02/26/2008 01:30 PM Senate LABOR & COMMERCE
| Audio | Topic |
|---|---|
| Start | |
| SB149 | |
| SB160 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| + | SB 160 | TELECONFERENCED | |
| += | SB 149 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
SENATE LABOR AND COMMERCE STANDING COMMITTEE
February 26, 2008
1:35 p.m.
MEMBERS PRESENT
Senator Johnny Ellis, Chair
Senator Gary Stevens, Vice Chair
Senator Bettye Davis
Senator Lyman Hoffman
Senator Con Bunde
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
SENATE BILL NO. 149
"An Act relating to redistribution of used eyeglasses."
MOVED CSSB 149(L&C) OUT OF COMMITTEE
SENATE BILL NO. 160
"An Act establishing an Alaska health care program to ensure
insurance coverage for essential health services for all
residents of the state; establishing the Alaska Health Care
Board to define essential health care services, to certify
health care plans that provide essential health care services,
and to administer the Alaska health care program and the Alaska
health care fund; establishing the Alaska health care
clearinghouse to administer the Alaska health care program under
the direction of the Alaska Health Care Board; establishing
eligibility standards and premium assistance for persons with
low income; establishing standards for accountable health care
plans; creating the Alaska health care fund; providing for
review of actions and reporting requirements related to the
health care program; and providing for an effective date."
HEARD AND HELD
PREVIOUS COMMITTEE ACTION
BILL: SB 149
SHORT TITLE: REDISTRIBUTION OF USED EYEGLASSES
SPONSOR(s): SENATOR(s) THERRIAULT
03/30/07 (S) READ THE FIRST TIME - REFERRALS
03/30/07 (S) L&C, HES
02/19/08 (S) L&C AT 1:30 PM BELTZ 211
02/19/08 (S) Heard & Held
02/19/08 (S) MINUTE(L&C)
02/26/08 (S) L&C AT 1:30 PM BELTZ 211
BILL: SB 160
SHORT TITLE: MANDATORY UNIVERSAL HEALTH CARE
SPONSOR(s): SENATOR(s) FRENCH
04/23/07 (S) READ THE FIRST TIME - REFERRALS
04/23/07 (S) HES, L&C, FIN
09/10/07 (S) HES AT 1:30 PM Anch LIO Conf Rm
09/10/07 (S) Heard & Held
09/10/07 (S) MINUTE(HES)
01/30/08 (S) HES AT 1:30 PM BUTROVICH 205
01/30/08 (S) Heard & Held
01/30/08 (S) MINUTE(HES)
02/18/08 (S) HES AT 1:30 PM BUTROVICH 205
02/18/08 (S) Moved CSSB 160(HES) Out of Committee
02/18/08 (S) MINUTE(HES)
02/19/08 (S) HES RPT CS 3DP 1DNP NEW TITLE
02/19/08 (S) DP: DAVIS, THOMAS, ELTON
02/19/08 (S) DNP: DYSON
02/26/08 (S) L&C AT 1:30 PM BELTZ 211
WITNESS REGISTER
SENATOR THERRIAULT
Alaska State Capitol
Juneau, AK
POSITION STATEMENT: Sponsor of SB 149.
HOWARD RIXIE
Aurora Borealis Lions Eyeglass Recycling and Vision Center
North Pole, AK
POSITION STATEMENT: Supported CSSB 149.
JENNIFER STRICKLER, Licensing Chief
Division of Corporations, Business and Professional Licensing
Department of Commerce, Community & Economic Development (DCCED)
Juneau, AK
POSITION STATEMENT: Supported SB 149.
SENATOR FRENCH
Alaska State Capitol
Juneau, AK
POSITION STATEMENT: Prime sponsor of SB 160,
LINDA HALL, Director
Division of Insurance
Department of Commerce, Community & Economic Development
Juneau, AK
POSITION STATEMENT: Commented on SB 160 issues.
LYNN HARTZ, Legislative Committee
Alaska Nurses Association
Anchorage, AK
POSITION STATEMENT: Supported SB 160.
GARVAN BUCARIA, representing himself
Wasilla, AK
POSITION STATEMENT: Commented on SB 160 issues.
BEVERLY SMITH
Christian Science Committee on Publication for Alaska
Juneau, AK
POSITION STATEMENT: Supported SB 160 if it covered Christian
Science healing practices.
PATRICIA BOILY, representing herself
Homer, AK
POSITION STATEMENT: Opposed SB 160.
ANDY MODEROW
Staff to Senator French
Alaska State Capitol
Juneau, AK
POSITION STATEMENT: Commented on SB 160 for the sponsor.
