Number 0414
CHAIRMAN ROKEBERG said he did not believe the legislation mandated
that the dentist be in Alaska. He referred the question to
Representative Bunde.
REPRESENTATIVE BUNDE indicated the legislation just says "dentist".
MS. BURKE referred to the last definition in the bill, subsection
(e), "(e) In this section, "dentist" means a person licensed in the
state to practice dentistry."
CHAIRMAN ROKEBERG agreed he sees the point. He noted he does not
think that was the intent and the definition could be corrected.
REPRESENTATIVE BUNDE indicated there may be reciprocity on
licenses; the legislation doesn't specify the dentist must reside
in the state.
Number 0461
MS. BURKE continued. She thinks the heart of HB 121 is the
restriction on an insurer from directly or indirectly reimbursing
a covered person at a different rate because of the person's choice
of dentist. Ms. Burke agreed with the previous testimony that this
is the core of controlling health care cost. For example, the
state's mental health plan has a similar provision which helps the
state manage and control spiraling health care costs. Ms. Burke
indicated health care costs in Alaska are spiraling upwards. There
are no HMOs in Alaska. There has been enabling statute since 1990.
Although the division occasionally receives calls, Ms. Burke
indicated Alaska's geography and limited health care resources
deter the formation of HMOs. Only one city has more than two
hospitals. Even Anchorage probably does not have an excess of
specialists in any particular field. An excess of specialists
would be the core necessity for an HMO to be really effective. The
division does not know of any PPO for dental services in the
insured market although a number ERISA plans do have PPOs. State
legislation has no authority over ERISA plans. Ms. Burke described
that in a PPO the person paying for the care - the insurer or
employer - contracts with a health care provider for the provision
of care at a particular price. In exchange, the person receives a
higher reimbursement for using the contracted providers. The
savings are passed on to the employee or covered patient. No
limits are placed on the time the provider can spend with the
patient and the patient is not mandated to see a contracted
provider. Ms. Burke indicated the provision restricting an
insurer from directly or indirectly reimbursing a covered person at
a different rate because of the person's choice of dentist would
effectively eliminate those arrangements.
Number 0627
MS. BURKE indicated denial of coverage, cancellation of health care
policy, or other action against a covered person or dentist because
rights are asserted, are also unfair trade practices. The division
can and does enforce against those practices through its statutory
authority. Complaint forms are available through the Internet or
by calling the division. She assured the committee that when the
division becomes involved the insurance companies listen. The
companies do business in Alaska under a certificate of authority
issued by the division. Regarding the bill provision concerning
civil action, the division is not aware of any current prohibition
on this. In many cases involving health care the division has
recovered hundreds of thousands of dollars from insurers and has
been able to resolve disputes in favor of the consumer. Ms. Burke
noted the consumer is not always right but it is the division's job
to protect the consumer - to help even the playing field.
Number 0718
CHAIRMAN ROKEBERG commented that utilization review by Outside
companies on a contractual basis has been one of the biggest forms
of health complaints in the state for a number of years. He
questioned whether enforcing unfair trade practices theories
against these utilization review people is a new practice.
MS. BURKE responded that it has been around a long time and the
division routinely uses this. Ms. Burke indicates there is a real
misunderstanding about UCRs [usual-customary-reasonable]. This is
not saying that some health care provider is charging too much.
Many insurance contracts offer reimbursement at a percentage of
what is the "usual and customary" [charge for the service]. By
regulations, the "usual and customary" must be based on a
population large enough to have some validity. "Usual and
customary" must be based on Alaska data to the extent possible, but
Ms. Burke indicated Outside data may also be used if Alaska data is
insufficient. The division often receives complaints about "usual
and customary." Ms. Burke noted in a complaint the division first
examines the consumer's policy to see what it provides. She added,
"If it's only 80 percent of usually and customary, then it is
profitable under the terms of that policy." Ms. Burke indicated
she thinks consumers may not always understand, and the booklets
provided to them, especially by self-insureds, are not always very
clear on that matter.
