03/09/2017 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB25 | |
| HB123 | |
| HCR3 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 25 | TELECONFERENCED | |
| += | HB 123 | TELECONFERENCED | |
| *+ | HCR 3 | TELECONFERENCED | |
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 9, 2017
3:01 p.m.
MEMBERS PRESENT
Representative Ivy Spohnholz, Chair
Representative Bryce Edgmon, Vice Chair
Representative Sam Kito
Representative Geran Tarr
Representative David Eastman
Representative Jennifer Johnston
Representative Colleen Sullivan-Leonard
MEMBERS ABSENT
Representative Matt Claman (alternate)
Representative Dan Saddler (alternate)
COMMITTEE CALENDAR
HOUSE BILL NO. 25
"An Act relating to insurance coverage for contraceptives and
related services; relating to medical assistance coverage for
contraceptives and related services; and providing for an
effective date."
- HEARD & HELD
HOUSE BILL NO. 123
"An Act relating to disclosure of health care services and price
information; and providing for an effective date."
- MOVED CSHB 123(HSS) OUT OF COMMITTEE
HOUSE CONCURRENT RESOLUTION NO. 3
Proclaiming April 2017 as Child Abuse Prevention Month; and
proclaiming April 7, 2017, as Go Blue Friday.
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: HB 25
SHORT TITLE: INSURANCE COVERAGE FOR CONTRACEPTIVES
SPONSOR(s): REPRESENTATIVE(s) CLAMAN
01/18/17 (H) PREFILE RELEASED 1/9/17
01/18/17 (H) READ THE FIRST TIME - REFERRALS
01/18/17 (H) HSS, FIN
02/28/17 (H) HSS AT 3:00 PM CAPITOL 106
02/28/17 (H) Heard & Held
02/28/17 (H) MINUTE(HSS)
03/09/17 (H) HSS AT 3:00 PM CAPITOL 106
BILL: HB 123
SHORT TITLE: DISCLOSURE OF HEALTH CARE COSTS
SPONSOR(s): REPRESENTATIVE(s) SPOHNHOLZ
02/13/17 (H) READ THE FIRST TIME - REFERRALS
02/13/17 (H) HSS, JUD
03/02/17 (H) HSS AT 3:00 PM CAPITOL 106
03/02/17 (H) Heard & Held
03/02/17 (H) MINUTE(HSS)
03/09/17 (H) HSS AT 3:00 PM CAPITOL 106
BILL: HCR 3
SHORT TITLE: APRIL 2017: CHILD ABUSE PREVENTION MONTH
SPONSOR(s): REPRESENTATIVE(s) TARR
01/23/17 (H) READ THE FIRST TIME - REFERRALS
01/23/17 (H) HSS, FIN
03/09/17 (H) HSS AT 3:00 PM CAPITOL 106
WITNESS REGISTER
LIZZIE KUBITZ, Staff
Representative Matt Claman
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented HB 25 on behalf of the bill
sponsor, Representative Claman.
JUDY ANDREE
League of Women Voters
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 25.
CARMEN LOWRY, Executive Director
Alaska Network on Domestic Violence and Sexual Assault
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 25.
ALYSON CURREY
Planned Parenthood Votes Northwest and Hawaii
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 25.
ELIZABETH FIGUS, PhD Student
University of Alaska Fairbanks
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 25.
MICHAEL PAULEY
Alaska Family Council
Anchorage, Alaska
POSITION STATEMENT: Testified against HB 25.
ARLENE BRISCOE, Vice President
Legislative Chair
Alaska Nurses Association
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 25.
RUDY POGLITSH
Wasilla, Alaska
POSITION STATEMENT: Testified against HB 25.
KATIE BRUGGEMAN
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 25.
JEANNETTE OKINCZYC
Fairbanks, Alaska
POSITION STATEMENT: Testified in support of HB 25.
ANNA LATHAM, Deputy Director
Juneau Office
Division of Insurance
Department of Commerce, Community & Economic Development
Juneau, Alaska
POSITION STATEMENT: Answered questions during discussion of HB
25.
REPRESENTATIVE MATT CLAMAN
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Answered questions during discussion of HB
25, as the sponsor of the bill.
BERNICE NISBETT, Staff
Representative Ivy Spohnholz
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented the committee substitute for HB
123, on behalf of the bill sponsor, Representative Spohnholz.
JENNIFER MEYHOFF, Senior Vice President
Marsh and McLennan Agency
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 123.
JOSH BIEGEL
Anchorage, Alaska
POSITION STATEMENT: Testified during discussion of HB 123.
TERRY ALLARD, Senior Benefits Advisor
Wilson Agency
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 123.
BECKY HULTBERG, President/CEO
Alaska State Hospital and Nursing Home Association
Juneau, Alaska
POSITION STATEMENT: Testified and answered questions during the
presentation of HB 123.
GINA BOSNAKIS
Small Business Owner
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 123.
T.J. ALINEN, Assistant Vice President
Human Resources
Denali Federal Credit Union
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 123.
KYLE MIRKA
Business Owner
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 123.
RHONDA KITTER, Chief Financial Officer
Public Education Health Trust
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 123.
SHAWN PURVIANCE, Owner
Valley Block and Concrete
Wasilla, Alaska
POSITION STATEMENT: Testified in support of HB 123.
DENISE DANIELLO, Executive Director
Alaska Commission on Aging
Division of Senior and Disabilities Services
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 123.
MAGDALENA OLIVEROS, Staff
Representative Geran Tarr
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Introduced HCR 3 on behalf of the bill
sponsor, Representative Tarr.
REPRESENTATIVE GERAN TARR
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Introduced HCR 3 as the sponsor of the
resolution.
PATRICK ANDERSON
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HCR 3.
ACTION NARRATIVE
3:01:37 PM
CHAIR IVY SPOHNHOLZ called the House Health and Social Services
Standing Committee meeting to order at 3:01 p.m.
Representatives Spohnholz, Sullivan-Leonard, Johnston, Eastman,
and Edgmon were present at the call to order. Representatives
Tarr and Kito arrived as the meeting was in progress.