ACTION NARRATIVE
CHAIR JOHNNY ELLIS called the Senate Labor and Commerce Standing
Committee meeting to order at 1:35:40 PM. Present at the call to
order were Senators Bunde, Stevens and Ellis. SENATOR DAVIS
joined the committee at 1:36:36 PM.
SB 149-REDISTRIBUTION OF USED EYEGLASSES
1:37:41 PM
CHAIR ELLIS announced SB 149 to be up for consideration.
SENATOR THERRIAULT, sponsor of SB 149, explained the only change
in proposed CSSB 149(L&C) 24-LS0788\M, appears on page 2, lines
24-25, because Mr. Harper testified at the last meeting that one
can't expect to get the exact prescription. So the drafter
suggested inserting "to the extent possible" to give a little
bit of latitude.
1:38:55 PM
SENATOR STEVENS moved to bring version M before the committee.
There were no objections and it was so ordered.
1:39:40 PM
HOWARD RIXIE, Aurora Borealis Lions Eyeglass Recycling and
Vision Center, North Pole AK, concurred with the CS.
1:39:56 PM
JENNIFER STRICKLER, Licensing Chief, Division of Corporations,
Business and Professional Licensing, Department of Commerce,
Community & Economic Development (DCCED), supported SB 149. She
hadn't seen the CS but indicated a letter dated July 23, 2007
from the chairman of the Board of Optometry suggested moving
this language to the Board of Optometry rather than Dispensing
Opticians, because that board had sunsetted in FY06.
SENATOR THERRIAULT explained that issue had been dealt with in
the CS on page 1, line 5 which removed "board" and inserted
"department".
SENATOR STEVENS asked if giving approval to a non-profit
organization is a complex process.
SENATOR THERRIAULT said he had to go with generic language,
because the drafter said that even though the intent is to work
with the Lions Club program, they didn't want to put "the Lions
Club" in statute. This wording gives flexibility to the
department if there are competing groups or more than one.
1:44:01 PM
SENATOR STEVENS moved to report CSSB 149(L&C), version M, from
committee with individual recommendations and attached fiscal
notes. There were no objections and it was so ordered.
SB 160-MANDATORY UNIVERSAL HEALTH CARE
CHAIR ELLIS announced SB 160 to be up for consideration. [CSSB
160(HES), 25-LS0728\N, was before the committee.]
SENATOR FRENCH, prime sponsor of SB 160, introduced Andy
Moderow, his staff who spent a good part of the last year
working on this bill. He then explained that at least 15 percent
of his neighbors do not have health insurance; 60 percent of
those have full-time jobs that do not provide health insurance
as a benefit. The upshot is that the costs they incur when they
seek health care, typically through the emergency room or low
cost clinics, get passed on to the rest who do have health
insurance. Estimates are that about 15 percent of the health
insurance premiums people pay go to care for those who have no
insurance. Should every Alaskan have a health insurance policy,
one might see as much as a $1000 annual reduction in premium.
The idea behind SB 160 is to provide a framework using the
existing landscape to provide affordable health insurance to
every Alaskan.
1:46:33 PM
SENATOR HOFFMAN joined the committee.
1:48:51 PM
SENATOR FRENCH showed a slide from a Rand Corporation study
indicating that most nations have a fairly tight relationship
between gross domestic product (GDP) and health care spending
until you come to the U.S. which spends far more on health care
- and gets the same, if not worse, results when you look at
infant mortality and life expectancy. That extreme amount of
spending has caught the eye of many economists and health care
reformers.
A slide prepared by the Institute of Social and Economic
Research showed a huge increase in spending in health care, both
as a total and per capita from $1.6 billion in 1991 to $5.3
billion in 2005. The idea of this reform is to get more people
covered by insurance while trying to decrease wasteful spending
in emergency rooms and other medical costs.
SENATOR FRENCH said one of the problems is that it's very
difficult for small firms or those who work for themselves to
provide insurance for employees. Ninety-three percent of the
large firms in Alaska offer health insurance, while 88 percent
of the medium sized firms offer health insurance. But when you
drop to smaller firms, it's very difficult to generate enough
income to provide insurance.
1:50:36 PM
He said the bill calls for the creation of a Health Care Board
that would oversee a health care fund, and recommend essential
health care services and certify private health care plans that
would rest in a Alaska Health Care Clearinghouse. The
Clearinghouse would not be a new bureaucracy, it would be a
virtual clearinghouse, much like the stock exchange, where
individual health care plans, having been certified by the board
as have essential health care services (as defined by the
legislature), are waiting to be purchased by a person with a
voucher to purchase it. The genius of this idea is to not
replace the existing private insurance landscape with a single
insurance plan, but to maintain the same competition within the
clearinghouse that promotes lower costs and better products that
works so well in many other aspects of our economic life -
competing for the consumer voucher.
