Legislature(2015 - 2016)BILL RAY CENTER 208
05/27/2016 09:00 AM House FINANCE
| Audio | Topic |
|---|---|
| Start | |
| HB374 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 374 | TELECONFERENCED | |
| + | TELECONFERENCED |
HOUSE FINANCE COMMITTEE
FOURTH SPECIAL SESSION
May 27, 2016
9:07 a.m.
9:07:00 AM
CALL TO ORDER
Co-Chair Thompson called the House Finance Committee
meeting to order at 9:07 a.m.
MEMBERS PRESENT
Representative Mark Neuman, Co-Chair
Representative Steve Thompson, Co-Chair
Representative Dan Saddler, Vice-Chair
Representative Bryce Edgmon
Representative Les Gara
Representative Lynn Gattis
Representative David Guttenberg
Representative Scott Kawasaki
Representative Cathy Munoz
Representative Lance Pruitt
Representative Tammie Wilson
[Note: Representative Pruitt was absent from the morning
portion of the meeting.]
MEMBERS ABSENT
None
ALSO PRESENT
Lori Wing-Heier, Director, Division of Insurance,
Department of Commerce, Community and Economic Development;
Fred Parady, Deputy Commissioner, Department of Commerce,
Community, and Economic Development; David Teal, Director,
Legislative Finance Division; Sheela Tallman, Premera Blue
Cross Blue Shield of Alaska; Jane Pierson, Staff,
Representative Steve Thompson; Representative Liz Vasquez.
PRESENT VIA TELECONFERENCE
David Morgan, Self, Anchorage; Jeff Ranf, Alaska
Association of Health Underwriters, Anchorage; Jennifer
Jolliffe, Self, Anchorage.
SUMMARY
HB 374 REINSURANCE PROGRAM; HEALTH INS. WAIVERS
CSHB 374(FIN) was REPORTED out of committee as
amended with a "do pass" recommendation and with
one new fiscal impact note from the Department of
Commerce, Community and Economic Development.
HOUSE BILL NO. 374
"An Act relating to a reinsurance program for
residents who are high risks and insurer assessments
to cover the costs of the reinsurance program;
relating to application for state innovation waivers
for health care insurance; relating to definitions of
'residents who are high risks' and 'covered lives';
and providing for an effective date."
9:07:37 AM
Co-Chair Thompson discussed the agenda.
Representative Wilson referred to a document from the
[House] Labor and Commerce [Committee] titled "HB 374
Reinsurance Program; Health Insurance Waivers" from the
Department of Commerce, Community and Economic Development
(copy on file). She referred to page 2 of the document
related to consumer impact. She detailed the document
addressed that the existing federal reinsurance program
would expire in the current year. She continued the
document referred to a 2016 estimated tax of $30 per
member, per month on individual plans, and an $18 per
member, per month charge for individuals in group plans.
She asked for verification that the original bill would
have maintained the tax; therefore, no one would pay more
than they paid currently.
LORI WING-HEIER, DIRECTOR, DIVISION OF INSURANCE,
DEPARTMENT OF COMMERCE, COMMUNITY AND ECONOMIC DEVELOPMENT
(DCCED), replied in the affirmative. She confirmed a
reinsurance fee had been set in 2014, 2015, and 2016 for
the federal government, which would terminate at the end of
the current year. She elaborated there was also a tax that
would be suspended at the end of the current year. She
relayed the state did not know if the tax would be
reenacted at some point in the future. She explained it was
a percentage - that the tax was equivalent to $18 on an
employee plan or $30 on an individual plan per month. She
clarified the reinsurance was $2.25 per member, per month
and the tax was estimated at $18 per member, per month
(approximately $20 total). With the knowledge the
reinsurance program was expiring, the department was trying
to back into a number at $20 multiplied by 12 [months] and
multiplied by the 224,000 in an insured population in
Alaska, which resulted in a total of about $55 million.
Ms. Wing-Heier furthered that within the insured population
there was primary and excess or stop-loss insurance. She
detailed the stop-loss insurance did not contribute to the
tax or contributed at a much lower rate because they were
paying at a percentage and because their premiums were much
less. She explained that participating employers (e.g. the
State of Alaska or another large employer) took a much
larger deductible, taking the losses in-house, buying stop-
loss insurance, and funding losses internally. For example,
instead of paying a $5 million premium, an employer was
funding a $4 million premium and only purchasing a $1
million premium. She continued the tax was paid on the $1
million instead of $5 million. She communicated that school
districts and other employers had been "crying foul" that
they did not pay 3 percent on the portion they self-funded
and they did not budget for it. She further explained that
the employers specified the entities were asked to pay the
$20 per person, per month "time out."
FRED PARADY, DEPUTY COMMISSIONER, DEPARTMENT OF COMMERCE,
COMMUNITY, AND ECONOMIC DEVELOPMENT, interjected that [the
employers in the example specified] it was a new tax.
Ms. Wing-Heier reiterated it was a new tax - the employers
specified they had never paid the amount because they self-
funded. The employers also emphasized they could not begin
to pay the amount because they did not have the funding.
She explained Representative Kurt Olson had come out with
the committee substitute (CS) to HB 374, which would go
with the premium tax. She discussed that related to the
fully insured, it was right to say the 3 percent tax
equated to $18 and everyone paid the $2.25 including the
plans with stop-loss. However, when it came to large
employers that self-funded the majority of the program (and
with high stop-loss), the percentage was so low, when the
$20 per person, per month was used, employers such as the
Kenai Peninsula School District, the North Slope Borough
School District, and others had called and sent letters
specifying the structure did not work.
9:13:11 AM
Representative Wilson asked if the amount was the same as
the 2.7 percent [tax] under discussion.
Ms. Wing-Heier answered "that amount equated to $55
million." She explained that $55 million according to the
actuarial study would impact the premium or rates by about
15 to 18 percent.
Mr. Parady added that the 2.7 percent was the state tax.
Ms. Wing-Heier continued that every [insurance] policy in
the state (i.e. life and health, workers' compensation,
auto, home, and other) paid a tax to the state, which was
most often 2.7 percent (there were some exceptions such as
title insurance, which paid 1 percent). The bill before the
committee assumed that the 2.7 percent tax would come in
for the reinsurance program.
Mr. Parady clarified "in this bill." Ms. Wing-Heier agreed.
Representative Wilson asked for verification that the 2.7
percent was currently coming into the General Fund (GF).
She asked for verification that the department was asking
to have the 2.7 percent designated to DCCED to offset and
reduce premiums for everyone (not only the high risk
group).
