Legislature(2013 - 2014)SENATE FINANCE 532
03/05/2014 05:00 PM Senate FINANCE
| Audio | Topic |
|---|---|
| Start | |
| SB169 | |
| SB129 | |
| SB161 | |
| SB191 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | SB 129 | TELECONFERENCED | |
| + | SB 161 | TELECONFERENCED | |
| *+ | SB 191 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | SB 169 | TELECONFERENCED | |
| += | SB 138 | TELECONFERENCED | |
SENATE BILL NO. 169
"An Act establishing in the Department of Health and
Social Services a statewide immunization program and
the State Vaccine Assessment Commission; creating a
vaccine assessment account; requiring a fee assessment
from health care insurers and other program
participants for statewide immunization purchases;
repealing the temporary child and adult immunization
program; and providing for an effective date."
5:10:12 PM
Co-Chair Meyer discussed housekeeping.
5:11:04 PM
SENATOR CATHY GIESSEL, stated that SB 169 was the second
part of a bill that was heard several years prior relating
to the state's vaccine program. She recalled that the state
had had a universal vaccine program in the past, with $4.3
million from the federal government in annual funds. By
2013, Alaska was forecasted to have only $700,000 for the
program. As a result, the number of vaccines offered to
Alaskans of all ages had diminished significantly. The bill
would use state funds to re-establish the vaccine program.
She stated that the bill was a result of the efforts
between Department of Health and Social Services (DHSS) and
insurance companies within the state.
5:13:08 PM
JANE CONWAY, STAFF, SENATOR CATHY GIESSEL, stated that the
bill would setup a state vaccine assessment council to
administer the immunization program under the auspices of
the Department of Health and Social Services (DHSS).
Members of the council would be appointed by the
commissioner of DHSS and would consist of the state's chief
medical officer or designee, the director of the division
of insurance, 3 representatives from insurance entities, 2
healthcare providers and 1 tribal or public healthcare plan
person. She stressed that the council would serve without
compensation or reimbursement of expenses. The council
would not be set up under state boards and commission and
staff and assistance would be provided by DHSS. The council
would set forth the plan of operation for the calculation
of assessment to insurers; the purchase, storage and
distribution of vaccines; monitoring and financial tracking
of the program and review of financial statements from
insurers. She pointed out that at least 9 other states had
setup something similar to what was in SB 169, elements of
which had been borrowed from each. The department would
estimate the costs needed to purchase vaccine universally
based on recommended vaccine schedules, vaccine pricing,
immunization rates and other factors. The council would
then assess the insurers their proportionate share of the
cost; a fee established by the council, taking into account
estimated covered lives, vaccine usage, administration
costs and other variables. The insurers would pay the
assessment to the state and the state would use the funds
to purchase specific vaccines in bulk; realizing the best
cost savings. The state would store the vaccine and
distribute it to the healthcare providers that were
participants in the program. Healthcare providers would be
able to store the vaccine with other prescribed medicines,
enjoy less cumbersome tracking and paperwork, freely
administering the vaccine while charging only for the
office visit. She hoped that simplifying the procedure
would entice more providers to offer the vaccinations and
that the public would be more apt to be immunized due to
the increased access. She felt that the bill was sound
public policy that laid framework for the statewide
immunization program.
5:16:44 PM
Senator Olson understood that there would be no
reimbursement for expenses in relation to the assessment
council.
Senator Giessel replied that it would not a conventional
board and commission where board members would get per
diem, lodging, or something similar; DHSS would provide all
of the staff support.
Senator Olson inquired if the staff support would include
travel expenses.
Senator Giessel replied that there was not any anticipation
of travel and that meetings would probably be
teleconferenced.
5:17:54 PM
DR. ROSALYN SINGLETON, SELF, ANCHORAGE (via
teleconference), presented a PowerPoint presentation,
"Alaska-What have vaccines done for you?"(copy on file).
