Legislature(2009 - 2010)HOUSE FINANCE 519

04/14/2009 08:30 AM FINANCE


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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
-- Delayed to 5 min. after Conf. Cmte. --
+ HB 204 POSTSECONDARY MEDICAL EDUC. PROG. TELECONFERENCED
Heard & Held
+ HB 222 MED. INS. ELIGIBILITY/NONDISCRIMINATION TELECONFERENCED
Moved Out of Committee
+ Bills Previously Heard/Scheduled TELECONFERENCED
                  HOUSE FINANCE COMMITTEE                                                                                       
                       April 14, 2009                                                                                           
                         9:17 a.m.                                                                                              
                                                                                                                                
9:17:02 AM                                                                                                                    
                                                                                                                                
CALL TO ORDER                                                                                                                 
                                                                                                                                
Co-Chair Stoltze  called the House Finance  Committee meeting                                                                   
to order at 9:17 a.m.                                                                                                           
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Mike Hawker, Co-Chair                                                                                            
Representative Bill Stoltze, Co-Chair                                                                                           
Representative Bill Thomas, Jr., Vice-Chair                                                                                     
Representative Allan Austerman                                                                                                  
Representative Harry Crawford                                                                                                   
Representative Anna Fairclough                                                                                                  
Representative Les Gara                                                                                                         
Representative Reggie Joule                                                                                                     
Representative Mike Kelly                                                                                                       
Representative Woodie Salmon                                                                                                    
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Representative Richard Foster                                                                                                   
                                                                                                                                
ALSO PRESENT                                                                                                                  
                                                                                                                                
Representative  Nancy  Dahlstrom,  Sponsor; Sam  Dix,  Staff,                                                                   
Representative  Nancy  Dahlstrom;  Diane  Barrans,  Executive                                                                   
Director, Postsecondary  Education Commission,  Department of                                                                   
Education;  Representative  Lindsey  Holmes,  Sponsor;  Linda                                                                   
Hall,  Director,   Division  of   Insurance,  Department   of                                                                   
Commerce,  Community and Economic  Development; Jeff  Jessee,                                                                   
Chief   Executive  Officer,   Alaska   Mental  Health   Trust                                                                   
Authority                                                                                                                       
                                                                                                                                
PRESENT VIA TELECONFERENCE                                                                                                    
                                                                                                                                
Dennis  Valenzeno,  Director and  Professor,  WWAMI  Program,                                                                   
University  of Alaska,  Anchorage;  Suzanne Tripp,  Director,                                                                   
Regional  Programs,   University  of  Washington   School  of                                                                   
Medicine                                                                                                                        
                                                                                                                                
SUMMARY                                                                                                                       
                                                                                                                                
HB 204    "An Act increasing the  number of students pursuing                                                                   
          a medical education who are provided postsecondary                                                                    
          educational services and programs; and providing                                                                      
          for an effective date."                                                                                               
                                                                                                                                
          HB 204 was heard and  HELD in Committee for further                                                                   
          consideration.                                                                                                        
                                                                                                                                
HB 222    "An Act  prohibiting discrimination by  health care                                                                   
          insurers based on genetic  information; requiring a                                                                   
          health  care  insurer  to offer  coverage  for  the                                                                   
          treatment  of alcoholism  or drug abuse;  providing                                                                   
          continuity of coverage  for college students during                                                                   
          medically   necessary   leaves  of   absence   from                                                                   
          college;  requiring  health  care insurers  in  the                                                                   
          group market  to provide parity in  the application                                                                   
          of mental health and  substance abuse benefits that                                                                   
          comply  with  federal  requirements;  amending  the                                                                   
          definition  of  'dentist' to  include  out-of-state                                                                   
          dentists for  purposes of certain  dental insurance                                                                   
          requirements;   and  providing  for   an  effective                                                                   
          date."                                                                                                                
                                                                                                                                
          HB  222 was REPORTED  out of  Committee with  a "do                                                                   
          pass" recommendation  and with two new  zero fiscal                                                                   
          notes  by  the  Department  of  Health  and  Social                                                                   
          Services  and fiscal note  #1 by the  Department of                                                                   
          Commerce, Community and Economic Development.                                                                         
                                                                                                                                
