Legislature(1993 - 1994)
02/09/1994 01:40 PM Senate HES
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SENATE HEALTH, EDUCATION AND SOCIAL SERVICES COMMITTEE
February 9, 1994
1:40 p.m.
MEMBERS PRESENT
Senator Steve Rieger, Chairman
Senator Bert Sharp, Vice-Chairman
Senator Loren Leman
Senator Mike Miller
Senator Jim Duncan
Senator Johnny Ellis
Senator Judy Salo
MEMBERS ABSENT
All members present.
COMMITTEE CALENDAR
SENATE BILL NO. 270
"An Act creating the Alaska Health Commission; relating to the
delivery, quality, access, and financing of health care; relating
to review and approval of rates and charges of health insurers;
relating to certain civil actions against health care providers and
health insurers; repealing Alaska Rule of Civil Procedure 72.1; and
providing for an effective date."
PREVIOUS SENATE COMMITTEE ACTION
SB 270 - No previous action to record.
WITNESS REGISTER
Nancy Usera
Commissioner, Department of Administration
P.O. Box 110200
Juneau, Alaska 99811-0200
POSITION STATEMENT: Reviewed SB 270.
ACTION NARRATIVE
TAPE 94-7, SIDE A
Number 001
CHAIRMAN RIEGER called the Senate Health, Education and Social
Services (HESS) Committee to order at 1:40 p.m. He introduced SB
270 (COMPREHENSIVE HEALTH CARE) as the only order of business
before the committee.
Number 022
NANCY USERA, Commissioner of the Department of Administration,
explained how SB 270 evolved. She emphasized that the main goal of
SB 270 was providing access to affordable quality health care for
all Alaskans. She stated that health care was assumed an
inalienable right regarding SB 270. The model of the AUPC was
chosen due to its depth, accountability and substantive attack on
the issue. She asserted that SB 270 is not a comprehensive reform
package, but rather a 10 percent advancement toward comprehensive
reform.
Ms. Usera discussed the three aspects of the Governor's Alaska
Health Commission:
(1) The Commission will perform insurance pooling,
implement a universal health form, provide for court ordered
non-binding arbitration for malpractice disputes and insurer-
beneficiary disputes, provide rate approval for insurance
premiums, and conduct public hearings.
(2) The Commission will collect and review data on Alaska's
health care needs and analyze the cost benefit.
(3) The Commission will weigh the various proposals and make
recommendations to the legislature and the Governor.
Number 205
SENATOR DUNCAN did not believe that the Canadian plan had been
submitted to the legislature or was even being considered. The
plan being submitted by the work group is not a Canadian plan, but
a uniquely Alaskan plan. NANCY USERA stated that she did not mean
to imply that the Canadian plan had anything to do with any of the
proposals submitted to the legislature.
SENATOR SALO noted that the Commission would have six year
staggered terms. She asked if the Commission would stay in
existence if some sort of health care reform beyond this study was
instituted.
NANCY USERA emphasized that the Commission's tasks will make
differences in the efficiency of the health care system. She
asserted that the Commission will be helpful when addressing the
ongoing issues of a comprehensive plan and its implementation.
SENATOR SALO expressed concern about Alaska's public health
services. She questioned if economical and common-sense approaches
like those mentioned at the December conference would be considered
in this plan.
NANCY USERA agreed that Alaska's public health system is important
in the overall health care system. SB 270 does not identify or
mandate specific sectors or issues for review , but that she was
amenable to including such.
SENATOR DUNCAN was concerned with the three member paid commission.
He stated that high paid positions usually become political
appointments, who help the Governor get elected. He felt that the
Permanent Fund Board of Trustees model was a more viable option
because the members were not highly paid. Their dedication to the
health care system would keep them in these positions.
Senator Duncan also asked how you could get public involvement or
other allied professionals on the three member Commission. He
proposed broadening the Commission so as not to limit input or
involvement.
Number 309
NANCY USERA stated that a variety of models had been reviewed.