5:18:23 PM
Dr. Singleton addressed Slide 2, "Vaccination: an ounce of
prevention saves a ton of lives":
· Vaccination is a Global Issue: The World Health
Organization estimates that vaccination saves
between 2 and 3 million lives every year.
Dr. Singleton stated that vaccine preventable disease was
at an all-time low in the United States. She stressed that
high-levels of vaccinations were critical to prevent
diseases from around the world reemerging in the U.S. and
in Alaska. She continued with the presentation:
· In the US, vaccination has prevented 103 million
infections and disease rates are at historic lows -
However, 1.5 million vaccine-preventable deaths
occur each year around the world.
· Keeping vaccination rates high requires sustained
commitment and access to vaccines.
5:18:44 PM
Dr. Singleton spoke to Slide 3, "Vaccine-Preventable
Disease Success, Alaska":
· BEFORE VACCINES:
· Hib meningitis and sepsis - 40-80 cases/yr in
children.
· Hepatitis A - Alaska-wide epidemics with up to 4,000
cases.
· Hepatitis B -10% of Alaska Natives in some regions.
· Measles outbreaks contributed to high infant
mortality.
· BECAUSE OF VACCINES:
· 0-2 cases of Hib per year!
· No hepatitis A epidemics since vaccine!
· Alaska Natives have the lowest rate of Hepatitis B
in the U.S.
· No measles cases in Alaska since 2000!
5:19:23 PM
Dr. Singleton addressed Slide 4, "Polio":
· Polio attacks the nervous system and can cause
muscle weakness, paralysis or death.
· In 1952 there were 21,000 polio cases in the US -
the last US polio case was in 1979.
· Thanks to polio vaccination, polio cases are down
99%; however, polio has recently reemerged in areas
that had been polio-free for years.
· Polio is just one plane flight away
5:19:39 PM
Dr. Singleton discussed Slide 5, "Diphtheria":
· In 1925 a diphtheria epidemic threatened Nome. The
nearest serum was in Anchorage.
· A relay of dog teams rushed the vaccine from Nenana
to Nome.
· The serum arrived in time to prevent the epidemic
and save hundreds of lives.
· Today diphtheria is a disease of the past because of
vaccine.
· However, a US citizen who had refused Td vaccine
died from diphtheria after visiting Haiti.
5:19:51 PM
Dr. Singleton addressed Slide 6, "Hib Disease":
· Haemophilus influenzae type b (Hib) causes
meningitis, pneumonia, cellulitis, epiglottitis and
sepsis in infants & children.
· Alaska Native Hib disease before Vaccine
· 5-10 times higher rate of disease than other US
children
· Younger peak age (4-6 months)
· Since Hib Vaccine: Hib disease has decreased >95%
5:20:30 PM
Dr. Singleton addressed Slide 7, "Hepatitis A and B in
Alaska":
· In 1970s-80 Alaska Natives had the highest rate of
hepatitis B infection and liver cancer any non-
immigrant group in US
· Alaska also had the highest rates of hepatitis A
infections in US in most years up to 1995.
· Universal vaccination and School requirements have
eliminated spread of hepatitis A and B in Alaska
o Alaska Native people have the lowest hepatitis
B infection rate of any US ethnicity:
o Alaska has one of the lowest rates of hepatitis
A infection of any state.
5:20:59 PM
Dr. Singleton spoke to Slide 8, "Measles":
· Measles causes a rash, fever, pneumonia and
diarrhea, and can leave children blind, deaf or
brain damaged.
· Measles deaths have decreased globally by 74%, but
measles still kills 450 people each day.
· Although measles is imported into the United States
every week, Alaska has had no measles since 2000 -
thanks to our 2 dose MMR school requirement
Dr. Singleton related that she supported the bill because
she understood that providers had to front the cost of
vaccines and keep separate stocks of private and public
vaccines. She noted that some providers were finding that
the cost and administrative headaches associated with
vaccinations were prohibitive. She believed that the bill
would streamline the process and provide a self-sustaining,
cost saving model that would improve access to vaccines for
all Alaskans.
