Legislature(1993 - 1994)
03/21/1994 03:00 PM House HES
| Audio | Topic |
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES
STANDING COMMITTEE
March 21, 1994
3:00 p.m.
MEMBERS PRESENT
Rep. Con Bunde, Co-Chair
Rep. Cynthia Toohey, Co-Chair
Rep. Al Vezey
Rep. Gary Davis
Rep. Bettye Davis
Rep. Irene Nicholia
Rep. Harley Olberg
Rep. Tom Brice
Rep. Pete Kott
MEMBERS ABSENT
None
COMMITTEE CALENDAR
HB 414: "An Act creating the Alaska Health Commission;
relating to the delivery, quality, access, and
financing of health care; relating to review and
approval of rates and charges of health insurers;
relating to certain civil actions against health
care providers and health insurers; repealing
Alaska Rule of Civil Procedure 72.1; and providing
for an effective date."
HEARD AND HELD
WITNESS REGISTER
DR. DON LEHMAN, President
Alaska State Medical Association
780 Katlian Street, Number E
Sitka, Alaska 99835
Phone: (907) 747-5861
Position Statement: Testified in support of HB 414
(spoke via teleconference)
NANCY USERA, Commissioner
Department of Administration
P.O. Box 110200
Juneau, Alaska 99811-0200
Phone: (907) 465-2200
Position Statement: Testified on HB 414
DON KOCH, Marketing Surveillance
Division of Insurance
Department of Commerce and Economic Development
P.O. Box 110805
Juneau, Alaska 99811-0805
Phone: (907) 465-0805
Position Statement: Testified on HB 414
REED STOOPS, Lobbyist
Aetna Insurance Company
240 Main Street, Suite 600
Juneau, Alaska 99801
Phone: (907) 463-3223
Position Statement: Testified in opposition to Amendment 16
and in support of Amendment 15 for HB
414
GORDAN EVANS, Lobbyist
Health Insurance Association of America
318 4th Street
Juneau, Alaska 99801
Phone: (907) 586-3210
Position Statement: Testified in opposition to Amendment 16
and in support of Amendment 15 for HB
414
BARBARA THURSTON, Actuary
Division of Insurance
Department of Commerce and Economic Development
P.O. Box 110805
Juneau, Alaska 99801-0805
Phone: (907) 465-2573
Position Statement: Testified on HB 414
JERRY REINWAND, Lobbyist
Blue Cross of Washington and Alaska
Juneau, Alaska 99801
Phone: (907) 586-8966
Position Statement: Testified in support of Amendment 15
for HB 414
PREVIOUS ACTION
BILL: HB 414
SHORT TITLE: COMPREHENSIVE HEALTH CARE
SPONSOR(S): RULES BY REQUEST OF THE GOVERNOR
JRN-DATE JRN-PG ACTION
01/28/94 2182 (H) READ THE FIRST TIME/REFERRAL(S)
01/28/94 2182 (H) HES, JUDICIARY, FINANCE
01/28/94 2182 (H) -2 FISCAL NOTES (GOV, DCED)
1/28/94
01/28/94 2183 (H) GOVERNOR'S TRANSMITTAL LETTER
02/15/94 (H) HES AT 03:00 PM CAPITOL 106
02/15/94 (H) MINUTE(HES)
03/04/94 (H) HES AT 03:00 PM CAPITOL 106
03/04/94 (H) MINUTE(HES)
03/09/94 (H) HES AT 03:00 PM CAPITOL 106
03/09/94 (H) MINUTE(HES)
03/12/94 (H) HES AT 01:00 PM CAPITOL 106
03/12/94 (H) MINUTE(HES)
03/16/94 (H) HES AT 03:00 PM CAPITOL 106
03/16/94 (H) MINUTE(HES)
03/21/94 (H) HES AT 03:00 PM CAPITOL 106
ACTION NARRATIVE
TAPE 94-57, SIDE A
Number 000
CHAIR BUNDE called the meeting to order at 3:07 p.m., noted
members present and announced the calendar. He brought HB
414 to the table and announced the committee would work from
version E, 3/19/94. He noted that Anchorage, Barrow and
Fairbanks were on teleconference for listening purposes
only. He said there were nine amendments to be addressed
and asked DR. DON LEHMAN if he wanted to testify at this
time.
HB 414 - COMPREHENSIVE HEALTH CARE
CSHB 414: "An Act creating the Alaska Health Commission;
relating to the delivery, quality, access, and financing of
health care; relating to health insurers, health maintenance
to certain civil actions against health care providers and
health insurers; amending Alaska Rules of Civil Procedure 26
and 27 and Alaska Rules of Evidence 802, 803, and 804;
repealing Alaska Rule of Civil Procedure 82.1; and providing
for an effective date."
Number 019
DR. DON LEHMAN, President, Alaska State Medical Association,
testified from Sitka and spoke in support of HB 414. He
said the association recognizes the bill provides a
framework for the study and development of significant
reforms. He emphasized that Alaska is a diverse and unique
state that warrants an Alaskan solution to its problems.
