Legislature(1993 - 1994)
03/02/1994 01:45 PM Senate HES
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
SENATE HEALTH, EDUCATION AND SOCIAL SERVICES COMMITTEE
March 2, 1994
1:45 p.m.
MEMBERS PRESENT
Senator Steve Rieger, Chairman
Senator Loren Leman
Senator Mike Miller
Senator Jim Duncan
Senator Johnny Ellis
Senator Judy Salo
MEMBERS ABSENT
Senator Bert Sharp, Vice-Chairman
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."
SENATE BILL NO. 284
"An Act establishing the Alaska Health Insurance Corporation and
requiring licensed health care providers to comply with certain
statutes and regulations relating to the corporation; relating to
disability insurance claims processing and to approval of rates for
disability insurance, including health insurance; and providing for
an effective date."
PREVIOUS SENATE COMMITTEE ACTION
SB 270 - See Health, Education & Social Services minutes dated
2/9/94 and 2/18/94.
SB 284 - See Health, Education & Social Services minutes dated
2/14/94 and 2/18/94.
WITNESS REGISTER
Justine Muench
Alaska Nurses Association
P.O. Box 32566
Juneau, Alaska 99803
POSITION STATEMENT: Supported SB 284.
Steve Larsen, International Union Representative
American Federation of State County and Municipal Employees
P.O. Box 93830
Anchorage, Alaska 99509-3830
POSITION STATEMENT: Supported SB 284.
John Schaffer
State Legislative Committee
American Association of Retired Persons
303 Kimsham
Sitka, Alaska 99835
POSITION STATEMENT: Urged movement of SB 284.
Mike Brogan
Licensed Insurance Representative
1435 N Street
Anchorage, Alaska 99501
POSITION STATEMENT: Reviewed health care.
John Riley
Alaskan Academy of Physicians Assistants
1217 E 10th Avenue
Anchorage, Alaska 99501
POSITION STATEMENT: Supported SB 284.
Greg Devereaux, Deputy Director
Washington Federation of State Employees
Olympia, Washington
POSITION STATEMENT: Supported SB 284.
Teresa Lyons, President
Fairbanks District of the Alaska Nurses Association
P.O. Box 74111
Fairbanks, Alaska 99707
POSITION STATEMENT: Supported SB 284.
Marlene Leak
771 8th Avenue
Fairbanks, Alaska 99701
POSITION STATEMENT: Opposed SB 270 and SB 284.
Wally Klinglehut
5072 N. Tongass
Ketchikan, Alaska 99901
POSITION STATEMENT: Supported SB 284.
Opposed SB 270.
Patti Hong
Registered Nurse
P.O. Box 321
Girdwood, Alaska 99587
POSITION STATEMENT: Supported SB 284.
PAUL WORREL, President
Anchorage Medical Association
Anchorage, Alaska
POSITION STATEMENT: Opposed SB 284.
Supported the concept of SB 270.
John Hanchett, President
Alaska Association of Life Underwriters
P.O. Box 10041
Fairbanks, Alaska 99710
POSITION STATEMENT: Opposed SB 284.
Steve LeBrun, Account Manager
AETNA Health Plan
Seattle, Washington
POSITION STATEMENT: Supported SB 270.
Hamlin Faure, Student Intern
Governor's Council on Disabilities and Special Education
Anchorage, Alaska
POSITION STATEMENT: Reviewed health care issues of importance to
disabled individuals.
Bonnie Nelson
Alaska Public Interest Research Group
Eagle River, Alaska
POSITION STATEMENT: Supported SB 284, conditional to a list of
principles from AKPIRG.
Gordan Evans
Health Insurance Association of America
318 4th Street
Juneau, Alaska
POSITION STATEMENT: Supported SB 270 with some modifications.
Dave Walsh, Director
Division of Insurance
Department of Commerce & Economic Development
Juneau, Alaska
POSITION STATEMENT: Offered information regarding fiscal note of
SB 270.
ACTION NARRATIVE
TAPE 94-14, SIDE A
Number 001
CHAIRMAN RIEGER called the Senate Health, Education and Social
Services (HESS) Committee to order at 1:45 p.m. He introduced SB
284 (COMPREHENSIVE HEALTH INSURANCE ACT) and SB 270 (COMPREHENSIVE VE
HEALTH CARE) as the only business before the committee. He noted
that public testimony would be heard on these two bills.
