Legislature(1999 - 2000)
04/06/1999 03:40 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 6, 1999
3:40 p.m.
MEMBERS PRESENT
Representative Fred Dyson, Co-Chair
Representative John Coghill, Co-Chair
Representative Joe Green
Representative Carl Morgan
MEMBERS ABSENT
Representative Jim Whitaker
Representative Tom Brice
Representative Allen Kemplen
COMMITTEE CALENDAR
Board of Dispensing Opticians
James Rothmeyer - Fairbanks
- CONFIRMATION ADVANCED
* HOUSE BILL NO. 70
"An Act relating to questionnaires or surveys administered in
public schools."
- HEARD AND HELD
CS FOR SENATE BILL NO. 48(HES)
"An Act relating to health insurance provided by and provisions
relating to the Comprehensive Health Insurance Association."
- MOVED CSSB 48(HES) OUT OF COMMITTEE
(* First public hearing)
PREVIOUS ACTION
BILL: HB 70
SHORT TITLE: PUBLIC SCHOOL SURVEYS
SPONSOR(S): REPRESENTATIVES(S) DYSON
Jrn-Date Jrn-Page Action
1/25/99 81 (H) READ THE FIRST TIME - REFERRAL(S)
1/25/99 81 (H) HES
4/06/99 (H) HES AT 3:00 PM CAPITOL 106
BILL: SB 48
SHORT TITLE: STATE HEALTH INSURANCE
SPONSOR(S): SENATOR(S) MACKIE
Jrn-Date Jrn-Page Action
1/28/99 109 (S) READ THE FIRST TIME - REFERRAL(S)
1/28/99 109 (S) HES, L&C
2/24/99 (S) HES AT 1:30 PM BUTROVICH ROOM 205
2/24/99 (S) MOVED CS (HES) OUT OF COMMITTEE
2/24/99 (S) MINUTE(HES)
2/25/99 363 (S) HES RPT CS 2DP 2NR SAME TITLE
2/25/99 363 (S) DP: MILLER, ELTON; NR:WILKEN, PETE
KELLY
2/25/99 363 (S) ZERO FISCAL NOTE (DCED)
3/16/99 (S) L&C AT 1:30 PM
3/16/99 (S) MOVED CS (HES) OUT OF COMMITTEE
3/16/99 (S) MINUTE(L&C)
3/17/99 583 (S) L&C RPT (HES) CS 3DP 2NR
3/17/99 583 (S) DP: MACKIE, TIM KELLY, DONLEY;
3/17/99 583 (S) NR: HOFFMAN, LEMAN
3/17/99 583 (S) PREVIOUS ZERO FN (DCED)
3/18/99 (S) RLS AT 11:40 AM FAHRENKAMP 203
3/23/99 (S) MINUTE(RLS)
3/24/99 662 (S) RULES TO CALENDAR AND 1 OR 3/24/99
3/24/99 664 (S) READ THE SECOND TIME
3/24/99 664 (S) HES CS ADOPTED UNAN CONSENT
3/24/99 665 (S) ADVANCED TO THIRD READING UNAN
CONSENT
3/24/99 665 (S) READ THE THIRD TIME CSSB 48(HES)
3/24/99 665 (S) PASSED Y20 N-
3/24/99 670 (S) TRANSMITTED TO (H)
3/25/99 567 (H) READ THE FIRST TIME - REFERRAL(S)
3/25/99 567 (H) HES, L&C
4/06/99 (H) HES AT 3:00 PM CAPITOL 106
WITNESS REGISTER
JAMES ROTHMEYER, Appointee
to the Board of Dispensing Opticians
4001 Geist Road, Number 7
Fairbanks, Alaska 99701
Telephone: (907) 479-4797
POSITION STATEMENT: Testified as appointee to the Board of
Dispensing Opticians.
JOHN MIDDAUGH, MD, Chief
Epidemiology Section
Division of Public Health
Department of Health and Social Services
P.O. Box 240249
Anchorage, Alaska 99524
Telephone: (907) 269-8000
POSITION STATEMENT: Testified on HB 70.
ELMER LINDSTROM, Special Assistant
Office of the Commissioner
Department of Health and Social Services
P.O. Box 110601
Juneau, Alaska 99811
Telephone: (907) 465-1613
POSITION STATEMENT: Provided information on HB 70.