9:17:56 AM                                                                                                                    
                                                                                                                                
HOUSE BILL NO. 204                                                                                                            
                                                                                                                                
     "An  Act increasing  the number  of students pursuing  a                                                                   
     medical   education  who   are  provided   postsecondary                                                                   
     educational services and  programs; and providing for an                                                                   
     effective date."                                                                                                           
                                                                                                                                
REPRESENTATIVE  NANCY DAHLSTROM,  SPONSOR,  related that  the                                                                   
bill  would  add  four  students  to  the  medical  education                                                                   
program.                                                                                                                        
                                                                                                                                
9:19:22 AM                                                                                                                    
                                                                                                                                
SAM  DIX, STAFF,  REPRESENTATIVE  NANCY DAHLSTROM,  explained                                                                   
that the  purpose of  the bill  is to  add four more  medical                                                                   
students and eventually  establish a 30-student  program.  It                                                                   
is an  attempt to maximize  the facilities at  the University                                                                   
of Alaska - Anchorage.                                                                                                          
                                                                                                                                
Vice-Chair Thomas asked if the  bill pertains only to medical                                                                   
doctors.  Mr.  Dix said that was correct.   Vice-Chair Thomas                                                                   
hoped  to see  the bill  expanded  to include  dentists.   He                                                                   
asked if the administration supports the bill.                                                                                  
                                                                                                                                
Representative  Dahlstrom  reported that  the  administration                                                                   
does support the bill.  She offered  to work on expanding the                                                                   
bill to include other areas.                                                                                                    
                                                                                                                                
Vice-Chair Thomas expressed frustration  and thought he might                                                                   
not support the bill.                                                                                                           
                                                                                                                                
9:21:38 AM                                                                                                                    
                                                                                                                                
Representative Dahlstrom offered to work on that problem.                                                                       
                                                                                                                                
Representative  Austerman  inquired  about  the cost  of  the                                                                   
program.   He  wondered,  since  it is  a loan  program,  why                                                                   
general  fund  dollars  would   be  needed.    Representative                                                                   
Dahlstrom stated that it was a loan forgiveness program.                                                                        
                                                                                                                                
9:23:02 AM                                                                                                                    
                                                                                                                                
DIANE  BARRANS, EXECUTIVE  DIRECTOR, POSTSECONDARY  EDUCATION                                                                   
COMMISSION,    DEPARTMENT   OF    EDUCATION,   agreed    with                                                                   
Representative  Austerman  that the  program  is funded  with                                                                   
state  general  funds.   The  existing  program  operates  in                                                                   
excess of $2 million a year.   She reported that it is a work                                                                   
obligation program  with a trigger if someone  in the program                                                                   
fails to return to Alaska.                                                                                                      
                                                                                                                                
Representative Austerman  asked how long the  obligation was.                                                                   
Ms. Barrans  replied that  students have 15  years to  pay if                                                                   
they fail  to return to the  state and provide three  to five                                                                   
years of service.                                                                                                               
                                                                                                                                
Representative  Austerman presented  an example  of a  doctor                                                                   
who returns to the state, provides  service, and has the loan                                                                   
forgiven.    Ms.  Barrans  agreed with  his  analysis.    She                                                                   
clarified  that   the  service  obligation  is   in  lieu  of                                                                   
repayment.                                                                                                                      
                                                                                                                                
9:24:38 AM                                                                                                                    
                                                                                                                                
Representative  Fairclough  reported  that she  followed  the                                                                   
bill last  year and  the discussions  in the HESS  committee.                                                                   
She asked  about the  dismal return rates  and wondered  if a                                                                   
residency program would help solve the program.                                                                                 
                                                                                                                                
Ms. Barrans  explained that past  return rates  proceeded the                                                                   
loan obligation  period of  the program.   The actual  return                                                                   
rate of Alaskans varied between  45 and 55 percent and should                                                                   
now increase.   Out  of state  WWAMI students  also chose  to                                                                   
participate  in  Alaska.   She  explained how  the  residency                                                                   
requirements work.   It takes  about seven years  to complete                                                                   
the  program.    The  cohort  of  students  that  would  have                                                                   
completed a three-year residency  in the fall of 2008 was the                                                                   
first group with the contractual service obligation.                                                                            
                                                                                                                                
9:27:27 AM                                                                                                                    
                                                                                                                                
Co-Chair  Hawker  asked  for more  information  about  return                                                                   
rates.                                                                                                                          
                                                                                                                                