Ms. Wing-Heier answered that the funds did currently go to
the General Fund. She deferred to Mr. Parady for further
detail.
Mr. Parady replied his best understanding was the tax was
collected by the Division of Insurance and at the year-end
it lapsed to the GF.
Co-Chair Thompson noted that Mr. Teal would be available
for questions.
Representative Wilson directed her question to Co-Chair
Thompson. She wondered if the bill was really only related
to funding something in the current year. She reasoned the
2.7 percent could be designated to a particular fund to do
exactly what DCCED was talking about versus looking at $55
million out of the GF.
Co-Chair Thompson noted that Mr. Teal would answer the
question.
9:16:19 AM
Representative Guttenberg asked about the statutory
references. He referred to Section 1 of the bill that
addressed funding the reinsurance program. He mentioned
statutory references that were included. He asked for
detail on how the structure worked.
Ms. Wing-Heier referred to a statute book for an answer.
Co-Chair Thompson noted that Commissioner Hladick was also
available.
9:17:34 AM
AT EASE
9:20:22 AM
RECONVENED
Ms. Wing-Heier answered that the primary tax collected by
the division was under AS 21.09.210, which was insurance
tax. In FY 15 the tax had brought in $55,941,000.
Additionally, the department had collected $108,000 for
unauthorized insurance premium tax under AS 21.33.055;
$38,000 for independently procured insurance tax under AS
21.33.061; $2,754,811 for surplus lines insurance under AS
21.44.180; and $274,847 for title insurance under AS
21.66.110 for a total of $59,117,449 in premium tax in FY
15. She noted the total did not include the receipts and
licensing fees collected by the division.
Representative Guttenberg asked what the funds were
currently used for. Ms. Wing-Heier answered that once the
funds left the division, it no longer tracked them.
Representative Guttenberg surmised that before leaving the
division, the money was used to fund the division.
Ms. Wing-Heier answered in the negative. She clarified the
division was funded separately. She elaborated that
insurance producers, agents, brokers, adjusters, and finger
printing funded the division. The division collected fees
for those services, which were responsible for funding the
division's operations (the fees were separate from any tax
collected by the division).
9:22:49 AM
Co-Chair Thompson noted that the Legislative Finance
Division would address a conceptual amendment.
DAVID TEAL, DIRECTOR, LEGISLATIVE FINANCE DIVISION,
discussed that Co-Chair Thompson had asked if there was a
way to show the amount as something other than an
expenditure of unrestricted general funds (UGF) and to
straighten out the fiscal note. In response, the
Legislative Finance Division had drafted an amendment that
would be included in a CS later in the day. He explained it
would establish an Alaska Comprehensive Health Insurance
Association (ACHIA) fund; rather than spending UGF premium
tax revenue directly to DCCED, the premiums would be
deposited into a fund, which would make it designated
revenue (very similar to the alcohol and drug treatment
money). The state could then specify the fund could be used
to make appropriations to DCCED to run the reinsurance
program.
Mr. Teal clarified the revenue that would go into the fund
was from premium taxes on all insurance lines, not just
health insurance. He added it would not include the 2.7
percent workers' compensation fee that was already going
into a workers' safety fund. He explained the revenue
included penalties and interest on late fees (it was not
purely premiums) and was net of refunds, errors, etcetera.
The fund would be modeled after the alcohol fund and the
premium taxes would be reclassified as designated general
funds (DGF) rather than UGF. As the bill was written, it
would spend UGF because the premium taxes were UGF revenue.
He detailed the taxes were UGF revenue because they were
appropriated to DCCED, but lapsed into the GF at the end of
the year. The alternative was to create a fund calling the
funds designated revenue, which would reclassify the
revenue as DGF (there would be a loss of UGF revenue). He
continued there was no change in the deficit - in one case
more UGF was spent and in the other case in creating the
fund there was a loss of an equivalent amount of UGF
revenue. He explained the deficit would still be exactly
the same and "there is no free money here."
Mr. Teal detailed the advantages to creating a fund were
that there was a lag, so the amount of funds in the account
were known. There would be an effective date of FY 16,
which would put the premiums collected in 2016 (due to
lapse on June 30) into the fund; the funds would be
available for appropriation in FY 17, which meant DGF
premium taxes would be spent in FY 17. A loss of UGF
revenue would be shown in FY 16 because it was
reclassified. Second, the current bill would put the
expenditures ($55 million) in the agency operations portion
of the budget by direct appropriation and then a grant to
ACHIA, which would inflate the DCCED operating budget. The
bill did not run the money through DCCED; it would go into
a fund under a statewide allocation and would appear in
DCCED as DGF. He reiterated there was no new money, it was
merely a question of how things were classified. He
underscored that the concept was not a "black magic budget
trick" and it would operate the exact same way as the
alcohol fund. He explained if the legislature was concerned
about its FY 17 expenditure level, the way the bill was
drafted UGF expenditures would go up by $55 million,
whereas, if the legislature implemented the fund, the UGF
expenditures would not change (UGF revenue would simply be
lost).
9:28:40 AM
Co-Chair Neuman summarized his understanding of Mr. Teal's
statements. He surmised the state was collecting premium
funds of about $55 million, which currently went into the
GF and were used to pay ACHIA. He asked for verification
the proposal would collect the premium tax and deposit it
directly into the ACHIA fund. He believed it was not new
money coming out of the GF and the method would be clear
for tracking and budgetary purposes.
Mr. Teal answered in the affirmative. He explained the
method would help in a way because (like with alcohol) the
legislature would be spending FY 16 money in FY 17 and it
would have a fairly good idea about the amount of money
available, which would avoid over-appropriation.
Additionally, as the years go by, the legislature may find
there was more money in the fund than it had appropriated,
which would enable the legislature to increase or decrease
the appropriation. He stated it was a matter of providing
affordable healthcare to individuals who would have very
high premiums and it was a way to avoid premium tax
increases for everyone. He explained it would be using
state money to make healthcare more affordable.
Co-Chair Neuman asked for verification the state would
maintain its ability to increase premiums through
regulation to help cover costs if the costs for ACHIA
increased.
Mr. Teal answered in the affirmative. He elaborated that if
the state raised premiums it would increase premium taxes,
which would go to the fund and could be used to pay
healthcare costs.
Co-Chair Neuman remarked the method was more self-
regulating. Mr. Teal agreed.
9:30:48 AM
Representative Gattis asked why the taxes on insurance
premiums had been instituted in the first place. She
elaborated that the money may not be new, but it was a new
"spend." She detailed the money had been deposited in the
GF in the past for GF purposes. She had spoken with some
insurance companies that did not know why they were
collecting the funds.
