02/19/1998 03:50 PM House HES
| Audio | Topic |
|---|
+ teleconferenced
= bill was previously heard/scheduled
HOUSE HEALTH, EDUCATION AND SOCIAL
SERVICES STANDING COMMITTEE
February 19, 1998
3:50 p.m.
MEMBERS PRESENT
Representative Con Bunde, Chairman
Representative Joe Green, Vice Chairman
Representative Brian Porter
Representative Fred Dyson
Representative J. Allen Kemplen
Representative Tom Brice
MEMBERS ABSENT
Representative Al Vezey
COMMITTEE CALENDAR
* HOUSE BILL NO. 300
"An Act relating to health insurance; and providing for an
effective date."
- HEARD AND HELD
HOUSE BILL NO. 350
"An Act requiring that the cost of contraceptives and related
health care services be included in health insurance coverage."
- PASSED HB 350 OUT OF COMMITTEE
SPONSOR SUBSTITUTE FOR HOUSE BILL NO. 148
"An Act relating to the public school funding program; relating to
the definition of a school district, to the transportation of
students, to school district layoff plans, to the special education
service agency, to the child care grant program, and to compulsory
attendance in public schools; and providing for an effective date."
- PASSED CSSSHB 148(HES) OUT OF COMMITTEE
(* First public hearing)
PREVIOUS ACTION
BILL: HB 300
SHORT TITLE: HEALTH CARE INSURANCE
SPONSOR(S): REPRESENTATIVES(S) BUNDE, James
Jrn-Date Jrn-Page Action
01/12/98 2023 (H) PREFILE RELEASED 1/2/98
01/12/98 2023 (H) READ THE FIRST TIME - REFERRAL(S)
01/12/98 2023 (H) HES, LABOR & COMMERCE
02/19/98 (H) HES AT 3:00 PM CAPITOL 106
BILL: HB 350
SHORT TITLE: INSURANCE COVERAGE FOR CONTRACEPTIVES
SPONSOR(S): REPRESENTATIVES(S) CROFT, Phillips, Bunde, Green,
James, Berkowitz, Davies, Elton, Kemplen
Jrn-Date Jrn-Page Action
01/26/98 2133 (H) READ THE FIRST TIME - REFERRAL(S)
01/26/98 2133 (H) HES, L&C
02/04/98 2223 (H) COSPONSOR(S): ELTON
02/10/98 (H) HES AT 3:00 PM CAPITOL 106
02/10/98 (H) MINUTE(HES)
02/16/98 2336 (H) COSPONSOR(S): KEMPLEN
02/19/98 (H) HES AT 3:00 PM CAPITOL 106
BILL: HB 148
SHORT TITLE: SCHOOL FUNDING ETC./ CHILD CARE GRANTS
SPONSOR(S): HEALTH, EDUCATION & SOCIAL SERVICES
Jrn-Date Jrn-Page Action
02/18/97 382 (H) READ THE FIRST TIME - REFERRAL(S)
02/18/97 382 (H) HES, FINANCE
04/04/97 988 (H) SPONSOR SUBSTITUTE
INTRODUCED-REFERRALS
04/04/97 988 (H) READ THE FIRST TIME - REFERRAL(S)
04/04/97 989 (H) HES, FINANCE
04/08/97 (H) HES AT 3:00 PM CAPITOL 106
04/08/97 (H) MINUTE(HES)
04/24/97 (H) HES AT 3:00 PM CAPITOL 106
04/24/97 (H) MINUTE(HES)
04/28/97 (H) HES AT 3:30 PM CAPITOL 106
04/28/97 (H) MINUTE(HES)
04/30/97 (H) HES AT 3:30 PM CAPITOL 106
04/30/97 (H) MINUTE(HES)
08/25/97 (H) HES AT 10:00 AM CAPITOL 205
08/25/97 (H) MINUTE(HES)
09/30/97 (H) HES AT 9:00 AM ANCHORAGE LIO
09/30/97 (H) MINUTE(HES)
01/27/98 (H) HES AT 3:00 PM CAPITOL 106
01/27/98 (H) MINUTE(HES)
01/29/98 (H) HES AT 3:00 PM CAPITOL 106
01/29/98 (H) MINUTE(HES)
02/05/98 (H) HES AT 3:00 PM CAPITOL 106
02/05/98 (H) MINUTE(HES)
02/17/98 (H) HES AT 3:00 PM CAPITOL 106
02/17/98 (H) MINUTE(HES)
02/19/98 (H) HES AT 3:00 PM CAPITOL 106
WITNESS REGISTER
PATTI SWENSON, Legislative Assistant
to Representative Con Bunde
Alaska State Legislature
Capitol Building, Room 104
Juneau, Alaska 99801-1182
Telephone: (907) 465-6824
POSITION STATEMENT: Testified on HB 300.