Having said that, he addressed Amendment 16, relating to
disability insurance claims processing. He explained that
the current delay in the processing of insurance claims is a
problem that is increasing for small and rural clinics. Dr.
Lehman asserted that insurance companies do not make money
by saying "yes," but by saying "no" and by saying nothing
and doing nothing. He said there is no reason why patients'
insurance claims should remain in the ditch for longer than
15 days and this amendment would improve health system
efficiency which is a key to controlling health costs.
DR. LEHMAN then addressed Amendment 17 and said the concept
of a "market based single payer" system, developed by a
doctor from Anchorage, is a uniquely Alaskan solution. He
said this proposal combines the efficiency of a single payer
with the economic reality of a market driven system. He
stated it includes provider defined fees, patient
copayments, sliding scale copayments, posted fees,
comparison lists for consumers, voluntary expenditure
targets, and provider peer reviews.
Number 062
REP. G. DAVIS asked Dr. Lehman what he envisioned as the
possible result of this proposed legislation as compared to
the compromised bill.
Number 065
DR. LEHMAN said the compromised bill was an all-encompassing
proposal that investigated the problem and had a definite
solution. He said he viewed the Governor's proposal as an
outline from which further study could be done. He said
development of an outline for health care system reform is
clearly an important step to take in order to safeguard
Alaskans from what bureaucrats in Washington might devise as
a solution. He said he feels like a managed care system
would not work in Alaska where there is one large urban area
and scattered populations throughout the rest of the state.
He stated the problem with the compromised bill is that it
is unrealistic during this session.
(Chair Bunde indicated that Rep. Nicholia arrived at 3:12
p.m.)
CHAIR BUNDE indicated that because Rep. Olberg was not yet
at the meeting, Amendment 15 would be overlooked at this
time.
CHAIR BUNDE asked that Amendment 16 be moved.
REP. B. DAVIS moved to adopt Amendment 16.
Number 090
CHAIR BUNDE objected for discussion purposes. He asked Rep.
Toohey if she cared to speak to the amendment.
REP. TOOHEY said she would feel more comfortable if
COMMISSIONER NANCY USERA addressed the amendment.
Number 096
NANCY USERA, Commissioner, Department of Administration
(DOA), said Amendment 16 deals specifically with insurance
claims processing. She stated the department thinks it is
conceptually a good idea to expedite matters, although she
questioned if mandating these new requirements would be
adding costs to the system. She pointed out that DOA's
interest was in streamlining and while this amendment would
be advantageous to consumers filing claims, she was
uncertain as to the additional costs to insurers. She
mentioned that the Division of Insurance and several
Representatives were in the audience and could possibly
address this issue.
Number 110
CHAIR BUNDE acknowledged the presence of Commissioner Lowe.
(Chair Bunde indicated that Rep. Olberg arrived at 3:16
p.m.)
Number 115
DON KOCH, Marketing Surveillance, Division of Insurance,
Department of Commerce and Economic Development, testified
on HB 414. He expressed concern that cost was being added
in the form of an interest payment. He further stated that
he did not come prepared to adequately address these
concerns. (the tape was somewhat indiscernible)
Number 135
CHAIR BUNDE said he understood Mr. Koch's point that there
was insufficient preparation time for a detailed analysis.
He then asked Mr. Koch if he cared to comment on
"enforcement" when an insurer does not pay and the insurance
is due.
Number 137
MR. KOCH responded that conjecturing was difficult because
there was no track record in dealing with this sort of
provision. He said he would refer to consumer complaints to
see if there were any statistics on late payments, but he
suspected that a lot of this information does not get
reported. He said there are specific time frames that
inform insurers how quickly they have to pay.
Number 148
CHAIR BUNDE wondered if he was correct in assuming that
enforcement would follow if a complaint was filed with the
division.
Number 150
REP. TOOHEY asked if 15 days seemed reasonable. She
commented that it seemed to be unreasonably short especially
if planes were not flying in or out of Juneau for several
days, thereby leaving only about a week to process a claim.
Number 153
MR. KOCH said there may be some requirements (indiscernible)
and he apologized for not knowing more about these
regulations.
Number 174
REP. VEZEY asked why Alaska Statute 45.45.010 was adopted as
the specified interest rate. He added that he thought this
was an inappropriate rate.
Number 181
DR. LEHMAN said he could not speak to that issue and was
uncertain where the rate originated.
Number 186
REP. VEZEY commented that 45.45.010 specifies a 10.5 percent
fixed interest rate not compounded, and given today's market
conditions, this is an inappropriate rate if equitable
treatment is the objective. He said he thought the rate was
more appropriate as a penalty measure.
Number 190
DR. LEHMAN said he thought this rate was set as a penalty
measure as there currently is no penalty for delayed claims.
In reference to Rep. Toohey's earlier question, he clarified
that "15 days" refers to paying a claim 15 days after a
claim is received, not after services are provided.