Number 0829
CHAIRMAN ROKEBERG questioned if the ERISA umbrella could be pierced
for enforcement using the unfair trade practice theory.
MS. BURKE replied she really wishes she could, but ERISA has been
in existence since 1974 and has been tested by every state in one
way or another. It has gone all the way to the Supreme Court and
has consistently been upheld. She clarified for the chairman that
the unfair trade practices she has been speaking of are in Chapter
36 of the insurance statutes, Title 21 [AS 21.36], and are specific
to insurance.
REPRESENTATIVE HALCRO noted Ms. Burke had commented that the
division has received no complaints about any patients having any
choice issues.
MS. BURKE clarified that the division has not received any
complaints about insurance companies refusing to cover because
someone went to a dentist of his/her choice. She noted the
reimbursement level may be different. In response to
Representative Halcro's question about where he would go if he is
caught in a situation HB 121 is trying to prevent, Ms. Burke
replied this is the division's statutory responsibility; this has
been upheld by the supreme court. The division has authority over
insured plans, but not ERISA, state or federal plans. The division
routinely receives and handles complaints on any number of
different subjects; Ms. Burke stated she is very proud of the
division's record of successful and timely resolution. In response
to the chairman's query about letters he has sent, Ms. Burke noted
she thinks they have an appointment.
Number 1006
GORDON EVANS, Lobbyist for Health Insurance Association of America
(HIAA), came forward to testify in opposition to HB 121. He noted
HIAA is a national association of commercial health insurance
companies that provides health insurance for approximately 55
million Americans. About 260 companies are involved, but not all
are licensed in Alaska. Mr. Evans spoke from a prepared statement:
"HIAA strongly opposes House Bill 121, and with all due
respect to my friend, the sponsor of the bill, we feel
that HB 121 is really anti-consumer legislation. If
you'd let me dissect the bill paragraph by paragraph in
a speedy way I'll try -- actually Director Burke did much
of this already.
"... Sections (a)(1) and (c)(1) are so closely
intertwined that I'll discuss them together. Under
Section (a)(1), a health care insurance plan could not
include a provision prohibiting a person from obtaining
dental care services from dentist of the person's choice,
including a specialist. As you're probably aware,
managed care plans attract providers by guaranteeing
access to a specified pool of enrollees, and most health
plans now offer the option of ... going out of the plan's
provider network if the enrollee is willing to pay a
surcharge to make up for the added cost. And that's as
it should be, since out-of-network providers haven't
offered these enrollees the volume discount that others
get."
Number 1083
"... Proposed section (c)(1) which requires the same rate
of reimbursement regardless of choice of dentist would
make it very difficult for PPOs to negotiate discounts
with dentists in their network in return for a guarantee
that the network dentist receive a certain volume of
business. And these volume discounts are now one of the
primary ways that costs of care are kept down, even more
so than management of care.
"... This provision would make it difficult, if not
impossible, for health plans to allow enrollees to
benefit from these negotiated discounts and so consumers
ultimately will be the losers.
"HIAA has no problem with section (a)(2) which regards
information on treatment options. We believe a person
should be told which treatment options are in his or her
best interest. In recent years there's been a lot of
talk that people should be told ... what the care should
be for their conditions, and HIAA tells me they're at a
loss to understand why this is coming up because they
don't know that it's not being done. ..."
Number 1148
"With regard to section[s] (b) and (e) of the bill on
page 2, HIAA believes it's both unnecessary and unwise to
require that all utilization review decisions be
conducted by a dentist licensed in this state, and we
interpret [it] the same way .... It's unlikely that most
health plans can have a dentist licensed in Alaska review
all dental care utilization review decisions. Many of
these national plans have licensed dentists and other
licensed health care professionals perform the review,
but can't possibly have them all licensed in all states.