DENNIS  VALENZENO,  DIRECTOR AND  PROFESSOR,  WWAMI  PROGRAM,                                                                   
UNIVERSITY OF ALASKA, ANCHORAGE,  via teleconference, related                                                                   
that  the return  rate  of Alaskans  is  actually quite  good                                                                   
compared to outside programs.   About 50 percent come back to                                                                   
the state  to practice.   Students coming  to the  state from                                                                   
other  states to  do short  clinical  experiences impact  the                                                                   
statistics.   The overall return  on the investment  is about                                                                   
88 percent  since the beginning of  the program in 1971.   It                                                                   
takes about seven  years to complete the program.   Residency                                                                   
is the  most important factor  as to where doctors  choose to                                                                   
practice.   Where students  go to school  is the  second most                                                                   
important  factor.   Through WWAMI  Alaska is  able to  offer                                                                   
three of the four years of medical school.                                                                                      
                                                                                                                                
9:30:39 AM                                                                                                                    
                                                                                                                                
Representative  Fairclough had  heard  a different  scenario.                                                                   
She wished to research the statistics further.                                                                                  
                                                                                                                                
Co-Chair  Hawker asked  if the  state would  benefit more  by                                                                   
increased  residency  programs or  by  more  students in  the                                                                   
WWAMI program.                                                                                                                  
                                                                                                                                
SUZANNE  TRIPP, DIRECTOR,  REGIONAL  PROGRAMS, UNIVERSITY  OF                                                                   
WASHINGTON  SCHOOL  OF MEDICINE,  via  teleconference,  first                                                                   
addressed Vice-Chair  Thomas's concerns about dentists.   She                                                                   
related that through the University  of Washington, there was                                                                   
an option for  developing dental programs in  Alaska based on                                                                   
the WWAMI model.                                                                                                                
                                                                                                                                
Ms. Tripp  turned to  the issue of  residency training.   She                                                                   
maintained that  it was  a huge factor  in WWAMI.   Residency                                                                   
programs  are  being  developed  currently.    She  spoke  of                                                                   
overcoming   obstacles   related  to   developing   residency                                                                   
programs in Alaska.   There needs to be  sufficient technical                                                                   
expertise, adequate  finances - based on Medicare  bed rates,                                                                   
and  enough  case volume  in  order  to  qualify to  take  on                                                                   
residents.  Branch  programs in pediatrics and  in psychiatry                                                                   
are currently  being developed.   Internal medicine  programs                                                                   
will be next.                                                                                                                   
                                                                                                                                
9:33:11 AM                                                                                                                    
                                                                                                                                
Representative  Fairclough summarized  that residency  is the                                                                   
number one factor.  She wished to check further.                                                                                
                                                                                                                                
Representative  Gara  agreed  with the  expansion  of  family                                                                   
practice  residency.   He voiced  support for  the bill.   He                                                                   
mentioned a  concern about an  acute shortage  of internists,                                                                   
family  care physicians,  and gerontologists.   He  suggested                                                                   
focusing scholarships in those areas.                                                                                           
                                                                                                                                
Representative  Dahlstrom  offered to  meet  to discuss  this                                                                   
issue and  to include  the Committee's  concerns.   She added                                                                   
that she has concerns  with lack of medical care  in parts of                                                                   
the state.                                                                                                                      
                                                                                                                                
9:36:22 AM                                                                                                                    
                                                                                                                                
Representative Gara said he was open to a conversation.                                                                         
                                                                                                                                
Co-Chair  Hawker  asked  for  an  opinion  of  Representative                                                                   
Gara's comments.                                                                                                                
                                                                                                                                
Mr.  Valenzeno  agreed  that targeting  an  area  of  medical                                                                   
practice was a  good idea.  He thought it would  be difficult                                                                   
to hold a student to that choice.   Representative Gara hoped                                                                   
there was a way to make it work.                                                                                                
                                                                                                                                
9:38:10 AM                                                                                                                    
                                                                                                                                
Representative Austerman  wondered whether  returning doctors                                                                   
are required to serve high-need areas or rural areas.                                                                           
                                                                                                                                
Ms.  Barrans   reported  that   there  is  an   incentive  to                                                                   
accelerate  the  discharge  of the  financial  obligation  by                                                                   
choosing a rural area.                                                                                                          
                                                                                                                                