JUSTINE MUENCH, representing the Alaska Nurses Association, stated
support of universal coverage for all Alaskans. The Association
supports a single payer approach to ensure a basic set of benefits
for every citizen. She welcomed the development of the corporation
which would control costs, increase coverage, and provide a
structure for addressing the health care needs of the state. Under
SB 284, she applauded the recognition of the need for strong public
health.
Ms. Muench expressed concern that as written, SB 284 does not
clearly prevent the exclusion of coverage for any reason. She
asked for the committee's careful consideration of any amendments
that would ensure universal and comprehensive coverage. She noted
that the Alaska Nurses Association supports the efforts to include
all appropriate providers in the cost reimbursement mechanism. The
incentives provided for primary care providers, which will
significantly impact accessibility for rural populations, is also
supported by the Alaska Nurses Association.
Ms. Muench acknowledged the required public involvement under SB
284; however, she urged the committee to add language to
demonstrate a commitment to greater consumer representation on the
board itself. The Alaska Nurses Association endorses SB 284.
Number 090
SENATOR DUNCAN thanked Ms. Muench for her testimony. He explained
that the language was not intended to exclude anyone, therefore it
should be clarified. JUSTINE MUENCH said that the language was
fairly clear on employment, but the pre-existing conditions portion
seems a bit vague. SENATOR DUNCAN noted that a pre-existing
condition would not be a reason to exclude anyone because SB 284
does state that every resident of the state would have the
insurance policy of the corporation.
SENATOR DUNCAN said that the seven member board should ensure that
there are consumers present. He explained that "experts" was not
intended to imply that they were health care providers. He
suggested that the term knowledgeable would be better.
STEVE LARSEN, American Federation of State County and Municipal
Employees, noted that he had sent a letter of support for SB 284.
He expressed support for universal coverage and the single payer
system. He related his experience that health care was a major
problem when negotiating a collective bargaining agreement. He
applauded the efforts of the committee.
JOHN SHAFFER, representing the State Legislative Committee (SLC)
and the American Association of Retired Persons (AARP), stated that
for many years SLC and AARP have placed health care reform as the
main priority in their legislative program. Increased health care
costs effect every citizen. He emphasized that now is the time for
action not the time for additional study. He urged movement of
SB 284, especially before the federal government imposes their
own plan.
Number 188
MIKE BROGAN, Licensed Insurance Representative, testifying for
himself stated that universal access should be considered. There
are two mechanisms available for universal access: the individual
high risk pool, and the small group pooling reform program. He
noted that the individual high risk pool should be stripped of the
pre-existing conditions clause. He expressed the need to have
provisions for an access mechanism, mainly to provide security for
uninsurables within the health care reform. He explained that the
economic incentives should be left in place so that the individual
can determine their own deductibles and take responsibility of
their own affairs.
CHAIRMAN RIEGER asked what firms in Alaska offer individual
policies. MIKE BROGAN said that Principal Mutual, Golden Rule, and
Blue Cross were the primary firms he knew.
SENATOR ELLIS asked if Mr. Brogan believed that the individual high
risk pool and the small group market reform did not solve the
problem of universal access. In his opinion, everyone has access
and the problem is that individuals cannot afford coverage. He
asked if the problems with the individual high risk pool and the
small group market reform were corrected, would that solve the
health care problem. He asked what was Mr. Brogan's opinion of
rate review authority.
MIKE BROGAN informed the committee that the individual high risk
pool has a six month pre-existing condition clause which seems to
defeat the purpose of having a high risk pool. He suggested higher
contributions to the pool so that the pre-existing conditions can
be covered or the state could work out a relationship with the
company. He pointed out that the small group pool does not allow
exclusion of anyone with a high risk; however, the enabling
legislation creating the pool for the insurance companies to fund
those high risks has not been provided. Regarding the rate review
authority, there should not be a loophole. He said that the rates
should be public and fair.
SENATOR ELLIS asked Mr. Brogan for which companies he writes health
insurance policies. MIKE BROGAN said he represented Blue Cross,
Principal Mutual, New York Life, Guardian, AETNA, and Golden Rule.