"And finally, Mr. Chairman, HIAA has problems with
section (c)(2) which would prohibit an insurer from
denying coverage, canceling a plan, or otherwise taking
action against either the insured or a dentist for
asserting a right described in the legislation, and also
with section (d) which would allow an insured to file
suit against the insurer to enforce the insured's rights
under the legislation. ... We believe the Division of
Insurance already has existing authority regarding unfair
trade practices which covers both circumstances, and
that's just what Director Burke just told you. ... [As]
a side comment, allowing private causes of action, or
pointing out that they may sue this when it's already
their right, could only serve to possibly further clog up
an oversaturated court system, and I say that as a
lawyer, that too many lawsuits have been filed already."
Number 1253
REPRESENTATIVE BRICE asked if Mr. Evans knew how many insurers in
the state provide dental coverage.
MR. EVANS replied he did not.
CHAIRMAN ROKEBERG asked Mr. Evans how many companies he represents.
MR. EVANS replied he represents the association. In response and
in response to the chairman's further question about how many of
the association's members do business in Alaska, Mr. Evans said he
believes there are 267 companies [in the association] and most of
them are licensed to do business in Alaska but do not do business
here. He commented that Aetna [Aetna U.S. Healthcare] is once
again a member of the association. Because Aetna has the state
employees, the company would naturally have a lot of policies.
CHAIRMAN ROKEBERG indicated that Aetna, however, is the third-party
administrator of the state's self-insured plan.
Number 1328
REPRESENTATIVE HALCRO asked how those companies headquartered in
the Lower 48 would be able to abide by subsection (b) - if the
dentist doing the review had to be "registered" [licensed] in
Alaska. Subsection (b) reads:
(b) A health care insurance plan or contract that
provides coverage for dental services that allows the
health care insurer to review a treatment plan or conduct
a utilization review must contain a provision that a
treatment plan review or utilization review relating to
dental care for a covered person receiving treatment in
this state must be conducted by a dentist.
MR. EVANS replied claims are usually sent to the company claim
office.
REPRESENTATIVE HALCRO questioned whether there was any local review
going on.
MR. EVANS replied generally not. He indicated some companies
might, but it just depends. Most of the insurance companies
contract with utilization review companies for this service, and
most of the utilization review companies are located in the Lower
48.
CHAIRMAN ROKEBERG questioned if the companies HIAA represents who
do business in Alaska are in conformance with the peer treatment
plan review and utilization review Ms. Burke indicated the Division
of Insurance enforces under AS 21.36.
MR. EVANS replied that is his understanding.
CHAIRMAN ROKEBERG questioned how that worked, asking if a person
telephoning speaks to the health care professional in that specific
field.
Number 1436
MR. EVANS said he could not answer completely. The general
practice is to get a peer - someone in that particular field.
However, he indicated he thinks there are probably times when the
reviewer may not be an exact peer.
CHAIRMAN ROKEBERG commented the biggest complaint seems to be
nurses making medical decisions. He expressed his concern, though,
that it is a waste of talent and manpower to have a fully-trained
person performing utilization review on the telephone for something
that is really an economic decision and approval matter. He thinks
it would be better if problems were appealed to a peer review, but
he noted he was unsure of the situation. The chairman asked Mr.
Evans if it would be his position that the peer review standard is
currently in place.
MR. EVANS answered in the affirmative.
CHAIRMAN ROKEBERG questioned whether enactment of HB 121 would
prohibit the establishment of a point-of-service style plan, or any
other kind of a managed care, restricted use panel.
MR. EVANS agreed that would be his interpretation. He indicated he
believes dentists' prices probably vary now. If the insurance
company is going to pay 80 percent of whatever the bill is, some
dentists will receive more than others.
Number 1664
GUY BELL, Director, Division of Retirement and Benefits, Department
of Administration, came forward. The division administers the
state health plans for active state employees and for retired
public employees. The division has just over 11,000 active state
employees in the division's active plan, plus their dependents; and
approximately 19,700 retired public employees and teachers, and
their dependents. The retiree dental plan is self-paid by the
retiree. About 13,000 retirees have opted for the
dental-vision-audio (DVA) plan for themselves and their dependents.