HB 25-INSURANCE COVERAGE FOR CONTRACEPTIVES
3:02:16 PM
CHAIR SPOHNHOLZ announced that the first order of business would
be HOUSE BILL NO. 25, "An Act relating to insurance coverage for
contraceptives and related services; relating to medical
assistance coverage for contraceptives and related services; and
providing for an effective date."
3:03:12 PM
LIZZIE KUBITZ, Staff, Representative Matt Claman, Alaska State
Legislature, stated that proposed HB 25 mandated that health
care insurers provide coverage for a 12-month supply of
contraceptives at one time. She reported that currently, women
who used prescriptive contraceptives needed to return to the
pharmacy every one to three months to refill their
prescriptions. She pointed to the difficulties for women who
did not have access to transportation, worked multiple jobs, or
lived in rural areas of the state of getting refills so often.
She shared that the Centers for Disease Control and Prevention
(CDC) recommended dispensing a year's supply of contraception,
as missing pills was a major reason for oral contraceptive
failure leading to unintended pregnancies. Greater access and
availability to contraceptives reduced unintended pregnancies,
with a direct cost savings to the state. She noted that
hormonal contraceptives were used for reproductive health care
and other medical reasons, including menstrual pain and
migraines. She declared that the proposed bill sought to make
prescriptive contraceptives more easily available, which made
sense for Alaskan women and families.
REPRESENTATIVE SULLIVAN-LEONARD asked about testimony from those
who were seeking contraceptives for a full year.
MS. KUBITZ replied that there were individuals ready to testify.
3:06:07 PM
CHAIR SPOHNHOLZ opened public testimony.
3:06:40 PM
JUDY ANDREE, League of Women Voters, stated that the League of
Women Voters fully supported comprehensive affordable health
care for all people, including reproductive health care, and the
availability of birth control. She stated that the ability to
avoid unintended pregnancies was of primary importance to a
woman's health and her ability to chart her own future. She
relayed that planning a pregnancy with the help of birth control
could increase a woman's economic opportunities. She said that
this could also lead to savings to the state, as 64 percent of
pregnancies required public financing. She pointed to a letter
of support [Included in members' packets]. She added that this
was the time to accept birth control as an important and normal
part of women's health care, and that it should be as affordable
and accessible, as possible. She reiterated support of the
proposed bill.
3:08:55 PM
CARMEN LOWRY, Executive Director, Alaska Network on Domestic
Violence and Sexual Assault, offered some background on the
network, that it was comprised of 19 member programs which
provided services to victims and survivors of domestic violence
and sexual assault across Alaska, about 7,000 people during the
previous year. She said that access for a 12-month supply of
contraceptives allowed protection and a reduced risk of coercion
from an abuser. She stated that it was a common tactic for an
abuser to attempt to control access to birth control. She
shared research which had shown that women were more vulnerable
during pregnancies, hence their range of choices for leaving an
abusive relationship became more limited. She stated that a 12-
month supply offered a wider range of choices. She declared, as
there was a disproportionate number of women experiencing
domestic violence in rural areas, it was important to ensure
full range access to contraceptives. She stated support for the
proposed bill.
3:12:21 PM
ALYSON CURREY, Planned Parenthood Votes Northwest and Hawaii,
stated support for the proposed bill. She declared that every
woman should have full access to the birth control method that
worked best for her, without any barriers to cost or
availability, regardless of insurance plan. She stated that
proposed HB 25 would remove any barriers, allow women more
career and education opportunities, encourage healthier
pregnancies, and make them less dependent on government
programs. She reported that consistent use of birth control was
the best way to prevent unintended pregnancy, although, one in
four women stated they had missed pills because of a lack of
availability. A full year supply improved consistent use,
reduced the odds of an unintended pregnancy by 30 percent and
was associated with a 46 percent drop in the chance of needing
an abortion. She declared that this was cost effective for both
public and private insurance plans, as it lowered the costs for
follow up visits, pregnancy tests, and the long term costs
associated with unintended pregnancy. She declared that this
was a solution that would work for women and she stated support
of HB 25.
3:14:24 PM
ELIZABETH FIGUS, PhD. Student, University of Alaska Fairbanks,
shared that she was a fisherperson during the summers which did
not allow much time to get to doctors, and she urged support of
the proposed bill. She declared that it was frustrating and an
unnecessary expense to alter schedules for a pre-approved
prescription pick-up. She offered her belief that this bill was
about streamlining prescription medication pick-ups. She
pointed out the need for economic efficiency. She stated her
support for HB 25.
3:16:13 PM
MICHAEL PAULEY, Alaska Family Council, stated that the council
was opposed to the proposed legislation, as it was essentially
taking a health care mandate and grafting it into state law. He
directed attention to written testimony [Included in members'
packets]. He expanded on a few of those points, noting that the
primary objection was for a sweeping one size fits all mandate
which would require every insurance plan issued in Alaska to
provide coverage for certain drugs and devices that "have the
effect of causing very early abortions." He stated his
organization's objections toward helping subsidize or facilitate
this. He opined that the proposed bill defined prescription
contraceptive as a drug or device as something which required a
prescription and was approved by the U.S. Food and Drug
Administration for the purpose of preventing pregnancy. He
offered definitions for conception and pregnancy, which he
opined were similar to those by numerous religious groups which
had filed lawsuits objecting to the Patient Protection and
Affordable Care Act (PPACA). He reiterated that the religious
exemptions offered in the proposed bill "ranged from inadequate
to non-existent." He offered the belief that it was a mistake
to "peg the religious exemptions to federal statutes and
regulations associated with [PPACA]" and that religious
exemptions "should be spelled out in plain English." He
suggested that the House Health and Social Services Standing
Committee seek legal advice for interaction of the proposed bill
with the existing statute, AS 25.20.025. He asked if a young
woman could receive contraception and have her parent's health
insurance pay for this. He asked that the committee review the
broader economic impact of the proposed legislation,
specifically on the effect of fertility on the long term
economic well-being. He referenced the "replacement level
fertility rate" which addressed the average number of children
born to each woman in a society in order for the population to
sustain itself. He spoke about an international "demographic
crisis" in developed countries.