Regarding the positions' pay scale, she informed the committee that
these are director level positions. Ms. Usera noted that terms-
certain and the legislature's confirmation of these positions
should transcend gubernatorial administrations. Furthermore, her
proposed Commission provides greater accountability due to their
specific tasks in a full-time position.
Ms. Usera explained that the three member Commission attempts to
foster a more global view of the issues. Furthermore, the
Commission provides a formal mechanism for the public to discuss
the issues. She noted that the key responsibilities of the
Commission are outreach and public hearings.
Number 348
SENATOR DUNCAN stated that a volunteer board, such as the Permanent
Fund Board of Trustees, does not necessarily lack commitment or
dedication. He was concerned that the three member board would
become a special interest group although Ms. Usera had stated she
did not want or intend this. He suggested that the members of
special interest groups could be prohibited from the commission,
but he did not know how this could be done.
NANCY USERA stated that a member is required to have a general
background and understanding knowledge of health care systems. She
described the individual as committed to the issue with a global
understanding of how the system works outside of any special
interest affiliation.
SENATOR ELLIS referred to rate approval authority and the loophole
in the law, when inquiring about the Governor's commitment to that
part of SB 270.
NANCY USERA said that the Governor believes this is a good package
and he is open to suggestions and changes. She explained that she
felt that the Governor wanted rate approval due to the public
mechanism it creates for confidence building of insurance systems.
She expressed the need to view the rate approval process as one
component of the multifaceted system.
Number 416
SENATOR DUNCAN reiterated that SB 270 is not a reform proposal only
a 10 percent advancement of many issues. He asked if she would
oppose more than a 10 percent advancement. NANCY USERA was not
opposed to including other items to increase advancement of
comprehensive reform. She viewed SB 270 as an incremental measure
to begin the process.
SENATOR DUNCAN said that SB 270 should add more specific duties and
he gave suggestions. He viewed SB 270 as multiple points of
decision making by the legislature and two to three years of study.
He pointed out that SB 270 does not implement measures it only
studies the various aspects.
NANCY USERA explained that this Commission will be collecting and
analyzing information, and offering recommendations. She
emphasized that they need to have the benefit package first in
order to determine the cost and implementation in Alaska. She
asserted that the task is determining how the system will work.
She felt that how the system should be applied in Alaska is
uncertain. Therefore, if any comprehensive plan is to include
universal coverage then a cost of the benefit package has to be
done before knowing how it will work in Alaska.
Number 502
SENATOR DUNCAN agreed that the benefit plan must come before the
cost can be known. He cited that SB 270 does not suggest a final
recommendation to the legislature. He stated that SB 270 is not a
plan of action, but rather a study of alternative systems for
Alaska. He pointed out that a lot of those studies have already
been done by the legislative task force and providers.
NANCY USERA supported more study. She did not think an
overwhelming consensus of the answer for Alaska had been reached.
SENATOR DUNCAN explained that a public consensus would never be
reached due to the many different recommendations of delivery
systems brought before the public by the Commission in SB 270. He
suggested identifying the system that would work and build public
support.
CHAIRMAN RIEGER emphasized that the debate on the delivery system
should be as important as the debate on the benefit package. He
suggested that the legislature is not the best forum to develop a
benefit package. He expressed that he did not believe there was a
consensus whether there should even be a mandate on health care and
if so how extensive. That itself would merit having many
alternatives presented to the public.
Chairman Rieger expressed his reluctance to mandate power delegated
away from the legislature and the Governor. The legislature should
review a mandate. He said that health promotion should be reviewed
and incorporated into anything moving out this committee. He did
believe there would be controversy if a price control mechanism was
implemented to increase the efficiency of the health care industry.
TAPE 94-7, SIDE B
Number 581
SENATOR ELLIS stated that there was no giving away of legislative
authority, it is more a matter of time lines and decisiveness to
bring back one decision to the legislature. He asked if the time
lines of SB 270 assume that the Congress will not act on health
care reform this year.