DAVID GRAY, Legislative Assistant
to Senator Jerry Mackie
Alaska State Legislature
Capitol Building, Room 427
Juneau, Alaska 99801
Telephone: (907) 465-3844
POSITION STATEMENT: Presented sponsor statement for SB 48.
MARIANNE BURKE, Director
Division of Insurance
Department of Commerce and Economic Development
P.O. Box 110805
Juneau, Alaska 99811
Telephone: (907) 465-2515
POSITION STATEMENT: Testified in support of SB 48.
ACTION NARRATIVE
TAPE 99-30, SIDE A
Number 0001
CO-CHAIRMAN DYSON called the House Health, Education and Social
Services Standing Committee meeting to order at 3:40 p.m. Members
present at the call to order were Representatives Dyson, Coghill
and Morgan. Representative Green joined the meeting at 4:48 p.m.
CONFIRMATION HEARING
Board of Dispensing Opticians
CO-CHAIRMAN DYSON announced the committee would consider one
nominee for the Board of Dispensing Opticians. They would not vote
for the nominee but would pass him out of committee for full
consideration of the House and Senate. (Resumes were provided for
all appointees.)
CO-CHAIRMAN DYSON asked James Rothmeyer why he would like to serve
on the Board of Dispensing Opticians.
Number 0082
JAMES ROTHMEYER, Appointee to the Board of Dispensing Opticians,
testified via teleconference from Fairbanks. He said he would like
to serve the state and the people of Alaska to ensure that they get
the best services from the state's licensed opticians.
CO-CHAIRMAN DYSON asked Dr. Rothmeyer if he planned to retire in
Alaska.
DR. ROTHMEYER said he was going to stay.
CO-CHAIRMAN COGHILL offered his thanks to Dr. Rothmeyer to be
willing to serve on this board.
CO-CHAIRMAN DYSON asked Dr. Rothmeyer if he could call him for his
opinion on medical issues, like laser surgery and dispensing of
some pharmaceuticals, when they come up.
DR. ROTHMEYER answered that he would be pleased to provide whatever
he could.
CO-CHAIRMAN DYSON informed Dr. Rothmeyer that when the committee
had a quorum, they would pass the appointment on to the full House.
HB 70 - PUBLIC SCHOOL SURVEYS
Number 0277
CO-CHAIRMAN DYSON announced the next order to business as House
Bill No. 70, "An Act relating to questionnaires or surveys
administered in public schools."
CO-CHAIRMAN DYSON handed over the gavel to Co-Chairman Coghill.
CO-CHAIRMAN COGHILL called on Co-Chairman Dyson to testify as
sponsor of HB 70.
Number 0342
CO-CHAIRMAN DYSON noted that there is not a quorum yet, but they
will continue testimony. He asked that the committee not vote on
HB 70 today since they just got the proposed CS in the last few
hours.
CO-CHAIRMAN DYSON went on to say that during this past year, there
was some controversy whether the Youth Risk Behavior Survey (YRBS)
could be administered without active parental permission. In AS
14.03.110 it says " ... whether anonymous or not, that inquires
into private family affairs of the student ..." and his first
thought was to insert "a private family or personal affairs of the
student" in order to make it clear that active parental permission
was required. In subsequent discussion with the Department of
Health and Social Services (DHSS), they made a clear and convincing
case that the logistics of doing that were insurmountable.
CO-CHAIRMAN DYSON said for the last two months he has been working
on a way that his concerns and parents' concerns for parental
consent and control could be satisfied without making a logistics
nightmare for the department. The proposed CS is more complicated
than he wanted, but it is comprehensive. It is very similar to a
proposal in Utah and allows for a once-per-year blanket approval by
the parent for surveys, and it sets down some conditions for doing
it. He intends to make this easy for the school districts. At
enrollment, the parent can sign another piece of paper or check a
box on the enrollment form, and then the school district knows they
have permission to do the surveys.
Number 0604
CO-CHAIRMAN DYSON continued that it his intention that parents will
get an additional notification in advance of the survey in case
they change their mind to opt out. Even the once a year blanket
permission is difficult, but the information that is obtained from
the YRBS is valuable. There are federal funding grants that are
jeopardized, if not eliminated, if the DHSS is not able to get this
information. He will make copies of the actual YRBS available to
the committee before they vote.