DAN PITTS, Dentist
155 Smith Way
Soldotna, Alaska 99669
Telephone: (907) 262-4989
POSITION STATEMENT: Testified in favor of HB 300.
TIM WOLLER, Dentist; and
President, Alaska Dental Society
3529 College Road, Number 205
Fairbanks, Alaska 99701
Telephone: (907) 479-6747
POSITION STATEMENT: Testified in favor of HB 300.
ROB ROBINSON, Dentist
935 Westpoint Drive, Suite 201
Wasilla, Alaska 99654
Telephone: (907) 373-0747
POSITION STATEMENT: Testified in favor of HB 300.
DEE JAY JOHANNESSEN, Executive Director
Aids Care Network
3650 Lake Otis Parkway
Anchorage, Alaska 99507
Telephone: (907) 563-2437
POSITION STATEMENT: Testified on HB 300.
QUINN McKENNA, Operations Administration
Providence Health Systems in Alaska
10710 Dolly Madison
Eagle River, Alaska 99577
Telephone: (907) 261-3134
POSITION STATEMENT: Testified in opposition to HB 300.
JIM JORDAN, Executive Director
Alaska State Medical Association
4107 Laurel Street
Anchorage, Alaska 99508
Telephone: (907) 562-0304
POSITION STATEMENT: Testified on HB 300.
REPRESENTATIVE ERIC CROFT
Alaska State Legislature
Capitol Building, Room 430
Juneau, Alaska 99801-1182
Telephone: (907) 465-2116
POSITION STATEMENT: Commented as the sponsor of HB 350.
EDDY JEANS, Manager
School Finance Section
Education Support Services
Department of Education
801 West 10th Street, Suite 200
Juneau, Alaska 99801-1894
Telephone: (907) 465-2891
POSITION STATEMENT: Commented on SSHB 148.
ACTION NARRATIVE
TAPE 98-11, SIDE A
Number 0001
CHAIRMAN CON BUNDE reconvened the House Health, Education and
Social Services Standing Committee meeting at 3:50 p.m. Members
present were Representatives Bunde, Green, Porter, Dyson, Kemplen
and Brice.
HB 300 - HEALTH CARE INSURANCE
Number 0008
CHAIRMAN BUNDE announced the first item on the agenda was HB 300,
"An Act relating to health insurance; and providing for an
effective date."
Number 0073
CHAIRMAN BUNDE read the following sponsor statement into the
record: "Often, insurers use health care consumers as trading
chips in order to obtain services for a lower price. The problem
is that the patients involved don't know always know they've been
traded away until they come to use the service, and then many
times, become aware that they are not able to go to the provider of
their choice. House Bill 300 protects the rights of health care
consumers to choose appropriate medical care. This legislation
prohibits insurers from reimbursing a covered person at a different
rate because of the person's choice of health care provider."
CHAIRMAN BUNDE directed the committee's attention to the proposed
committee substitute.
Number 0147
REPRESENTATIVE BRIAN PORTER made a motion to adopt proposed
committee substitute 0-LS1248\K, Ford, 2/19/98, as a work draft.
There being no objection, that version was before the committee.
CHAIRMAN BUNDE asked Patti Swenson to come forward to present her
testimony.
Number 0168
PATTI SWENSON, Legislative Assistant to Representative Con Bunde,
Alaska State Legislature, testified, "The legislation before you
today is HB 300; it concerns the rights of patients to choose who
will provide their medical care. This legislation also supports
health care providers by giving some recourse to physicians if
their patient's treatment is denied.
"House Bill 300 holds implications for all health care consumers.
Managed care organizations as well as preferred provider
organizations (PPOs) have traditionally limited their enrollees'
choice of provider by imposing a closed panel or closed network of
providers. By enabling consumers to choose their provider the
closed panel will expand to meet the consumers needs. Choice is
important to consumers. It is an arbiter of quality and lets them
get the care they need, which may otherwise be limited by managed
care organizations. These limits are due to the built-in incentive
to reduce medically inappropriate and unnecessary care, as well as
care that is actually needed.
