Legislature(2017 - 2018)BELTZ 105 (TSBldg)
04/20/2018 01:30 PM Senate JUDICIARY
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Audio | Topic |
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Start | |
HB355 | |
HB123 | |
HB259 | |
HB336 | |
Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
+= | HB 355 | TELECONFERENCED | |
+= | HB 208 | TELECONFERENCED | |
+= | HB 123 | TELECONFERENCED | |
+ | HB 259 | TELECONFERENCED | |
+ | HB 336 | TELECONFERENCED | |
+ | TELECONFERENCED |
HB 123-DISCLOSURE OF HEALTH CARE COSTS 1:51:32 PM CHAIR COGHILL announced the consideration of HB 123 and noted the proposed committee substitute (CS). 1:52:11 PM SENATOR COSTELLO moved to adopt the work draft Senate CS for CSHB [123], version 30-LS0380\Q, as the working document. CHAIR COGHILL objected for an explanation. 1:52:45 PM JORDAN SHILLING, Staff, Senator John Coghill, Alaska State Legislature, Juneau, Alaska, reviewed the following substantive changes between version B and version Q of HB 123: Page 2, the disclosed price information that is required to be posted no longer reflects the Medicaid price. It will reflect the undiscounted price. Also on page 2, the requirement for a health care facility to post the 50 most common procedures is changed to the 25 most common procedures. Page 4, line 22, insurers were removed from the requirements under subsection (h). They will no longer have to comply with the components of (h) that are a part of the good faith estimate. MR. SHILLING explained that insurers indicated they would not be able to comply with a few elements of subsection (h). They would have difficulty providing the procedure code unless the provider or patient supplied it. Further, Primera said they could not provide, as part of a good faith estimate, the information required under subsection (h)(5). This information is the identity or suspected identity of any other person who "may charge the patient for a service, product, procedure, or supply in connection with the health care services included in the estimate,". Page 6, line 26, under subsection (n)(3), a facility operated by an Alaska tribal health organization is exempted from the definition thereby exempting them from the requirements of the bill. CHAIR COGHILL said it was a federal preemption issue. 1:55:52 PM REPRESENTATIVE IVY SPOHNHOLZ, Alaska State Legislature, Juneau, Alaska, sponsor of HB 123, said her minor concern about reducing the number of prices a facility is required to post from 50 to [25] is ameliorated by a forthcoming amendment. CHAIR COGHILL advised that the amendment he had drafted would take 10 common health care services from each of the six sections of Category I, Current Procedural Terminology. The idea is to provide patients with the most relevant information. REPRESENTATIVE SPONHOLHLZ clarified that she supports the CS with the forthcoming amendment. 1:57:51 PM CHAIR COGHILL opened public testimony on HB 123. 1:58:34 PM GINA BOSNAKIS, representing self, Anchorage, Alaska, said she is a small business owner and has worked in the Alaska employee benefits industry for over 30 years. Outside of a death claim, the most difficult part of her job is receiving a call from a patient who thought they'd done everything they were supposed to do to make sure they were getting their procedure from the right doctor or facility, but they did not ask if the provider was a preferred provider or in-network with their insurance company. If they aren't, it changes the whole dynamic for the patient. She said HB 123 will make it easier for the patient to find out approximately what their out-of-pocket expenses will be if the provider is in-network with their insurance company and what the procedure code for the recommended treatment will be. If the provider is not in-network, the patient will know their out-of- pocket expenses will almost certainly be much more than anticipated. At that point they can and probably should consider other options such as traveling outside of the state for their care. Most insurance companies in Alaska offer that option. If HB 123 becomes law as written, it will absolutely save a lot of Alaskans from unnecessary debt and potentially curb the high cost of health care and therefore health insurance in Alaska. She said she believes with all her heart that the positive impacts of HB 123 will be felt in every city, borough, and village in Alaska. 2:02:03 PM JENNIFER MEYHOFF, representing self, Anchorage, Alaska, said she is a principal with Marsh & McLennan Agency which is part of the worldwide consulting firm, Marsh & McLennan Company. She has over 25 years of experience working with employers on their employee benefits and what can be affordable. She asked members to think about the economic decisions they make in an average day about purchasing various goods and services in the market. She also asked them to think about the complexity of exploring for oil and getting it to market and that the company can tell you to the penny what the price will be before you buy it. She pointed out that throughout the day and in virtually all aspects of life, consumers are participants in the market and the exchange of goods and services. The price of the good or service is known and communicated before every transaction, except when you go to the doctor or the hospital. Medical providers have said they can't disclose prices because it's just too complicated, but there are a lot of complicated goods and services in the marketplace and somehow consumers figure it out. She said a lot needs to be done to help rebalance the health care marketplace and HB 123 is an important part. It's time to empower consumers with information to make good economic decisions about their health care just like the information most consumers use to make good economic decisions throughout their average day. HB 123 provides that opportunity and will help toward containing the cost of health care. CHAIR COGHILL noted who was available to answer questions. 