CO-CHAIRMAN COGHILL asked how different the proposed CS is from the
original version.
CO-CHAIRMAN DYSON answered that it is quite different and more
comprehensive. He will also have a sectional analysis available.
He called their attention to some important points. On page 2,
line 30, subsection (e) is where it talks about getting blanket
permission; page 3, line 3, subsection (e) (2) provides for parents
to change their mind after they have given written consent.
Number 0920
JOHN MIDDAUGH, MD, Chief, Epidemiology Section, Division of Public
Health, Department of Health and Social Services (DHSS), came
forward to testify. He said they share many of the principles and
are trying to get to the right place for everyone. He explained
that the YRBS was developed by the National Center for Disease
Prevention and Control in collaboration with 71 state and local
departments of education and 19 federal agencies.
DR. MIDDAUGH explained that the YRBS collects information on middle
school and high school students about behaviors that relate to the
major causes of disability, injury and disease for their age group
and later in their lives. The school-based survey uses a
systematic, nationally comparable methodology. It is conducted in
all the states and in many school districts; so Alaska could get
data and compare itself to other school districts and states. The
DHSS was able to conduct this in 1995, did so very successfully,
and got valid statewide results that gave them some information
about the behaviors of that age group.
Number 1012
DR. MIDDAUGH stated this information has allowed the DHSS to craft
programs to try to assist and support students who are doing things
right; it turns out that most of the students are doing things
right, and target programs to students who need additional
assistance. Given the success of this survey in 1995, the DHSS
anticipated little controversy and similar support and success in
1999. To their surprise, they encountered a lot of questions.
There was a lot of misinformation. Questions were raised on
different legal opinions, about what constituted a family affair,
and about the interpretation of existing laws. Unfortunately, a
great amount of incorrect information characterized the YRBS as
wanting to be done without parental permission.
DR. MIDDAUGH stated that the YRBS always has been and always would
be done with parental permission. The YRBS is voluntary, not
mandatory. It is done based on the voluntary participation of a
local school district. Under current procedures, the districts
have an option, if they choose, of conducting the survey with
passive permission. If the district wished to get active written
parental permission, they clearly can do so. The whole approach
has been a partnership to help get information for use in public
health and schools to assist the students. Passive parental
permission is where there is an implied consent: the schools
notify the parents in writing, newsletters, and/or offer the
complete survey for parent's review. Any parent or child can then
opt out of participating in the survey by informing the school.
DR. MIDDAUGH told the committee the problem the DHSS has with
active parental permission is that the notices sent home to get
parental permission are not returned to the school. Numerous
activities are done in the schools with passive parental
permission. The difficulties they face in conducting the survey
with active parental permission is threefold. The first one is a
selection bias because many of the students whose behaviors they
are most interested in learning about are just the ones who don't
bring the permission slips back. It isn't necessarily a case of
the parent objecting to the student's participation, it is a
logistic barrier of getting the actual slips back. The second one
relates to the cost of doing it. The third one relates to
confidentiality. The way the YRBS is done with passive parental
permission is that the sample of students to participate is only a
small proportion of the students enrolled in the district. The
students are not individually identified, but the classrooms are.
The questionnaire comes in an envelope with no name on it; the
survey is distributed in the classroom so the survey people never
know the students' names. Up until actually executing the survey,
a parent or child can elect not to do it, and any questions the
students don't want to answer can be skipped. When the survey is
completed, it is put back in the envelope and turned in. No names
are on the surveys, no list of the students who participated is
available; so the survey is completely confidential and anonymous.
Answers could never be linked back to any individual students.
DR. MIDDAUGH explained that with active parental permission, a list
of students who have permission has to be maintained by somebody,
and potentially it could provide a source of breach of
confidentiality later. Every questionnaire would have to be
labeled with the student's name, and records would have to be kept
to verify that only the students with permission were the ones who
participated. These three problems are why it causes a great
barrier to conduct these surveys. If the parents wish to undertake
active parental permission, they can do so under current
procedures. The DHSS would hope to get support to craft a solution
that would indeed allow these future surveys done efficiently,
maintaining the current situation of local district autonomy to
make those decisions, but also to enable the DHSS to efficiently
collect this information.