Mr. Teal answered by comparing the taxes to Division of
Motor Vehicles fees. He detailed the state charged money
for license plates, which exceeded the cost of making and
issuing the plates. He explained the tax was a revenue
generator.
Representative Gattis stated that it was not new money, but
surmised it was clearly a new spend. Mr. Teal answered that
it was a loss of $55 million in GF revenue, which could be
characterized as a new spend or a loss in revenue - it
amounted to the same thing.
Vice-Chair Saddler understood that the insurance industry
model passed on the risk to ever-increasing pools; if one
insurer did not believe they could cover all of their
claims, they purchased reinsurance insurance. He furthered
the risk was passed along until someone had to pay. He
discussed that currently Premera had the risk pool, had
determined the cost of fulfilling claims was more than it
was collecting, and was trying to pass on its risk to
somebody. He surmised the state was not buying more
insurance, but it was merely appropriating money to pay for
it. He believed the state was the last payer. He asked for
the accuracy of his statements.
Mr. Teal believed it was accurate, but deferred to Ms.
Wing-Heier for detail. He spoke to insurance and
reinsurance in simpler terms and explained subsidizing the
cost with state money was making healthcare affordable. He
continued that otherwise, premiums would increase for
everyone because premiums could not be increased for very
high risk people. He did not know it was even fair to
classify them as high risk people. He furthered many of the
individuals had known conditions and expensive healthcare
cost where no one would insure them. For example, he
questioned what an insurer would have to charge an
individual for healthcare premiums if it was known a person
had a medical condition that would cost $250,000 or
$300,000 per year. He explained the cost would be totally
unaffordable. He detailed that normally premiums were
spread to everyone; the bill provided a way to pay some of
the medical costs out of state funds instead of increasing
all Alaskan's premium costs. He saw it as affordable
healthcare as opposed to an insurance premium. He added it
was not a risk, it was a known expense.
9:35:00 AM
Ms. Wing-Heier answered that reinsurance was common in the
insurance world for health, workers' compensation, auto,
and other. She specified insurance companies bought
reinsurance in great volumes. For example, Alaska National
and American International purchased reinsurance because
they only wanted to take a certain amount of loss
themselves. She elaborated reinsurance was insurance for an
insurance company because they could only afford to take so
much risk themselves, particularly for catastrophic loss.
She explained an insurance company may take the first $1
billion or $100 million of a catastrophic loss and it would
then submit a claim to its reinsurer. She detailed the
claim may go to the first layer of the reinsurance program
and then to the second layer depending on the loss. The
program was attempting to reinsure for the catastrophic
claims of the individual market. She reiterated the
practice was not uncommon in the industry - she did not
know of many insurance companies that took every loss net
to their bottom line.
Vice-Chair Saddler stated it was one of the reasons the
insurance industry was one of the first industries to use
computers to calculate "this kind of stuff." He referred to
Ms. Wing-Heier's testimony related to self-funding
insurance pools (e.g. school districts and others) that may
self-insure for a portion of their risk and then go to
reinsurance or different insurance coverage for another
portion, which was the source of the inequity of applying
the premium tax. He noted the school districts had their
own funds to self-insure from. He asked if the money
originated from the State of Alaska paying an amount per
employee. He stated that contracts were usually negotiated
and included health insurance costs. He wondered about the
source of funds school districts used to provide the self-
insurance coverage.
Ms. Wing-Heier replied that she did not know about the
school district funding. She deferred to Mr. Parady.
Mr. Parady answered that he had been the former chief
operating officer of the North Slope Borough School
District. He detailed that the district had self-insured
its 500 employees and 2,000 covered lives for $7 million
and had purchased insurance to cover losses exceeding $7
million or individual claims exceeding $150,000. The source
of the funds was school district operating funds, which
came from the foundation formula.
Vice-Chair Saddler asked for verification the state paid to
help populate insurance funds used by school districts to
provide self-insurance for health insurance. He surmised
the goal was to find a way to equitably share the costs of
the high risk insurance pool. He construed the school
districts and others were objecting to the imposition of
additional premium taxes; however, the state was currently
paying most of the cost already.
9:38:52 AM
Mr. Parady noted that the school district was a political
subdivision of the state; therefore, all of its expenses
were essentially the state's, absent some federal grants or
private fundraising. Secondly, one of the district's
objections would be timing and the fact that when the state
was looking at the $20 per person, per month option it
included 256,000 insured lives, 150,000 of the individuals
were carrying stop-loss insurance. He explained it was not
offset by an expiring federal tax; it was a form a new tax
that hit districts in a way they were not budgeting for.
Vice-Chair Saddler asked Mr. Parady if the premium tax went
through, whether the school districts would ask for more
money to cover the cost. Mr. Parady affirmed the districts
would look for help with the money.
Representative Gara believed the presenters had
sufficiently demonstrated why something like the bill
needed to pass. He did not want to increase the premiums
for other policy holders and there was a certain amount of
compassion reflected in helping people with severe medical
conditions. He asked if the $55 million generated by the
premium tax that went into the insurance fund was used for
anything else at present. He wondered whether the bill
would take money away from other things the legislature was
presently funding, meaning the legislature would have to
locate alternative funding sources for those items.
Mr. Teal answered that the premium tax receipts went into
the GF. Once the money went into the GF it was
indistinguishable from royalty proceeds or any other GF
receipts. He detailed that the money was definitely being
spent on something at present, but he could not identify
specifically what that was. The bill would reduce GF
revenue by $55 million, leaving the state with a $55
million deficit. He explained the scenario would be exactly
the same as if the legislature used UGF to make the
expenditures.
Representative Gara referred to an earlier statement that
the department could change the premium tax through
regulation if there was a shortfall in the future. He
believed the tax was set by statute. He asked for
clarification.
Ms. Wing-Heier answered that it was set by statute.
Representative Gara asked for verification the premium tax
could not be changed unless it was changed in statute. Ms.
Wing-Heier replied in the affirmative.
9:42:41 AM
Representative Guttenberg did not know what the actuarial
chart indicated about the specific group of individuals and
rising healthcare costs or how large the group was.
Additionally, he did not know whether the group was growing
disproportionately to the rest of the population. He spoke
to the rest of the insured population and asked if the
taxes were based on percentages or a flat fee. He wondered
if the percentage or flat fee was able to keep up with
rising costs. He asked whether the money that would go into
the future designated fund rising as rates rose. He did not
image a flat fee would keep up with rising healthcare costs
of the specific population; however, a percentage would
keep up more proportionately. He asked if there was a gap
between the two lines.