2:05:08 PM SHAUN LEWIS, representing self, Fairbanks, Alaska, said he has been in the health insurance industry for the last 25 years. He believes that HB 123 is a good bill because it is good for businesses to have transparency. It will also make the consumer responsible for looking at why doctor XYZ charges more than doctor ABC. He said he believes posting the 25 most common procedures is a step in the right direction. HB 123 is not a silver bullet that will magically drive costs down, but it's a good start in the marathon. 2:08:04 PM TERRY ALLARD, representing the Alaska Association of Health Underwriters, said she is a Senior Benefits Advisor with The Wilson Agency in Anchorage, Alaska. She has been in the industry for over 25 years and is testifying in support of HB 123. The very high cost of health insurance is an issue the state has been dealing with for some time. Some might say we've reached a crisis point. Her clients have asked why expenses are so high and what can be done about it/ There isn't a single solution, but HB 123 is a starting point. It gives consumers the tools they need to access information from their providers so they can make informed decisions about when to get services, who to get services from, and how to deal with that in their own personal budgets. There is no silver bullet, but passage of HB 123 will, over time, help bring health care costs down. 2:11:25 PM ELIZABETH WARLICK, Advocacy Coordinator, Greater Fairbanks Chamber of Commerce, Fairbanks, Alaska, said the more than 700 businesses they represent absolutely support market transparency, information availability, and the role in government to bring the cost of health care into balance. 2:12:13 PM DR. THOMAS KOBYLARZ, representing self, Soldotna, Alaska, said he appreciates the legislative efforts to control costs health care costs. He related a personal experience of trying to get quotes from five clinics on the cost of getting a physical examination. He was given five different quotes over the phone. The only issue was the lab tests were different. The exam he chose to have took about one hour, whereas other exams he's had lasted about 10 minutes. That illustrates a difference in the equality of health care. He said the biggest problem he has in his private practice is with insurance companies. Preauthorized services are often not paid as promised. This is frustrating to both providers and consumers. He believes in health care transparency and disclosure of health care costs. However, he does not want to post a menu in his office to describe the cost of each procedure. That won't lower prices but will make his office look different. 2:14:28 PM DR. HEATHER WILLIS, Governmental Affairs Chair, Alaska Dental Society (ADS), Fairbanks, Alaska, said ADS appreciates the intent of HB 123 to increase transparency. She highlighted that in the dental industry it is not difficult to get accurate estimates for a service. They have no issues with that part of the bill. However, they do have concerns with posting the top 25 procedures and the fees. The highest fees consumers will see will be from specialists but they won't necessarily know it is for specialty care. Based on the fee alone, patients may go to the wrong or an unqualified provider. She opined that posting the fees for services tells consumers that health care is a commodity, but it is not gas or oil. She concluded that the bill is a step in the right directions for consumers overall, but it will have unintended consequences as currently drafted. 2:17:24 PM DR. GRAHAM GLASS, representing self, Anchorage, Alaska, said he is a neurologist and past president of the Alaska State Medical Association/ He applauds the sponsor for pushing for transparency in health care. He referenced his practice and noted that it can be particularly difficult for patients to ask the right questions and get needed information about health care costs when they've just been told they have something like Parkinson's or ALS. He said he strongly supports good-faith estimates and his office has been proactive in doing this. It is appreciated and also helps the office because patients do not like to pay surprise bills. He said his concern with the bill relates to listing rack rates for services because those rates almost never reflect what the patient will actually pay for their contracted rates. It's a little misleading on the transparency scale. He said contracted rates would be the most valuable but that's difficult to do. He supports good faith estimates and believes the bill could be amended to say that "no contracts with providers are allowed to have nondisclosure clauses." Consumers should know basically what they're going to pay and some of that burden should be on insurance companies, he said. 2:21:25 PM RHONDA PROWELL-KITTER, Chief Financial Officer, Public Education Health Trust, Anchorage, Alaska, said she is testifying as the president of Alaskans for Sustainable Healthcare Costs. This is a group of Alaskan employers who are working to find solutions to the rising health care costs. They fully support HB 123 and urge its passage. Their employees are being asked to contribute more out-of-pocket, increase their deductibles, and to be informed consumers. Part of being an informed consumer is knowing the cost of services, starting with the rack rate. She said HB 123 is not the silver bullet to bring down health care costs, but it is the silver BB that is needed in the market. 