Number 294
JOHN RILEY, Alaskan Academy of Physicians Assistants, stated
support for SB 284. He noted that SB 284 addresses the increasing
costs of health care and the 15 percent of Alaskans who do not have
health care coverage. He pointed out that SB 284 will control
increases in cost by setting a target budget and by encouraging the
training and attention of lower cost primary care providers. The
notion that lower income Alaskans have access to Medicaid or
general medical relief is a myth; 30,000 Alaskans who live 200
percent below the poverty level have no health coverage. He also
negated the myth that those without health care are non-productive
and living off the system; 90 percent of those who are uninsured
Alaskans are working people and their dependents. He related some
of the health care problems he sees on a daily basis. He stated
that many who do receive charity care often only receive it when
the problem has reached a critical level. He urged taking action
on SB 284.
GREG DEVEREAUX, Deputy Director of the Washington Federation of
State Employees, testified on behalf of the American Federation of
State County and Municipal Employees International. He stated that
the AFSCME International Union supports the concept of single payer
health care reform. He discussed the Clinton plan. He noted the
importance for Alaska and other states to consider health reform
options in order to have greater leverage when and if the national
plan passes. He commended the work done on SB 284. He pointed out
Alaska's unique geographical and market place health care
obstacles: the dispersed low density population and the
transportation issues. He said that it would be unlikely that a
competitive health care market place would develop in much of
Alaska, therefore, one state level entity makes more sense.
The establishment of the Alaska Health Insurance Corporation would
ensure the establishment of a minimum benefit package, expenditure
targets, and long term examination of the provider network which
are all critical to cost containment. He noted that the data
section in SB 284 would permit the corporation to make better
informed decisions regarding utilization and cost containment. Mr.
Devereaux stated that generally SB 284 merges the best of the
managed care model with the strengths of the single payer system.
AFSCME International supports SB 284.
Number 389
TERESA LYONS, President of the Fairbanks District of the Alaska
Nurses Association, testified in support of SB 284 with
consideration to reviewing the composition of the board. The board
should be consumer-driven with access to knowledgeable advisors.
She also stated that the pre-existing conditions clause are not
acceptable. She explained that just because everyone may be
covered by some sort of insurance plan does not guarantee that
health care services will be available in a timely, cost effective,
and quality manner, especially with the current delivery system.
She said that the current health care system is an illness driven
system. She discussed the access problems in Fairbanks. She urged
support of SB 284 in order to enter the twenty-first century as
healthy, educated, and productive individuals.
CHAIRMAN RIEGER asked what would be present in a wellness driven
system as opposed to an illness driven system. TERESA LYONS said
that a wellness driven system would be willing to pay for early
diagnosis. Ms. Lyons noted that such a system would look at
substance abuse from the source not the symptoms. Ms. Lyons also
noted the need to review the issues of violence. The benefits
package should be geared toward prevention and paying in the
beginning rather than late in life.
Number 443
MARLENE LEAK stated that she believed that health care problems are
really a Congressional crisis. She referred to information she had
sent the committee. She indicated that cost shifting due to
Congress' passage of COBRA increased health care costs. She
pointed out that SB 270 and SB 284 suggest that cost shifting would
be allowed at the state level under view of the state established
commission. She did not believe that would be necessary,
especially when costs are increased due to the creation of a large
state bureaucracy. She stated that the creation of a bureaucracy
increases costs and bureaucracy, while service goes down.
Ms. Leak pointed out that the board in SB 270 would determine if
claims were legitimate while it also determines what services are
covered. The board's dual responsibility for judicial and
executive functions would create a conflict of interests. She
opposed SB 270 and SB 284. She emphasized the need to address the
acts of Congress such as ERISA in order to support private sector
health care where there is accountability and responsibility. She
expressed that the best value for the patient would occur when
decisions are made by the patient and the physician, not by
bureaucrats.
WALLY KLINGLEHUT opposed SB 270. He said that there had been
enough study on health care. SB 284 is a step in the right
direction. He commended the work group on SB 284. He also noted
the need for consumer involvement. He related his own health
experiences when stating that SB 284 would address health care
problems.
Number 547
PATTI HONG, Registered Nurse, supported SB 284. She explained that
universal coverage and direct access to the full range of
appropriate providers would be an effective strategy to achieve
what she saw as the ultimate goal, a healthy population. She
stated that the data collecting aspect of SB 270 has already been
collected. Furthermore, SB 270 does not commit to universal
coverage, long term care, or wellness and prevention. She urged
the legislature to pass SB 284.