Ms. Wing-Heier believed Representative Guttenberg was
asking whether the $55 million would be adequate in the
future or should the amount be a certain percentage of the
claims (e.g. 10 or 20 percent). She did not know whether
the answer was known, but the receipts or revenue collected
by the division was limited. Only so much insurance would
be sold in the state and with a 2.7 percent tax a limited
amount would be collected to put towards the program. The
bill intended that the legislature may appropriate because
the ACA [Affordable Care Act] was in its infancy. Section 3
of the bill also proposed an innovation waiver. She
expounded that there may be changes coming from the federal
Congressional delegation that may impact how the program
looked in two or three years, which could mean the state
may not need $55 million. She believed the term "may
appropriate" would depend on how they looked at the issue
in 2019 and 2020 in terms of whether $55 million was the
correct number. She detailed the division did not know how
successful the innovation waiver would be or the impact it
would have on Alaska, but it did want to consider the
option to see how it would impact the individual and small
group markets in the state. The division also wanted to
work with the Congressional delegation. She reiterated the
ACA had only been implemented three years earlier and had
been passed as a "one size fits all" program. The division
believed the ACA would change over time. She relayed the
division had received a notice the previous day that Texas
received a rate filing from Blue Cross Blue Shield for 58.6
percent. She underscored the rate was not sustainable even
for Texas. She stressed that things would have to change
and as things changed the division hoped it was "not
sitting here asking you for, just saying, $75 million.
That's not the intent." She concluded the bill language
used the term "may appropriate" and the issue would have to
be revisited the next year.
Representative Guttenberg spoke to his prior question and
asked what portion of the funds were flat fees and how many
were percentages of [insurance] policies. Ms. Wing-Heier
answered that the funds were all percentages of one point
or another.
9:47:09 AM
Co-Chair Thompson OPENED public testimony.
DAVID MORGAN, SELF, ANCHORAGE (via teleconference), shared
that he was an economist and had 30 years of experience
working in the healthcare field. He testified that it was a
pattern that had been seen throughout the whole process of
the ACA, which had originally promised to save money and
contain costs. However, he emphasized that costs had
exploded in both large and small states; primarily because
efforts to contain costs had not been made. He was
concerned that the old pool had certain managed care
processes that helped contain costs of high cost patients.
He detailed that to get into the program there was a
process to make sure that everyone who was supposed to pay
(i.e. insurance, tribes, and others that had health
benefits) paid first and the pool paid last. Second, the
act had looked at using Medicare centers equality and
negotiated certain prices and purchase of certain services.
It had tried to shift patients to a higher volume, bigger
quality scenario in order to save money for the pool. He
observed that in 2016 Alaska only had the second highest
rate increases on average; Minnesota was at 47 percent and
Alaska was at 39.1 percent. He relayed that virtually every
state had gigantic increases. He understood the process
that had been set up and the information being used were
changing greatly. He remarked that in six months Medicaid
expansion went from a savings of $32 million for four years
to a cost of $56 million. He stated he agreed with the
director of the Division of Insurance that the state was in
a debt spiral.
9:51:16 AM
JEFF RANF, ALASKA ASSOCIATION OF HEALTH UNDERWRITERS,
ANCHORAGE (via teleconference), testified in support of the
legislation. He explained that the association represented
over 100 licensed insurance agents throughout Alaska. He
detailed the association's members consulted with
individual Alaskans and Alaskan employers on how to
purchase, administer, and utilize their health insurance
coverage. He provided further detail about the association.
He shared the organization had seen first-hand what
residents were experiencing as they attempted to purchase
insurance to help pay for their medical expenses. He
stressed that the situation was very serious. He furthered
that health insurance had gone from being expensive to
potentially unavailable to a large group of Alaskans. He
discussed the bill would amend statute related to ACHIA. He
communicated that Alaskans had not heard a significant
amount about ACHIA because ACA was supposed to have dealt
with the issue; therefore, the focus had been on ACA in
Alaska. However, ACA had not worked. The bill would enable
the state to put ACHIA back to work, which he supported. He
underscored that doing nothing put many more people at
risk. The association's concern was that erosion could
start to occur in the group market if the individual market
was not stabilized. He relayed it would become a more
widespread and complicated problem to solve. He asked the
committee to support the bill.
SHEELA TALLMAN, PREMERA BLUE CROSS BLUE SHIELD OF ALASKA,
spoke in support of the legislation. She read from a
prepared statement:
Premera has operated in Alaska since before statehood
in 1952 and provides coverage to over 110,000 Alaskans
in all lines of business including the individual and
family policy holders, small group, large group, as
well as providing services to the larger self-funded
employers in the state. The individual health
insurance market was in crisis. I would like to start
by briefly describing what has got us here, explaining
the impacts to the health insurance industry, and most
importantly what Alaskan residents are facing in
trying to buy individual coverage.
With health reform in 2014 the major change to the
insurance market was guaranteed issue to all
individuals without preexisting condition exclusions
and this provided access to insurance for several
thousands of individuals which has been a good thing.
Premera and the other insurers priced products,
estimating the impact of an uninsured purchasing
coverage for the first time. However, we've
experienced a significant influx of new enrollees with
very high medical costs. Many leaving the high risk
pool, ACHIA, which has shrunk by half and the federal
preexisting condition pool. Premera lost approximately
$13 million in the individual market in 2014. For 2015
and 2016, Premera had approximately 37 percent and 39
percent average rate increases for the individual
metallic plans, but the claims continue to exceed
premiums. To break even in 2015 Premera would have
needed a 70 percent rate increase.
To say it differently, Premera is taking in on
average, $713 in premium per member, per month, but
paying claims at $919 per member, per month,
demonstrating the very high claims costs in this
individual pool. In a very small sized market like
Alaska there was simply not enough healthy individual
purchasers to offset the costs of enrollees with very
high claims costs. Today, Alaska's average benchmark
plan premium in the individual market is the highest
in the country at over $700 per month. The next
highest state is $468 per month. So while states,
you've heard, are experiencing similar increases or
even higher percentage rate increases, the impacts in
Alaska are more than double since the premium is
already so high. While subsidies will help many, there
are still over 1,200 individuals that do not qualify
for any subsidies and are picking up the full payment
of that premium.
We're very concerned that premiums will continue to
skyrocket, due to the small size of the individual
pool and with fewer people to spread the risk across,
the small number of individuals with these conditions
are destabilizing the pool, which is resulting in
these premium increases. To give you an example, just
for the first half of 2015 we had over $45 million in
claims, $11 million of those claims came from 47
individuals.