DR. MIDDAUGH pointed out one concern in the proposed CS is the
burden on the school districts to get parental permission, maintain
the list of students with permission and then re-notify the parents
before the survey is given in case they want to opt out. The
purpose is to get valid, "generalizable" data, and protect
confidentiality. The power of the information is to identify the
students who need help; help evaluate the programs; provide an
advantage to districts for competition of federal grant funds to
have the solid data to help them leverage resources.
Number 1433
DR. MIDDAUGH stated the DHSS is conducting the YRBS surveys in
Alaska in 1999. Because Anchorage elected not to participate, they
will not have a "generalizable" statewide result to compare to
1995. They will have results for 28 districts, who are currently
participating, involving over 1,300 classrooms and about 25,000
surveys. Two of the districts elected to use active parental
permission; all the rest are using passive parental permission and
are doing so successfully.
DR. MIDDAUGH hopes they can continue the dialog to reach a win-win
situation because he believes they share many of the goals. The
DHSS wants to protect the scientific validity of the survey,
minimize the costs and burdens on the schools districts, while
preserving the absolute commitment to notify parents to give them
the opportunity to opt out, and then absolutely maintaining the
confidentiality and privacy of the data.
Number 1490
CO-CHAIRMAN DYSON asked how much money is riding on this.
DR. MIDDAUGH answered that he didn't know the answer to that
because the goal of the DHSS is to use the data related to public
health programs. For example, the drug and alcohol program was
able to use the YRBS that resulted in new federal funding of $3
million which was distributed to Alaska communities for drug and
alcohol prevention programs. He thought that the Department of
Education could better respond to the funding streams available to
districts.
CO-CHAIRMAN DYSON asked if the $3 million funding requires that the
YRBS be done or just that information be gathered.
DR. MIDDAUGH said no, there is no money that specifically requires
the survey.
CO-CHAIRMAN DYSON asked if the data gathered was used to
demonstrate what a powerful need exists in Alaska and thereby
secure some funding.
DR. MIDDAUGH answered yes.
CO-CHAIRMAN DYSON asked Dr. Middaugh to address how the once a year
blanket permission at enrollment would be a tremendous burden on
the school district.
Number 1626
DR. MIDDAUGH explained that it takes staff time to collect the
permission slips when the students haven't brought them back to
school. It wasn't because the parents didn't want the students to
participate, but perhaps the parents were out of town or the slip
got lost. The DHSS did not use the simple mechanism of handing
something to the child to take home to the parents in the passive
parental permission exercise. There was a letter to every parent
or guardian, there were newsletters, local publicity,
Parent-Teacher Association meetings and public meetings to get
information. In talking to school district colleagues, the DHSS
found out that the logistics of getting a blanket permission at a
time before the actual survey would be given, then to enter the
data, and use it later would be very cumbersome.
CO-CHAIRMAN DYSON asked why it is difficult for the school
enrollment form to include another page to sign or check off a box
when they are already maintaining registration records.
DR. MIDDAUGH said it will require the schools to set up a new
mechanism to collect and maintain those permission records which
they currently aren't doing. With the turnover in school
enrollment, at the time of actually administering the survey, they
would have to go back and specifically identify every single child
by name who then did or didn't have permission. The logistics, the
costs and the practicality of pulling the samples are going to add
a tremendous burden to the school districts as well as those
conducting the survey. He would argue that the protections of
notifying parents and giving them the chance to opt out exists
today, is effective and would meet the need of almost every person
in the state.
CO-CHAIRMAN DYSON commented that most schools are automating their
records, and he suggested that the permission information could be
sorted on the computer.
DR. MIDDAUGH suggested from discussions with the school districts
that it isn't as easy as it would seem or appear.
Number 1815
CO-CHAIRMAN DYSON asked if Dr. Middaugh thought they couldn't get
enough parents to give permission for the survey on an active
basis.
DR. MIDDAUGH said the mechanisms to get active parental permission
are much more cumbersome. In 1995, Juneau used active parental
permission, and this year Sitka used active parental permission,
and both had a very interesting experience in terms of the extra
costs and burdens, the number of volunteers and clerical time it
took. In order for the survey to be valid, there has to be a
certain response rate; if they don't get the response rate, then
they can't generalize the results of the survey. He encouraged the
committee to get specific testimony from those who were involved in
Juneau and Sitka to relate their experiences, because they speak
quite powerfully to the difficulty of doing this.