9:39:12 AM                                                                                                                    
                                                                                                                                
Vice-Chair Thomas  asked what  the average obligation  to the                                                                   
state  was.  Ms.  Barrans said  it was  $90,000, which  would                                                                   
increase by  about 4 to 6 percent  per year.  That  amount is                                                                   
in addition to  about $100,000 of education  debt the student                                                                   
has already  incurred.  Vice-Chair  Thomas asked  if $190,000                                                                   
was  the amount  forgiven.   Ms. Barrans  explained that  the                                                                   
$100,000  was  owed  to  the   federal  government  or  other                                                                   
lenders.                                                                                                                        
                                                                                                                                
Vice-Chair  Thomas  wondered why  15  years  was allowed  for                                                                   
paybacks.   He suggested  the payback  be accelerated  if the                                                                   
student does not  return to the state.  Ms.  Barrans observed                                                                   
that collectability must be considered.   It is difficulty to                                                                   
leverage  an accelerated  repayment  on such  a large  amount                                                                   
without collateral.                                                                                                             
                                                                                                                                
9:41:56 AM                                                                                                                    
                                                                                                                                
Representative  Fairclough  inquired  about  the  delinquency                                                                   
rate  of the  loans.   Ms.  Barrans reported  that  currently                                                                   
there is zero delinquency.                                                                                                      
                                                                                                                                
Representative Austerman  asked about the  forgiveness period                                                                   
and amount collected.  Ms. Barrans  reported that $170,000 is                                                                   
the  amount collected  with  interest by  the  state if  they                                                                   
don't return and work in the state.                                                                                             
                                                                                                                                
Representative Austerman  asked if the $90,000  original loan                                                                   
was forgiven if the student returns  to the state to work for                                                                   
five years.  Ms. Barrans said that was correct.                                                                                 
                                                                                                                                
9:43:37 AM                                                                                                                    
                                                                                                                                
Representative  Salmon   asked  about  incentives   to  bring                                                                   
physicians to  come to Alaska to  work.  Ms. Barrans  was not                                                                   
aware of such a program.                                                                                                        
                                                                                                                                
Co-Chair Hawker opened public testimony.                                                                                        
                                                                                                                                
9:44:27 AM                                                                                                                    
                                                                                                                                
Ms. Tripp  clarified that the  average amount of debt  for an                                                                   
Alaska  WWAMI graduate  is about  $130,000  because they  pay                                                                   
tuition in  addition to state  support.  The amount  of money                                                                   
the  state   sends  to  the   University  of   Washington  is                                                                   
equivalent in context,  not amount, to the amount  of general                                                                   
fund  used  by  the  University  of Alaska.    It  makes  the                                                                   
partnership of  the University of Washington  and the state's                                                                   
medical  school, similar  to  any publically  funded  medical                                                                   
school.  The money  the state pays is not a  scholarship or a                                                                   
grant; it is  the state's support for medical  education.  In                                                                   
addition, students may receive  scholarships or loans and pay                                                                   
tuition to  the University of  Washington and  the University                                                                   
of Alaska.   Students usually  have more than  $200,000 worth                                                                   
of obligation upon completion  of their education.  In Alaska                                                                   
there is  a need  for primary  care physicians.   There  is a                                                                   
correlation between debt and the  type of medicine practiced.                                                                   
                                                                                                                                
9:46:39 AM                                                                                                                    
                                                                                                                                
Co-Chair Hawker closed public testimony.                                                                                        
                                                                                                                                
Co-Chair Hawker requested information  about the fiscal note.                                                                   
                                                                                                                                
Mr. Dix  explained that  in 2012  the total operating  budget                                                                   
would be $210,300.  For 2013 it  would be $425,200.  For 2014                                                                   
it would be $550,300 and for 2015 it would be for $557,400.                                                                     
                                                                                                                                
Co-Chair Hawker asked why it accelerates over the years.                                                                        
                                                                                                                                
Ms. Tripp related that it accelerates  because there are more                                                                   
students  in  the  program  every   year.    Co-Chair  Hawker                                                                   
concluded that it was a cumulative bill.                                                                                        
                                                                                                                                
9:48:37 AM                                                                                                                    
                                                                                                                                
Representative Gara  asked if the WWAMI subsidy  was for four                                                                   
years of  medical school, but  not for the residency  because                                                                   
the students would be getting  paid.  Ms. Tripp said that was                                                                   
correct.                                                                                                                        
                                                                                                                                