Number 205
REED STOOPS, Lobbyist, Aetna Insurance Company, testified in
opposition to Amendment 16. He said in spite of the
requirement for completion of the claim, this does not
guarantee that all necessary information has been submitted
to the insurer. He offered this as a possible explanation
as to why it might take longer than 15 days to process a
claim. He said according to his clients, more than 80
percent are paid within 15 days, but those that are delayed
often lack the necessary information from the provider to
justify the claim. He said the second problem with this
amendment is that on the request of the client, Aetna makes
payments by batches to large providers. He explained that
the 15 day payment schedule might not mesh with a monthly
batch payment schedule. The third problem he mentioned was
that interest beginning on the 15th day at the rate cited by
Rep. Vezey seemed unreasonable. He said he knew of no other
state with a similar provision and added that this interest
would be triggered even if the information necessary to make
a judgement was not provided.
DR. LEHMAN responded by pointing out that "the claim form
must be fully completed."
Number 240
GORDAN EVANS, Lobbyist, Health Insurance Association of
America (HIAA), stated he associated with the comments made
by Mr. Stoops, and thereby testified in opposition to
Amendment 16.
Number 249
REP. B. Davis asked that Mr. Stoops repeat the reasons for
opposition to Amendment 16. She asked if he maintained
opposition to the amendment given that it specifies that the
claim form must be completed.
Number 253
MR. STOOPS said he did not believe his statement was
inaccurate and said, "In spite of the fact that the bill
says that a claim form is fully completed doesn't
necessarily mean that the information necessary to justify a
particular claim is present. Line 16 on the claim form
might be filled out, but it might not be filled out with
enough information to justify a particular procedure which
has been accomplished, and if the insurer then comes back
and says `we don't think you have given us the information
that is required under our contract' there could be a
dispute about whether the claim form has been completed."
MR. STOOPS said this discussion was about terminology, but
it would be better if the amendment was clarified to
indicate that the information necessary to make the decision
was available.
Number 265
REP. B DAVIS agreed that perhaps modifications should be
made to include the language Mr. Stoops used. She said she
understood that just because pages on a form were completed,
this does not guarantee that the necessary information has
been included. She asked if this would be acceptable to Mr.
Stoops.
Number 270
MR. STOOPS said this would address the problem relating to
subsection (b), but the other two concerns would remain. He
restated those other concerns as: 1) an inconsistency
between monthly batch payments and the 15 day billing period
and 2) interest accruing on the 15th day as being an
unreasonable provision.
Number 282
CHAIR BUNDE said he would like to give the Division of
Insurance more time to respond to this amendment, so with
the concurrence of Rep. B. Davis, he would table this
amendment until the next hearing of HB 414. Chair Bunde
indicated that with the presence of Rep. Olberg the
committee could now address Amendment 15.
Number 290
REP. OLBERG moved Amendment 15. He mentioned there might be
cross-reference problems because the amendment relates to
the 3/11/94 version of the work draft rather than the
3/14/94 draft.
CHAIR BUNDE objected for discussion purposes.
REP. OLBERG said the amendment takes the health commission
out of the rate approval business and out of the rate review
business as well.
Number 304
COMMISSIONER USERA said this amendment does two things:
1) it removes any review or relationship to insurance rates
from the commission and places it with the Division of
Insurance and 2) it dilutes the rate approval authority
because the only requirement is that rates be filed with the
division. She said the implications of this would be a
reduction of the fiscal note associated with the rate review
process and would probably, depending on regulatory
requirements, effectively allow for the collection of
additional data that is presently unavailable to the state.
Number 326
REP. G. DAVIS mentioned this would not preclude the
authority from establishing a subcommittee to review rates
or anything else related to insurance.
Number 334
COMMISSIONER USERA said she saw no provision requiring the
Division of Insurance to provide any of this information to
the commission, and further stated she did not know what
confidentiality constraints were being placed on this
information. She said as a practical matter her preference
would be that the division put together aggregate
information and report that to the commission.
Number 354
REP. OLBERG said if rates were going to be regulated, then
either everybody's rates or nobody's rates should be
addressed, and this indicates that nobody's rates are going
to be regulated.
Number 357
REP. TOOHEY said basically this leaves it as status quo in
that there is no regulation now.
Number 362
CHAIR BUNDE asked to hear from the Division of Insurance on
Amendment 15 and on the fact of current regulation.
Number 364
BARBARA THURSTON, Actuary, Division of Insurance, Department
of Commerce and Economic Development, testified on HB 414.
She stated that currently the division does not regulate
rates for most medical or disability insurance. She said
that the only disability company they receive rate filings
from is Blue Cross. She pointed out that this amendment
would strengthen that situation and they would receive rate
filings from other companies as well. She said this
amendment would give the division more authority, but her
concern was that it does not have any teeth in that if
someone files an inappropriate rate, there is not much
recourse from the division other than providing consumer
information. Ms. Thurston wanted to clarify something from
the previous week's testimony and she explained that
companies do not file specific rates for each person because
rates are set according to a formula.
Number 390
CHAIR BUNDE asked if all kinds of insurance was handled in
the same way.