One solution is an approach other insurers have taken
already, which is simply to exit the individual
market. However, we've been working, Premera and Moda,
have been working collaboratively with the Division of
Insurance to come up with a sustainable option for
Alaskans, which is the reinsurance program we've
discussed, administered by ACHIA. That program would
cover or reinsure the claims costs for some of the
highest cost medical conditions. These are the long-
term, chronic conditions such as kidney disease and
heart failure that are impacting the pool. The program
would help mitigate premium increases for all
individual policy holders, but also stabilize the
market, which could potentially attract new
competitors into this market. It would also provide
financial certainty for customers, knowing that health
insurance will continue to be available to them in
their time of need.
We also support the innovation waiver. We support
flexibility at the state level to help Alaskans
maintain the coverage they've had and to tailor
reforms to meet the unique needs of the Alaska market.
The waiver would allow the state to explore longer-
term positions and policies to help address the very
high cost of care in the state.
What Alaska needs is immediate relief from these year-
over-year premium increases and House Bill 374 will
help to mitigate these swings and on behalf of the
23,000 individual policy holders in the state, we ask
for your support.
9:58:49 AM
Co-Chair Neuman thanked Ms. Tallman for coming to address
the committee in person. He asked how the committee could
be assured that the insurance companies would pass the $55
million to the consumers.
Ms. Tallman answered that the intent of the program was to
reduce the rate of the premium increase. She detailed if
there was a reinsurance program - much like how the federal
reinsurance program had worked - it would be factored into
the rate filings the company would be submitting to the
Division of Insurance for review.
Representative Munoz asked about the individuals receiving
insurance through federal subsidized plans. She asked how
the subsidies were being funded.
Ms. Tallman answered that the entire pool under discussion
was individuals purchasing coverage in the federal exchange
or outside of the exchange; it was all one pool for each
insurer. Federal subsidies through the ACA were paid for
under other revenues that went to the federal government
and the ACA (e.g. insurer tax, penalties for individuals
without insurance, and other revenue sources in the ACA).
Ms. Wing-Heier elaborated that while a significant
population received premium tax credit, it were not equal
to all constituents. She detailed it was based on income.
Approximately 70 percent probably received a subsidy of 1
percent or another, but it was not equal to every member -
everyone did not get 90 percent of their premium paid. For
example, a family of four with a $1,000 per month premium
who received a 50 percent tax credit, would still
responsible for a $2,000 payment. She reiterated it was
based on income and it changed depending on how a member's
income varied within a year. She explained the system was
complicated and the division tried to work with
constituents. She furthered a person learned the amount of
their premium tax credit when they filed their taxes with
the Internal Revenue Service (IRS).
Representative Munoz asked whether some of the 23,000 under
discussion received some subsidy, while others did not.
Alternatively, she wondered if the individuals were all
unsubsidized.
Ms. Wing-Heier estimated that about 70 percent of the
23,000 individuals were receiving a subsidy. She estimated
that about half (or fewer) of the 70 percent received a
full subsidy. She reiterated her previous testimony that
the credit varied by income. One of the reasons the
division supported the innovation waiver was that it had
the ability "to soften the cliffs." She detailed that in
some of the income levels, if a person earned one cent
more, their subsidy could change or go away. She explained
it was trued up by the IRS, not by the Centers for Medicare
and Medicaid Services (CMS) or the state. She continued
people were more than surprised when they went to pay their
taxes and discovered their subsidy had been calculated
incorrectly and they ended up owing back their subsidy. She
stressed the ACA was in its infancy and had created some
problems for many constituents in the calculation of the
subsidy.
10:03:34 AM
Vice-Chair Saddler referred to background information
provided by Ms. Tallman that some health insurance
companies were responding to the high claim costs by
limiting their coverage in specific sections of the state
or the entire state (i.e. Eastern Washington versus the
whole state). He asked if Premera was considering limiting
its scope of coverage in portions of Alaska or all together
and if so, he wondered what the decision point was.
Ms. Tallman answered that currently the company was working
on its rate filing and was obtaining the claims data from
Moda, which would be used in the rate development process.
All of the factors were under consideration. The company
was committed to the individual market, but it was a
tenuous market. She added that each state had its own
market and was evaluated on its own.
Vice-Chair Saddler believed the calendar for the rate
filing was in approximately six weeks. He asked for
verification that a decision would be made by Premera
within six weeks to continue as is or to scale back in part
or in total.
Ms. Tallman answered in the affirmative.
Vice-Chair Saddler asked if Ms. Tallman believed the
proposed funding mechanism would be sufficient for the
short-term and long-term.
Co-Chair Thompson believed the question pertained to a
corporate decision.
Ms. Tallman answered that based on the analysis looking at
the markets, the $55 million would have a fairly
significant impact on individual premiums. She detailed the
question could only be answered for year-one. She believed
a reinsurance program would help mitigate the premium
increases and the rates. She thought the impacts would be
what happened over time to the pool if there were new
competitors coming in. She reiterated the $55 million would
have a significant impact and would potentially bring the
rate of the increase to the 20 to 25 percent range that had
been mentioned the previous day.
Vice-Chair Saddler asked about any experience Ms. Tallman
had with the 1332 innovation waivers under ACA. He asked if
it would be a good move for the state.
Ms. Tallman answered that Premera did not have direct
experience with the 1332 waiver. She explained the waiver
was still in the very initial stages and it had not been
formally explored by the State of Washington. Given the
unique nature of the insurance market and the overall
Alaskan market for insurance it would be a very positive
way to look at longer-term solutions to address the high
cost of healthcare in Alaska.
10:07:06 AM
Representative Gara referred to a reference to a
disappearing federal tax that may be causing some of the
problem. He asked if it was worth $55 million. He wondered
if the tax was ending for certain. He asked if other states
were erupting over the issue because they were facing the
same problem as Alaska.
Ms. Wing-Heier answered that the tax had been suspended for
2017 and the division did not know whether the federal
government would reenact it at some point or not; the
federal government had not committed one way or another.
She explained the reinsurance had been eliminated and had
sunset; to reinstate the reinsurance it would have to be
passed in federal legislation. She reiterated that the tax
had merely been suspended.
Representative Gara asked if it was the origin of the $55
million new problem.
Ms. Wing-Heier replied in the negative. She explained
Alaskans were paying the 3 percent tax and the $2.25 per
member per month fee. The goal was to consider what the net
impact would be if both the 3 percent and the $2.25 went
away. She expounded if they took the net impact and put it
into a state program so there was no additional cost. She
continued the money had previously been paid to the federal
government and would now be paid to the state, which was
how the division had come up with a rough number at $20 per
person, per month. The division did not realize the 3
percent was not being paid at the extent to the stop-loss
carriers, which was an error in its calculation.