Representative Austerman inquired  if the amount was for four                                                                   
new students.   He asked if  there was already $2  million in                                                                   
the program.  Ms. Tripp said that was correct.                                                                                  
                                                                                                                                
Vice-Chair  Thomas  asked  if  the  fiscal  note  covers  the                                                                   
student  that has  an assistant.   Ms. Tripp  stated that  it                                                                   
does include all expenses.  Vice-Chair  Thomas asked how many                                                                   
more  teachers  would be  added.    Ms. Tripp  explained  the                                                                   
apprenticeship program  and how sites are found.   Additional                                                                   
persons are  then brought on,  however, she did not  know how                                                                   
many.                                                                                                                           
                                                                                                                                
9:50:57 AM                                                                                                                    
                                                                                                                                
Vice-Chair  Thomas thought  extra individuals  were hired  to                                                                   
supervise the students.  Ms. Tripp  recalled that there was a                                                                   
coordinator who would help students  navigate through medical                                                                   
school,  as well  as career  counselors.   In  the third  and                                                                   
fourth year additional supervisors  are involved.  Vice-Chair                                                                   
Thomas wanted  to know the costs  in addition to  funding the                                                                   
students.                                                                                                                       
                                                                                                                                
9:52:04 AM                                                                                                                    
                                                                                                                                
Representative  Joule wondered what  the shortage  of doctors                                                                   
would  look  like  without  this program.    He  asked  where                                                                   
residencies take  place.  Ms.  Tripp reported  that residency                                                                   
training can happen  in a number of sites,  determined by the                                                                   
population of  the town and  type of  residency.  One  of the                                                                   
requirements for pediatricians  is that a doctor be available                                                                   
on site  for training.   In  Bethel the  residents go  out to                                                                   
various rural sites for one month.                                                                                              
                                                                                                                                
Ms. Tripp addressed  the issue of physician  training and the                                                                   
physician shortage  in Alaska.  There  is a need for  30 more                                                                   
physicians  a  year  in  order to  address  the  shortage  of                                                                   
doctors in the state.  There are  currently 260 WWAMI doctors                                                                   
in  the state.   A  primary care  physician  has about  3,000                                                                   
patient visits a year.                                                                                                          
                                                                                                                                
Representative  Joule   thought  that  was  a   "pretty  good                                                                   
picture" of the situation.                                                                                                      
                                                                                                                                
9:54:58 AM                                                                                                                    
                                                                                                                                
HB  204  was   heard  and  HELD  in  Committee   for  further                                                                   
consideration.                                                                                                                  
                                                                                                                                
9:55:47 AM                                                                                                                    
                                                                                                                                
HOUSE BILL NO. 222                                                                                                            
                                                                                                                                
     "An  Act  prohibiting  discrimination   by  health  care                                                                   
     insurers  based  on  genetic  information;  requiring  a                                                                   
     health care insurer to offer  coverage for the treatment                                                                   
     of  alcoholism or  drug abuse;  providing continuity  of                                                                   
     coverage   for   college   students   during   medically                                                                   
     necessary  leaves  of absence  from  college;  requiring                                                                   
     health  care insurers  in  the group  market to  provide                                                                   
     parity   in  the  application   of  mental   health  and                                                                   
     substance  abuse  benefits   that  comply  with  federal                                                                   
     requirements;  amending the  definition of 'dentist'  to                                                                   
     include  out-of-state dentists  for purposes of  certain                                                                   
     dental  insurance  requirements;  and providing  for  an                                                                   
     effective date."                                                                                                           
                                                                                                                                
REPRESENTATIVE  LINDSEY HOLMES,  SPONSOR, explained  that the                                                                   
bill  implements  federal law.    It  gives the  Division  of                                                                   
Insurance  the ability  to implement  new  federal laws  that                                                                   
will kick  in this  summer.  She  summarized the  sections of                                                                   
the bill:                                                                                                                       
                                                                                                                                
     Section 1: This section incorporates requirements in 42                                                                    
     U.S.C. 300gg-53 into state law. 42 U.S.C. 300gg-54                                                                         
     prohibits health care insurers from discriminating                                                                         
     against individuals on the basis of genetic                                                                                
     information. It prohibits health care insurers from                                                                        
     requiring individuals to undergo genetic testing  as a                                                                     
     condition of insurance.                                                                                                    
                                                                                                                                