2:23:09 PM NIBERT LUJAN, Alaska Association of School Business Officials (ALASBO), Juneau, Alaska, said there is a recognition in the capitol that there are lots of cost pressures on school districts. Flat funding results in a cut to education services. The high cost of health care is one of those cost pressures that school districts and all employers face. HB 123 is a bill that can help school districts that are struggling with costs. It won't solve the problem, but it will help health care consumers become better consumers and hopefully bend the cost curve. She urged passage of HB 123. 2:24:53 PM JEANNIE MONK, Alaska State Hospital and Nursing Association (ASHNA), Juneau, Alaska, thanked the sponsor for working with stakeholders in the development of HB 123. She said ASHNA supports price transparency and believes that this legislation is a reasonable first step. They appreciate that the CS removes the posting of Medicaid prices. Medicaid payment rates are negotiated between the state and provider and are already published. ASHNA also supports good faith price estimates. Hospitals have existing systems to help patients get estimates for planned procedures and ASHNA members believe they will be able to comply with this legislation. She said insurers often have access to the best data on prices and that is who consumers should work with to get accurate information on the cost of services, out-of-pocket expenses, and to make sure the provider is part of the insurer's network. HB 123 is a first step toward transparency and ASHNA looks forward to continuing to work with the legislature on this initiative and others to help consumers. She highlighted the fairhealthconsumer.org website as an example of what can be done to make price transparency meaningful. 2:28:06 PM DR. JOSEPH ROTH, MD and President elect Alaska State Medical Association (ASMA), Juneau, Alaska, stated that ASMA supports transparency in medicine, ongoing work on improving health care and its costs, and good faith estimates by physicians and insurers. However, ASMA does not support the requirement for providers to list undiscounted charges. These charges do not reflect what a patient will actually pay. What they pay is based on the patient's type of insurance and whether their provider is in-network or out-of-network. Most procedural charges cannot be listed accurately because changes in the description of the procedure can lead to marked changes in charges. For example, there can be a wide disparity in cost to treat an ankle fracture because it depends on what is done to the ankle. Another problem is that studies show that the posting of prices by physicians leads to increased overall health care costs. They are able to see what other providers charge and price discrepancies narrow in an upward fashion. Also, medical billing is a complicated process. His office of 15 providers has 3.5 billers who are always available to discuss the cost of a patient's medical care based on their insurance type. DR. ROTH advised that both he and ASMA support good faith estimates from providers and insurers, but they believe that an all-claims database would serve patients more fully. This means that both insurers and providers would fully disclosure their prices. He cautioned members against using information from an undisclosed cost list to determine health care costs, and encouraged them to talk to their providers and insurance companies to get accurate information. CHAIR COGHILL said he's been working with the sponsor to make the information a little more valuable, but having the rack price will be a big part of having one end of the conversation." DR ROTH replied the concern is that patient won't get the information they want if insurers aren't also involved. It shouldn't be any more difficult for insurers to provide that information than it is for providers. CHAIR COGHILL noted that they learned that the insurers wouldn't be able to provide some of the information that was originally required. CHAIR COGHILL asked Mr. Shilling the substance of the proposed amendment that seeks to make the price information more valuable. 2:34:04 PM MR. SHILLING explained that an ongoing concern has been that listing the 25 most common procedures could result in a list of admission or diagnostic and admission codes that are not relevant to some consumers. To make the data more relevant, the amendment models a bill in the Senate that provides for the posting of the most common procedures and services within the six different Current Procedural Terminology (CPT) categories. CHAIR COGHILL asked the sponsor to comment on the proposed amendment. 2:35:42 PM REPRESENTATIVE SPOHNHOLZ said the amendment works conceptually and it makes sense for hospitals, but the applicability may be problematic in the various health care settings. The legal definition of health care facility is any practice that has more than one health care provider, which encompasses the many facilities that do not provide services such as radiology, anesthesiology, or surgery. She said finding something that works for everybody has been very complicated and that is why she and the other sponsors decided on the 50 most offered services. That is simple enough to implement in any health care setting. 2:37:35 PM SENATOR WIELECHOWSKI asked for an explanation of the six sections of Category I, Current Procedural Terminology. REPRESENTATIVE SPOHNHOLZ listed evaluation and management, anesthesia, surgery, radiology, pathology labs, and medicine. The idea is to serve patients who go to a hospital as well as the patients who only visit their local provider. CHAIR COGHILL said he wouldn't offer the amendment today but would bring it up again when the bill is heard on Monday. He reiterated his concern about providing relevant information. REPRESENTATIVE SPOHNHOLZ noted she had samples from members of ASHNA that show the top 50 procedures in several health care facilities in the state. CHAIR COGHILL removed his objection and version Q was adopted. 2:40:15 PM CHAIR COGHILL held HB 123 in committee for further consideration.