3:25:43 PM
ARLENE BRISCOE, Vice President, Legislative Chair, Alaska Nurses
Association, stated support for the proposed bill, and directed
attention to a letter of support [Included in members' packets]
stating the strong belief that Alaskan women and families should
have an opportunity to have available, adequate birth control
supplies for 12-months at a time. She declared that this would
prevent unintended pregnancies which cost the state millions of
dollars annually.
3:27:15 PM
RUDY POGLITSH said that the proposed bill allowed abortion and
not contraception, which he deemed was "the gravest of moral
issues." He stated that lawmakers should not force someone's
morality on someone else. He declared his opposition to HB 25.
3:28:15 PM
KATIE BRUGGEMAN declared that the U.S Supreme Court, not
advocacy groups, had decided that women could decide for
themselves whether they wanted to bear and raise children. She
shared that one reason to support the bill was that lower income
women working several jobs and relying on public transportation
would benefit from fewer trips to the pharmacy. She opined that
there were also fewer administrative costs. She stated that the
proposed bill made sense for women in the tourism and fishing
industries who did not have access readily available to
pharmacies. She declared that family planning was an essential
component of economic opportunity for women, and that
reproductive choice allowed for great access to education and
career advancement.
3:29:24 PM
JEANNETTE OKINCZYC stated her support of the proposed bill and
said that birth control was a responsible action and that family
planning should be a right. She stated that the proposed bill
offered families the power to make responsible decisions.
3:31:12 PM
CHAIR SPOHNHOLZ closed public testimony.
REPRESENTATIVE EASTMAN asked for the division's perspective.
3:31:46 PM
ANNA LATHAM, Deputy Director, Juneau Office, Division of
Insurance, Department of Commerce, Community & Economic
Development, replied that the Division of Insurance had prepared
a zero-fiscal note for the proposed bill, and that the
administration's stance was officially neutral. She relayed
that this legislation would be processed to ensure that it
adhered to Alaska statute before approval by the division.
MS. LATHAM, in response to Representative Eastman, said that
self-funded plans under ERISA [Employee Retirement Income
Security Act of 1974] could take this into account and any group
health or individual market plans would require legislative
action prior to the change.
REPRESENTATIVE EASTMAN asked what changes would need to be made
for this to be done voluntarily.
MS. LATHAM replied that it would need to be driven by a change
in Alaska statute.
REPRESENTATIVE EASTMAN asked what, in statute, would keep this
from being changed if it was desired.
MS. LATHAM offered her belief that nothing in statute would
prevent this from an insurance standpoint, although there could
be another prescribing requirement or other issues.
CHAIR SPOHNHOLZ suggested that the bill sponsor could offer
additional information.
MS. KUBITZ in response to Representative Eastman, said that the
proposed bill was not a mandate to insurance companies, however
it allowed for an option to the consumers. The proposed bill
would be a mandate to make it available, as it was currently the
"culture of the insurers" to only offer shorter supplies.
REPRESENTATIVE EASTMAN questioned the financially beneficial
aspect as insurance companies were not currently offering it,
when they usually acted in their own economic best interest.
REPRESENTATIVE MATT CLAMAN, Alaska State Legislature, offered
his belief that it would be necessary to ask the insurance
companies.
MS. KUBITZ cited a letter in opposition, and added that there
was a general "push back" to any mandates to insurers.
REPRESENTATIVE EASTMAN asked if any insurance companies had
taken this step.
MS. KUBITZ said that although a number of states had implemented
this mandate, she was not aware of any insurance companies
offering this on their own.
REPRESENTATIVE EASTMAN asked about a response to the concerns
for claims that this was a mandate for early abortions.
MS. KUBITZ replied that emergency contraceptive pills were
covered under contraceptives, and that the proposed bill was
offering a safe and effective means of preventing pregnancy.
She declared that emergency contraceptive pills did not
terminate or interrupt an established pregnancy, hence they did
not cause an abortion. She declared that the only connection to
abortion was the potential to prevent the need.
REPRESENTATIVE EASTMAN asked for her definition to pregnancy.
MS. KUBITZ offered her understanding that emergency
contraceptive pills prevented ovulation, and not the termination
of an established pregnancy.
CHAIR SPOHNHOLZ pointed out that these were already available on
the market and that the proposed bill did not specifically
address them. She stated that this was a different issue, the
proposed bill was for an extension to the availability of
contraception.
REPRESENTATIVE JOHNSTON asked why this 12-month supply was not
being offered for other prescription drugs with similar benefits
to the patient.
MS. KUBITZ replied that there were a number of maintenance
medications available, including birth control, high blood
pressure, and heart disease, and prescribers could write
prescriptions for a 90 day supply with three refills. She
opined that control of the dispensation was a choice of the
insurance companies, which was different for different insurance
companies.
REPRESENTATIVE JOHNSTON asked about an extension of this mandate
to include other drugs, citing that "it's not broad enough" as a
possible problem with the legislation.
REPRESENTATIVE CLAMAN reminded that there had been discussion in
a previous meeting for "a number of medications that are
prescribed up to 12-month supply." He offered his understanding
that there were other medications dispensed for more than 90
days, citing some of the mail-in prescription programs, although
he was unsure of the details for specific medications.
REPRESENTATIVE EASTMAN asked if anything prevented the
dispensation of contraception medication through the mail.
MS. KUBITZ replied that there were mail order programs through
some insurers for a 90-day supply. She pointed out that the
proposed bill allowed for all of the prescription to be mailed
in bulk at one time. She offered her belief that women would
like access to more than what was currently available.
REPRESENTATIVE EASTMAN opined that a year was a long period of
time, and that it was possible for some loss of the pills. He
asked about any associated cost and impact on the insurers.
REPRESENTATIVE CLAMAN offered his belief that the risk of losing
prescriptions did not depend on the length of the supply, and
that there was not a significant impact to the actuarial world.
MS. KUBITZ added that the fiscal note labeled OMB 2077 provided
by the Department of Health and Social Services [Included in
members' packets] did take into account the potential loss of
supply.