     Section 2: This section changes the requirements for                                                                       
     insurance coverage for treatment of alcoholism or drug                                                                     
     abuse. Currently, insurers are mandated to provide                                                                         
     coverage for treatment of alcoholism and drug abuse to                                                                     
     employer groups with 20 or more employees and mandates                                                                     
     that insurers offer such coverage to employer groups                                                                       
     with fewer than 20 employees.  This section would                                                                          
     replace that mandate and only require insurers to offer                                                                    
     coverage for substance abuse to all employer groups.                                                                       
     Under the mental health parity provisions in Section 6                                                                     
     of the bill insurers are prohibited from placing limits                                                                    
     on substance abuse coverage that are not placed on the                                                                     
     general medical coverage of the plan.                                                                                      
                                                                                                                                
     Section 3: This section amends the definition of                                                                           
     dentist for insurance purposes to cover dentists who                                                                       
     are not licensed in Alaska.                                                                                                
                                                                                                                                
     Section 4: This section incorporates requirements in 42                                                                    
     U.S.C. 300gg-54 and 42 U.S.C. 300gg-7 into state law.                                                                      
     Those sections of federal statute require that health                                                                      
     care insurers continue to cover college students under                                                                     
     their parent's health insurance coverage when the                                                                          
     students take leave from school for medical reasons.                                                                       
                                                                                                                                
     Section 5: This section has two changes to enrollment                                                                      
     requirements for employees who are eligible for their                                                                      
     employer's health insurance plans but have previously                                                                      
     chosen to not enroll in that plan. The first change                                                                        
     allows a person who was covered by Medicaid or similar                                                                     
     plan and loses eligibility for that plan, to enroll in                                                                     
     their employer's health insurance plan. The second                                                                         
     change allows a person to enroll in their employer's                                                                       
     health insurance plan if they become eligible for                                                                          
     assistance to help pay for their employer's health                                                                         
     insurance plan from Medicaid or a similar plan.                                                                            
                                                                                                                                
     Section 6: This section incorporates requirements in 42                                                                    
     U.S.C. 300gg-5 to apply to state law. The federal                                                                          
     requirements are that a health care insurer may not                                                                        
     place restrictions on mental health and substance use                                                                      
     coverage in an insurance plan that are not placed on                                                                       
     the general medical coverage of that plan.                                                                                 
                                                                                                                                
     Section 7: This section provides an effective date for                                                                     
     section 1 of the bill.                                                                                                     
                                                                                                                                
     Section 8: This section provides an effective date for                                                                     
     sections 4 and 6 of the bill.                                                                                              
                                                                                                                                
9:59:48 AM                                                                                                                    
                                                                                                                                
Co-Chair Hawker  inquired why Representative Holmes  chose to                                                                   
sponsor  this legislation.   Representative  Holmes  reported                                                                   
that Linda  Hall, the Director  of the Division  of Insurance                                                                   
in  the  Department  of  Commerce,   Community  and  Economic                                                                   
Development, requested the bill.                                                                                                
                                                                                                                                
Representative  Kelly  voiced   concern  about  the  lack  of                                                                   
doctors who will see Medicare  patients.  He pointed out that                                                                   
the  Division of  Insurance will  now be  required to  expand                                                                   
services.   He was  concerned about  senior medical  coverage                                                                   
under a "leveling" program.                                                                                                     
                                                                                                                                
10:04:13 AM                                                                                                                   
                                                                                                                                
Co-Chair  Hawker shared  those concerns.   He requested  more                                                                   
information.                                                                                                                    
                                                                                                                                
LINDA HALL,  DIRECTOR, DIVISION  OF INSURANCE, DEPARTMENT  OF                                                                   
COMMERCE, COMMUNITY  AND ECONOMIC DEVELOPMENT,  observed that                                                                   
all  items in  the bill,  with  the exception  of the  dental                                                                   
definition,  are federal  mandates that  will be adopted  and                                                                   
enforced on a  federal level.  The request  is to incorporate                                                                   
them into Alaska  law for enforcement reasons  and to prevent                                                                   
conflicts,  particularly  in the  mental  health  area.   The                                                                   
federal  laws  will  preempt  state  laws  and  will  present                                                                   
conflicts.   She  emphasized that  the  federal mandates  are                                                                   
geared to larger employees and,  if coverage is offered, then                                                                   
it will be on parity with the other health plan.                                                                                
                                                                                                                                