"Many people think that managed care, PPOs and other similar plans
contain costs without sacrificing medical benefits or attracting
intrusive governmental regulations. However, it is the health care
consumers that are making the sacrifice.
"Insurers promise preferred providers a high volume of patients in
exchange for charging lower rates for their services. The idea is
that, as medical costs rise, they have to contain costs to maintain
affordability and access to health care. The reality is, insurers
are using health care consumers as bargaining chips, without their
knowledge or consent. Because of the insurers bargaining, health
care consumers now face restrictions on the type of care they
receive and where they can get it.
"The optimism about cost containment is misplaced. Managed care
and PPO contracts are subject to the same upward pressure on costs,
resulting from new technology and rising wages, that other
providers face. Unable to control these forces, managed care
providers have instead kept costs below those of fee-for-service
providers. They accomplish this by using fewer hospital days,
denying newer and perhaps more expensive treatment for patients,
and by reducing access by limiting the number of care providers in
a PPO. This strategy delays treatment to the point that it may not
be done or it forces the patient outside the plan where
remuneration for the treatment is lower than that paid under the
PPO. As more patients go outside the PPO, the cost savings for the
managed care or PPO appears to be greater than it would for a fee-for-service p
"Consumers have to ask if their medical care has improved or become
more efficient since the beginning of managed care. Many consumers
say they can't see the physician they wish to see; they spend less
time with the physician they go to see; and they feel rushed out of
the hospital when they are ill.
"Physicians on the other hand say they can't afford to spend as
much time with patients as they used to; many tests that they would
like to use for diagnosing medical conditions are denied by
insurance companies; their patients are not approved for time in
the hospital and physicians have very little recourse; and the
insurance companies are not paying for care in a timely manner.
"Is this the efficient low cost system we were told to expect when
insurers were touting managed care? Consumers are putting more
money out of their pockets at each doctor's visit than ever before.
When insurers wish to contain costs, they simply use less medical
services or force consumers outside of the program. House Bill 300
will go a long way to help health care consumers and physicians.
I urge the committee's positive consideration of this legislation."
Number 0458
MS. SWENSON directed the committee's attention to the committee
substitute and noted the following changes: First, the title is
changed to reflect the emphasis of the legislation, which is
patients' rights; a short title has been added in Section 1; and
Section 2(b) is changed to require physician to physician contact
in cases where patients are denied care, reduced care or terminated
health care benefits. The remainder of the committee substitute is
the same as the original bill.
Number 0523
DAN PITTS, Dentist, testified that he is currently in private
practice and as a care provider he supports HB 300. He explained
the first provision of this legislation is patients' freedom of
choice. As a provider, this legislation tells him that he is in
competition with other providers and his quality of care should be
second to none. If his quality of care is less than what other
providers give, the marketplace will affect his business. He
believes that competition breeds quality of care. Without
competition, quality slips. He said there is a grassroots surge
throughout the nation as a result of managed care, health
maintenance organizations (HMO), preferred provider organizations
(PPO) provisions and in his opinion, their concern is the bottom
line, and the quality and service received by the patients is
beginning to slip.
Number 0674
DR. PITTS said the second provision of HB 300 deals with review.
As a provider, he has had treatment denied to his patients and upon
inquiry, the individual making the decision and denying the
treatment is an administrative individual without any experience or
degree in the health care field. He supports the provision
requiring a health care professional to review the request for
treatment.
Number 0734
DR. PITTS spoke in support of the third provision which holds
insurance companies accountable for their decisions. This is in
the patients' best interest and with an open marketplace, the costs
will not go up and quality will remain the same.
Number 0773
CHAIRMAN BUNDE thanked Dr. Pitts for his testimony and said that
one of the concerns expressed about HB 300, is that prices will go
up if providers do not have a guaranteed market. Competition will
cause the price of medical care to explode. He gave several
examples of prices going down as competition increased. Based on
Dr. Pitts' testimony, it appeared that he did not believe a
guaranteed market was necessary to keep cost containment on dental
care.