Co-Chair Thompson remarked that the committee was still
hearing public testimony.
Representative Gara clarified that he had heard the
question earlier but had not received an amount. He
referred to the $55 million.
Mr. Parady answered that it was not $55 million. The
department had arrived at $55 million by multiplying $20
per month for 236,000 insured individuals. He clarified
that only 150,000 of the total were stop-loss and did not
pay the tax. At best, the amount was one-third of the $55
million.
Representative Gara stated that a number of people who
qualified for ACHIA probably qualified for social security
disability insurance also. He noted that Medicare was like
an exclusive insurance program. He wondered if a person
could qualify for social security disability health
insurance and ACHIA could pay for any remaining costs.
10:10:48 AM
Ms. Tallman answered that it was a complex question and
issue. She believed to the benefit of individuals who would
qualify for both programs, they should certainly have the
ability to tap into the program. She was unsure given the
complexity of the interplay with the federal program.
Representative Kawasaki asked if Premera also operated in
other small markets with very few insurers across the
United States.
Ms. Tallman answered that Premera operated in the State of
Washington. Additionally, it currently operated in Oregon,
but would be leaving that market in 2017. Those states had
a number of other competitors in the individual and group
markets.
Representative Kawasaki stated it looked like there were 11
in Washington and 11 in Oregon. He observed that the rates
in Washington appeared to have dropped from 2015 to 2016 by
4 percent. He asked if Premera would anticipate a
competitor coming into the market if ACHIA took the highest
risk pool out of the equation.
Ms. Tallman would anticipate that it would provide some
stability to the market and would be more attractive to
competitors. She detailed that a program to help stabilize
the market meant a company would not be faced with
significant swings year-over-year. The program would be
available to any insurer and she believed it would make the
market more attractive for others.
Representative Wilson asked if any other state had a
program like Alaska's ACHIA that helped to compensate for a
specific group.
Ms. Tallman answered that the high risk pool, prior to ACA,
had been in effect in a number of other states. The goal
with the reinsurance program was to utilize the high risk
pool and to do a similar thing to what it had been doing
before a guaranteed issue. She detailed that Oregon was
implementing what had previously been a temporary
reinsurance program. She knew that other states were very
interested in the program under discussion. She specified
that Premera had conversations with other Blue Cross plans
in Arizona, Illinois, and Texas, who were very interested
to see how the program would work and if it could be
applied in their states.
10:13:57 AM
JENNIFER JOLLIFFE, SELF, ANCHORAGE (via teleconference),
shared that she is a small business owner in Anchorage. She
was a large fan of having health insurance. She stated if
insurance rates continued to increase at the same level
they had in the past two years, her annual premium for 2017
could easily be $16,800 with a $6,500 deductible. She
believed the amount was insane when compared to her income,
which was not much over the qualifying rate for a tax
subsidy. She asked the committee to consider what it would
be like to not have health insurance even though they
worked hard and contributed to the social and economic
wellbeing of the state's communities. She did not want to
be a person looking in the mirror and terrified to go to
the doctor because she could not afford it. She implored
the committee to think about Alaskans.
Co-Chair Thompson CLOSED public testimony.
Representative Wilson stated that 2.7 percent was going
into a fund, which could exceed the $55 million; however,
the money was not specifically designated to one agency -
it would be up to the department to utilize. She believed
the change could mean increased competition in Alaska
because the goal was to try to alleviate some of the high
risk. Additionally, everybody on insurance paying the 2.7
percent would be funding the particular issue. She surmised
that hopefully most everyone should benefit in some way -
individuals may not see a decrease in what they pay, but
hopefully the increase would not be as significant as it
would be if no action was taken.
10:18:06 AM
Mr. Parady answered in the affirmative. The fund would be
available to any insurer providing coverage and it would
moderate the rate increase for the individual market.
Representative Wilson stated that the federal government
may choose to continue the tax, but it was not yet known.
She added the program and waiver could also change. She
surmised that it was possible that in one or two years the
money may not be needed due to potential federal changes.
Mr. Parady answered that it was the hope.
Vice-Chair Saddler believed the bill was focused at the
individual health insurance market. He referred to the
previous question related to all of the other policy
holders who would pay the cost. He wondered if there were
any other lines of insurance in the same dire straits as
health insurance. He asked if there was a risk of other
people going after the money.
Ms. Wing-Heier answered that at present the small group
market, which was the only other market, was performing
fairly well. She relayed she could not say it was
performing excellently, but at present it was supporting
itself.
Vice-Chair Saddler provided scenario that involved "a rash"
of marijuana induced auto accidents and there was
insufficient money to pay for all of the auto accident
collisions. He asked if the auto insurance industry would
have access to the money. Ms. Wing-Heier answered in the
negative. The fund was strictly for healthcare insurance
through ACHIA.
Co-Chair Thompson relayed that the committee would
reconvene later in the day to address a forthcoming CS.
10:20:32 AM
RECESSED
5:16:49 PM
RECONVENED
Co-Chair Thompson discussed the agenda.
Co-Chair Neuman MOVED to ADOPT the proposed committee
substitute for HB 374, Work Draft 29-GH2126\N
(Glover/Wallace, 5/27/16). There being NO OBJECTION, it was
so ordered.
JANE PIERSON, STAFF, REPRESENTATIVE STEVE THOMPSON,
explained the changes in the CS. She directed attention to
Section 1, page 2, lines 1 through 5, which was a new
section relating to the duties of the director to formulate
general policy and adopt regulations to administer "this
chapter" and to specify covered conditions that were
eligible for payment from the Alaska Comprehensive Health
Insurance fund. Under Section 2, page 2, lines 7 through 27
a new subsection was created in AS 21.55.430 that defined
the disposition of proceeds from tax on insurance premiums.
She detailed that insurance premium taxes collected would
be deposited directly into the new Alaska Comprehensive
Health Insurance fund. The legislature would then have the
ability to appropriate monies from the fund to DCCED to pay
claims under the ACHI reinsurance program. Section 2
further defined net proceeds that would be deposited into
the fund.
5:19:40 PM
Representative Wilson pointed to page 2 lines 3 through 5
related to specifying covered conditions [eligible for
payment through the fund]. She thought the bill was based
on high risk individuals who may be outside "of that." She
remarked that at present the list was very short. She asked
if there would be the same type of list as the one
currently utilized for ACHIA. She asked for verification
that even if people were rejected they would still have to
be on the list.
Ms. Pierson deferred the question to the department.
Ms. Wing-Heier replied that the current ACHIA, which was a
direct payment, had a very specific list of qualifying
conditions. The reinsurance program would be different. She
detailed that under the ACA everyone was guaranteed issue.