10:06:58 AM                                                                                                                   
                                                                                                                                
Representative Kelly  did not want  the seniors to  buy their                                                                   
insurance in the  same category with drug abusers  and mental                                                                   
health patients.   He maintained  that the bill is  not going                                                                   
to  help seniors  obtain  health  insurance.   He  called  it                                                                   
discrimination.                                                                                                                 
                                                                                                                                
Co-Chair  Hawker concurred  that it was  an unfunded  federal                                                                   
mandate.  He asked if the Division  of Insurance supports the                                                                   
bill.                                                                                                                           
                                                                                                                                
Ms. Hall  reported that  the Division  of Insurance  supports                                                                   
the  legislation.   Co-Chair  Hawker  asked  if the  governor                                                                   
supports  the  bill.   Ms.  Hall  replied that  the  governor                                                                   
authorized the bill.                                                                                                            
                                                                                                                                
Co-Chair  Hawker spoke  of the problematic  issue of  holding                                                                   
the  legislature responsible  for  the outcome  of the  bill.                                                                   
Ms.  Hall reported  that she  is  looking at  the ability  to                                                                   
enforce health insurance provisions.                                                                                            
                                                                                                                                
10:10:00 AM                                                                                                                   
                                                                                                                                
Representative  Kelly asked if  Ms. Hall requested  the bill.                                                                   
Ms. Hall said she did.                                                                                                          
                                                                                                                                
Representative  Gara  thought Ms.  Hall  was  in a  difficult                                                                   
position.    Ms.  Hall  said she  had  listened  to  previous                                                                   
discussions and implied that she  was aware of the situation.                                                                   
                                                                                                                                
Representative   Gara   understood   Representative   Kelly's                                                                   
concerns.   He  shared his  understanding  of the  bill.   He                                                                   
thought it  was a constituent  service bill.  He  described a                                                                   
scenario of  what would happen  if the  bill does pass.   Ms.                                                                   
Hall agreed.  He thought the bill was needed.                                                                                   
                                                                                                                                
10:12:51 AM                                                                                                                   
                                                                                                                                
Co-Chair  Hawker  didn't see  that  the legislature  had  any                                                                   
choice but to adopt the legislation.                                                                                            
                                                                                                                                
Representative Fairclough  wanted to know the  effective date                                                                   
of the change.   Ms. Hall reported that there  were different                                                                   
effective dates.   The genetic information  nondiscrimination                                                                   
section is effective May 21, 2009;  the coverage of dependent                                                                   
students section  is effective  October 9, 2009;  the special                                                                   
enrollment  for Medicaid  and Denali  Kid Care-type  programs                                                                   
are effective  April 1,  2009; and  the mental health  parity                                                                   
section is effective January 1, 2010.                                                                                           
                                                                                                                                
Representative Fairclough  asked when the  federal government                                                                   
passed the changes.   Ms. Hall reported on  enrollment dates,                                                                   
which  were recent.   Representative  Fairclough reported  on                                                                   
another  bill  which  contained   a  good  faith  effort  for                                                                   
extensions  for implementation.    She wondered  if that  was                                                                   
included  in  this  bill.   Ms.  Hall  thought  it  was  not.                                                                   
Representative  Fairclough commented  that  some state  might                                                                   
not  be meeting  in time  to address  these  changes, so  she                                                                   
assumed there was an extension provision.                                                                                       
                                                                                                                                
10:15:47 AM                                                                                                                   
                                                                                                                                
Co-Chair  Hawker reported  that the  same situation  occurred                                                                   
with the Federal Stimulus Act.                                                                                                  
                                                                                                                                
Representative  Holmes  summarized  that  the  federal  rules                                                                   
would go  into effect,  but the  Director of Insurance  would                                                                   
have no ability to act in the  event that a constituent had a                                                                   
problem.                                                                                                                        
                                                                                                                                
Representative Fairclough related  that the Committee has had                                                                   
many conversations about the federal  government overstepping                                                                   
into state rights.                                                                                                              
                                                                                                                                
10:17:03 AM                                                                                                                   
                                                                                                                                
Representative   Kelly  asked   for  information  about   the                                                                   
consequences if the legislation  is not passed.  Ms. Hall did                                                                   
not have  that information, but  thought that  the provisions                                                                   
of  the bill  would  be enforced  through  the Department  of                                                                   
Labor.                                                                                                                          
                                                                                                                                