Number 395
MS. THURSTON said the division both reviews and approves for
most of the property casualty.
REP. TOOHEY asked how many carriers were used for auto
insurance.
Number 401
MS. THURSTON said a dozen do the vast bulk of the market.
She said a lot of companies file but may not write. She
added that they want to be able to write in all 50 states.
REP. TOOHEY asked if that information was brought to the
awareness of the public. She asked how to go about choosing
the best auto insurance.
Number 405
MS. THURSTON said there are two ways: 1) one could dig
through the files which contain public information on rate
filings, or 2) the division publishes auto and homeowners'
rate comparisons twice a year and distributes the
publication to various consumers throughout the state.
CHAIR BUNDE commented that an informed consumer would shop
around and call several agents.
Number 415
REP. TOOHEY asked if this same sort of thing would be done
with health insurance.
Number 417
MS. THURSTON said this certainly could be done with health
insurance and it seemed like a reasonable thing to do. She
said if the division received rates on disability there
would be a good chance of doing it.
Number 420
REP. TOOHEY asked if consumers would be able to understand
the ratings information.
Number 422
MS. THURSTON explained that with the auto publication, which
is analogous, the rates are based on fictitious scenarios.
She explained that this gives a person an idea of which
companies would have the best rates for a situation which
approximates one's own specific situation. She added that a
consumer could then call the agents of those companies.
Number 434
CHAIR BUNDE asked about distribution of the auto insurance
publication.
Number 436
MS. THURSTON said a booklet called "Rating Examples" is
published and mailed to anyone interested who is on the
mailing list.
(Chair Bunde indicated that Rep. Brice arrived at 3:40 p.m.)
CHAIR BUNDE asked for further public testimony on Amendment
15.
Number 455
MR. STOOPS referred to a chart, previously provided, which
illustrated how other states regulate health insurance. He
summarized and said eight states do not regulate at all, six
states have a prior approval system requiring the division's
approval before implementation, and the remaining states
have a file and use system similar to the one proposed under
this amendment. He pointed out that Alaska would move from
having no regulation to having more mainstream regulation.
He also stated that 90 plus percent of the claim dollars pay
for medical fees and therefore regulating health insurance
rates really addresses a small percentage of the problem and
certainly does not address the lion's share of the cost. He
mentioned an equity issue of regulating both insurance rates
and provider rates if the object is to reduce costs. Mr.
Stoops endorsed approval of Amendment 15.
Number 479
MR. EVANS associated with the comments made by Mr. Stoops.
He said this particular amendment approximated procedures
used by Idaho, Montana, and several other western states.
Number 487
JERRY REINWAND, Lobbyist, Blue Cross of Washington and
Alaska, said he agreed, thereby testifying in support of
Amendment 15.
Number 493
CHAIR BUNDE said one concern previously expressed was the
passing on of this information. He asked Rep. Olberg if
there was an interest in having some indication in Amendment
15 that the division, when finished with its work, would
pass information on to the health commission.
Number 499
(Chair Bunde indicated that Rep. Kott arrived at 3:45 p.m.)
TAPE 94-57, SIDE B
Number 068
COMMISSIONER USERA referred to Sec. 44.19.626 page 15, line
19, and said the commission may obtain information from a
wide variety of people who must provide it, and obviously
the Division of Insurance would be one of those entities.
She said the commission would require through some
regulatory process that the division provide the information
in an appropriate form.
Number 082
REP. G. DAVIS added that page 13, line 4, reads that the
purpose of the commission is to improve health care in this
state by "establishing and implementing a system for
collecting and analyzing information and data relating to
the individual and public health care needs of and services
provided to residents of the state."
Number 085
REP. TOOHEY stated her support of Amendment 15 and said,
"The thicker this gets the less chance it has of going
anywhere... and I kind of like this sort of a step
backward."
Number 094
CHAIR BUNDE thanked Rep. Toohey for her support. Chair
Bunde asked for further public testimony on Amendment 15.
Hearing none, Chair Bunde closed public testimony on
Amendment 15.
(Chair Bunde took a brief at-ease from 3:48 to 3:50 p.m.)
CHAIR BUNDE noted that Amendment 15 was before the
committee, withdrew his previous objection and asked for the
pleasure of the committee.
Number 112
REP. B DAVIS moved Amendment 15.
Number 113
CHAIR BUNDE indicated that Amendment 15 had been previously
moved by Rep. Olberg. He asked if there were any
objections. Hearing none, declared that Amendment 15 was so
adopted.
CHAIR BUNDE directed the committee's attention to Amendment
17 and asked Rep. Toohey to move the amendment.
REP. TOOHEY moved to adopt Amendment 17.
REP. BRICE objected to the amendment.
REP. TOOHEY asked that DR. LEHMAN and COMMISSIONER USERA
speak to this amendment.
Number 127
CHAIR BUNDE said he realized DR. LEHMAN had previously
spoken to this issue and asked if he would give a summation.