Being self-insured, the state is not legally subject to the
provisions of AS 21. However, for public policy reasons the state
has followed the requirements of Title 21. Mr. Bell noted the
legislature sets the policy and the state feels obligated to follow
that policy whether or not the legal obligation exists. The state
has no preferred provider arrangements with dentists and no
immediate plans to do so; a state employee or retiree can go to the
dentist of his/her choice. There are different plans with
different levels of coverage available, especially in the Select
Benefits component. Given that the state follows the legislature's
mandates, this legislation would foreclose the future offering, as
a way to control costs, of a point-of-service type option to active
employees or retirees. Mr. Bell confirmed to the chairman that the
retirees pay premiums for the dental-vision-audio plan. He
explained that the PERS [Public Employees' Retirement System] and
TRS [Teachers' Retirement System] medical systems provide medical
plans. Depending on a person's tier, the medical premium is paid
in full or part by the public employees' or teachers' retirement
funds. The DVA plan is separate and is entirely self-paid by the
retirees who have opted in.
Number 1870
CHAIRMAN ROKEBERG commented there is now somewhat of a managed care
arrangement on the vision (indisc.) certain restrictions, asking if
that is correct.
MR. BELL responded that a person enrolling in the Select Benefits
plan has two options: a full-service plan or a managed care plan.
In response to the chairman's question about a differentiation in
benefit, Mr. Bell answered that, yes, there is a small
differentiation in benefit. There is also about a $4 dollar
difference in premium per employee per month.
CHAIRMAN ROKEBERG indicated, then, the division would prefer to
keep the option open for some future type of managed care involving
dental coverage.
MR. BELL agreed.
Number 1973
DAVID LOGAN, DDS, President, Alaska Dental Society (ADS), came
forward to testify in support of HB 121. He noted he is a dentist
in Juneau. The idea behind HB 121 is to preserve basic patient
rights. Ms. Burke's testimony was that there is no current
provision allowing anyone to restrict freedom of choice, but there
was no mention that freedom of choice is guaranteed. Dr. Logan
stated he thinks the point is strong enough that it bears some
repeating, and perhaps some redundancy in legislation. He noted
the reasons for prohibiting gag clauses seem to be self-evident.
Regarding whether licensed dentists should review claims, Dr. Logan
indicated Ms. Burke testified the Division of Insurance's policy is
that it should be done under a peer system, where a dentist reviews
claims. Dr. Logan stated Mr. Evans, representing the overwhelming
majority of insurance plans within the state, said they don't think
it should happen. Dr. Logan indicated he feels something is being
withheld, noting, "If they think the dentists shouldn't be
reviewing the claims, and she says that's the requirement, I think
that also bears some redundancy in legislation."
Number 2079
DR. LOGAN stated HB 121 asks that patients not be discriminated
against by their insurance companies for financial considerations.
This is the most misunderstood part of HB 121 by far. The dentist
is going to see the same reimbursement regardless of the passage of
HB 121; it would not change the amount a dentist receives. The
patient is the one who suffers under the current system. When
patients see dentists outside of the panel they have a copayment to
meet. When patients see participating dentists there is no
copayment. House Bill 121 would not change this at all. Because
of the copayments, there will still be overwhelming financial
considerations for patients to continue seeing dentists involved in
the managed care plans. This will continue to ensure the viability
of PPOs and HMOs in this state. Dentists will still have the same
incentives to be members of these plans: a directed source of
patients in exchange for a discounted fee structure. House Bill
121 will not change this relationship in any way. The majority of
patients will continue to see participating dentists to avoid
copayments and dentists will participate to insure that steady
influx of patients. This bill seeks to address the small number of
patients who see a dentist outside of managed care plans. The
nonparticipating dentist fares no better or no worse under HB 121.
Number 2207
DR. LOGAN continued that everyone is only too aware of the high
costs of all parts of health care coverage including dentistry.
