Legislature(1995 - 1996)
04/25/1996 03:10 PM House HES
| Audio | Topic |
|---|
* 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
April 25, 1996
3:10 p.m.
MEMBERS PRESENT
Representative Cynthia Toohey, Co-Chair
Representative Con Bunde, Co-Chair
Representative Gary Davis
Representative Caren Robinson
Representative Tom Brice
MEMBERS ABSENT
Representative Norman Rokeberg
Representative Al Vezey
COMMITTEE CALENDAR
CS FOR SENATE BILL NO. 253(FIN)
"An Act relating to insurance coverage for costs of prostate cancer
or cervical cancer detection."
- PASSED HCS CSSB 253(HES) OUT OF COMMITTEE
PREVIOUS ACTION
BILL: SB 253
SHORT TITLE: INS.FOR PROSTATE & CERVICAL CANCER TESTS
SPONSOR(S): SENATOR(S) DUNCAN,Ellis,Salo,Zharoff,Lincoln,Kelly;
REPRESENTATIVE(S) Robinson,Kubina,Navarre
JRN-DATE JRN-PG ACTION
02/02/96 2279 (S) READ THE FIRST TIME - REFERRAL(S)
02/02/96 2280 (S) L&C, FIN
02/05/96 2309 (S) COSPONSOR(S): ELLIS, SALO
02/07/96 2330 (S) COSPONSOR(S): ZHAROFF
03/07/96 (S) L&C AT 1:30 PM FAHRENKAMP RM 203
03/07/96 (S) MINUTE(L&C)
03/12/96 (S) MINUTE(L&C)
03/14/96 2736 (S) L&C RPT 3DP 1NR
03/14/96 2736 (S) ZERO FISCAL NOTES (DCED, ADM)
03/28/96 (S) FIN AT 8:30 AM SENATE FINANCE 532
04/02/96 (S) FIN AT 9:00 AM SENATE FINANCE 532
04/03/96 (S) RLS AT 1:15 PM FAHRENKAMP RM 203
04/03/96 (S) MINUTE(RLS)
04/03/96 3042 (S) FIN RPT CS 7DP NEW TITLE
04/03/96 3042 (S) ZERO FN TO CS (ADM)
04/03/96 3042 (S) PREVIOUS ZERO FN (DCED)
04/10/96 3112 (S) RULES TO CALENDAR 4/10/96
04/10/96 3115 (S) READ THE SECOND TIME
04/10/96 3115 (S) FIN CS ADOPTED Y18 N2
04/10/96 3115 (S) ADVANCE TO THIRD READING FLD
Y14 N6
04/10/96 3136 (S) COSPONSOR: LINCOLN
04/10/96 3116 (S) THIRD READING 4/11 CALENDAR
04/11/96 3167 (S) READ THE THIRD TIME CSSB 253(FIN)
04/11/96 3168 (S) PASSED Y19 N1
04/11/96 3168 (S) KELLY NOTICE OF RECONSIDERATION
04/12/96 3205 (S) RECON TAKEN UP - IN THIRD READING
04/12/96 3205 (S) COSPONSOR(S): KELLY
04/12/96 3206 (S) PASSED ON RECONSIDERATION
Y18 N1 E1
04/12/96 3220 (S) TRANSMITTED TO (H)
04/15/96 3733 (H) READ THE FIRST TIME - REFERRAL(S)
04/15/96 3733 (H) L&C, STATE AFFAIRS
04/15/96 3783 (H) HES REFERRAL ADDED
04/15/96 3785 (H) CROSS SPONSOR(S): ROBINSON,KUBINA
04/22/96 3936 (H) CROSS SPONSOR(S): NAVARRE
04/23/96 (H) HES AT 3:00 PM CAPITOL 106
04/23/96 (H) MINUTE(HES)
04/25/96 (H) HES AT 3:00 PM CAPITOL 106
WITNESS REGISTER
GENE DAU, Representative
American Association of Retired Persons and
Veterans of Foreign Wars
P.O. Box 20995
Juneau, Alaska 99802
Telephone: (907) 586-3816
POSITION STATEMENT: Testified in support of CSSB 253(FIN)
CAROLE EDWARDS, Certified Oncology Nurse
3998 Diane Road
Juneau, Alaska 99801
Telephone: (907) 789-3345
POSITION STATEMENT: Testified in support of CSSB 253(FIN)
KRISTINE PELLET, Student Intern
for Senator Jim Duncan
Alaska State Legislature
Capitol Building, Room 119
Juneau, Alaska 99801-1182
Telephone: (907) 465-4766
POSITION STATEMENT: Testified on CSSB 253(FIN)
JANET PARKER, Deputy Director
Division of Retirement & Benefits
Department of Administration
P.O. Box 110203
Juneau, Alaska 99811-0203
Telephone: (907) 465-4470
POSITION STATEMENT: Answered questions on CSSB 253(FIN)
BOB STALNAKER, Director
Division of Retirement & Benefits
Department of Administration
P.O. Box 110203
Juneau, Alaska 99811-0203
Telephone: (907) 465-4470
POSITION STATEMENT: Testified on CSSB 253(FIN)
ACTION NARRATIVE
TAPE 96-46, SIDE A
Number 001
The House Health, Education and Social Services Standing Committee
was called to order by CO-CHAIR CON BUNDE at 3:10 p.m. Members
present at the call to order were Representatives Bunde, Toohey, G.