DR. PITTS said the marketplace will control the cost of the health
care. If there is a need for more health care providers in an
area, more health care providers will move in, whether it be in
dentistry or medicine. As a point of interest, in Alaska a dental
license can be obtained by applying for it as long as the
individual has a license in another state and five years
experience. He views the position of insurance companies as
wanting a locked-up market, or a monopoly on the providing of
services.
Number 0888
REPRESENTATIVE PORTER said in general terms, health care across the
United States has gone up at a higher rate than inflation. He
asked Dr. Pitts if he knew what was causing that.
DR. PITTS responded there are a lot of high technology things
happening in medicine now. A lot of the health care dollars are
going to a number of disease processes like HIV, transplants,
hepatitis and other areas where care is extremely expensive. In
his opinion, prevention is the key and as health care providers get
better with the technologies, prices will come back down.
Number 0972
REPRESENTATIVE JOE GREEN referred to Dr. Pitts' statement that if
HB 300 passes, costs will not go up; yet the committee has gotten
conflicting information from HMOs and other organizations. He
asked if the information from HMOs was false or was Dr. Pitts
saying that because of competition, the costs will stay low.
DR. PITTS remarked that he could not debate statistics with
insurance companies. He noted that Texas had adopted an extremely
strict patients' rights bill and the results of a study indicated
that costs rise at about the same rate as inflation; less than 3
percent. He added that in dentistry, insurance is not for a
catastrophic problem, but it's more of an employee benefit.
There's a certain amount of dollars an employee is allowed to spend
as a result of being employed by a certain employer; the amount is
limited, as well as controlled, and there is co-payment with the
patient. All those things built into the fee for service system
keeps costs under control.
Number 1116
MS. SWENSON directed the committee's attention to the information
on cost savings and said a lot of the HMOs, PPOs and managed care
organizations have decreased bed time and decreased access to
different medical services and that's the way they show initial
cost savings. But over time as that continues, these organizations
can only stop people from staying in the hospital so many days and
stop so many medical procedures before running out of things to
stop, so eventually the cost will become even with people who are
using fee-for-service.
CHAIRMAN BUNDE asked Dr. Woller to come forward to present his
testimony.
Number 1173
TIM WOLLER, Dentist and President, Alaska Dental Society, testified
that he has practiced dentistry for 26 years. He was testifying on
behalf of not only his patients, but those patients of the Alaska
Dental Society. The Alaska Dental Society has 291 members and
endorses HB 300. He cautioned that cost containment and cost
savings should not be done on the back of the patient, and that's
what this legislation is about - it's about patients' rights and
the right to have remuneration on a fair scale. If a patient steps
outside a plan, the remuneration is at a much lower rate in most
cases, which is what he has found with United Concordia in
Fairbanks who insures the military dependents. He said, "On a
procedure that they are paid in one office, they are paid at a much
lower rate in another office. This is payment back to the patient
under that schedule." If indeed there is cost savings, the cost
savings are then borne by the patient.
Number 1251
DR. WOLLER said dentistry is a relationship with the patient; it's
not like a medical surgeon who operates once on a patient and never
sees that patient again. He has patients that have been his
patients since he started his practice 26 years ago and have become
comfortable with him doing their dentistry. When patients are
negotiated into a preferred provider plan, those patients generally
don't have the input; the employer decides that. But once the
patient is in the preferred provider plan, it becomes a dictate as
to what provider the patient can see and is severely penalized for
going outside that plan.
DR. WOLLER said, "I'd like them to not be as severely penalized.
We're not trying to call this an any willing provider bill, whereby
a dentist would go ahead and accept as 100 percent payment, thereby
competing directly with the PPO person who is admittedly given a
lower rate to garner more patients. We're simply saying that they
should not be as heavily penalized; they should get the same amount
of money for the procedure to see their dentist. They're going to
have to have a co-pay; there's still going to be some financial
imposition, but it will not be the penalty by the insurance
company. That's the big provision."
Number 1317
DR. WOLLER referred to the gag order provision and said in the
Lower 48, providers are joining an HMO or a PPO, and in signing
onto that, the provider is guaranteeing not to discuss certain
procedures with a patient. These procedures are usually high end
cost procedures and could be in the patient's best interest. These
are commonly known as gag orders. At this point, this has not been
imposed in Alaska, but the language was inserted in HB 300 to
prevent that from happening. Dr. Woller said the Alaska Dental
Society favors the recourse provision, and suggested the language
be changed to read "an Alaska licensed physician or dentist." It's
not restrictive on the insurance companies; it's meant to have
recourse for the patient. The attorney general's office has
advised that if the person auditing or reviewing the plan for the
insurance company is not Alaska licensed, the attorney general's
office has no recourse against that person; thus the patient
doesn't have the ability to get an answer from the insurance
company.