Number 1907
CO-CHAIRMAN COGHILL asked why Anchorage decided not to take the
survey.
DR. MIDDAUGH answered that they were concerned about a potential
lawsuit over the interpretation of the current law if they were to
undertake it with passive parental permission. The second issue is
they felt the costs and burden on their district were too great to
undertake it with active parental permission under the time frame.
They did suggest they would entertain the survey if DHSS would pay
for all the additional costs of trying to undertake it with active
parental permission, but the DHSS had no funds to do that."
Number 1953
ELMER LINDSTROM, Special Assistant, Office of the Commissioner,
Department of Health and Social Services, came forward to testify.
Based upon the concerns of the Anchorage School District raised
over a potential lawsuit, he said, "With your permission we did
have a potential amendment drafted referenced to the original bill
that I think very narrowly addresses the concern that was raised by
Anchorage, making it abundantly clear that passive parental
permission is permissible for anonymous surveys that are conducted,
even though they might inquire into the private or personal matters
of the student or the student's family. But again, making it clear
it was only related to anonymous surveys where there was no ability
to identify individual students who took part in the study or the
results for those individuals."
CO-CHAIRMAN COGHILL said one of his concerns is the ability of a
parent to speak to the very issue of their child taking even an
anonymous questionnaire that unduly defiles them. They may not
want them to go through that mental exercise. He said he believes
parental notification is going to be a high issue. He entertained
this amendment under advisement since they don't have a quorum.
Number 2042
MR. LINDSTROM referred to the tobacco tax discussion a few years
ago and mentioned that the state is obligated over time to show
that the increase of the tobacco tax was having the effect they
promised it would: it would reduce youth's use of tobacco. The
YRBS is the instrument to gather the data to prove to the
legislature whether the programs are working. "For youth issues
the YRBS really is the gold standard. It is something we hang our
hat on everyday in the department."
CO-CHAIRMAN COGHILL acknowledged that it is valuable information.
He thought it would be helpful if parents did a similar survey.
Number 2150
DR. MIDDAUGH said there is an adult survey, and he would love to
see it given if they could find funding. "We are identically
concerned about confidentiality and anonymity. This mechanism
assures that. It absolutely assures that no answer can be
identifiable to a person. The power of the data is that it is
'generalizable.' That's why we think this is a major thing that we
hope we can convince you of our case to assure our ability to do
it. We would be very happy to continue to provide additional
information and explore ways to see if we can sort out this
conundrum right now."
CO-CHAIRMAN COGHILL reiterated that parents do have access to the
actual questions prior to the survey.
CO-CHAIRMAN DYSON commented that it takes the parents paying
attention to the notice and then asking for a copy of the
questions.
DR. MIDDAUGH explained if parents ask for the questions, they will
be mailed to them; they are made available at the school and
depending on the local district, a public meeting is held where
parents can come and discuss the survey and all the mechanisms for
it with someone involved in administering the survey.
DR. MIDDAUGH said the DHSS has had a lot of experience with the
survey and was caught blind sided. In 1995 things were effective
and smooth, the DHSS thought they had gained wide support to
continue to do the survey. They hope by continuing to do the
survey, it is something that can be supported; and that it does
have integrity in the notification mechanism. Their intention is
to do it every two years to have good monitoring data to tell
whether the programs are working.
Number 2253
CO-CHAIRMAN COGHILL remarked that parents quite often will not
answer very probing questions which are similar to the ones on the
survey. He believes if parents were given the questionnaire, many
would resist probing questions, even under anonymous conditions.
"In a school setting quite often, the authoritativeness of giving
a questionnaire at school almost goes unquestioned by many students
just because of the nature of the situation. Therefore, I think
that the active participation in the parents, that anybody would
agree with, that parental involvement is so important, is worth the
effort. As I read this, I am going to be looking for not only the
cost of the effort but how to facilitate that effort."