The bill looked at taking the top cost drivers and only
reinsuring those individuals under the ACA; those differed
from what was under the old ACHIA. She explained there
would still be a condition list, but only certain
conditions would be eligible - it would not include
everything under the ACA - otherwise it would assume every
claim. She elaborated that under the first 21 months it
would be the $240 million paid. The bill only looked at
taking $55 million or whatever amount was appropriated by
the legislature. She relayed that the $55 million would
address the top cost driver claims (shown in the claims
data) for the first 21 months of the program started in
2014.
Representative Wilson pointed to the definition of high
risk residents on page 2, beginning on line 29. She noted
the definition specified an individual would have to be
rejected for medical reasons [after applying for a
subscriber contract]. She asked if an individual could be
rejected, but not fall under the proposed plan.
Ms. Wing-Heier answered that the language had been left for
the Medigap/Medsup policies [Medicare Supplemental
Insurance]. To pick up the high risk residents or claims
under the ACA, only subsection (C) [of Section 3] had been
amended in the CS (in order to make it ACA compliant). To
pick up the Medicare supplemental insurance payments under
the old ACHIA, the language remained as-is in subsections
(A) and (B) to keep the condition list in the current
ACHIA. She relayed there were still constituents under the
policy, there was not a market in Alaska for Medicare
patients for pharmaceutical policies.
Representative Wilson wanted to ensure that with the
passage of the bill situations would not occur where an
individual may be unable to find insurance from the pool
and could not qualify under the bill either. She remarked
the situation had happened in the past prior to the ACA
where an individual with a high cost disease could not get
coverage because they were not in one of the top high risk
categories.
Ms. Wing-Heier answered that under the ACA it was
guaranteed issue; no one could be rejected. The reinsurance
bill was only defining the claims it would seat and pay
with state funds.
5:24:16 PM
Representative Munoz asked if the payments would be made
directly from the fund to the claimant or if the claims
would go to the insurance company for payment. She asked if
the individual purchased insurance through "your
organization" or through ACHIA. Alternatively, she wondered
if the individuals would still be under the insurance
company.
Ms. Wing-Heier answered that people and families in the
individual market would go to healthcare.gov, a broker, or
a navigator, and would purchase insurance just as they did
at present. Additionally, the individuals would submit
claims just as they did at present. She noted that all of
the mechanics were still being worked out, but in theory,
Premera would pay the claims as they came in on a monthly
basis. Those claims based on the 10 to 15 (or whatever the
cutoff point may be) claims for the $55 million or
appropriated amount would be triggered and sent to ACHIA
for payment. She furthered that ACHIA would then reimburse
Premera; ACHIA and its administrator would carefully
monitor the condition list against what was appropriated
against what was submitted by Premera. She added that DCCED
would oversee the entire process.
5:25:58 PM
Representative Gara asked for verification that the bill
applied to people who would be covered under a private
insurance company, but they would have conditions and the
insurance company would go to the ACHIA program for some
reimbursement to keep the cost down for the insurance
company and hopefully the premiums down for the members. He
noted that sometimes the two did not get tied together.
Ms. Wing-Heier replied in the affirmative. She detailed
that at the same time reimbursement was sought for the
claims, the premium would seat. She expounded that when an
individual was diagnosed and the claim was seated, the
premium was also seated. She continued that essentially the
whole person (claim and premium) was seated to ACHIA for
the policy year and the claims were paid by ACHIA.
Representative Kawasaki asked if it would be a negotiation.
He remarked there were a very limited number of diseases
currently covered under ACHIA. He asked if the issue would
be up to the department to decide.
Ms. Wing-Heier answered that the bill focused on the top
cost drivers that were causing premiums to see 40 percent
increases for the third year in a row - it was not so much
a decision, but what was driving the market. The bill was
trying to remove the increases from the market through the
reinsurance program.
Representative Kawasaki spoke to the mechanics of the
program. He referred to the end of Section 1 of the
legislation related to high risk residents and the
Comprehensive Health Insurance fund. He asked for
verification DCCED would be making the decisions. He
clarified he was speaking about high cost individuals that
the department was either negotiating with or talking to
(current insurers) that the department would identify.
Ms. Wing-Heier answered that in January of the current year
the division had submitted a "data call" to Assurant,
Premera, and Moda. The division had asked the companies to
provide the claim data from 2014 and 2015, which it had
sent to an independent actuary. The actuary had reviewed
all of the losses for the three insurers that were doing
business in the individual market. She noted Aetna only had
a handful of insurers (103) and had been excused from the
data call. The actuary had listed the top claims included
in the data provided. She clarified that instead of having
the division make the call, it had asked the actuary to
aggregate and list the data of the three insurers from the
highest cost claims down.
Representative Kawasaki surmised that it could pertain to
an individual with multiple complications within a
particular list. He asked how the situation would work.
Ms. Wing-Heier answered that the division had gone from a
diagnosis code to a fixed code to ensure it was not double
counting. The process had dropped the number of claimants
in half. For example, the division was looking at
individuals as opposed to a person with asthma and cancer.
She explained it was the reason the division was looking at
the entire treatment of a person and their premium instead
of only picking up certain doctor bills or treatments.
5:30:32 PM
Representative Gara MOVED to ADOPT Conceptual Amendment 1:
Page 1, line 1, following "Act":
Insert "relating to coverage under the Comprehensive
Health Insurance Association;"
Page 1, following line 5:
Insert a new bill section to read:
"* Section 1. AS 21.55.320 is amended by adding a new
subsection to read:
(b) When a person with a disability that is covered
under 42 U.S.C. 1935 - 1935b-10 (Title XVIII of the
Social Security Act) is referred by an insurer to a
state plan under AS 21.55.310, the plan administrator
shall request that the Department of Health and Social
Services provide information to the person about
applying for the federal benefits."
Page l, line 6:
Delete "Section 1"
Insert "Sec. 2"
Renumber the following bill sections accordingly.
Page 3, line 24:
Delete "Section 2"
Insert "Section 3"
Page 3, line 25:
Delete "Sections 1 and 3 - 5"
Insert "Sections 1, 2, and 4 - 6"
Co-Chair Thompson OBJECTED for discussion.