Number 1400
CHAIRMAN BUNDE asked what the impact of that requirement would be
on a national insurance company, whose headquarters are located in
Chicago, for example.
DR. WOLLER responded that Alaska licensure is very broadly
available. An individual who passes the western regional
examination, a consortium of about 15 western states, can simply
apply and get an Alaska license.
CHAIRMAN BUNDE thanked Dr. Woller for his testimony and asked Dr.
Robinson to present his comments.
Number 1464
ROB ROBINSON, Dentist, stated he is not currently practicing, but
was testifying on behalf of individuals in the Mat-Su Valley who
have expressed concerns. He testified in support of HB 300 and
doesn't view it as restricting HMOs or PPOs. He felt strongly that
patients have rights and that's how he views this legislation. He
supports the recourse provision as well as the requirement for an
Alaskan licensed physician or dentist as suggested by Dr. Woller.
He felt it was important for a patient to have recourse in the
state of residence through the attorney general's office or the
Division of Occupational Licensing.
Number 1459
DR. ROBINSON referred to Representative Porter's question about the
guaranteed market and said there's still a guaranteed market, the
way he views this legislation. For example, if a group of
providers want to charge $50 for $100 fee, that group has their
guaranteed market and insurance companies can adjust fees however
they see fit. The fee is not what he wanted to address; however,
if a patient wanted to go to a provider who charged $100 fee, that
should be the patient's choice.
CHAIRMAN BUNDE noted there were people waiting to testify via
teleconference. He asked Dee Jay Johannessen to present his
comments.
Number 1634
DEE JAY JOHANNESSEN, Executive Director, AIDS Care Network,
testified via teleconference from Anchorage. He said the AIDS Care
Network is a statewide AIDS service organization based in Anchorage
and one of the main focuses of the AIDS Care Network is to educate
for the proper primary care for treatment of HIV and AIDS. He
urged careful consideration of HB 300 which addresses three major
issues: The patient's right; assessability to quality health care;
and cost. He believes that Alaskans have the right to not only
seek out, but to obtain the highest quality of care that is
available to meet individual medical needs. While his main focus
is directly related to the treatment of HIV, the premise transfers
directly to any chronic illness which may be terminal in nature.
Primary care for persons living with HIV and AIDS is complex and
rapidly changing. Currently, there are over 100 clinical studies
taking place in the United States to treat this disease more
effectively. It is integral that the outcomes of these studies be
instituted in treatment-type protocols in order to institute the
highest level of care. He referenced two different studies that
have shown that when treatment for HIV infection is provided by HIV
experienced physicians, clinical outcomes are optimal. HIV
experienced physicians are largely in private practice; not people
who will be bidding on these managed care programs and it is
important to note that in the state of Alaska there are only ten
HIV experienced physicians; seven of which live in Anchorage and
none work in the major hospitals. The overall cost of care when
treatment is provided by an HIV specialist is reduced by 38 percent
and most importantly, the long term survival rate for patients is
increased by 43 percent. If a specialist is willing to accept the
cost reimbursement rate which is established by the insurance
company, the insurance company should have no right to deny access
to quality care. It is important in the treatment of HIV and AIDS
that everything available be used.
CHAIRMAN BUNDE thanked Mr. Johannessen for his testimony and called
on Mr. McKenna to present his comments.
Number 1778
QUINN McKENNA, Operations Administration, Providence Health Systems
in Alaska testified via teleconference from Anchorage in opposition
to HB 300. In reviewing the legislation, he said a large part
comes down to choice versus community commitments to pay for health
care services. He recalled that a few years ago, health care
inflation was in double digits - three times higher than inflation,
and employers began to realize it was no longer feasible to
continue paying the increased costs, which contributed in a large
part to the advent of managed care. He said that managing or
coordinating health care is no different than the process the
legislature is following to balance the state budget. The choice
of constituents is to have all their wishes funded, but the
legislature has to work hard to carefully prioritize according to
the greatest need versus funds available. In the same way,
purchasers of health care, usually employers, can no longer offer
carte blanche health care coverage. With limited resources, those
employers are attempting to use the available dollars wisely;
meaning more careful decisions in purchasing and more oversight of
the process when care is needed.