House Bill 121 is not an attempt to short-circuit the managed care
process. It is simply to ensure that patients covered by insurance
plans are treated fairly. Even though the financial provisions of
this legislation will affect only a small number of patients, these
patients' rights are no less important. Under the current system,
patients who see dentists outside of managed care panels receive a
double financial penalty. The patients have copayments to meet for
their treatment, which is fair and why there is an incentive to
stay with the plan. However, the patients are also forced to pay
the penalty costs between what is paid to plan dentists and what is
paid to nonparticipating dentists. This is the unfair part. Dr.
Logan reiterated that the dentist is paid the same regardless of
the passage of HB 121. He noted there are two possibilities for
how HB 121 would affect insurance companies: if the insurance
company has planned on all patients seeing participating dentists
then the company will see no revenue difference whatsoever.
However, if the insurance company has counted on reimbursing some
patients at a lesser rate because the patients went outside the
plan, the insurance company will see a revenue difference. Dr.
Logan stated, "If this is the case, they are no longer seeking to
control costs but to punish patients for seeking care from a
nonparticipating dentist, and they are pocketing the profit to be
made in that situation."
Number 2382
REPRESENTATIVE HALCRO asked if any of the Alaska Dental Society
members are in PPOs.
DR. LOGAN answered in the affirmative, noting he did not have any
numbers.
REPRESENTATIVE HALCRO asked if the Alaska Dental Society members in
PPOs are in support of the society's stance on the legislation.
DR. LOGAN replied he would not say they had 100 percent support
because they had not polled to that, but they had not talked to any
dentists who did not support this.
REPRESENTATIVE HALCRO noted part of the concern seems to be the
access to quality care and choice issues. Representative Halcro
mentioned the Alaska Bar Association as a governing body for
attorneys and indicated he wondered if there is a similar group for
dentists in the state. He thought Dr. Fell had mentioned a board
of peers or peer review.
Number 2469
DR. LOGAN replied that is a voluntary group. It can be initiated
either by the dentist or the patient. The Board of Dental
Examiners is the regulatory body overlooking the state's dentists.
REPRESENTATIVE HALCRO asked if he would go to the Board of Dental
Examiners if he, as a patient, had a question or complaint about
shoddy workmanship.
DR. LOGAN replied, "Or..." [TESTIMONY INTERRUPTED BY TAPE CHANGE]
[Tape log notes indicate Representative Halcro asked a further
short question about 'any complaints' during the tape change.]
TAPE 99-28, SIDE A
Number 0001
DR. LOGAN continued, "... I would say most of the complaints,
rather than be directed toward the dental society, are heard by
individual dentists .... As a general rule, when we receive
complaints at the dental society we encourage them to seek
remediation through the board. We're not equipped to deal with
their problems with insurance companies - that's not what the
dental society is there to function for. We would refer either, if
it's a quality issue, to the dental board, or if it's a problem
with the insurance company, to the insurance commission."
Number 0049
REPRESENTATIVE HALCRO apologized for not making himself clear. He
noted he is trying to ascertain if there is a problem out there
with quality care. Representative Halcro added, "So, I'm sorry,
didn't mean in general the society, I meant if I am a patient, I
have a concern about an individual dentist, I would go to the Board
of ... Dental Examiners. What has the history been the last couple
of years with regards to complaints regarding quality care?"
DR. LOGAN responded that would be information from the dental
board. Not all of that is public record; the only time that
becomes public record is when there is action taken against a
dentist.
CHAIRMAN ROKEBERG confirmed the teleconference connection had been
restored and noted there had been a miscommunication [the
connection was mistakenly switched off at the end of Dr. Logan's
formal testimony]. However, the chairman is not sure if more
testimony would be taken at this hearing due to time constraints.
Chairman Rokeberg asked Dr. Logan if peer-to-peer review is
actually working as a practical matter. The chairman noted from
the testimony heard that the state believes there should be
peer-to-peer review.
Number 0207
DR. LOGAN replied the current system certainly leaves a lot to be
desired. No matter how it is mandated in the law, how it actually
happens is a different matter, for a variety of reasons. There is
quite a delay between when a claim is submitted and when it finally
comes out of a review process.