3:46:01 PM
CHAIR SPOHNHOLZ stated that the bill would be held over.
HB 123-DISCLOSURE OF HEALTH CARE COSTS
3:46:26 PM
CHAIR SPOHNHOLZ announced that the next order of business would
be HOUSE BILL NO. 123, "An Act relating to disclosure of health
care services and price information; and providing for an
effective date."
3:46:48 PM
REPRESENTATIVE EDGMON moved to adopt the proposed committee
substitute (CS) for HB 123, labeled 30-LS0380\T, Glover, 3/9/17,
as the working draft.
CHAIR SPOHNHOLZ objected for discussion.
BERNICE NISBETT, Staff, Representative Ivy Spohnholz, Alaska
State Legislature, paraphrased the changes in the proposed
committee substitute [Included in members' packets], which read:
Section 2, subsections (a) and (b) states that health
care facilities and providers will compile a list by
procedure code.
We've also changed "including a brief and easily
understandable description," to "in plain language
that an individual with no medical training can
understand."
Line 23 we added "and" after "performed;"
Subsection (d) states that the health care provider or
facility may add a disclaimer explaining that what the
consumer pays may be higher or lower than the amount
listed.
Subsection (g) states that if the individual is fined
and wants to appeal, the individual is entitled to a
hearing conducted by the office of administrative
hearings.
In Subsection (h), the definition of health care
facility does not include federal health a facility
operated by an Alaska tribal health organization or a
hospital operated by the United States Department of
Veterans Affairs or the United States Department of
Defense, or any other federally operated hospital or
facility.
Subsection (h), number (7) undiscounted price is
defined.
3:49:22 PM
CHAIR SPOHNHOLZ opened public testimony.
3:49:43 PM
JENNIFER MEYHOFF, Senior Vice President, Marsh and McLennan
Agency, stated that the agency was a global consulting firm.
She added that she was the Legislative Chair for the Alaska
Association of Health Underwriters, and that she had 25 years of
employee benefits consulting experience and she worked with
employers statewide for selection of products to the employee
benefit packages. She offered a comparison for the purchase of
health care to the determinations for buying coffee or gas or an
airline ticket, and declared that a consumer can make a
reasonable decision. She declared her support for the proposed
bill, as it was time to offer this information to patient
consumers, in order to allow decisions prior to receiving care.
She suggested that this could contain or reduce the cost of
health care.
3:53:12 PM
CHAIR SPOHNHOLZ removed her objection. There being no further
objection, Version T was adopted as the working draft.
REPRESENTATIVE JOHNSTON stated that full disclosure offered
choice and the knowledge of cost. She asked for the reason for
the exemptions to publicly funded organizations named in the
proposed bill.
MS. MEYHOFF expressed her agreement that the charges at those
organizations would not affect her clients, although she offered
her belief that it was "a very valid question of the information
being available could be useful to the overall market."
3:55:13 PM
JOSH BIEGEL shared a saga of the medical costs after an accident
in which his wife broke her arm when she fell on the ice.
3:57:29 PM
TERRY ALLARD, Senior Benefits Advisor, Wilson Agency, said that
she was also a charter member of the Alaska Association of
Health Underwriters and a member of the Legislative committee.
She urged passage of the proposed bill. She reported that she
had been in the insurance and employee benefits field all across
Alaska for more than 30 years. She reported that she spent a
significant amount of time educating employees about their
benefits and how to best use them, which included conversations
for being a responsible consumer. She declared that it was
difficult for an individual to be a responsible consumer of
health care services in Alaska, as it was not always possible to
get the information necessary to make an informed decision. She
said that it was easier to determine the procedural options than
making an informed decision for the cost and the provider. She
stated that consumers could make informed decisions about almost
everything except medical services. She relayed that the
Municipality of Anchorage had recently passed an ordinance
requiring transparency from providers within the city. She
stated that this needed to be available all over the state. She
cited that almost 30 other states had passed transparency bills
similar to the proposed bill. She offered her belief that
health care needed to evolve and provide information to the
consumers in a more relevant and timely way. She stated her
support of HB 123.
REPRESENTATIVE SULLIVAN-LEONARD asked if her agency had a data
base available to the consumer for the cost of various
procedures.
MS. ALLARD said that her firm was an independent employee
benefits advisory company and did not have access to that data.
REPRESENTATIVE SULLIVAN-LEONARD asked if the proposed bill would
have helped Mr. Biegel with the challenges posed by his
insurance company.
MS. ALLARD opined that the proposed bill would help in some
ways, although the issue for in-network providers and the
charges was a separate issue. She said that the proposed bill
does get to the heart of the matter, as full understanding of
the insurance coverage would have allowed him to seek care from
another provider.
REPRESENTATIVE SULLIVAN-LEONARD offered her belief that the
variables could make it a different price for each patient.
MS. ALLARD acknowledged that the price could be different. She
offered her understanding that the proposed bill would ask the
providers to post the rack rate, and then the responsibility
would be for the consumer to speak with the insurance company to
understand the charges and how they would be covered.
REPRESENTATIVE JOHNSTON shared that this was an opportunity for
collusion by the insurance companies when publishing rack rates.
MS. ALLARD said that this would put prices on the open market
and allow the consumer to shop. She pointed out that there were
laws against collusion among medical providers.
REPRESENTATIVE JOHNSTON asked if a public clinic should be
excluded.
MS. ALLARD said that she did not know enough about the proposal
for public clinics, although in a setting for health care that
was being reimbursed, it would be logical to have that cost
information disclosed to the consumer.
CHAIR SPOHNHOLZ pointed out that the aforementioned disclaimer
information was included in Version T of the proposed bill, so
that consumers were not intimidated by pricing. A community
health center could mention its sliding fee schedule as well as
the providers insurance accepted, and a private office could
mention it was a preferred provider for certain organizations.
REPRESENTATIVE JOHNSTON asked if there was any use for an
additional disclaimer stating that rates were negotiable.
CHAIR SPOHNHOLZ acknowledged that it could be written into the
disclaimer as the language had intentionally been left fairly
broad.