TAPE 99-30, SIDE B
Number 2336
CO-CHAIRMAN DYSON summarized where he believes they are. They
agree that the information is valuable and useful for getting
grants, and they agree they want parents in the loop. The
disagreement seems to be whether the parental permission will be
active or passive. He commented that Dr. Middaugh's position is
that active permission is logistically difficult enough to call
into question the ability to do the job and get the survey.
CO-CHAIRMAN DYSON said, "You didn't say, but were on the edge of
inferring there might not be enough parents who would actively
agree if it was really easy to get their permission. You didn't
say that, but there might not be a high enough percentage of
parents that would agree...you have no problem with active
permission if we can find a good way to do it that wasn't
logistically impractically overwhelming, and because the ways that
we've come up with of getting active permission are too cumbersome,
you're wanting to go with the best kind of a passive program, with
all the ways of notifying." He asked if that accurately
characterized Dr. Middaugh's perspective.
Number 2271
DR. MIDDAUGH said that was a very close summary. His additional
concern is the bias of the survey and the costs related to the
mechanisms of active and passive permission based on national
experience of published data in Alaska's experience. "Perhaps we
could explore what has happened here related to that question. I
don't think it is a question that enough parents don't want their
kids doing the survey that that is the issue. That's not been our
experience. I absolutely do think there are many parents who
absolutely do not want their kids to do the survey. I think the
goals, and I think we've met the goal, is to give a mechanism for
them to have that right protected under existing procedures. I
would like a chance to have an opportunity to arrange for you to
hear from the districts that have undergone the experience of
trying to do the active permission. I also want to make certain
that these remarks are only directed for a survey that is
completely anonymous and confidential. When we talk about anything
else then we're talking a completely different ballpark."
CO-CHAIRMAN DYSON asked Dr. Middaugh if he just said that getting
the active permission would take enough of a group of students out
of it to bias the results, and therefore not give them an accurate
enough data base.
Numbrt 2208
DR. MIDDAUGH replied it is a concern.
CO-CHAIRMAN DYSON commented, "I think you just made my case."
DR. MIDDAUGH explained the reason that the question "why do they
not get the permission in" is not because the students or the
parents object to the questions; it is because the students do not
get the permission slips returned. When given an opportunity, they
do take the survey, and they do answer it. There's a great amount
of information about that.
CO-CHAIRMAN DYSON commented it doesn't seem to him that is
addressed to the parents who are doing the enrolling.
DR. MIDDAUGH continued saying, "Those data are available as well
about the acceptability to parents, and again I think actually, the
experience here of individuals involved in local districts with
their communities can help answer that exact issue that you're
getting at about why is it that individuals don't do it. The ones
that don't do it, articulate that and clearly don't participate.
There's a group that just don't participate. It's not that they
object to doing it, and given an opportunity to facilitate their
participation, they participate and the information is valuable.
It's just about a selection bias. It's very difficult to always
get to the non-responders in a survey. Their characteristics are
often very different than those who respond. Those are often
exactly the kids we're most interested in learning about. I think
we can provide a lot of information to back that up in terms of
experience."
CO-CHAIRMAN DYSON asked if Dr. Middaugh was saying that the parent
who, at the time of enrollment doesn't give permission, is the very
one they want to get information from.
Number 2111
DR. MIDDAUGH said, "No it isn't. I was talking about a specific
active written parent permission at the time of the survey. We
have no experience with your proposal which would be 'what would
parents behavior be at the start of a school year to give a blanket
permission for a survey they can't see because it's not available
at the time they enroll their kid to be administered six months
later.' I think that is an unfair comparison."
CO-CHAIRMAN DYSON agreed. I'm glad we got through that.
DR. MIDDAUGH said, "Yes we're talking about two different
scenarios."
Number 2084
CO-CHAIRMAN COGHILL said to Co-Chairman Dyson, "According to the
bill you have, having checked that at the beginning of the year,
they still have the chance or opportunity to opt out once the
survey is brought up for notification to be done, right?"
CO-CHAIRMAN DYSON said yes.
The committee took an at-ease from 4:35 p.m. to 4:36 p.m.
Number 2058
CO-CHAIRMAN COGHILL said his intention is to keep testimony open
and deal with this when they have a quorum. HB 70 will be
continued until Thursday.
CO-CHAIRMAN COGHILL passed the gavel back to Co-Chairman Dyson.