CHAIRMAN ROKEBERG commented the legislation would revolutionize the
way utilization review is done in the state by requiring review by
an in-state dentist. He asked how that would happen and who would
bear those costs.
DR. LOGAN answered he does not think that was necessarily the
intention of the bill. The Alaska Dental Society supports having
a licensed dentist, wherever the dentist is licensed, review the
claims.
CHAIRMAN ROKEBERG confirmed the Alaska Dental Society was not fixed
on having an Alaska dentist.
DR. LOGAN noted they certainly would not object to having a
licensed dentist in the state do the claims, but their concern is
that somebody review the claims who has some dental knowledge and
who is also held accountable. Having an actively-licensed dentist
ensures both of those things. Dr. Logan indicated having a dentist
who was not actively licensed would not ensure accountability.
Number 0319
CHAIRMAN ROKEBERG questioned that when one initially telephones for
authorization on a procedure, it is almost like an accounting
problem.
DR. LOGAN replied there is no telephone authorization for dental
procedures. He explained that typically a pretreatment
authorization would be submitted with whatever documentation the
dentist has to support his/her determination that the treatment is
necessary. This goes through a review process and usually
somewhere between four to eight weeks later the dentist receives a
response. Dr. Logan indicated this process has remained the same
during his time in practice. In response to the chairman's comment
about the insurance companies Dr. Logan is used to working with,
Dr. Logan replied he does not think there is a huge difference
across the board. Overall, he thinks most insurance companies fall
into the four to eight week category.
CHAIRMAN ROKEBERG stated, then, because of the slow process of
dental preapproval, the panel could very well have a licensed
dentist. He asked what the normal appeal procedure is if there is
a dispute about whether or not the insurer will authorize or about
the level of reimbursement.
Number 0423
DR. LOGAN answered it is a very good question. Essentially, the
dentist resubmits the claim which undergoes a review process at the
insurance company. Using the 'fox guarding the henhouse analogy,'
Dr. Logan noted the insurance companies are reviewing their own
work so the dentists have no idea what takes place or how it is
arrived at.
CHAIRMAN ROKEBERG asked if they were speaking more of elective-type
treatment, noting the patient would be seriously in pain or injured
if he/she had to wait that long for treatment.
DR. LOGAN said, "Let's say that it's non-pain, non-pain related ...
as a general rule, but it still covers basic restorative treatment
in some instances."
CHAIRMAN ROKEBERG asked Dr. Logan to provide a copy of his
testimony to the committee aide, noting he points out a significant
concern of the chairman's. Chairman Rokeberg commented Dr. Logan's
testimony indicates that HB 121, as it is drafted, will not
prohibit existing-type panels in the insured area if those panels
do exist. It will also not prohibit the market entry of a
point-of-service or managed care type panel. He asked if that is
correct.
Number 0534
DR. LOGAN answered in the affirmative. Other states which have
passed similar legislation have not seen really any change in the
managed care market. They have not seen anyone drop out; in some
instances they have seen other insurance companies move into the
market. There haven't been any repercussions in terms of changes
within the fee structure for managed care plans or in terms of
managed care plans leaving the market.
CHAIRMAN ROKEBERG expressed his concern. His reading of the bill
indicates it would prohibit the entry of some type of managed care
plan into the marketplace, particularly if there is a differential
in the reimbursement on the copayment - to make the distinction
between the choice in a point-of-service provision.
DR. LOGAN asked for clarification.
Number 0622
CHAIRMAN ROKEBERG noted subsection (c)(2) on page 2 seems to run
counter to Providence Health Systems' plan, for example, which is
basically structured like a point-of-service plan. If a person
want to choose his/her own dentist, he/she pays a higher premium
or, in the converse, he/she receives a lower reimbursement. The
chairman noted there has to be some kind of distinction or
differential. He expressed some confusion regarding parts of Dr.
Logan's testimony and questioned, "Why wouldn't you allow that if
you got reimbursed at the same rate by the insured? Is that the
point you're making?" Subsection (c)(2) reads:
(c) A health care insurer may not ...