NANCY USERA said that SB 270 assumes that comprehensive federal
reform will not happen this year and that the National Governor's
Association will prevail; the other mandatory component of any
federal plan will be state option. SB 270 is not hanging on those
assumptions, it can only enhance and facilitate any other
comprehensive reform measures at the state or federal level.
SENATOR ELLIS explained that he believed federal health care reform
would be phased in over time under any of the plans passed. There
will be a date by which states must submit their plan that meets
the national goals of the federal government.
Senator Ellis pointed out that Nancy Usera used the words access
and coverage interchangeably regarding universal access and
universal coverage. He inquired about the Governor's position,
whether his goal would be universal access or universal coverage.
NANCY USERA emphasized that SB 270 assumes that there will be a
universal benefit plan with a specific benefit package. SB 270
does what it can now. SENATOR ELLIS stated that choosing the goal
either of universal access or universal coverage is very crucial
for the starting point. NANCY USERA noted that this approach does
not foreclose either option.
SENATOR ELLIS asked if the Cooper Plan, which guarantees universal
access, was approved would the Governor go along with the federal
government. NANCY USERA could not respond for the Governor. She
felt that the 10 percent advancement was a firm first step allowing
adjustment for the best interests of Alaskans.
Number 477
CHAIRMAN RIEGER agreed with Senator Ellis that there is a
significant difference between universal access and universal
coverage. He said that universal access pools do not seem to work
as well as universal coverage. He asked how narrowly they should
mandate the constraints of what the Commission should take as
givens when developing the alternatives within those givens.
SENATOR DUNCAN stated concern with analyzing and studying programs
that do not ultimately result in universal coverage when President
Clinton specifically said he would veto any program that does not
have universal coverage. He thought that SB 270 was too broad.
NANCY USERA pointed out that if SB 270 passes and the Commission is
in place and functioning this summer and President Clinton gets his
universal plan in place, then that is what the Commission will
study.
SENATOR DUNCAN asked if the intent of SB 270 is to study President
Clinton's plan and how to implement it in Alaska. He said that
they should study an Alaskan plan so that the federal plan does not
have to be implemented in Alaska.
NANCY USERA explained that if the mechanism that SB 270 provides is
already in place to design the benefit plan, Alaska is in a better
position to implement the plan.
SENATOR SALO expressed frustration with the Commission's focus on
study rather than on implementation. She said that a lot is
already known about what the problem is and the solution; is there
a need to study more. She asked if the studying was to advance or
slow the solution.
NANCY USERA indicated that she is open to other options for further
advancement. She stressed that she had not seen all the data
specific to Alaska and until then it is guessing. She said that
thus far the Department of Health and Social Services does not know
specifically where the costs are and what the system in Alaska
would look like.
Number 390
SENATOR SHARP asked if a determination had been made as to what
level of universal coverage Alaska is going to have. He proposed
various options regarding the level of universal coverage. He
asked what level the state is going to mandate.
SENATOR DUNCAN clarified the need to have public health as a
portion of this legislation as well as long-term care. He felt
that everyone should have the same comprehensive preventive health
care plan available to them; if some people want more, they can
negotiate and purchase more. The Commission is responsible for
developing a preventative health care plan as determined by federal
guidelines and the needs of Alaska.
SENATOR SHARP pointed out that those who are paying for health
plans with long-term contributions through wages do not want to
give up their premium to bring everyone to the same level, a lower
level than they are now. He said that these people want some
premium left to buy the optional coverage.
SENATOR DUNCAN put this issue into perspective by pointing out that
the issue is not what you pay today but rather what you will pay in
the future. He suggested that one would pay less in the future
under a reform system.
Number 342
CHAIRMAN RIEGER proposed that Monday or Wednesday Senator Duncan's
bill will be before the committee. After the sponsor statements
have been heard, public testimony will be taken.
There being no further business before the committee, the meeting
was adjourned at 2:50 p.m.
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