5:22:12 PM
Co-Chair Meyer announced that the committee would continue
with the public testimony before introducing the new
committee substitute for the bill.
5:22:37 PM
PHYLLIS ARTHUR, BIOTECHNOLOGY INDUSTRY ORGANIZATION,
WASHINGTON D.C. (via teleconference), read from a prepared
document (copy on file):
Mr. Chairman and Committee members, my name is Phyllis
Arthur and I represent the Biotechnology Industry
Organization (BIO) and I am here to speak on Senate
Bill 169.
BIO opposes Senate Bill (S.B.) 169. While we recognize
and share the State's goals of increasing the
administrative ease of vaccine administration and
achieving high vaccination rates, we believe the
proposed program would result in an additional
administrative burden for the State, create redundancy
relative to the Affordable Care Act (ACA) and have
very little impact on immunization rates among
Alaskans.
America's vaccine manufacturers strongly support
efforts by states to increase immunization rates among
people of all ages. We work closely with state
governments, insurers and other vaccine stakeholders
to develop and implement solutions that are proven to
increase access to immunizations through sustainable
public-private partnerships.
I would like to discuss three key issues:
1. UP programs have not actually helped to
increase immunization rates;
2. The implementation of this program may not
actually solve the current issues of many
providers; and
3. Providing private insurers access to
federally discounted vaccine intended for
disadvantaged children runs counter to the
original intent of the VFC program and provides a
pass through to insurers at the expense of
vaccine companies.
The UP program created by S.B. 169, will most likely
not lead to higher immunization rates.
o For 30 years, Alaska had a full UP program.
Higher immunization rates along with increased
access to vaccines have long been touted as
benefits of universal purchase programs.
o However, according to 2012 data from the
CDC, only 3 UP states were ranked among the top
10 states nationally for childhood immunization
rates while another 3 UP states were ranked in
the bottom 10.[1]
o From 2000 to 2009 Alaska ranked at or well
below the U.S. average for all standard series
vaccines.
o In 2012, the year for which the most recent
CDC data is available, the estimated vaccination
coverage rate among children aged 19-35 months in
Alaska was 59.5%, the lowest in the nation for
the standard series. . [2]
The Affordable Care Act (ACA) has addressed many of
the financial barriers to immunization affecting
patients by requiring private insurers to cover ACIP-
recommended vaccines for children, adolescents and
adults with no out-of-pocket expense and no
deductible. While there are still some issues
affecting providers, UP programs may not help to solve
these problems.
o The ability of the state to assess all types
of insurance plans in the state is unclear and
may not be allowed under federal law. This may
result in a multi-tiered immunization system
where providers still must access the private
sector for some patients or specific vaccines but
with smaller volumes.
o In addition providers will still be required
to screen patients for eligibility, stock private
sector doses for children and adults whose
insurance plan is not paying into the assessment
pool, submit for reimbursement and track use of
these doses. Moreover, providers will still need
to bill for the administration of vaccines.
o Lastly UP programs often burden state health
departments with the additional administrative
costs of managing the vaccine supply for the
entire state, such as warehousing and shipping
doses to multiple sites. Accountability for
ordering, storing, tracking and shipping vaccine
ultimately rests with the Alaska Department of
Heath during a time when public sector funding
for infrastructure is being cut.
Lastly this type of UP program, tax assessments and
insurance pools, create a pass through of a federal
discount intended for vulnerable populations.
o Parents and employers pay premiums for their
immunization coverage, so the vaccine cost is
already paid for, as is the visit and all of the
other medical care.
o Vaccine costs are not a high or significant
cost for insurers as a portion of insurance
premiums. In fact a 2009 HHS study showed that
vaccine coverage accounts for only 0.8% of family
premiums.
o Health plans reap the benefits of fully
immunized populations through reductions in
health expenditures for hospitalizations, office
visits, testing, and treatment.