Representative Gara explained there was social security
disability insurance that was disability-based as opposed
to asset or income-based. He noted it was a determination
about whether or not a person could work. He explained
there were a number of conditions covered by ACHIA (e.g.
end-stage liver disease, acute liver failure, cystic
fibrosis, and other). He relayed that many of the
individuals could not work and qualified for the definition
of disability. Currently if a person was receiving social
security disability they could not be on the ACHIA plan. He
discussed the bill's substantial cost. He had worked with
DCCED and the Department of Health and Social Services
(DHSS) and the departments would like to help refer people
to get the federal insurance they were entitled to because
of their condition. He elaborated it would mean the
individuals and the state would not have to pay for the
insurance. He believed it was a win-win scenario. The
amendment specified the departments should help individuals
through the process to apply for the disability insurance
when eligible.
Representative Wilson believed a lawyer was needed to go
through the social security disability [application
process]. She remarked it was not merely about filling out
a form. She asked if a person could get the insurance
without actually qualifying and being put into social
security disability. She did not believe so.
Ms. Wing-Heier answered that when a person applied in the
marketplace at healthcare.gov, they were asked if they had
a disability. In theory the application was then sent to
Medicare or Medicaid and CMS sent it to the state agency.
She furthered that in theory what Representative Gara was
suggesting should be taken care of. However, in the event
that someone was not taken care of, the amendment was
asking the departments to double check to ensure the proper
benefits were being applied when the departments sent the
claim on to Medicare or Medicaid.
Representative Wilson spoke to social security disability.
She believed there were disabled people who could be on the
list and qualify for ACHIA who were working and did not
want social security disability because it could "mess with
everything else" a person had. She thought the amendment
would require individuals to go through the process because
there was a chance they would qualify for social security,
which would provide insurance. She agreed it would work,
but she believed a person who was working and had a
disability would have to go after social security
disability even if they did not want to or they would not
be covered.
Representative Gara countered that the amendment did not do
what Representative Wilson thought it did. He pointed to
line 11 and explained the amendment did not require
individuals to get on social security disability. He added
there were other related laws the amendment did not
address. He clarified the amendment would ask the
departments to provide individuals with the information
about how to apply [for social security disability]; it did
not require a person to apply. He stated that individuals
in the condition often did not have much money and often
did not know their way through the federal bureaucracy. He
underscored the amendment would only specify that
individuals would be given information about how to apply.
He furthered it was insurance the individuals were entitled
to at no cost. He believed the individuals should not be
stuck paying high premiums because they did not know about
a program they could apply for. He emphasized a lawyer was
not needed to get social security disability; however, if a
person was denied the benefit they may need an attorney to
help them with the appeal process.
5:35:50 PM
Co-Chair Thompson stated that based on personal experience,
social security was not that difficult to deal with. He
shared that his wife had gone through chemotherapy for two
years and had been unable to work. He furthered that social
security had requested a letter from her doctor and she was
able to immediately begin drawing social security benefits
at 52 years of age. He stated that it was not a big process
that required an attorney. He added the amendment pertained
to slightly different situations; his wife had drawn social
security payments like she had retired.
Representative Wilson understood the amendment slightly
better. She surmised the amendment specified the
departments would merely provide individuals with the
paperwork needed to apply [for social security disability].
She initially thought the amendment would force individuals
to apply for the benefit. She read from the amendment and
surmised the departments would merely provide the
application information to individuals to use if they
chose.
Ms. Wing-Heier answered in the affirmative.
Representative Wilson clarified that it was not possible to
just get a federal insurance without being qualified as
disabled. She reiterated her understanding of the amendment
and relayed she was fine with its action. She wanted to
ensure the state was not forcing working individuals who
had a disability into a federal system they did not want to
use.
Co-Chair Thompson noted that Representative Liz Vasquez was
in the audience.
Representative Gattis stated she did not know any specifics
on how a person received social security disability
insurance benefits. She remarked that because the amendment
was only about providing information to individuals, she
did not need further information about the process.
Co-Chair Thompson WITHDREW his OBJECTION to Conceptual
Amendment 1. There being NO OBJECTION, Conceptual Amendment
1 was ADOPTED.
Vice-Chair Saddler addressed the fiscal note from the
Department of Commerce, Community and Economic Development,
which called for an appropriation of $55 million in FY 17
in the grants and benefits line and included no changes in
positions.
Representative Wilson wanted to ensure the $55 million was
not GF and would be funds collected with the 2.7 percent
tax.
Mr. Teal explained that the premium tax collections went
into the fund. The premium taxes were currently classified
as UGF, but as soon as the legislature specified the
revenue was directed to a specific fund for a specific
purpose they became DGF. He provided a scenario where the
premium taxes generated totaled $65 million, which he noted
may be more accurate than $55 million. He explained it did
not matter how much was collected. The collections would go
into the fund and the legislature could appropriate money
from the fund to the Division of Insurance. He explained
under the scenario $55 million could be allocated to the
division and would put a cap on the amount the department
could spend for the program.
Representative Wilson asked if the $55 million would be a
cap "from here on out." Mr. Teal answered in the negative.
He explained the cap would be whatever the legislature
decided upon. He furthered if it turned out that insurance
premiums continued to rise, taxes rose, and there was $70
million collected in FY 17, the $70 million would go into
the fund and the legislature would decide how much of the
amount it wanted to appropriate. He elucidated that any
flow to the fund and the appropriations from the fund were
not necessarily connected. He added they were connected in
a way because the legislature could not appropriate more
money than it had.
Co-Chair Neuman MOVED to REPORT CSHB 374(FIN) as amended
out of committee with individual recommendations and the
accompanying fiscal note.
Representative Kawasaki OBJECTED. He recognized that the
legislation was a stopgap bill. He referred to a 37 percent
increase in September of 2014 and another 38 percent in
2014 and surmised the bill represented a "Band-Aid on a
bullet hole." He stressed the importance of solving the
healthcare cost increase problem in Alaska. He hoped it was
a project the committee could undertake over the interim.
He expressed hope that the $55 million would go a long way
in the coming year, but he believed it was "looking down
the barrel of a gun."
Representative Kawasaki WITHDREW his OBJECTION.
Vice-Chair Saddler noted that Section 4 of the legislation
gave the Division of Insurance director the authority to
apply for the innovation waiver. He encouraged Ms. Wing-
Heier to do so.
Ms. Wing-Heier confirmed the division would apply for the
waiver.
There being NO further OBJECTION, CSHB 374(FIN) was
REPORTED out of committee as amended with a "do pass"
recommendation and with one new fiscal impact note from the
Department of Commerce, Community and Economic Development.
Co-Chair Thompson addressed the schedule for upcoming
meetings.
ADJOURNMENT
5:45:13 PM
The meeting was adjourned at 5:45 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB374 AK Premium Tax Rates DCCED Annual Report.pdf |
HFIN 5/27/2016 9:00:00 AM |
HB 374 |