Number 1867
MR. McKENNA referred to previous testimony regarding limiting
choices and said currently in the market, everyone does have
choice. A person can choose a traditional indemnity plan or a
managed care plan, knowing up-front there are limitations on the
panel and some differences in the benefits. The usual difference
is price; the management care plan usually being a lower cost. To
the extent that the legislature and HB 300 make the managed care
plan and the traditional indemnity plan look more alike, the thing
that will change is that the two plans will cost alike and the cost
benefits of a managed care plan will be lost. As a managed care
organization comes to a provider like Providence Health Systems and
requests a discount, the question asked is, "What are you able to
offer?" and typically the answer is volume. To the extent that
managed care plans cannot offer volume, then it limits Providence
Health Systems' ability to give a discounted price.
Number 1914
MR. McKENNA referred to a 1993 letter from the Acting Director of
the Federal Trade Commission to the Attorney General of Montana,
who had implemented any willing provider legislation in Montana
and said the opinion of the Federal Trade Commission is similar to
his. In summary, it said that any (indisc.) provider requirement
may discourage competition among providers, in turn raising prices
to consumers and unnecessarily restricting consumer choice without
providing any substantial public benefit.
CHAIRMAN BUNDE thanked Mr. McKenna for bringing forth another side
of the argument. He noted that discussion will continue on HB 300
at a later meeting. He called a brief at-ease at 4:29 p.m.
CHAIRMAN BUNDE called the meeting back to order at 4:30 p.m. with
another individual to testify via teleconference.
Number 1986
JIM JORDAN, Executive Director, Alaska State Medical Association,
testified via offnet and read the following letter into the record:
"The Alaska State Medical Association (ASMA) represents nearly 500
private practice physicians and their patients. Thank you for the
opportunity to provide commentary on HB 300.
"ASMA's governing body, the House of Delegates, has long supported
the concept of a patient's reasonable choice in the physician that
provides his or her medical care. This concept is included in
HB 300.
"ASMA's interest in any health care plan focuses on what impact it
would have on the quality of medical care and the patient/physician
relationship. Generally, the physician community is interested in
assuring that:
1) patients have a reasonable choice in which physician
provides their health care;
2) patients have a clear understanding of all material
benefits and restrictions involved with any health plan;
3) each physician desiring to participate as a contracted
provider of care has a fair opportunity to do so;
4) any physician contract criteria, contracting procedures,
and contract termination be on a fair and equitable
basis;
5) any utilization review or medical necessity determination
be accomplished on a peer review basis; and finally
6) patients aren't unreasonably denied benefits after
receiving emergency care in a hospital or other emergency
facility."
He noted the last paragraph of the letter had been somewhat
addressed by the adoption of the committee substitute, so he didn't
read the last paragraph. The letter was signed by Kevin Tomera,
M.D., President of the Alaska State Medical Association.
He thanked Chairman Bunde for the opportunity to testify.
Number 2076
CHAIRMAN BUNDE noted there had been earlier discussion from
individuals who wished to see the review process completed by an
Alaskan licensed physician as it related to the recourse provision.
He asked Mr. Jordan if he would care to comment.
MR. JORDAN said it was an interesting issue and in many other
states it has been determined that such activity by a physician is
determined to be the practice of medicine. If that is the case,
licensure in the state of Alaska would be required. He suggested
the question be posed to the Alaska State Medical Board.
CHAIRMAN BUNDE thanked Mr. Jordan for his comments and closed
testimony on HB 300 and reiterated that HB 300 would be held in
committee for a further hearing.
HB 350 - INSURANCE COVERAGE FOR CONTRACEPTIVES
Number 2110
CHAIRMAN BUNDE announced the next item on the agenda was HB 350,
"An Act requiring that the cost of contraceptives and related
health care services be included in health insurance coverage." He
asked the sponsor, Representative Eric Croft to present his
comments.