SENATOR SALO asked if Ms. Hong believed that the study called for
in SB 270 was redundant. PATTI HONG said yes. Ms. Hong noted her
belief that many of those on the task force did not originally
support the single payer approach, but after the months of input
from a variety of sources the task force did support the single
payer approach.
CHAIRMAN RIEGER asked Ms. Hong if she knew what the financial
mechanism would be, the amount per capita, or the forum in which
the money would be collected. PATTI HONG deferred to the findings
of the task force. She did not believe that the task force had an
actual dollar amount. She noted that one of the duties of the
insurance corporation would be to formulate such a plan.
TAPE 94-14, SIDE B
Number 591
SENATOR DUNCAN stated that the question of the cost of delivering
health care under the single payer system and the inquiries
regarding cost savings under the single payer system are good
questions. He pointed out that the task force had an estimated
savings of $200 million a year or $1.2 billion over ten years. The
Congressional Budget Office reports and the General Accounting
Office (GAO) reports regarding the savings under the single payer
system at the federal level have identified tremendous savings. He
noted that the last GAO report estimated that due to the single
payer system a $114 billion reduction in the deficit would be
present by the year 2003.
Senator Duncan discussed the Vermont evaluation of the single payer
system versus the multiple payer system in delivering health care.
Solutions for Progress, the research firm who did the Vermont cost
analysis, estimated tremendous savings under the single payer
system. He emphasized that in general, there are tremendous
savings overall under the single payer approach to providing health
care due to administrative savings, universal access, and cost
controls.
PAUL WORREL, President of the Anchorage Medical Association and
physician, stated opposition to SB 284. He said that many of the
doctors in Anchorage had just found out about the bill and were
opposed to its content. He believed that the Anchorage Medical
Society would probably change its support of SB 284. He explained
that he was in the process of collecting the replies of an opinion
survey regarding SB 284; he stated that the majority were opposed
to the bill.
Dr. Worrel expressed concern that SB 284 does not have any funding
in place. He was concerned that his industry would be giving up
pricing control with nothing in return if funding did not develop,
eventually; they would be giving up their economic future. He
explained that the majority of physicians do not have any
confidence in the government's ability to solve the problems or the
cost of health care. Most of these physicians have worked in
government run hospitals during their training years and they
complain that these hospitals are poorly run. He did not want such
sloppy management to spread to private hospitals.
Number 520
Dr. Worrel cited the last paragraph of SB 284 as a point of
concern. He also pointed out that page 2 of SB 284 presents the
underlying premise of the bill which places physicians responsible
for cost controls. He said that to single out physicians for price
control is not a real solution. The hypothesis that physicians
have a lot of control over there overhead is false. He referred to
page 11, line 22 which does not allow the physician the choice of
who to see or not to see. That would eliminate an important legal
right of the physician. He explained that both the physician and
the patient should be able to choose who they would or would not
see.
Dr. Worrel suggested that the committee use the Tort Reform as a
starting point to decrease costs. He expressed the desire that SB
284 be kept in committee. He supported the concept of SB 270.
Number 469
SENATOR ELLIS asked Dr. Worrel if he wrote an opinion piece about
health care reform in the Voice of the Times . PAUL WORREL said
yes. SENATOR ELLIS asked if that opinion piece concluded that
health care reform was a plot by Democrats and President Clinton to
get re-elected and stir the country up. PAUL WORREL did not agree.
Dr. Worrel said that the health care issue is very complicated with
a historical background.
SENATOR ELLIS encouraged everyone to read Dr. Worrel's article.
PAUL WORREL informed the committee that another article would be
published in a week or so. This article suggests that many
hospital expenses could be decreased by eliminating the federal
government rules from the hospitals.
SENATOR ELLIS asked if Dr. Worrel was unaware of the physicians and
health folks participating in the discussions of the task force and
other health related groups. He asked if Dr. Worrel was unaware of
the effort to create a change in health care. PAUL WORREL vaguely
recollected the meetings and such. Dr. Worrel said that the
physicians that were involved were not known by he and many other
physicians. Dr. Worrel suggested that changes to the health care
system should be done through rational thinking with real numbers
and real solutions.
SENATOR ELLIS clarified that Dr. Worrel believed that the financial
figures being suggested regarding health care were insignificant,
but that Tort Reform would be a help in addressing the health care
problem. He encouraged Dr. Worrel to get up to date on the numbers
and their proportions.