SB 48 - STATE HEALTH INSURANCE
Number 2024
CO-CHAIRMAN DYSON announced the next order of business as CS For
Senate Bill No. 48(HES), "An Act relating to health insurance
provided by and provisions relating to the Comprehensive Health
Insurance Association." He informed the committee that they would
go ahead and take testimony even though there is no quorum. He
will call Representative Green down when it is time to vote.
Number 2000
DAVID GRAY, Legislative Assistant to Senator Jerry Mackie, came
forward to present SB 48. He told them that the sponsor statement
comes from the Alaska Comprehensive Health Insurance Association
(ACHIA), which was established in 1992 to provide a health
insurance pool for individual Alaskans whose health condition was
considered uninsurable, or who could not otherwise find adequate
health coverage. The legislation mandated that all providers of
health insurance in the state must participate in the pool. The
association then makes health insurance available to Alaska
residents who are high risk. In addition to operating the pool,
the board of directors of ACHIA includes two consumer advocates.
MR. GRAY commented that two consumer advocates are not able to
testify today via teleconference, but they have been very active in
the Senate in presenting the reason for this legislation. The
legislation also asks ACHIA to periodically report on the
effectiveness of this pool in promoting rate stability, product
availability, and affordability of coverage. Senate Bill 48 is a
direct result of this effort by the association to make the program
work better and more efficiently; it is a relatively new program.
The legislation has the support of the Division of Insurance.
Number 1924
MR. GRAY stated that this legislation is trying to allow more cost-
effective plans for the individuals who get coverage under ACHIA;
better administer the program; allow flexibility in evaluating the
administration of the program; to simplify the administration by
decreasing the number of declinations required for eligibility; and
to make some other technical improvements to the program. The
legislation will allow the board to manage the ACHIA in a more
cost-effective and efficient manner. The legislation also brings
their program in conformance with new federal requirements
particularly as it concerns portability of insurance.
Number 1872
MR. GRAY informed the committee that a bill similar to this was
introduced at the end of last session, so there was a vehicle
during the summer the people involved in health insurance could
look over the provisions and see what other improvements. The bill
in front of them is the result of recommendations from that review
and it was reintroduced.
Number 1830
MARIANNE BURKE, Director, Division of Insurance, Department of
Commerce and Economic Development, came forward to testify. She
informed the committee that the proposed legislation is the
outgrowth of a lot of hard work by the members of the board of
directors and the division, as well as the input from all of the
insurers who write health care in the state. Every insurer that
writes health care has a vested interest in making sure this entity
is as efficient and effective as possible. This mechanism is a
last resort. If people have a condition that precludes them
getting coverage anywhere else, they can come to the ACHIA and get
coverage. The program is not self supporting. If it were, people
could get the insurance from the regular market. It does however
provide a mechanism for people to participate in the cost of their
health care. The premiums, which are about 175 percent of a
standard premium, only covers about 20 percent of the cost. "The
remainder is allocated to the insurers that write business in this
state on a percentage of premium. If they write 40 percent, they
pick up 40 percent of the assessment."
Number 1753
CO-CHAIRMAN DYSON asked if they write 40 percent of the policies in
the state, they get the opportunity to pick up 40 percent of the
cost of this.
MS. BURKE answered yes. She continued saying they want to make it
as efficient as possible. Costs are high because the people who go
into this insurance company have conditions such as hemophilia,
where the drug medication alone can cost $4,000 to $12,000 per
month; people dying of cancer, people who have terminal conditions,
and people seeking organ transplants. It is not a mechanism for
people who are rich or poor; it is for people who get hit by a
devastating illness and cannot get coverage. Without this
mechanism, they would wind up with Medicaid, and the state would be
picking up the tab. It gives them dignity and a chance to
participate. With ERISA [Employee Retirement and Income Security
Act] and the self-insured plans being exempted, it is as fair as it
can be.
Number 1668
MS. BURKE explained because of existing statutes, the board must
use an insurer to provide these services, collect premiums, make
payments, and do all of the services of a normal insurance company.
They pay four times as much as the next highest state in this
country which is $112 per person, per month for the administrative
services. That is unconscionable, but the board has no choice.
They want the flexibility to be able to go out and make a business
decision; to find a qualified administrator to provide these
services.