Davis, Robinson and Brice. Members absent were Representatives
Rokeberg and Vezey.
CSSB 253(FIN) - INS.FOR PROSTATE & CERVICAL CANCER TESTS
Number 007
CO-CHAIR BUNDE announced that CSSB 253(FIN) was the only bill on
the agenda for the meeting. He asked Gene Dau to come forward and
testify.
Number 097
GENE DAU, Representative, American Association of Retired Persons
and Veterans of Foreign Wars testified in support of CSSB 253(FIN).
He noted that in the last meeting on CSSB 253(FIN) Co-Chair Toohey
had asked him if he would have the PSA test again if he had to pay
for it personally. He neglected to report at that time that he is
a disabled veteran and the Veteran's Administration pays his
medical costs. He recalled the testimony from representatives of
the insurance companies at the last meeting indicating this was an
experimental procedure. According to conversations with his
doctor, it is not an experimental procedure; it is well established
and it is within 5 percentage points of being 100 percent. His
doctor had also pointed out that with the PSA test, the cancer can
be detected much earlier than with the other test. He encouraged
committee members to pass this bill out of committee.
Number 280
CO-CHAIR TOOHEY commented the test is absolutely no good unless a
person gets the test.
MR. DAU said that's why people should be encouraged to get the
test. He noted that if the Veteran's Administration had not paid
for his first PSA test, he may have put it off to the following
year. He believed that men would be more inclined to have the
first PSA test done if the cost was covered by insurance.
Number 368
CAROLE EDWARDS, Certified Oncology Nurse, testified that she has
been nationally certified for nine years and serves on a national
committee. She stated that last year when her husband had his
annual physical, everything was covered by the insurance company
except for the PSA testing. She noted he does carry the
Supplemental Benefit with the state of Alaska. They contacted
Senator Duncan and asked him to look into the matter. Her father-
in-law died of prostate cancer at the age of 82. Many men do die
with prostate cancer in their advanced years, not of it; however,
he happened to die of it. That puts her husband at high risk in
that anyone who has a father or brother who has had prostate cancer
is considered a high risk patient just as a woman who has a mother,
sister or first degree relative is considered at high risk for
breast cancer. She pointed out that about seven years ago, Texas
was the first state to mandate by law that mammogram screening be
paid for according to the American Cancer Society guidelines for
women to find breast cancer earlier. Many of the states followed
suit and she believed there were now 48 states which mandate by law
that mammograms be paid for by insurance companies. Until that
time, the insurance companies would pay only if there was a
symptom. The same thing is happening with prostate cancer in men
and she felt that men have the same right to have early screening
for prostate cancer that women have for breast cancer. Her husband
just recently had his physical and if Aetna doesn't pay for the PSA
test, they will pay for it personally. They are in a position to
pay, but the economically disadvantaged and less educated people
are not going to make the decision on their own to pay $70 for a
test that might well save their lives. In her profession, she
administers chemotherapy for people in the advanced stages of
cancer and she tries to help these people through it as best she
can. She would like to save lives by either preventing cancer by
teaching people what they need to do to prevent cancer in the first
place, or save lives and money by finding it early before it has
metastasized to other body parts.