PAUL WORREL explained that there are a lot of opinions on the exact
figures. He said that no one has actually measured the cost of
health care. He discussed his interaction with Senator Stevens
regarding federal information for analyzation of this issue. He
noted that his analyzation was different. SENATOR ELLIS agreed
that Dr. Worrel had analyzed the facts and figures differently.
Number 381
SENATOR DUNCAN referred to Section 13 when clarifying that the 1.5
percent increase is the cost increase on top of other factors.
PAUL WORREL did not believe the language was to that effect.
SENATOR DUNCAN pointed out that SB 284 said "not withstanding"
which means in addition to the 1.5 percent increase. PAUL WORREL
said he would be glad to work with the committee on these problems.
SENATOR DUNCAN asked Dr. Worrel how long he had been president of
the Anchorage Medical Association. PAUL WORREL said he had been
president for a couple of months. SENATOR DUNCAN noted his
presence at the Anchorage Medical Association's meeting that voted
to support SB 284. Senator Duncan pointed out that the physicians
who worked on SB 284 have been involved in the Anchorage Medical
Association for years and are well known. Senator Duncan asked Dr.
Worrel if he was a member of Alaska State Medical Association
(ASMA). PAUL WORREL said yes. SENATOR DUNCAN informed Dr. Worrel
that ASMA supported SB 284. PAUL WORREL stated that many
physicians oppose SB 284 and the votes referenced by Senator Duncan
could change.
JOHN HANCHETT, President of the Alaska Association of Life
Underwriters, stated that the Alaska Association of Life
Underwriters support health care reform, affordability, the Tort
Reform, and improved access. He stated that they oppose SB 284;
there is no need for more bureaucracy to further raise health care
costs. He noted the need for realistic funding mechanisms before
legislation is passed that could further current deficit problems.
He explained that Vermont and its solutions for health care are
different than Alaska.
SENATOR ELLIS asked if Mr. Hanchett supported SB 270 and its
proposed rate review authority for health insurance companies.
JOHN HANCHETT indicated that he had not reviewed SB 270 in depth.
Mr. Hanchett stated that he would be in favor of rate review
authority. Mr. Hanchett noted that they represented the people of
Alaska who need the health care reform and the taxpayers who will
incur the cost.
SENATOR ELLIS asked for which companies Mr. Hanchett writes
policies. JOHN HANCHETT said he wrote policies for Blue Cross,
AETNA, Principal Mutual, Golden Rule, and New York Life.
SENATOR DUNCAN clarified that the Vermont study reference was
intended to point out that the study indicated tremendous savings
in the single payer system. JOHN HANCHETT stated that he opposed
the single payer system.
STEVE LEBRUN, AETNA Account Manager, noted that AETNA has the
largest share of the Alaska health insurance market. He said that
AETNA agrees that changes are needed in health care and access
system and that Alaska is different from other states. Managed
care principles could and would work in urban Alaska. He expressed
the belief of AETNA that federal legislation is likely to pass this
year and some requirements will effect every state, even Alaska.
SB 270 has advantages to approaching the health care issue. He
stated that SB 270 would allow the legislature to know:
(1) the federal requirements to be applied to all states and
those requirements left to the discretion of the states before
finalizing their own plans;
(2) which specific health care benefits would be guaranteed or
required by Congress;
(3) how universal care can, should, or would be financed at
the federal level; and
(4) an estimate of the cost of additional health care reform
recommendations made by the proposed State Health Care
Commissioner.
Mr. LeBrun explained that when more information is available, the
effects of federal and state health care reform legislation on
individuals and Alaskan businesses will be clearer. He noted
immediate improvements to Alaska's health care system as
recommended by SB 270:
(1) reduction of administrative costs by requiring uniform
claims forms for providers and consumers;
(2) design and implementation of a comprehensive data
collection system in order to improve financial and quality of
care decisions;
(3) formation of voluntary insurance pools to achieve better
rates and purchasing power while lowering the costs of small
business employees;
(4) requiring an annual public health plan to improve
coordination among public health agencies, promote primary and
preventive care, and to set public health objectives; and
(5) reduction of health care costs and the utilization impact
through Tort Reform.
Mr. LeBrun pointed out that the Health Care Commission should focus
on such long term objectives as the development of alternative
benefit packages and costs for universal care with submission to
the next legislature, and development of recommendations for
additional legislative action which would be compatible with
federal legislation but tailored to Alaska.