DR. LEHMAN said the proposal combines the efficiency of a
single payer system with the economic reality of a market
driven system. (the tape was indiscernible at this point)
CHAIR BUNDE, in response to Dr. Lehman's comment, noted for
the record that not one bureaucrat smiled at the mention of
the phrase "single payer" and suggested that perhaps they
were restraining their glee. He asked Commissioner Usera if
she cared to comment on Amendment 17.
Number 144
COMMISSIONER USERA stated her appreciation of Dr. Lehman's
comments and said her concern with this amendment was that
it was very specific and that if any of the provisions were
to drop out it would significantly change the definition.
She suggested, on line 3, the deletion of "including
provider defined fees" and the insertion of "and may
include."
Number 163
DR. LEHMAN said he had no objection to Commissioner Usera's
suggestion.
Number 166
CHAIR BUNDE, in response to Commissioner Usera, acknowledged
that in previous discussions there was no hidden agenda with
the inclusion of "single payer."
Number 171
REP. BRICE asked for clarity on this issue, and after some
discussion commented that the terminology of "market based
single payer" was as confusing as saying "competitive
monopoly."
Number 189
REP. TOOHEY said possibly Dr. Lehman could address the issue
of using the phrase "market based single payer."
Number 196
DR. LEHMAN said his basic understanding of positioning the
phrase "market based" with the phrase "single payer" was
that there would still be one payer involved, although
market forces would come into play as providers would be
required to quote their fees. Patients would still elect to
choose any provider that they wanted, recognizing that
certain providers might be charging different fees for those
same services.
Number 218
COMMISSIONER USERA responded to Rep. Brice by asserting that
"market based single payer" is a coined phrase. She said it
is the moniker that has been placed on the primary
comprehensive reform bill that has been introduced, and is
meaningful within the current context only.
Number 240
CHAIR BUNDE asked if there was any further discussion on
Amendment 17. Seeing none, he closed public testimony and
brought the amendment to the attention of the committee.
Number 244
REP. B. DAVIS asked if including a definition section on
"market based single payer" would be an improvement. After
some discussion, she was informed that a definition was
included in the amendment.
Number 261
REP. OLBERG brought up the spelling of "payor" and "payer,"
noting that "payor" was not located in the dictionary.
Number 273
CHAIR BUNDE commented that the question before the committee
involved addressing whether or not "single payer" was as bad
as some people thought "single payer" might be.
Number 280
REP. TOOHEY stated her support of the amendment and of
striking the phrase "single payer" and using the phrase
"market based."
Number 285
CHAIR BUNDE asked for the pleasure of the committee. He
confirmed that Rep. Brice maintained his objection. Chair
Bunde stated that there had been an amendment to the
amendment so that line 3 of the second section of the
amendment would read, "is based on market forces and may
include" as opposed to "including."
Number 296
REP. TOOHEY moved to move the amendment to the amendment.
CHAIR BUNDE acknowledged that the amendment to the amendment
had been moved and asked for further discussion.
Number 298
REP. BRICE said his major concern was that the language had
been watered down with "mays" instead of requirements. He
stated this was the reason for his objection to the
amendment to the amendment.
Number 304
CHAIR BUNDE called for the vote on the amendment to the
amendment that refers to the use of the term "may." Reps.
Toohey, Bunde, Vezey, Kott, and Olberg voted "Yea" and Reps.
G. Davis, B. Davis, Nicholia and Brice voted "Nay."
CHAIR BUNDE declared that Amendment 17 in its amended form
was now before the committee. He confirmed that Rep. Brice
wished to maintain his objection and called for the vote.
Reps. Bunde, G. Davis, Vezey, Kott, Olberg and Toohey voted
"Yea" and Reps. B. Davis, Nicholia, and Brice voted "Nay."
Chair Bunde stated that Amendment 17 as amended was so
moved.
CHAIR BUNDE directed the committee's attention to Amendment
18 and asked Rep. B. Davis to move the amendment.
Number 326
REP. B DAVIS moved to adopt Amendment 18.
CHAIR BUNDE objected for discussion purposes and asked
Commissioner Usera for comment.
Number 335
COMMISSIONER USERA spoke in support of this amendment,
saying it was good consumerism in that it requires
disclosure and is designed to be very specific so consumers
would consequently have a clearer idea of what would and
would not be included in their insurance policy.
Number 344
CHAIR BUNDE said he would like to hear from the Division of
Insurance.
Number 345
MS. THURSTON said the division supports this and
theoretically this is already being done in policy form, but
not every consumer reads the policy.
Number 356
REP. G. DAVIS said he has seen this in policies, but it is
in legalese and very small print.
Number 360
REP. TOOHEY agreed with Rep. Davis that this would promote
consumer confidence but then asked what the cost would be.
Number 365
MS. THURSTON responded that if this refers to a separate
disclosure form provided by the insurance company, there
would be an additional cost to the insurance company. She
said she did not know what the cost would be.
Number 371
CHAIR BUNDE observed that clarification was needed as to
whether this was going to be provided by the state or by the
insurance company.