America's vaccine manufacturers are continuously
investing in both existing and new vaccines for
children, adolescents and adults. This is only
possible when there is a sustained, viable market for
these vital public health products.
BIO believes that a private sector solution can be
found that solves the issues of all vaccine
stakeholders - patients, providers, insurers and
vaccine manufacturers. We have worked closely with
states to develop public- private solutions to many of
these same problems. For example, in Colorado BIO
works with a large coalition of vaccine stakeholders
to develop a set of recommendations for the state on
ways to increase immunization access and rates. The
group is evaluating unique contracting options
specifically targeted to small volume providers in
rural and underserved areas, researching organizations
that can help providers with billing of insurance
plans and developing better educational programs for
provider offices and staff. We are working on similar
programs in California and New Mexico.
Thank you again for this opportunity to share our
issues. I will be glad to answer any questions.
5:30:00 PM
DR. WARD HURLBURT, CHIEF MEDICAL OFFICER, DEPARTMENT OF
HEALTH AND SOCIAL SERVICES, spoke in support of the bill.
He agreed the partnerships that medical profession had with
the pharmaceutical industry had been one of the key
breakthroughs in supplying vaccinations. He shared that
Small Pox was seen in humans around 10,000 B.C. and that in
the earliest days of America; about 500,000 Europeans per
year were dying of Small pox. He related that even in the
19th century 500 million people per year contracted Small
Pox, 1 million died. He explained that in 1796 Edward
Jenner, an English physician, observed that milkmaids were
not contracting Small Pox because the Cow Pox on the udders
was protective. In 1979 the World Health Organization (WHO)
stated that Small Pox had been eradicated from the face of
the earth; the only people who were currently immunized
were research scientists. He said that Polio eradication
was on the horizon, which was endemic in Afghanistan,
Pakistan and Nigeria. He reiterated that that the bill
would create a public/private partnership, modeled on what
other states had done. He stated that New Hampshire had
participated in a similar program for one year and had seen
a 20 percent increase in their immunization rates, second
only to Hawaii. He noted that Alaska was cited in 2012 for
having the worst infant immunizations rates; however, the
data had been incorrect and CDC had made an erroneous
presumption. He said that Alaska was now number 38, which
was a significant improvement from the past. He stated that
the bill had support from the Alaska Pediatric Association
and a number of other groups. He stated that the money to
buy the vaccine would be recovered through a surcharge on
the payers. He relayed that the department wanted to
eventually include adults, but that children were the
priority.
5:36:52 PM
Dr. Hurlburt stated that the program could be run as a
public/private partnership without accessing state general
funds and that less than 1.5 percent of the funds would pay
for the storage fees for procurement through the depot. He
believed that the bill would reduce costs for the public,
while also benefiting pharmaceutical companies. The program
would not be mandatory.
5:38:02 PM
Senator Olson inquired how many of the vaccines covered by
the bill were required for children to attend public
school.
Dr. Hurlburt replied that all of the required vaccines
would be covered under the legislation.
5:39:11 PM
Senator Olson inquired how high the hepatitis A vaccine was
on the priority list.
Dr. Hurlburt replied that it was one of the most effective
vaccines and would be a high priority.
5:39:36 PM
Senator Olson shared that, in his experience, children with
Hepatitis A did not exhibit any symptoms, unlike infected
adults. He queried if vaccinating children was the
priority, why would the Hepatitis A vaccination take
precedence over other vaccinations.
Dr. Hurlburt replied that it would be prioritized based on
cost effectiveness. Hepatitis A could spread by the
ingestion of contaminated water and that put children at
high risk, particularly in rural areas.
5:40:53 PM
PATRICIA SENNER, NURSE PRACTITIONER, ALASKA NURSE'S
ASSOCIATION, ANCHORAGE (via teleconference), voiced the
Alaska Nurse's Association's support of SB 168. She
attested to the difficulty of providing immunizations to
those at most risk. She said that she had to keep two
separate sets of vaccines in her clinic: one for those
eligible for vaccines through state programs, and one for
those who were ineligible. She opined that providing
vaccinations to the public was challenging. She stated that
the cost difference between the price of vaccinations under
the legislation and the current cost to her as a private
provider was tremendous. She concluded that the program
would be an immense help to private providers.