Mr. LeBrun stated that SB 284 is premised on the conclusion that
Alaska would appoint a commission who would be responsible for
decision making and financing of health care under a single payer
system. The single payer system would give the Commission the
power to decide what benefit package should be available to all
Alaskans, who would pay for it and how the payment would be
distributed among individuals. The single payer system could act
as its own insurer and claims payer which would replace the role of
private insurers. He also noted that the single payer system would
give the Commission the power to regulate health care provider
rates if providers do not meet statewide expenditure limits as set
by the Commission. Finally, this system would allow the
establishment of health care spending limits including private
expenditures if the voluntary limits fail within the specified time
period. He stated that SB 284 goes too far with governmental
control of Alaska's health care system with no assurances that the
new system would be better than the one it replaces. There is too
much responsibility given to the Commission with no future thought,
trade offs, financing impacts or consequences.
Number 152
SENATOR ELLIS asked if AETNA was a member of Health Insurance
Association of America (HIAA). STEVE LEBRUN said no. SENATOR
ELLIS asked if AETNA supported the rate review authority. STEVE
LEBRUN stated that any rate review procedure should be consistent
with the prevailing approach used by most state insurance
departments. Mr. LeBrun expressed limited concerns with the two
tier review approach in SB 270, but they would be supportive of
reasonable rate regulations.
SENATOR ELLIS asked if they supported SB 270, but were going to
attempt to change the portion relating to rate review. STEVE
LEBRUN offered to provide written comments on rate review. Mr.
LeBrun was not opposed to the general concept of rate review at the
level practiced in other states.
SENATOR DUNCAN asked if Mr. LeBrun supported SB 270 and the
requirement that they come before the next legislature with a
defined benefit package. STEVE LEBRUN said yes. SENATOR DUNCAN
stated that even SB 270 realizes that a benefit package cannot be
designed in four or five months.
SENATOR DUNCAN pointed out that Mr. LeBrun testified that the
Corporation would decide upon its own the benefit package that
would be available to Alaskans which is at odds with Mr. LeBrun's
earlier statement that the benefit package would be controlled by
federal requirements as to what would be in a benefit package.
STEVE LEBRUN stated that the federal picture has not become clear.
In general, there will be a move toward defining a comprehensive
benefit package whether the federal government will exercise
authority or not.
SENATOR DUNCAN asked if both bills approach a comprehensive data
system and the collection of comprehensive data on health care in
a similar manner. STEVE LEBRUN said that both bills are similarly
seeking comprehensive data, cost, and utilization factors.
Number 049
HAMLIN FAURE, Social Work student at UAA, stated that as a student
intern for the Governor's Council on Disabilities and Special
Education she has been following health care reform in Alaska for
the Council's subcommittee. This has increased her awareness of
health care issues that face disabled individuals and their
families. She noted that she was not speaking on behalf of the
Council or its subcommittee. She said that consumer representation
on any health care commission or corporation is important.
Consumer Representation would ensure that health care concerns of
the consumer are considered and acted upon. Furthermore a feeling
of ownership would be promoted with consumer representation. She
appreciated the inclusion of consumer representation in SB 284.
Ms. Fore pointed out that universal coverage is essential to those
with disabilities. Often disabled individuals have complex and
specialized medical needs which increases the importance of
provider choice and full coverage for services. A benefit package
that addresses the needs of disabled individuals is of major
importance. She expressed appreciation that SB 284 specifically
includes long term health care provisions. She noted the
importance of public involvement of all Alaskans and their feeling
of ownership. Without public ownership, reforming Alaska's health
care system is nearly impossible. She asserted that input from
disabled individuals when defining a benefit package is necessary
in order to fill the gaps in services currently in the system. She
encouraged anyone interested in health care concerns of disabled
individuals to contact Kathy Fitzgerald, Chair of the Governor's
Council on Disabilities and Special Education.
TAPE 94-15, SIDE A
Number 008
BONNIE NELSON, representing Alaska Public Interest Research Group,
stated support for SB 284 conditional upon the principles AKPIRG
had suggested. She emphasized that they believe comprehensive
universal coverage is a right. Both AKPIRG and the U.S. Public
Interest Research Group believe that the single payer system is the
only way to provide guaranteed coverage. She pointed out that
there is no assurance of universal coverage in SB 270. She stated
that pre-existing conditions clauses currently in many statutes are
discriminatory. She explained that businesses often face increased
claims and premiums when they hire disabled individuals. There
should be incentives provided to businesses and municipalities when
they hire the handicap.