Number 376
MS. THURSTON said the division would probably need more
specific authority in the statute if it was going to
prescribe the format of this disclosure statement. She said
the way it is written each insurance company designs its own
statement.
Number 384
REP. G. DAVIS commented if this was going to be left to the
commission's discretion, then the amendment should be left
as is.
Number 393
CHAIR BUNDE closed public discussion on Amendment 18 and
asked if there was further debate in the committee.
REP. TOOHEY moved Amendment 18.
CHAIR BUNDE observed that the motion had been made and he
removed his objection. He asked if there were any
objections. Hearing none, Chair Bunde stated that Amendment
18 was so adopted.
CHAIR BUNDE brought Amendment 19 to the committee's
attention.
REP. B. DAVIS moved Amendment 19.
CHAIR BUNDE objected for discussion purposes and asked for
Rep. B. Davis's presentation of the amendment.
Number 448
REP. B. DAVIS referred to page 16, line 10, and after
considerable discussion about the exact location, Rep. B.
Davis said she wanted to insert the language listed.
Number 450
CHAIR BUNDE asked Commissioner Usera for further comment on
the amendment.
Number 454
COMMISSIONER USERA said this was part of subsection (b)
where it says "the commission shall" and it adds two
additional mandates, one is the incentive program bringing
incentive providers to the state and the other is
establishing advisory committees to make recommendations on
cost containment. She referred to subsection (9) and said
it was her understanding that cost containment had to be
part of a comprehensive plan, but as this is premised the
commission's analysis would be on packaged plans presented
to the commission as opposed to the commission taking bits
and pieces. She said she didn't necessarily object to
establishing an advisory committee on cost containment,
although she would prefer to have this under the "may"
section because it is not necessarily a primary
responsibility. She referred to (8) and said there had been
a number of programs discussed in attempts to attract
providers and they had all been costly. She said her
understanding was that this refers to the design of an
incentive program, not necessarily the implementation of
that program. She stated again that her preference was to
have this under the "may" section rather than the "shall"
section because the resources were not available to the
commission to do all of this and doing so would initially
add significantly to the fiscal note.
Number 486
REP. TOOHEY asked if "may" could be added in or after
subsection (9).
Number 489
COMMISSIONER USERA referred to page 15, subsection (a),
where it reads, "the commission may" and clarified this
would be subsection (4) and (5) of that provision as opposed
to subsection (b) which reads, "the commission shall."
Number 493
REP. G. DAVIS said paragraph (9) seemed to reemphasize what
was inserted under the public health initiative and asked
Rep. B. Davis for comment.
Number 500
REP. B. DAVIS said everything under the public health
section says "may" and this says "shall."
Number 502
REP. G. DAVIS said these items seem to fit under the purview
of the public health aspects and after considerable
discussion he pointed out to Rep. B. Davis that subsection
(9) seemed like a duplication.
TAPE 94-58, SIDE A
Number 020
REP. B. DAVIS said after more discussion that she would be
willing to delete subsection (9).
Number 023
CHAIR BUNDE said the committee could amend the amendment.
REP. G. DAVIS moved to amend Amendment 19 by deleting
paragraph (9).
CHAIR BUNDE asked if there was any objection.
REP. BRICE objected and asked for further clarification.
CHAIR BUNDE asked Rep. G. Davis for comment.
Number 033
REP. G. DAVIS said paragraph (9) appears to contain the cost
of health care to include the public health initiatives. He
added that he considers these to be general duties and
inclusions of a public health policy.
Number 038
CHAIR BUNDE then referred Rep. Brice to page 16.
Number 040
REP. BRICE said he understood and withdrew his objection.
Number 041
CHAIR BUNDE said the amendment as amended includes paragraph
(8) only as (9) had been deleted. Chair Bunde mentioned
that the student loan program was still operating at a
deficit and could not afford a forgiveness program. He also
pointed out that it would cost half a million dollars a year
to establish a family residency program in Anchorage. He
said the question is, "Do we want to encourage them to do
something that is probably not likely to be funded?"
Number 050
REP. G. DAVIS said he liked the amendment and thought that
the inclusion of a student loan forgiveness program would
shoot the amendment down.
REP. B DAVIS acknowledged there were some problems with the
health care program, but said she did not know why the
comparison was being made between the two and asked for
further clarification.
Number 067
REP. TOOHEY said her understanding was that it had been
suggested to delete "a student loan forgiveness program"
because "that, in itself, was unacceptable."
Number 072
REP. G. DAVIS responded to Rep. B. Davis and said he thought
this was perceived as money outlay with no return and
thought this would be detrimental to the amendment.
Number 079
CHAIR BUNDE said his objection was not in reference to the
notion of student loan forgiveness but that the student loan
program currently operates at a deficit and any forgiveness
program would increase that deficit. He restated that the
proposed residency program would cost half a million dollars
per year and he was not sure this was a justifiable expense.
He asserted that this amendment was intended to design a
program and does not fund or mandate a program. He said it
could be assumed that the student loan forgiveness program
relates to primary care providers even though it is not
explicitly stated.