REPRESENTATIVE EASTMAN asked if insurance providers usually
considered competition pricing.
MS. ALLARD said that frequently the insurance providers were
aware of other charges, although she did not know how that
knowledge was attained.
4:07:23 PM
BECKY HULTBERG, President/CEO, Alaska State Hospital and Nursing
Home Association, said that ASHNHA supported the concept of
price transparency and consumer engagement in health care
decision making. She stated that the third party payment to the
insurance mechanism made health care decisions much more
complicated. She reported that there were many differences
between typical commodities and complex health care payment and
delivery systems. She stated that, although there was not an
easy solution to the problem without dismantling and rebuilding
the health care system, the proposed bill was a good first step
toward more transparent pricing. She said that providers to the
state should aspire to transparent pricing in a way that did not
add additional cost to the system. She declared that cost in
the form of compliance should not outweigh the benefits, and the
proposed bill would not impose significant administrative
burdens that would be transferred as higher costs to the
consumer. She reported that ASHNHA hospitals provided
estimates, and she expressed her desire that consumers would
call and ask for price estimates, to either the insurer or the
hospital. She stated that the insurers had the best access to
the best data, and that insurers should be required to also make
transparency tools available to consumers. She declared that
health care price transparency was a complex topic.
REPRESENTATIVE TARR asked if the insurer was also making the
transparency tool available to allow the consumer to determine
what they would owe.
MS. HULTBERG explained that she was not recommending anything
directly related to the proposed bill but simply an additional
way for the consumer to gain access to price information. She
stated that many insurers and many self-insured employers had
price transparency tools. She shared that it was possible to
share information on the employee deductible and out of pocket
cost. She suggested that the proposed bill focused on patients
without insurance who would be paying a rate comparable to the
rack rate. She declared that improvement for the provision of
price information was a shared responsibility of providers and
insurers.
4:12:50 PM
GINA BOSNAKIS, Small Business Owner, stated that she had worked
in the insurance industry for about 30 years. She reported that
she worked daily with employees and families, in addition to her
employer clients, to find the best fit for health insurance.
She testified in support of the proposed bill. She reported
that, although coding issues or incorrect payments could be
quickly fixed, the most common reason for patient calls was for
procedures performed by a provider deemed as out-of-network.
She explained that acceptance of insurance by a provider, and
being an in-network and preferred provider were two very
different things and resulted in a very different charge to the
patient. She said this legislation would give patients the
power to better understand what to ask, prior to incurring
unexpected expenses. She offered her belief that the proposed
bill had the potential to affect the increasing cost of health
care in Alaska.
4:16:08 PM
T.J. ALINEN, Assistant Vice President, Human Resources, Denali
Federal Credit Union, reported that Denali Federal Credit Union
was the third largest credit union in the state, and had 325
employees residing in Alaska. He declared that Denali Federal
Credit Union supported the proposed bill. He stated that the
escalation in cost of health care was one of the greatest
challenges faced by many organizations in the state. He said
that, in a free market, buyers and sellers engaged in
communication in determining pricing for services and goods, yet
this did not occur in the health care industry. He emphasized
that market transparency and the availability of information
would assist all Alaskans for being better health care
consumers.
4:19:01 PM
KYLE MIRKA, Business Owner, reported that his business employed
50 people and provided an employer sponsored health care plan.
He pointed out that, as premiums had risen almost 40 percent, it
would have been cheaper to discontinue the plan and simply pay
the PPACA fine. However, his business wanted to provide health
care benefits to its employees, even though the business
"shouldered the remainder of the burden." He pointed out that
any additional increases would make it not affordable for an
employer sponsored plan. He declared that health care costs in
Alaska "are simply out of control." He opined that it was the
only industry where the costs for services were unknown before
the service was rendered. He shared that a standard answer from
health care professionals for the high cost of health care in
Alaska was that "it's expensive to practice in the state." He
reported that most of his business products could be purchased
in Anchorage for the same price as in Seattle, Pocatello, or
Portland. He acknowledged that, although there were added
freight costs to Alaska, as well as higher labor costs, it was
generally agreed that health care costs in Alaska were
disproportionately higher than anywhere else in the world. He
offered his belief that price transparency was the first step
toward solving the health care problems in Alaska. He declared
his support for the proposed bill.
4:21:17 PM
RHONDA KITTER, Chief Financial Officer, Public Education Health
Trust, reported that the Public Education Health Trust was a not
for profit health insurance provider for public education
employees in Alaska. She relayed that there were 17,000
Alaskans with health insurance through the trust. She added
that she was also the Co-Chair of the Alaskans for Sustainable
Health Costs, a group of employers working together to address
the rising costs of health insurance premiums in Alaska. She
pointed out that the question of how much does it cost was so
integrated into the act of buying that consumers did not have to
ask, as prices were printed, stamped, and posted. She
acknowledged that there were some practices, such as car repair
and home improvement, which did not usually publish prices,
although most professions could not feign a "hard to say"
attitude when questioned about costs. She declared support for
the proposed bill. She stated that the bill "correctly requires
the disclosure of fees at the provider and facility offices,
placing the requirement for public disclosure ... in the offices
of those organizations." She conceded that, while the proposed
bill was not the silver bullet solution for sustainability, it
was "one silver BB that is needed to address the rising cost."
4:23:47 PM
SHAWN PURVIANCE, Valley Block and Concrete, offered his belief
that health care costs had driven health insurance premiums so
high that it was difficult for his business to take care of its
40 employees. He opined that the free enterprise system
required competition, which could not exist unless people knew
the cost of goods, and that the health care needed "to be
brought into the fold of the free enterprise system, so the
consumer can decide what gets them the best value for the
services they require." He declared that he was not a "huge fan
of government regulation of any industries," but he felt this
was an important first step for something which would happen of
its own accord. He offered his belief that the cost of health
care was out of proportion in Alaska, although the insurance
companies did have some culpability. He offered an analogy for
the increased cost of health insurance compared to the cost of
concrete during the past 9 years, pointing out that that it was
not possible to raise concrete prices to stay in step. He asked
why health care was so expensive in Alaska, as it did not cost
that much more to do business in Alaska. He noted that his
business proudly posted its prices on handouts and on its
website. He offered his belief that the proposed bill was an
important first step to provide affordable health care in
Alaska. He declared his support for the proposed bill.