Number 583
CO-CHAIR TOOHEY commented that Ms. Edwards had mentioned the cost
of a PSA test was $70; however, according to information she had
received the test can be done at Bartlett Memorial Hospital for
$26.50.
MS. EDWARDS stated she had contacted the lab and was told the cost
was $70.
CO-CHAIR TOOHEY responded that Bartlett Memorial Hospital contracts
with a lab in Seattle and gets tests done for a rate of $26.50 plus
carrying and handling charges. Also, the Health Fair charges $30
for a PSA test.
MS. EDWARDS didn't know what the handling charges were but she was
told $60-$70 for the cost of the test by the lab at the hospital
which was the cost last year when her husband had the test. She
commented that in an earlier discussion, Co-Chair Toohey had stated
that she didn't like to see government get involved and mandate
health care. As a health care provider, Ms. Edwards agreed 100
percent but added that health care is being mandated by the
insurance companies in what they will or won't pay, not by the
doctors according to what they feel is necessary for the patient.
In her own personal situation, it is important that her husband
have a PSA test annually, but the insurance company is refusing to
cover the cost. She commented the test is controversial, but more
and more studies are being released which support PSA screening in
that it is more accurate, it is decreasing mortality and morbidity
and it is more accepted as a stronger and beneficial test. She
believed that in the next year or two there will be more research
studies; John's Hopkins is very involved in research studies in
this area at the present time.
MS. EDWARDS concluded that she would like to see it mandated by the
state of Alaska that insurance companies pay for the test according
to the American Cancer Society guidelines, which would be an annual
screening for men over the age of 50, and for men over the age of
40 if they are high risk.
CO-CHAIR TOOHEY interjected that was part of the existing contract.
There had been previous testimony that if there was suspicion
following a digital examination, the insurance companies would
cover the cost of the PSA testing. It is not however, offered as
an option for a screening at this time.
Number 797
CO-CHAIR BUNDE recalled there had been testimony from three
individuals who had undergone PSA testing by the same physician and
the rate was $25-$30. Based on articles that he had read, it was
decided initially that the screening wasn't the "end all/be all,"
statistically it increased the life expectancy of an individual for
only six months and if individuals were scared into or encouraged
into surgery, the consequences of the surgery could be devastating.
He asked Ms. Edwards to comment.
MS. EDWARDS said the background was that when autopsies were done
on men over the age of 90, almost 100 percent had prostate cancer.
Therefore, the older a man gets, the more likely he is to have
prostate cancer, but will not die from it. However, if a man in
his 50s has prostate cancer, there is a very good chance he will
die from it, not with it. There is a better chance of saving lives
if it is detected early and men in the 50-70 age group have a
better chance. She stated the surgery has greatly improved in the
last couple of years. There is decreased impotence and
incontinence now with the surgery which were issues that impacted
the quality of a person's life.
Number 945
KRISTINE PELLET, Student Intern for Senator Jim Duncan, testified
that Senator Duncan feels the amendment would defeat the purpose of
the bill. She noted that it is currently on the list of offerings,
so essentially it would do nothing. By making it a mandatory
offering, there is no way to encourage men who are unaware of the
benefits of early screening and there is no way of educating them
of the relevancy of the PSA test. She pointed out that page 2,
Section 1(e), does allow for more advanced testing, not just the
PSA test.
CO-CHAIR TOOHEY questioned the zero fiscal note.
MS. PELLET deferred that question to Janet Parker of the Division
of Retirement & Benefits.
Number 1006
JANET PARKER, Deputy Director, Division of Retirement & Benefits,
Department of Administration, explained the state plan already pays
for a medically necessary PSA exam. The only PSA exams that are
currently not covered are in a routine screening when individuals
are having a well-physical exam. The well-physical exam is paid
for by state employees themselves under the Supplemental Benefits
System (SBS) Option 1 plan. There is no additional cost to the
state.