Number 092
COMMISSIONER USERA asked if this was an assignment for the
commission itself and not its public health committee. She
noted that this really seemed like a public health matter of
having adequate health providers in the state and she
questioned if this would be better handled by the public
health committee.
Number 107
REP. B. DAVIS said she thought the role of the commission
was to be responsible for overseeing all of this. She said
this amendment was designed to work specifically with
bringing in incentives that would allow other primary care
providers to come to Alaska.
Number 118
COMMISSIONER S. USERA said she was addressing where this
would best fit in the bill. She referred to page 15 and
read, "established a public health advisory committee," and
on the bottom of page 16 she read, "includes (a) analysis,
(b) assessment, (c) delineation, (d)documentation,
(e)identification, and (f) recommendations..." She said the
phrase, "a program to give incentives to primary care
providers" might be inserted under (f) where it says
"pertaining to the following."
Number 137
REP. B. DAVIS agreed with Commissioner Usera that this
probably could fit.
CHAIR BUNDE asked Rep. B. Davis if she would consider ending
the amendment after the phrase in section (8) that reads,
"underserved areas of the state."
Number 142
REP. B. DAVIS said this did not go as far as she would like,
but "sometimes half a loaf is better than none" and said she
would consider this.
Number 148
CHAIR BUNDE said with the given modification he would
consider supporting the amendment.
Number 149
REP. VEZEY asked, "If we want to provide incentives, why
don't we just pay them more money?"
Number 151
CHAIR BUNDE replied by saying, "That's premiums on prices."
He indicated that premiums on prices for health care
providers translates into regulating rates.
Number 155
REP. VEZEY said it seemed like the rates being offered would
not attract providers, so other forms of compensation would
have to be designed.
Number 160
CHAIR BUNDE responded that the reason rural and underserved
areas are underserved is not based entirely on price. He
said it also has to do with where people choose to live.
Number 165
REP. B. DAVIS said she wanted to amend the amendment
according to Chair Bunde's and Commissioner Usera's
suggestion.
Number 169
COMMISSIONER USERA clarified this was on page 17, line 17,
subsection (v), under the "may" section but is included in
the task of the public health commission under the section
(f) that reads, "recommendations, including recommendations
for specific legislative action when necessary, pertaining
to the following."
Number 177
REP. TOOHEY asked if the phrase "student loan forgiveness
program" was removed.
Number 179
CHAIR BUNDE responded that everything after "underserved
areas of the state" was being removed.
CHAIR BUNDE stated that the amendment to the amendment
deletes everything in section (8) beginning with the word
"incentives."
REP. B. DAVIS read, "...design a program to give incentives
to primary care providers to practice in the state,
especially in rural and underserved areas of the state."
Number 188
CHAIR BUNDE asked if there were any objections. Hearing
none, the amendment to the amendment passed. Chairman Bunde
stated that Amendment 19 as amended was before the
committee. He identified the location on page 17, line 17,
section (v) and asked if there was any further objection.
Hearing none, the amended Amendment 19 was so moved.
CHAIR BUNDE brought the committee's attention to Amendment
20.
REP. B. DAVIS moved to adopt Amendment 20.
CHAIR BUNDE indicated that the amendment had been moved and
objected to and asked Rep. B. Davis for comment.
REP. B. DAVIS said "the amendment speaks for itself" and
indicated that if there were any objections she had no
compromise to make and so therefore stated that she would
like for a vote to be taken on the amendment.
Number 212
CHAIR BUNDE asked Commissioner Usera if this would impact
the fiscal note.
Number 213
COMMISSIONER USERA spoke in opposition to the amendment.
Number 215
REP. B. DAVIS asked if the administration would accept
"five" instead of "three." She said she did not think three
people would be able to manage the workload and asked for a
recommendation from the administration regarding this.
Number 220
COMMISSIONER USERA said the administration's concept was
that three people would direct the work of the commission
and a support staff would be available to do much of the
day-to-day analysis.
Number 226
REP. B. DAVIS maintained that she wanted the amendment to be
voted on and she encouraged committee members to do what
they thought was best and to vote in favor of the amendment.
Number 231
REP. BRICE moved that an amendment to the amendment be made
by changing Step "C" to "A" and Range "26" to "10" on page
14, line 28.
Number 256
REP. OLBERG said his fiscal note indicated nine employees
and $150,000 worth of technical and legal assistance.
CHAIR BUNDE said there was an amendment to the amendment.
After hearing an objection from Rep. Toohey, Chair Bunde
called for the vote. Reps. Kott and Brice voted "Yea" and
Reps. G. Davis, Vezey, Olberg, B. Davis, Nicholia, Toohey,
and Bunde voted "Nay."
CHAIR BUNDE stated that Amendment 20, which would increase
the members of the commission to five and further define the
membership of the commission, was before the committee.
There being no further discussion, Chair Bunde called for
the vote. Reps. B. Davis, Nicholia, and Brice voted "Yea"
and Reps. Vezey, Kott, Olberg, Toohey, Bunde, and G. Davis
voted "Nay." Chair Bunde declared that Amendment 20 failed
to be adopted.