(2) deny coverage, cancel a health care
insurance plan or contract, or otherwise take action
against a covered person or a dentist because the person
has asserted a right described in this section.
DR. LOGAN answered in the negative, commenting he thinks they are
running in two separate issues. To his understanding, HB 121 would
allow a company to offer several plans within their insurance
group, and, as part of those plans, there would probably be
different rates. Typically they choose that as part of a panel of
medical, dental, vision services, et cetera. However, what is
being asked is that, as part of that subsection of the plan, if the
patient chooses to go outside that panel, the patient be reimbursed
at the same rate. If the patient would get "X" dollars to use at
Dentist 1, then the patient would get "X" dollars to use at Dentist
2. However, with Dentist 2 who is outside the plan, the patient
would have a copayment to meet.
Number 0796
CHAIRMAN ROKEBERG commented that is his major concern. He thinks
they should encourage menu selections. Giving more choices is one
way to drive down health care costs. The chairman confirmed that
is something Dr. Logan would basically agree with.
DR. LOGAN said their position is they endorse any policy that
provides dental benefits that still allows for freedom of choice of
the dentist. They are just asking for equality within those
policies.
CHAIRMAN ROKEBERG noted he agrees with that philosophically.
However, he indicated he also does not want to discourage the
establishment of options which may drive down the costs but still
allow the employee-insured to make that selection of dentists. He
commented on the current situation of an employer choosing to
select an in-panel group of dentists as the only coverage offered.
This legislation disallows that - the pure HMO managed care model
is being prohibited by this. The chairman asked if that would be
correct.
Number 0889
DR. LOGAN indicated the legislation would essentially prohibit
closed panels. He reiterated he thinks HB 121 says that the
patient should be reimbursed the same regardless of the choice of
dentist. Dr. Logan reiterated again that the patient going outside
of a managed care plan would still have copayments to meet and that
would be the patient's incentive to stay within that plan. Dr.
Logan confirmed to the chairman that a patient going outside a
closed panel would have to pay 100 percent. If a patient goes
outside of a regular PPO panel, the patient would have copayments
to meet and currently receives an additional financial penalty.
Assuming that the average treatment is $100, a plan dentist would
usually offer a discount in the $70 range. The patient going to
that plan dentist would have no copayments and the dentist would
receive $70. If the patient goes outside the plan, the patient
typically would receive about $35 in reimbursement and have to pay
the additional $65 to the nonparticipating dentist, who does
receive his $100.
CHAIRMAN ROKEBERG asked if it wasn't common for insurance companies
to reimburse the health care provider for the first instance...
DR. LOGAN said through an assignment of benefits. He commented,
however, as they have gone round and round with the "insurance
commission" trying to resolve some issues, the "insurance
commission" is very careful to point out that the insurance
policies are the patients' and the dentists have no standing with
those policies. It is only as a matter of courtesy that there is
an assignment of benefits. In response to the chairman's comments,
Dr. Logan confirmed that most health care providers file the
request for reimbursement as a courtesy, accept it in lieu of
payment, and go back for the unpaid portion.
CHAIRMAN ROKEBERG expressed concern that that might create some
problems unless it is clarified.
Number 1038
REPRESENTATIVE HALCRO discussed the employer's role in providing
health care coverage to employees. He noted the ultimate fear of
government involvement in health care is that there will somehow be
additional costs and those costs will have to be borne by the
provider of the policy, the employer. Representative Halcro
indicated the arguments they have heard is that this is
cost-neutral, mentioning a specific telephone conversation he has
had with Dr. Fell. He thinks all would agree the goal is to
provide more coverage for more employees, but they need to protect
the employer. Representative Halcro asked if it there would be any
problems with provisions exempting an employer if the employer
could show a certain percentage increase in the cost of maintaining
a policy due to this change.
DR. LOGAN indicated he would not philosophically be opposed to such
provisions, but how that increase is arrived at would have to be
spelled out so that a company couldn't simply come up with
unjustified overhead figures to show an increase in cost. Dr.