Number 2116
REPRESENTATIVE ERIC CROFT, Alaska State Legislature, sponsor of
HB 350, said he wanted to report back to the committee on a couple
of issues that had been raised in the testimony at the last meeting
on HB 350. With reference to Mr. Evans' testimony that he was not
aware that most health insurance plans routinely covered abortions,
Representative Croft said that is the factual situation in the
nation. But more specifically relating to Alaska, according to the
Division of Insurance, Blue Cross and Aetna do routinely cover
abortions and sterilizations. There is no mandate by law, but both
companies do it for their own reasons. Both companies publish a
list of procedures that are not covered as part of their basic
coverage and the lists do not include abortion. He noted that
Principal Mutual Insurance Company, Alaska's third largest
insurance company, may not routine cover abortions; it was somewhat
unclear.
Number 2166
REPRESENTATIVE CROFT said there had been some concerns expressed
that HB 350 could have a wider application; i.e., that it might
cover Medicare supplemental and/or dental. According to Katie
Campbell, Division of Insurance and Mike Ford, bill drafter from
Legislative Legal Services, the Medicare supplemental and/or dental
would not be covered.
Number 2192
REPRESENTATIVE CROFT referred to the philosophical discussion at
the previous meeting regarding whether the provision of
contraceptives causes promiscuity. He said there may be a
correlation, but it seemed to him that it works the other way. For
example, more promiscuous people might use contraceptives for the
very obvious reason they're engaging in that activity, and less
people might not, because they don't need to. He hasn't been able
to find any evidence and has asked Mr. Heidersdorf for his sources,
but as of this meeting, Representative Croft had not received any
information from Mr. Heidersdorf.
Number 2235
REPRESENTATIVE CROFT was of the opinion the legislation puts a tool
in the hands of Alaskans that allows individuals to plan their
families.
Number 2243
CHAIRMAN BUNDE surmised that if HB 350 passes, insurance companies
would offer this option, but people who belong to health plans
would not necessarily have to subscribe to that option.
REPRESENTATIVE CROFT replied that no one would have to use
contraceptives if they didn't want to, but the option is there.
CHAIRMAN BUNDE inquired if a person would have to pay for an
insurance policy that provided that coverage.
REPRESENTATIVE CROFT responded the individual wouldn't have to use
contraceptives, but would be paying on an insurance policy that did
provide the coverage to other people.
Number 2276
CHAIRMAN BUNDE asked if there were further questions of the
sponsor. Hearing none, he closed public testimony and asked the
pleasure of the committee.
Number 2329
REPRESENTATIVE DYSON said, "It seems to me that what we're doing
here is not providing the devices, in a sense what we're doing is
through the insurance company providing ...
TAPE 98-11, SIDE B
Number 0001
REPRESENTATIVE DYSON ... devices." He wondered if the argument was
that people who have health insurance don't have enough disposable
or marginal income to acquire the devices for themselves. It has
been his experience that health insurance is so expensive that
people who can afford health insurance or have a job that provides
it, probably have some discretionary income. As he recalled,
contraceptives are not prohibitively expensive.
Number 0045
REPRESENTATIVE DYSON said he is not convinced that the reason
people are not using birth control is because they don't have
enough money because people who are able to afford insurance or
have a job that provides it, would likely have the money. He said,
"So then it seems to me if that's the case, then what we're doing
is providing a mechanism for those who want to use their insurance
company to buy it or just kind of providing a little discount for
them because they can get someone else to help subsidize the cost
of buying the birth control devices." Certainly, this issue can
be argued from a safety standpoint in that there's less health risk
if a person doesn't become pregnant and certainly with some birth
control devices, there are less risks of sexually transmitted
diseases. Is it then in an insurance company's or a person's best
interest to avail themselves of these safety devices. In lots of
cases it is. It appeared to him the insurance industry is in
business to make money and if industry data indicated their clients
were better off not getting pregnant, insurance companies would be
offering incentives. He indicated he would not vote to pass this
bill out of committee.
Number 0132
CHAIRMAN BUNDE directed the committee's attention to a letter of
intent in the packets.
Number 0140
REPRESENTATIVE GREEN made a motion to adopt the letter of intent.
There being no objection, the letter of intent was adopted.
Number 0150
REPRESENTATIVE PORTER said after much personal debate, he had
advised the sponsor the previous day that he would not be voting to
pass HB 350 from committee. His concern was with the message
that's being sent by asking that birth control devices be provided.
It has been his experience that most children don't have an ideal
home life and are guided by other outside influences, as well as
what is legal and illegal, rather than by a set of principles
instilled by the parents.