4:29:22 PM
DENISE DANIELLO, Executive Director, Alaska Commission on Aging,
Division of Senior and Disabilities Services, Department of
Health and Social Services (DHSS), expressed support by the
commission for the proposed bill. She offered a brief overview
of the commission. She referenced an earlier statewide meeting
with seniors discussing the proposed bill, and added that there
was an overwhelming positive response for the bill. She shared
that a priority strategy was to disclose health care pricing.
She acknowledged that this was a first step toward a solution
for a very complicated situation. She declared support for HB
123.
4:32:20 PM
CHAIR SPOHNHOLZ closed public testimony.
REPRESENTATIVE EASTMAN asked if a cost comparison with a
competitor had been considered as a means to accomplish price
transparency.
CHAIR SPOHNHOLZ, as the sponsor of the bill, said that this
comparison was usually required of insurance providers, and she
acknowledged that this was a potential option. She said that
the changes to health care costs and reform of the health care
system was a marathon and that the proposed bill was only a few
hundred yards into the first mile, although it was a very
important first step. She offered her belief that it was very
important for consumers to have the necessary information to
make an informed decision at the time of service. She opined
that this was a simple first movement.
REPRESENTATIVE EASTMAN said that he was in support of
transparency and that the proposed bill offered modest gains.
He opined that this information did not necessarily translate to
the transparency he would hope to achieve. He acknowledged that
he did not have an answer, but that he was not overoptimistic
for success.
CHAIR SPOHNHOLZ stated that the feedback was valid, and there
were more comprehensive ways to address the issue. She
suggested that an all payer claims database could be the gold
standard, as it would allow people to look at much more detailed
information which incorporated each individual's insurance
situation. She added that it would also require a significant
fiscal note, which was not feasible in the current financial
situation.
4:37:03 PM
REPRESENTATIVE EDGMON moved to report CSHB 123, Version 30-
LS0380\T, Glover, 3/9/17, out of committee with individual
recommendations and the forthcoming fiscal notes. There being
no objection, CSHB 123 (HSS) was moved from the House Health and
Social Services Standing Committee.
4:37:35 PM
The committee took an at-ease from 4:37 p.m. to 4:41 p.m.
HCR 3-APRIL 2017: CHILD ABUSE PREVENTION MONTH
4:41:40 PM
CHAIR SPOHNHOLZ announced that the final order of business would
be HOUSE CONCURRENT RESOLUTION NO. 3, Proclaiming April 2017 as
Child Abuse Prevention Month; and proclaiming April 7, 2017, as
Go Blue Friday.
4:41:57 PM
MAGDALENA OLIVEROS, Staff, Representative Geran Tarr, Alaska
State Legislature, stated that the proposed resolution nominated
the month of April to be named and recognized as "Child Abuse
Prevention Month" and proclaimed April 7, 2017, to be recognized
as "Go Blue Friday." She explained that "Go Blue Friday" would
allow Alaskans statewide to wear blue as a symbolic gesture that
child abuse would not be tolerated in Alaska. By speaking up
and raising awareness, Alaskans could stand together to put an
end to the violence, and be a part of the effort toward
prevention. She offered a history of the national child abuse
prevention month, and pointed out that it recognized a
commitment and dedication to implementing and identifying
solutions to ending child abuse. She stated that every year,
many states recognized the month of April to stand strong in
support of children. She reported that Alaska had one of the
highest rates of child abuse in the country - 42 out of 1,000
children were victims of abuse - and that in 2014, the Office of
Children's Services had received more than 40,000 allegations of
harm. She noted that children who were subject to abuse were
more likely to become abusers and engage in criminal activity,
as well as have more psychological and physiological issues.
She declared that every child deserved a safe home and an
opportunity to grow into a responsible member of society. She
emphasized that everyone needed to work together to support the
children in the state.
4:44:29 PM
REPRESENTATIVE GERAN TARR, Alaska State Legislature, directed
attention to the "Alaska OCS Protective Service Reports Received
During 2016" [Included in members' packets] and shared that
these reports were produced monthly. She offered her opinion
that these reports should be monitored closely, pointing out
that the total number of alleged victims of physical abuse in
this report was equal to the total number of students at Wasilla
High School, at East High School, and half the students at
Juneau-Douglas High School. She declared that the numbers were
staggering, reporting that rates of child abuse in Alaska were
six times the national average. She opined that this was a
public health crisis, as well as a moral crisis. She directed
attention to the handout about ACEs (Adverse Childhood
Experiences) [Included in members' packets] and explained that
the challenge presented by the current fiscal situation offered
an opportunity to better understand the cost to society from the
impact of child abuse, estimated to be in excess of $700 million
annually. She reported that these Adverse Childhood Experiences
had impacts on relationships, the ability to keep jobs, and the
engagement in risky behaviors. She added that there was also a
physiological impact, which included obesity and diabetes. She
declared that, not only was there a cost benefit to the health
care system, but there was an added benefit for healthier
communities, stronger individuals, and a healthier Alaska. She
offered her belief that the state did not have "a handle on it
enough" to not have this resolution presented for discussion
each year. She stated that it was necessary to be reminded of
the violence in our communities, the families that were
struggling, the children that were impacted, and the ways that
could be offered for a solution. She explained that "Go Blue
Friday" provided a day for everyone to be a participant in the
process, as everyone could wear blue or have a blue button,
which could spark conversation. She expressed a strong hope
that more people than ever would participate and encourage
others to seek out help, which could help prevent child abuse.
REPRESENTATIVE SULLIVAN-LEONARD asked why she chose the color
blue.
REPRESENTATIVE TARR explained that blue was the national color
for child abuse prevention. She suggested that the House Health
and Social Services Standing Committee all wear blue.
4:51:33 PM
PATRICK ANDERSON stated that he had sent in written testimony.