5:43:16 PM
Co-Chair Meyer CLOSED public testimony.
5:43:30 PM
Vice-Chair Fairclough MOVED to ADOPT the proposed committee
substitute for SB 169, WORK DRAFT 28-LS1219\I (Mischel
3/5/14) as a working document. There being NO OBJECTION, it
was so ordered.
5:43:55 PM
AT EASE
5:44:38 PM
RECONVENED
5:44:45 PM
CHRISTINE MARASIGAN, STAFF, SENATOR KEVIN MEYER, spoke to
the changes in the new committee substitute. She related
that the only change could be found on Page 5, section
18.09.230. She said that the language had been changed in
order to reflect more flexibility in accounting by allowing
the state to capitalize a fund for the vaccine assessment
fund. The changes in the bill addressed concerns with the
previous fiscal note attached to the bill.
5:46:53 PM
DAVID TEAL, DIRECTOR, LEGISLATIVE FINANCE DIVISION, spoke
to the fiscal notes attached to the bill. He related that
the fiscal notes were complicated because the bill was a
fund capitalization, which caused money to move around in
ways that were not typical for a fiscal note; this was
caused by the language that Ms. Marasigan had mentioned. He
explained that there could not be a mixture of duplicated
and unduplicated funds going out with a single fund code.
He referenced the fiscal note labeled "fund caps".
Co-Chair Meyer noted that the note had a date of 3/5/14 at
the bottom.
5:48:38 PM
Mr. Teal that the words "fund cap" could be found under the
department affected on the note.
5:49:05 PM
AT EASE
5:49:37 PM
RECONVENED
5:49:44 PM
Mr. Teal noted that the top of the note reflected $31.5
million in expenditures. He said that the $.5 million in
general funds going in to the account, with $27 million of
the vaccine assessment program receipts going into the
account as well; both would appear as language
appropriations because it was a fund capitalization and was
contingent on passage. He stressed that both general funds
and the program receipts would be appropriated into the
account.
5:50:36 PM
Mr. Teal discussed the other draft fiscal note labeled
"epidemiology." He noted that the $4.5 million in the
operating expenditures portion of the note was currently
included in the governor's FY15 requested budget. He said
that the money would come from the agency and go directly
into the account, mirroring the number found on the
previously discussed fiscal note. He noted the use of a
temporary code, which reflected $31.5 million, and would be
replaced with the vaccine assessment account when the bill
passed. He furthered that the money in the account would
not lapse; a specific amount could be appropriated in an
appropriation bill, or an estimated amount, which would
allow the department the flexibility to spend all program
receipts should they have higher receipts than anticipated.
5:52:58 PM
Co-Chair Meyer pointed out to the committee that the backup
reflected a net zero fiscal note.
Mr. Teal replied in the affirmative.
Co-Chair Meyer wondered if there was a less complicated way
to set up the fund.
Mr. Teal understood that the general fund money going into
the general fund was seed money; vaccines would be
purchased and then provider would use the vaccine and
replace those funds, and the cycle would continue as such.
How many times the money would circulate was unknown.
5:55:40 PM
AT EASE
5:55:58 PM
RECONVENED
5:56:08 PM
Co-Chair Kelly MOVED to REPORT CSSB 169(FIN) out of
committee with individual recommendations and the
accompanying fiscal notes. There being NO OBJECTION, it was
so ordered.
5:56:16 PM
CSSB 169(FIN) was REPORTED out of committee with a "do
pass" recommendation and with a previously published
indeterminate fiscal note: FN5(ADM), a previously published
zero fiscal note: FN4(CED), a new fiscal impact note from
Department of Health and Social Services, a new fiscal
impact note from Department of Health and Social Services,
and with an indeterminate fiscal not from Department of
Health and Social Services.