REPRESENTATIVE PORTER recalled when marijuana was legal in Alaska
for adults in their own home and said it was extremely difficult to
conduct any drug prevention programs for children during that
period of time, because it was technically legal. The public
perception was that marijuana must be alright because it was legal.
His concern is that kids will perceive that contraception is
alright because it's being provided. This was not the message he
wanted to pass on.
Number 0268
REPRESENTATIVE BRICE said there were other aspects of society that
needed to be looked at. For example, a tremendous amount of money
is spent on drug and alcohol abuse and yet alcohol is legal.
Tobacco is another example where funds are spent on educating young
people, and yet it is still legal. In both cases, insurance
companies cover the cost of the associated diseases. He viewed
HB 350 as providing a certain amount of safety, not only for
teenagers but for young married adults not wishing to start a
family immediately, and don't have the disposable income available
for contraception. He was of the opinion these types of programs
should be covered through an insurance policy.
REPRESENTATIVE BRICE said he was not necessarily enamored with the
idea of mandating insurance coverage, but he thought that HB 350
had brought forth a very valid debate and he was going to vote to
pass HB 350 from committee.
Number 0398
REPRESENTATIVE KEMPLEN made a motion to move HB 350 with attached
letter of intent and fiscal notes.
CHAIRMAN BUNDE asked for a roll call vote. Representatives Brice,
Kemplen, Green and Bunde voted in favor of moving the bill.
Representatives Dyson and Porter voted against it. Representative
Vezey was absent. Therefore, HB 350 moved from the House Health,
Education and Social Services Standing Committee on a vote of 4-2.
SSHB 148 - SCHOOL FUNDING ETC./ CHILD CARE GRANTS
Number 446
CHAIRMAN BUNDE announced the next bill to be heard was SSHB 148,
"An Act relating to the public school funding program; relating to
the definition of a school district, to the transportation of
students, to school district layoff plans, to the special education
service agency, to the child care grant program, and to compulsory
attendance in public schools; and providing for an effective date."
He directed the committee's attention to the two technical
amendments in the committee packets.
CHAIRMAN BUNDE explained Amendment 1 deleted "1" and inserted "10"
on page 5, line 16.
Number 0461
REPRESENTATIVE GREEN made a motion to adopt Amendment 1. There
being no objection, Amendment 1 was adopted.
Number 0469
CHAIRMAN BUNDE explained that he had asked the Department of
Education, in preparing the spreadsheet, to ensure there wouldn't
be any net loss in the formula. When the spreadsheet was run
initially, there was a savings of $10 million to the state.
Chairman Bunde said it wasn't his intent to cut the foundation
formula by $10 million, so the numbers in Amendment 2 would bring
the formula back to current funding levels.
Number 0501
REPRESENTATIVE PORTER made a motion to adopt Amendment 2, which
read:
TO: HB 148 (version H)
Page 5, line 28,
Delete "4045", insert "4150".
Page 28, line 2,
Delete "3400", insert "3840".
Page 28, line 3,
Delete "3925", insert "4010".
Page 28, line 4,
Delete "3970", insert "4060".
Page 28, line 5
Delete "4010", insert "4105".
CHAIRMAN BUNDE asked whether there was any objection.
Number 0508
REPRESENTATIVE GREEN asked for a point of clarification. He said,
"So, what I heard you say was the $10 million indicated would be
allocated back to all the various sites."
CHAIRMAN BUNDE said that was correct, based on this formula.
REPRESENTATIVE GREEN observed that it would end up neutral.
Number 0520
EDDY JEANS, Manager, School Finance Section, Education Support
Services, Department of Education, confirmed that.
CHAIRMAN BUNDE announced that Amendment 2 was adopted without
objection.
Number 0534
CHAIRMAN BUNDE asked committee members to examine the spreadsheet
and noted that it does not include the area cost differential. It
was his intent to move the bill to the Finance Committee where the
area cost differential would be addressed. An updated fiscal note
would accompany the bill as it moved from committee.
Number 0585
REPRESENTATIVE PORTER made a motion to move CSSSHB 148(HES) from
committee with individual recommendations and amended fiscal notes,
as amended. There being no objection, CSSSHB 148(HES) moved from
the House Health, Education and Social Services Standing Committee.
ADJOURNMENT
Number 0635
CHAIRMAN BUNDE adjourned the House Health, Education and Social
Services Standing Committee at 4:55 p.m.
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