He shared that, in 2003, he had left law practice in order to
pursue "a very nebulous vision of healing." He referenced a
paper he had written in 2009 in which he stated that health care
costs could be reduced by 50 percent by addressing a "lean
health care" management system, which would include programs
that addressed child abuse and neglect. He pointed out that
there was a "huge cost to childhood acquired trauma," an issue
for which criminal penalties could not be legislated. He said
that the original Adverse Childhood Experiences study found that
22 percent of a predominantly white, middle class, well-educated
population had identified sexual abuse in their lives. He
stated that the legal definition of child abuse did not take
into account all the iterations of adverse childhood
experiences, and did not adequately reflect these costs. He
suggested that policy dialogues needed to go further to include
the programs which supported the elimination of child abuse. He
declared his support for HCR 3.
4:56:02 PM
CHAIR SPOHNHOLZ closed public testimony and stated that the
resolution would be held over.
4:57:28 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 4:57 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HCR003 ver A 2.23.16.pdf |
HHSS 3/9/2017 3:00:00 PM HHSS 3/23/2017 3:00:00 PM |
HCR 3 |
| HCR003 Sponsor Statement 2.23.17.pdf |
HHSS 3/9/2017 3:00:00 PM HHSS 3/23/2017 3:00:00 PM |
HCR 3 |
| HCR003 Fiscal Note - Prepared by House H&SS.pdf |
HHSS 3/9/2017 3:00:00 PM HHSS 3/23/2017 3:00:00 PM |
HCR 3 |
| HCR003 Letters of Support A 2.23.17.pdf |
HHSS 3/9/2017 3:00:00 PM HHSS 3/23/2017 3:00:00 PM |
HCR 3 |
| HCR003 Letters of Support B 2.23.17.pdf |
HHSS 3/9/2017 3:00:00 PM HHSS 3/23/2017 3:00:00 PM |
HCR 3 |
| HCR003 Supporting Document - Governor Parnell Proclamation HCR21 2014 2.23.17.pdf |
HHSS 3/9/2017 3:00:00 PM HHSS 3/23/2017 3:00:00 PM |
HCR 3 |
| HCR003 Supporting Document - Providence Hospital Facts About Child Sexual Abuse 2.23.17.pdf |
HHSS 3/9/2017 3:00:00 PM HHSS 3/23/2017 3:00:00 PM |
HCR 3 |
| HCR003 Supporting Document - Governor Walker Proclamation Child Abuse Prevention and Awareness Month March 2016 2.23.17.pdf |
HHSS 3/9/2017 3:00:00 PM HHSS 3/23/2017 3:00:00 PM |
HCR 3 |
| HCR003 Supporting Document - Governor Walker Proclamation Sexual Assault Awareness Month March 2016 2.23.17.pdf |
HHSS 3/9/2017 3:00:00 PM HHSS 3/23/2017 3:00:00 PM |
HCR 3 |
| HCR003 Supporting Document - Office of Child Welfare Consequences of Child Abuse and Neglect 2.23.17.pdf |
HHSS 3/9/2017 3:00:00 PM HHSS 3/23/2017 3:00:00 PM |
HCR 3 |
| HB025 ver A 2.16.17.PDF |
HHSS 2/28/2017 3:00:00 PM HHSS 3/9/2017 3:00:00 PM HHSS 4/6/2017 3:00:00 PM HHSS 4/11/2017 3:00:00 PM |
HB 25 |
| HB025 Sponsor Statement 2.16.17.pdf |
HHSS 2/28/2017 3:00:00 PM HHSS 3/9/2017 3:00:00 PM HHSS 4/6/2017 3:00:00 PM HHSS 4/11/2017 3:00:00 PM |
HB 25 |
| HB025 Sectional Analysis ver A 2.16.17.pdf |
HHSS 2/28/2017 3:00:00 PM HHSS 3/9/2017 3:00:00 PM HHSS 4/6/2017 3:00:00 PM HHSS 4/11/2017 3:00:00 PM |
HB 25 |
| HB025 Fiscal Note DHSS-Medicaid Services 2.28.17.pdf |
HHSS 2/28/2017 3:00:00 PM HHSS 3/9/2017 3:00:00 PM HHSS 4/6/2017 3:00:00 PM HHSS 4/11/2017 3:00:00 PM |
HB 25 |
| HB025 Fiscal Note DHSS-DHCS 2.28.17.pdf |
HHSS 2/28/2017 3:00:00 PM HHSS 3/9/2017 3:00:00 PM HHSS 4/6/2017 3:00:00 PM HHSS 4/11/2017 3:00:00 PM |
HB 25 |
| HB025 Fiscal Note DCCED-DIO 2.28.17.pdf |
HHSS 2/28/2017 3:00:00 PM HHSS 3/9/2017 3:00:00 PM HHSS 4/6/2017 3:00:00 PM HHSS 4/11/2017 3:00:00 PM |
HB 25 |
| HB025 Supporting Document-ADN Commentary 2.16.17.pdf |
HHSS 2/28/2017 3:00:00 PM HHSS 3/9/2017 3:00:00 PM HHSS 4/6/2017 3:00:00 PM HHSS 4/11/2017 3:00:00 PM |
HB 25 |
| HB025 Supporting Document-Cost Savings Study 2.16.17.pdf |
HHSS 2/28/2017 3:00:00 PM HHSS 3/9/2017 3:00:00 PM HHSS 4/6/2017 3:00:00 PM HHSS 4/11/2017 3:00:00 PM |
HB 25 |
| HB025 Supporting Document-Guttmacher Alaska Statistics 2.16.17.pdf |