Ms. Nelson noted that consumer control in the composition of the
corporation is very important. She stated that they believe that
the presence of a health care provider or anyone in a health
related field on the corporation would have a conflict of interest.
She explained that disabled individuals or parents of disabled
individuals have valuable life experience that is often more
ethically important than a health care provider or legal
professional's expertise. She asserted that the public process of
decision making has to be done by those who have had or been with
or know the emotions of the experience. She is trying to come up
with language to define a consumer that would include the disabled.
She said that a board of disabled individuals would probably arrive
at the single pool faster due to their vested interest.
Number 129
Ms. Nelson believed that many national disability coalitions are
supporting the single payer concept because it is inexpensive, good
for business, and it encourages businesses to hire disabled
individuals. The single payer system provides equality and
comprehensiveness. She explained that disabled individuals should
not be considered a special interest group, but rather the litmus
test for any reform that passes.
Ms. Nelson pointed out that AKPIRG supports the notion that
regulations are the responsibility of the state not the federal or
local government. She stated that there could not be any free-
riders. Disabled individuals want to pay their fair share. She
expressed concern with high payments and co-payments. She noted
that successful developed and industrialized countries use cost
sharing from the wealthy in order to control costs. She suggested
that cost sharing from those at the top should be reviewed for
Alaska. Most disabled individuals are willing to pay the same as
wealthy individuals if that means higher premiums spread in a
single pool concept in order to eliminate high deductibles and co-
payments. She reiterated the need for the young and healthy to
think about what would happen if they were in an accident or became
ill. She noted that the Tort Reform takes money from individuals
at the bottom, the poorest individuals.
Number 206
GORDAN EVANS, representing the Health Insurance Association of
America (HIAA), offered to present his written testimony. HIAA
supports SB 270 with some changes. He noted that HIAA supports the
following building blocks of comprehensive health care: measurable
quality and outcome standards, physician choice, and administrative
simplification. Reform must shift from an emphasis on sickness and
repair to an emphasis on health and wellness. He pointed out that
HIAA does not agree with the sponsor of SB 284 placing the
government as the most appropriate mechanism for delivering health
care to Alaskans. HIAA supports the government as an enabler and
not a doer. He stated that HIAA believes that everyone is entitled
to health care coverage and in order to accomplish this goal the
employer based system should be built upon to create a consumer
responsive prevention focused affordable and cost effective health
system.
A government run, single payer system would not provide the service
or access to technology that most Americans expect and deserve. He
said that the Canadian style single payer public health insurance
is not the solution. He discussed the problems Canada's health
care system is facing such as the incredible waiting lists for
surgery and treatments which leads to many Canadians seeking health
care in the U.S. He stated that there is no reason to assume that
the U.S. government will financially restrain health care when it
has failed to restrain other government run programs. He noted
that the position of HIAA is paralleled by Mr. LeBrun's testimony.
SENATOR DUNCAN clarified that SB 284 does not refer to free health
care but rather a much more cost efficient and effective way to pay
for health care. SB 284 does not address a Canadian style system.
He noted that SB 284 speaks to a uniquely Alaskan system. He
pointed out that the HIAA expresses concern about health care, but
no action has been taken by the insurance industry to assure that
there are not increases in the number of uninsured Americans or
increases in costs. He asserted that if there is any crisis in
this country, it would be an insurance crisis which SB 284
addresses.
Number 275
GORDAN EVANS noted the small group employer bill that Senator
Duncan voted for last year. That legislation would address many of
the health care problems when it goes into effect. He stated that
SB 284 does not have a financial system.
CHAIRMAN RIEGER proposed that Mr. Evans return for further
testimony in the future. He asked Mr. Walsh to be prepared to
testify on Friday, March 11th, on the fiscal notes of SB 270 and
SB 284, the uniform claims form, and the regulation of insurers.
SENATOR DUNCAN asked if Mr. Walsh, the Division of Insurance had
been directed to prepare a detailed fiscal note on SB 270. DAVE
WALSH said no, they had prepared a fiscal note for only their
portion. SENATOR DUNCAN said that fiscal notes should be prepared
by the same people. Senator Duncan requested that the Division of
Insurance be directed to do a fiscal note on SB 270; currently the
fiscal note only addresses rate review.
There being no further business before the committee, the meeting
was adjourned at 3:35 p.m.
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