Representative Kelly wished to know the exact consequences.                                                                     
                                                                                                                                
Representative  Crawford  commented  that  he does  not  feel                                                                   
pressured by the  federal government at all.   He thought all                                                                   
requests were the right thing to do.                                                                                            
                                                                                                                                
Co-Chair Hawker opened public testimony.                                                                                        
                                                                                                                                
10:19:45 AM                                                                                                                   
                                                                                                                                
JEFF JESSEE,  CHIEF EXECUTIVE  OFFICER, ALASKA MENTAL  HEALTH                                                                   
TRUST AUTHORITY, testified in  favor of HB 222.  He responded                                                                   
to Representative  Kelly's concerns.  One of  the concerns in                                                                   
the  health  care  system is  that  insurance  companies  can                                                                   
dictate  the  rules.   They  would  rather have  the  private                                                                   
sector  - government -  have the  primary responsibility  for                                                                   
providing  the  services.   When  people can't  get  coverage                                                                   
through  private insurance  for mental  health and  substance                                                                   
abuse problems,  the state  government ends  up paying.   The                                                                   
idea behind health  insurance is to spread the  risk across a                                                                   
group  of   people  for   their  medical  needs.   Currently,                                                                   
insurance companies have decided  not to meet certain groups'                                                                   
needs.    He  thought  the  bill  was  headed  in  the  right                                                                   
direction.                                                                                                                      
                                                                                                                                
10:22:17 AM                                                                                                                   
                                                                                                                                
Representative Kelly  asked if Mr. Jessee was  happy with the                                                                   
Medicare situation  in Alaska.   Mr.  Jessee related  that he                                                                   
was not.   He thought it  was imperative to deal  with health                                                                   
care  costs.   Representative  Kelly  talked  about what  has                                                                   
crippled the Medicare  system.  He commented  on the problems                                                                   
with the social security system.                                                                                                
                                                                                                                                
Mr.  Jessee shared  some of  Representative Kelly's  concern.                                                                   
He  spoke  of   needing  to  keep  the  boat   from  sinking.                                                                   
Representative  Kelly  commented  that  the  problem  remains                                                                   
unsolved.                                                                                                                       
                                                                                                                                
10:25:37 AM                                                                                                                   
                                                                                                                                
Co-Chair Stoltze preferred to  move the bill out of Committee                                                                   
unless there was more testimony.                                                                                                
                                                                                                                                
Co-Chair Hawker closed public testimony.                                                                                        
                                                                                                                                
10:26:38 AM                                                                                                                   
                                                                                                                                
Co-Chair Hawker pointed out the zero fiscal notes.                                                                              
                                                                                                                                
Co-Chair  Stoltze MOVED  to report  HB 222  out of  Committee                                                                   
with individual  recommendations and the  accompanying fiscal                                                                   
notes.  There being NO OBJECTION, it was so ordered.                                                                            
                                                                                                                                
HB  222  was REPORTED  out  of  Committee  with a  "do  pass"                                                                   
recommendation  and with  two new  zero fiscal  notes by  the                                                                   
Department of Health and Social  Services, and fiscal note #1                                                                   
by  the  Department  of  Commerce,   Community  and  Economic                                                                   
Development.                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
The meeting was adjourned at 10:27 AM.                                                                                          

Document Name Date/Time Subjects
Frequently Asked Questions.pdf HFIN 4/14/2009 8:30:00 AM
HB 204
AARP.pdf HFIN 4/14/2009 8:30:00 AM
HB 204
HB222-DHSS-MS-04-11-09NEW.pdf HFIN 4/14/2009 8:30:00 AM
HB 222
HB222-DHSS-BHMS-04-11-09NEW.pdf HFIN 4/14/2009 8:30:00 AM
HB 222
HB 222 Sectional.pdf HFIN 4/14/2009 8:30:00 AM
HB 222
HB 222 Sponsor Statement.pdf HFIN 4/14/2009 8:30:00 AM
HB 222
Stateof AlaskaDeptHSS.pdf HFIN 4/14/2009 8:30:00 AM
HB 204
Sponsor Statement WWAMI (3).pdf HFIN 4/14/2009 8:30:00 AM
HB 204
Physician Shortage Fact Sheet Header.pdf HFIN 4/14/2009 8:30:00 AM
HB 204
HB 204 - Increase WWAMI Class Size.pdf HFIN 4/14/2009 8:30:00 AM
HB 204