Logan noted the Alaska Dental Society's goal is simply a revenue
policy that protects patient rights.
Number 1178
CHAIRMAN ROKEBERG referred to Dr. Fell's mention of Concordia
questioning if it is a managed care organization.
DR. LOGAN answered in the affirmative, commenting United Concordia
took over for Champus on the military contract. In response to the
chairman's question about Fairbanks, Dr. Logan noted Concordia
operates statewide - any place with military or United States Coast
Guard (USCG) dependents. He indicated military and USCG active
personnel are treated by active-duty dentists. In response to the
chairman's further question about Concordia being a closed panel,
Dr. Logan noted it is an open panel, a PPO, with pretty substantial
penalties for going outside the plan. He believe the penalties are
in the 60 percent range.
CHAIRMAN ROKEBERG asked if Concordia paid the covered person or
paid the provider.
DR. LOGAN replied it is typically an assignment of benefits, but it
could function in either form.
CHAIRMAN ROKEBERG stated, then, it would Dr. Logan's testimony and
opinion that HB 121, as currently written, would prohibit closed
panels - classic HMO-type organizations.
Number 1257
DR. LOGAN answered, "That would be my reading of prohibiting
freedom of choice, yes."
CHAIRMAN ROKEBERG questioned that it would not prohibit PPOs or
POSs [point-of-service organizations, "PSOs" stated on tape].
DR. LOGAN replied he did not personally see anything within the
legislation that would change how they function in the state.
CHAIRMAN ROKEBERG indicated the importance of ensuring and
clarifying that point. The chairman added he thinks Representative
Halcro raised an interesting point. One of the committee's goals
is to make sure affordable quality health care and insurance is
available to everyone in the state. He indicated there should be
some kind of protection if costs increase because of the
prohibition on closed panels. The chairman thanked Dr. Logan for
his testimony and recognized that Mr. Evans wished to make a
comment.
Number 1340
MR. EVANS stated he wanted to clear the record regarding something
Dr. Logan indicated. Mr. Evans did not think he said, and
certainly did not mean to imply, that HIAA does not agree dental
health utilization review should be performed by a peer. He noted
in certain other areas it is a physician-on-physician review and
the specialties may not be the same. However, Mr. Evans indicated
the Division of Insurance requires dental review by a dentist and
HIAA does not oppose this.
Number 1378
REPRESENTATIVE BUNDE, in summary, stated the chairman himself had
said he would not go to the cheapest provider. Representative
Bunde noted HB 121 is in the committee because it is a labor and
commerce issue. In spite of the altruistic conception of health
care, this is also a business. Representative Bunde indicated if
health care isn't a business, Providence wouldn't be facing a
nurses' strike or wouldn't use cost-shifting to cover expenses in
other areas. Representative Bunde gave the example of a patient
being charged $1 for an aspirin. If health care isn't a business,
insurance companies wouldn't insure at the highest rate for the
lowest risk and, in some cases, delay payment on a claim because
the companies profit on the "float." He exhorted the committee to
not forget they are also talking about small businesses.
Representative Bunde indicated the concern expressed by
Representative Halcro about employers buying insurance. However,
he noted the purchase of an unusable or non-employee-friendly
product will not expand health care coverage and is not helping
employees. Representative Bunde commented on the Lower 48 HMO
horror stories, commenting that preventing them in Alaska is a
laudable goal, not a detriment to business. He indicated the
Division of Insurance had testified it is already doing some of the
things mentioned in HB 121; he described the legislation as a
protective measure, using the 'belt and suspenders analogy.'
Representative Bunde noted he felt none the testimony he heard from
Ms. Burke would speak against the bill. He asked the committee to
keep in mind that this a business and not to be too emotionally
swayed because this concerns medical care.
CHAIRMAN ROKEBERG noted he does not necessarily share the views
that Alaska shouldn't have HMOs if they could provide good quality,
lower cost care. [HB 121 WAS HELD OVER]
| Document Name | Date/Time | Subjects |
|---|