CO-CHAIR BUNDE remarked if that's the way things are now, then
people who are unaware are not going to be encouraged to take the
PSA test. He wondered what would change if the legislation passed
as it is written; individuals would still be paying for their well-
physical and not covered by insurance.
MS. PARKER said if the bill passes, as it is written which mandates
PSA coverage, when a person has their well-physical and the doctor
includes that PSA test, whether it is requested by the patient or
not, it will be covered by their insurance.
CO-CHAIR TOOHEY asked if there was no charge?
MS. PARKER replied not to the state. She explained a fiscal note
is based upon what additional state dollars are required.
CO-CHAIR TOOHEY questioned the impact of the inclusion of this
provision when the insurance plan is renegotiated.
MS. PARKER said there would be no fiscal impact to the state
because the entire cost of the well-physical exam is paid by the
employee. She explained it was about $20 through an employee's SBS
premiums for employee only coverage.
Number 1112
CO-CHAIR BUNDE said that's his point exactly. The employees are
paying for the well-physical. If this legislation passes and the
employee wants a PSA test, they get it but they're still paying for
the well-physical.
CO-CHAIR TOOHEY inquired why this bill was needed.
Number 1135
BOB STALNAKER, Director, Division of Retirement & Benefits,
Department of Administration, directed the committee's attention to
the analysis of the fiscal note which addresses the fact that it is
anticipated to increase the costs of the SBS Option 1 by about
$60,000 per year. That's the additional cost of having the PSA
test included under the Option 1. The reason the fiscal note is
zero on its face is because that cost is picked up by the employees
who elect to pay for Option 1. He explained that whether that
$60,000 would in fact have any kind of impact on the $50 a month
per family or $25 a month for an individual is hard to tell because
$60,000 is not a lot of money when it is spread over the thousands
of people who select Option 1.
Number 1189
CO-CHAIR BUNDE said in reality this bill as it is written is a
mandatory offering; it's offered, people can have it, but they pay
for it.
MR. STALNAKER said, "I think we too often get into what I think in
this bill is confusing the state plan with something offered to
everybody. The fact that the state plan has through public policy
by administrations, the legislature and the unions in collective
bargaining, include a lot of things that most plans don't include
because it's a good idea. And as I testified before, I may not
personally support mandated coverages across-the-board; there are
times when it's wise to do it. I think mammograms is a prime case
of that and I think statistics will show overall health costs will
decrease over time because of that. I think this is another
example of that. I think we will find over time that this will
detect a disease that every man has at some time in his life. Some
people die of it and this will detect it at an earlier, much less
costly stage."
Number 1262
CO-CHAIR TOOHEY said the pros and cons of these tests are not the
discussion, but rather is it government's job to mandate that a
person get these tests; who was paying for it. She commented they
had spent the last five months cutting the budget by $70 million;
how could it be explained they were now raising it by $60,000
because people do not have enough education to spend $30 to get
their own PSA test. She questioned whether people really needed to
be "spoon fed."
MR. STALNAKER understood what Co-Chair Toohey was getting at, but
there are times when it is appropriate to "spoon feed" someone
because the cost of the test may mean buying a new pair of shoes
for the kids or whatever, and they won't do it on their own.
CO-CHAIR BUNDE asked if there were further questions or testimony.
Hearing none, he closed the meeting to public testimony. He had an
amendment making it a mandatory offering, not a mandatory coverage.
Number 1370
CO-CHAIR TOOHEY moved to adopt Amendment 1.
REPRESENTATIVE ROBINSON objected.
CO-CHAIR BUNDE thought the committee understood the philosophical
difference between mandatory coverage and mandatory offering. He
asked if there was further discussion. Hearing none, he asked for
a roll call vote. Voting in favor to adopt Amendment 1 were
Representatives Davis, Toohey and Bunde. Voting against Amendment
1 were Representatives Robinson and Brice.
Number 1385
REPRESENTATIVE ROBINSON made a motion to pass HCS CSSB 253(HES)
with attached fiscal notes and individual recommendations out of
committee. Hearing no objection, it was so ordered.
ADJOURNMENT
There being no further business to come before the House Health,
Education and Social Services Committee, Co-Chair Bunde adjourned
the meeting at 3:36 p.m.
| Document Name | Date/Time | Subjects |
|---|