CHAIR BUNDE, indicated that Amendment 21 had been moved and
asked Rep. B. Davis address the amendment.
Number 286
REP. B. DAVIS referred to page 22, line 2, and said this
would delete "(a)" and would also delete all material on
lines 14-16 on page 22.
Number 293
COMMISSIONER USERA said the administration received a letter
of opinion from the Department of Law in response to Mr.
Michael F. Ford's comments. Her recollection of his
testimony was that there was a problem with the Governor
getting involved with the legislators' purview. She stated
that, in essence, the letter received says that because of
the nature of the work of this commission, they do not know
when a plan is going to be available for analysis and to
have to go back to the legislature for a specific extension
authority would not be very cost or time effective.
Furthermore, one of the primary purposes of this commission
is to provide management and implementation analysis for
plans as they are presented and at this time it is not
known, for example, when the primary federal plan is going
to be firm enough to be workable. The idea here is that the
Governor would have the authority to extend the deadline for
making that report. She said the administration would
certainly be amenable to making that more explicit but as a
practical matter having to come back to the legislature just
to say that the deadline has not been met does not seem to
work very well. Commissioner Usera noted that the letter
had been made available that day.
Number 321
REP. B. DAVIS said even with the letter, the language needs
to be more explicit. She further stated that she did not
quite see the validity of taking authority away from the
legislature and giving it to the Governor, based on the
possibility that there might be some difficulty with meeting
the deadline. She added that the window would be more than
seven months and could possibly be one or two years.
Number 328
COMMISSIONER USERA said they would be happy to talk about
crafting something more narrow. She suggested that perhaps
it was because she was sued so often for not meeting
deadlines that she was particularly sensitive to providing
some flexibility. She again suggested that the letter be
taken into account and that crafting something more narrow
be looked into.
Number 336
REP. B. DAVIS withdrew her objection.
Number 337
CHAIR BUNDE brought Amendment 22 to the attention of the
committee and asked Rep. B. Davis to address the amendment.
Number 340
REP. B. DAVIS moved the amendment and explained that the
date for the forms to be completed was set at July 1, 1995.
Number 348
CHAIR BUNDE asked Commissioner Usera for comment.
Number 349
COMMISSIONER USERA deferred to the Division of Insurance.
Number 352
MS. THURSTON said she was unsure of the time lines involved
and that the division would probably receive relevant
information from one of the national organizations working
on uniform claim forms. She added that although she was
unsure, she thought this timing sounded reasonable.
Number 359
REP. TOOHEY said she had inquired at the Division of
Insurance about this specific time line and the deputy
commissioner said this time line was too close and that June
30, 1995, was the date suggested as being most comfortable.
Number 363
MS. THURSTON said the deputy director arrived...
(indiscernible).
Number 371
REP. TOOHEY withdrew her objection after it was pointed out
that the difference between June 30, 1995, and July 1, 1995,
was only one day.
Number 373
COMMISSIONER USERA said there was not a big objection to
this time frame, it seemed reasonable, and the division had
avoided a specific time frame because they were waiting to
see the national standards. She said the division found
this as an acceptable amendment.
Number 382
CHAIR BUNDE asked if there were any objections to Amendment
22. Hearing none, Amendment 22 was so adopted.
Number 384
CHAIR BUNDE indicated that Amendment 23 was before the
committee.
REP. B. DAVIS moved Amendment 23 and said she would like to
delete "may" and insert "shall" on page 16, line 11.
REP. TOOHEY objected.
Number 398
COMMISSIONER USERA mentioned there had previously been
extensive discussion on this and a compromise had been
struck that the commission not be mandated but be allowed
discretion. She said, therefore, the administration
believes the wording is appropriate as it is.
Number 405
CHAIR BUNDE asked for further discussion. Hearing none,
Chair Bunde called for the vote. Reps. B. Davis, and
Nicholia voted "Yea" and Reps. Kott, Olberg, Toohey, Bunde,
G. Davis and Vezey voted "Nay." (Indiscernible regarding
Rep. Brice - the voting record showed that he did not vote.)
Chair Bunde stated that Amendment 23 failed to be adopted.
CHAIR BUNDE noted that the next meeting on HB 414 was
scheduled for Wednesday, March 23, and Rep. Brice would have
an amendment at that time. Chair Bunde said he intended to
move HB 414 from the HESS Committee at that time.
Number 419
REP. B. DAVIS asked if another witness from insurance would
address Amendment 16.
Number 424
CHAIR BUNDE confirmed that Amendments 16 and 24 would be
addressed.
Number 426
REP. B. DAVIS requested that there be further clarification
from the administration as to the exact workings of this
bill.
Number 431
CHAIR BUNDE said the current working draft committee
substitute would be available to the committee members
before the next meeting to allow for further study.
Seeing no further business before the committee, CHAIR BUNDE
adjourned the meeting at 4:55 p.m.
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