MS. BURKE commented they also want to be able to make it less
onerous to get coverage. The two declinations required now means
two insurance companies have to turn the person down before he/she
can come to ACHIA. If someone is dying of cancer, it does not take
an insurance company to tell him/her they are not going to cover
him/her. The division strongly supports this legislation.
CO-CHAIRMAN DYSON asked her if anyone opposed this bill.
Number 1592
MS. BURKE said this legislation has been discussed for over three
years. Originally it was opposed by Aetna when they insured the
state because Aetna would have had to pick up a portion of the
cost. Now Aetna is one of the companies represented on the board
and they support it. She is not aware of any opposition to this
legislation.
CO-CHAIRMAN DYSON sent word for Representative Green to come down
to vote. He noted that this bill also has a referral to the Labor
and Commerce Committee.
Number 1518
REPRESENTATIVE GREEN asked if this is picked up by the private
insurance companies that'll be scattered over all insurance payers.
MS. BURKE answered that is correct.
REPRESENTATIVE GREEN asked if she had any idea about how much this
would affect premiums.
MS. BURKE said the health care premiums in this state are roughly
$300 million. The assessments that have been levied have been in
the range of $1.5 million.
Number 1470
REPRESENTATIVE GREEN asked if high risk people are in a pool, and
each insurance company is assigned a certain number of those, would
it impact various health insurance companies negatively.
Number 1436
MS. BURKE said the ACHIA is actually an insurance company. It
collects the premiums and pays the payments for services. This
does not work like the auto pool.
REPRESENTATIVE GREEN asked if that company is owned and set up by
all the other carriers.
Number 1388
MS. BURKE explained it was created by the legislature. Clearly it
is not a money-making organization; it assesses what it needs to
pay the premiums. The board of directors are made up of
representatives of the companies writing insurance in this state.
It is in the best interest of every health care provider or every
insurance company writing health care to have this be as efficient
as possible. Inefficiencies will cost them.
REPRESENTATIVE GREEN asked how the company would be set up.
Number 1329
MS. BURKE replied that by statute there will be five insurance
companies who are the largest writers of the state with two
additional members who will be consumer advocates.
REPRESENTATIVE GREEN wondered if company number six would be a part
of it.
MS. BURKE said the other companies would be a part of it in the
sense that they pay their pro rata share.
CO-CHAIRMAN COGHILL asked if people are going to pay a portion of
the premium or the cost of health care.
Number 1250
MS. BURKE replied if he is referring to the amount the covered
individuals pay, they pay premiums just like they would if they
were insured by Blue Cross or Aetna. She may have confused them
when she said they pay about 20 percent; by that she meant the
total cost of all the covered services; their premiums only amount
to about 20 percent of that total cost.
CO-CHAIRMAN COGHILL wondered if the flexibility that the board is
looking for now is to go outside and look for other professional
administrative services.
MS. BURKE said that is correct.
CO-CHAIRMAN DYSON announced with the arrival of Representative
Green they now have a quorum.
Number 1191
REPRESENTATIVE GREEN made a motion to move CSSB 48(HES) from
committee with individual recommendations and zero fiscal note.
There being no objection, CSSB 48(HES) moved from the House Health,
Education and Social Services Standing Committee.
CONFIRMATION HEARING
Board of Dispensing Opticians
CO-CHAIRMAN DYSON made a motion to advance the confirmation of
James Rothmeyer to the Board of Dispensing Opticians. There being
no objection, it was so ordered.
HB 70 - PUBLIC SCHOOL SURVEYS
Number 1140
CO-CHAIRMAN DYSON brought the committee's attention back to House
Bill No. 70, "An Act relating to questionnaires or surveys
administered in public schools."
CO-CHAIRMAN DYSON explained to Representative Green that they held
public hearing on HB 70 but needed a quorum to make a motion to
adopt the committee substitute as the work draft.
Number 1112
REPRESENTATIVE GREEN made a motion to adopt the proposed committee
substitute (CS) for HB 70, version 1-LS0263\G, Ford, 4/6/99, as a
work draft. There being no objection, proposed CSHB 70 was before
the committee.
ADJOURNMENT
Number 1090
There being no further business before the committee, the House
Health, Education and Social Services Standing Committee meeting
was adjourned at 5:00 p.m.
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