HHSS 2/28/2017 3:00:00 PM HHSS 3/9/2017 3:00:00 PM HHSS 4/6/2017 3:00:00 PM HHSS 4/11/2017 3:00:00 PM |
HB 25 |
| HB025 Supporting Document-Guttmacher Public Costs from Unintended Pregnancies 2.16.17.pdf |
HHSS 2/28/2017 3:00:00 PM HHSS 3/9/2017 3:00:00 PM HHSS 4/6/2017 3:00:00 PM HHSS 4/11/2017 3:00:00 PM |
HB 25 |
| HB025 Supporting Document-HB025 Support Emails 2.27.17.pdf |
HHSS 3/9/2017 3:00:00 PM HHSS 4/6/2017 3:00:00 PM HHSS 4/11/2017 3:00:00 PM |
HB 25 |
| HB025 Supporting Document-Letter Kachemak Bay Family Planning Clinic 2.23.17.pdf |
HHSS 2/28/2017 3:00:00 PM HHSS 3/9/2017 3:00:00 PM HHSS 4/6/2017 3:00:00 PM HHSS 4/11/2017 3:00:00 PM |
HB 25 |
| HB025 Supporting Document-Letter League of Women Voters Alaska 2.24.17.pdf |
HHSS 2/28/2017 3:00:00 PM HHSS 3/9/2017 3:00:00 PM HHSS 4/11/2017 3:00:00 PM |
HB 25 |
| HB025 Supporting Document-UCSF Study Newspaper Article 2.16.17.pdf |
HHSS 2/28/2017 3:00:00 PM HHSS 3/9/2017 3:00:00 PM HHSS 4/11/2017 3:00:00 PM |
HB 25 |
| HB025 Supporting Document-Unintended Pregnancies Study 2.16.17.pdf |
HHSS 2/28/2017 3:00:00 PM HHSS 3/9/2017 3:00:00 PM HHSS 4/6/2017 3:00:00 PM HHSS 4/11/2017 3:00:00 PM |
HB 25 |
| HB025 Supporting Document-Letter Planned Parenthood Votes Northwest & Hawaii 2.16.17.pdf |
HHSS 2/28/2017 3:00:00 PM HHSS 3/9/2017 3:00:00 PM HHSS 4/6/2017 3:00:00 PM HHSS 4/11/2017 3:00:00 PM |
HB 25 |
| HB025 Supporting Document-Letter Dr. Tina Tomsen 2.27.17.pdf |
HHSS 2/28/2017 3:00:00 PM HHSS 3/9/2017 3:00:00 PM HHSS 4/6/2017 3:00:00 PM HHSS 4/11/2017 3:00:00 PM |
HB 25 |
| HB025 Supporting Document-Support Emails 2.27.17.pdf |
HHSS 2/28/2017 3:00:00 PM HHSS 3/9/2017 3:00:00 PM HHSS 4/6/2017 3:00:00 PM HHSS 4/11/2017 3:00:00 PM |
HB 25 |
| HB025 Supporting Document-HB025 Support Emails 3.7.17.pdf |
HHSS 3/9/2017 3:00:00 PM HHSS 4/6/2017 3:00:00 PM HHSS 4/11/2017 3:00:00 PM |
HB 25 |
| HB025 Supporting Document-Letter Anne Green 3.3.17.pdf |
HHSS 3/9/2017 3:00:00 PM HHSS 4/6/2017 3:00:00 PM |
HB 25 |
| HB025 Supporting Document-Letter Alaska Nurses Association 3.6.17.pdf |
HHSS 3/9/2017 3:00:00 PM HHSS 4/6/2017 3:00:00 PM |
HB 25 |
| HB025 Supporting Document-Letters of Support 3.8.2017.pdf |
HHSS 3/9/2017 3:00:00 PM HHSS 4/6/2017 3:00:00 PM |
HB 25 |
| HB025 Opposing Document-Letters of Opposition 3.8.2017.pdf |
HHSS 3/9/2017 3:00:00 PM HHSS 4/6/2017 3:00:00 PM HHSS 4/11/2017 3:00:00 PM |
HB 25 |
| HB025 Opposing Document-Letter NFIB 2.16.17.pdf |
HHSS 2/28/2017 3:00:00 PM HHSS 3/9/2017 3:00:00 PM HHSS 4/6/2017 3:00:00 PM HHSS 4/11/2017 3:00:00 PM |
HB 25 |
| HB025 Opposing Document-America's Health Insurance Plans 2.27.17.pdf |
HHSS 2/28/2017 3:00:00 PM HHSS 3/9/2017 3:00:00 PM HHSS 4/6/2017 3:00:00 PM HHSS 4/11/2017 3:00:00 PM |
HB 25 |
| HB0123 ver O 2.22.17.PDF |
HHSS 3/2/2017 3:00:00 PM HHSS 3/9/2017 3:00:00 PM |
HB 123 |
| HB0123 Sponsor Statement 2.22.17.pdf |
HHSS 3/2/2017 3:00:00 PM HHSS 3/9/2017 3:00:00 PM |
HB 123 |
| HB 123 Sectional Analysis 2.22.17.pdf |
HHSS 3/2/2017 3:00:00 PM HHSS 3/9/2017 3:00:00 PM |
HB 123 |
| HB 123 Fiscal Note DHSS DPH 3.1.17.pdf |
HHSS 3/2/2017 3:00:00 PM HHSS 3/9/2017 3:00:00 PM |
HB 123 |
| HB0123 Supporting Document-AAMC Price Transparency in the News 2.22.17.pdf |
HHSS 3/2/2017 3:00:00 PM HHSS 3/9/2017 3:00:00 PM |
HB 123 |
| HB0123 Supporting Document-American's For Progress-Price Transparency 2.22.17.pdf |
HHSS 3/2/2017 3:00:00 PM HHSS 3/9/2017 3:00:00 PM |
HB 123 |
| HB0123 Supporting Document-Article ADN-A Doctor's Quest to Remain Human Inside an Insane Medical System 2.22.17.pdf |
HHSS 3/2/2017 3:00:00 PM HHSS 3/9/2017 3:00:00 PM |
HB 123 |
| HB0123 Supporting Document-Truven Health Analytics-Save $36 Billion in US Healthcare Spending Through Price Transparency 2.22.17.pdf |
HHSS 3/2/2017 3:00:00 PM HHSS 3/9/2017 3:00:00 PM |
HB 123 |
| HB123 Draft Proposed Blank CS ver T 3.9.2017.pdf |
HHSS 3/9/2017 3:00:00 PM |
HB 123 |
| HB123 Explanation of Changes ver T 3.9.2017.pdf |
HHSS 3/9/2017 3:00:00 PM |
HB 123 |