He said essentially individuals who earn less than 100 percent
of the federal poverty limit would get a free voucher for a
health insurance policy. Today probably 95 percent of those
people are on Medicaid; the bill takes the other 5 percent into
account. The vast bulk of the folks that this bill is meant to
help falls between 1 - 300 percent of the federal poverty level.
Other states that are looking at these reforms tend to use this
range of limits. The vast bulk of Alaskans would be eligible for
a voucher in relationship to their income; the lower the income,
the bigger the voucher. The higher income the smaller the
voucher, until you get to 300 percent, in which case you get no
voucher whatsoever.
1:53:02 PM
SENATOR FRENCH explained that the fund would also have
"specified beneficiary funds." Laile Fairbairn of the Snow City
Café said she would love to be able to contribute $100-$300 to
help employees buy health insurance, but she couldn't afford the
full price. Companies like hers that want to offer to subsidize
employees' health insurance policies could put money into the
specified beneficiary fund to help them buy insurance. A person
would take their voucher to the Health Care Clearinghouse and
choose their fund.
1:53:30 PM
CHAIR ELLIS asked if this approach is market-based and consumer
driven.
SENATOR FRENCH replied yes; market-based means you haven't
remade the health insurance landscape to go to a single payer. A
single payer operates in different parts of the country;
Medicare for instance is a single payer for people over 65, the
Veterans Administration is another example. But that model has
never proved to be successful in any setting. So, market-based
preserves the private insurance industry competing for
customers. The consumer driven portion is just that - by letting
an individual with a voucher pick the insurance plan that best
meets his or her needs, the bill maintains the vital market-
place where consumers meet a seller in a free exchange, staying
in line with out capitalistic principles.
SENATOR STEVENS said Senator Ted Stevens was talking about aging
of Alaskans a few days ago in addressing the joint body and
asked if Alaska is any worse than other states.
1:56:51 PM
SENATOR FRENCH replied he didn't know. He thought Senator
Stevens was saying 90 percent of health care costs one incurs
are in the last 18 months of one's life, but he didn't think
that problem had a solution.
CHAIR ELLIS inserted that people are fearful of rationing care
when they get to that age and that this is troubling to medical
ethicists.
SENATOR FRENCH said this approach was first enacted in
Massachusetts where they were "able to meet in the middle."
Everyone could get health insurance entity, and the free market
was maintained. Most models being presented now work along the
lines of this plan.
CHAIR ELLIS said some folks argue for the single payer approach,
which isn't socialized medicine but rather socialized insurance
through a government entity; and there are good examples of
that. He said criticism exists of this approach that the profit
motive is still involved and health insurers will still be
making a profit. He asked Senator French if he had any thoughts
about controlling costs being a negative to the profit side of
the picture.
SENATOR FRENCH replied that is a legitimate concern, but the
central question is if you have a health insurance policy; this
is a pragmatic approach to the problem. The flip side to
lowering costs is better infant care and longer and healthier
lives.
CHAIR ELLIS asked if he just faced up to the political reality
that the U.S. won't likely pass a law to outlaw private health
insurers.
2:00:31 PM
SENATOR FRENCH responded this is a compromise between the left
that wants everybody covered and the right that wants a free
market approach.
SB 160 sectional analysis
2:01:08 PM
Section 1 is the findings section of the bill. Article 2A is the
meat and potatoes of the legislation and starts on page 2, line
26 where it establishes the health care program laying out what
the legislation will accomplish. It ensures that all state
residents can afford quality health care coverage and that it be
meaningful. It reduces unsustainable health care cost increases
through encouraging primary care and prevention and it centers
on consumer choice by providing a framework for competition
where insurance plans must compete to acquire and retain
customers.
Section 21.54.210 on page 3, line 9, establishes the health care
board under the Department of Health and Social Services (DHSS).
It will have 13 voting members divided between those who operate
the business side and those who provide the care delivery:
labor, physicians, nurses and consumers. The commissioner is the
th
13 member serving as a tie-breaker.
SENATOR FRENCH said that Section 21.54.220 describes the powers
and duties of the board. Essentially it oversees the two main
elements of the bill - the health care clearinghouse and the
health care fund. In particular it ensures that a variety of
plans are available in the clearinghouse and that people are
aware of them. It establishes enrollment criteria and procedures
and provides for an annual open season when customers can change
their plans.
2:04:35 PM
He said this annual open season also keeps the competition
element of the bill in force because insurers will have to be
concerned about people jumping from one company to another. That
concern about losing customers helps them drive prices down and
promotes greater efficiency in a private insurance market. The
board will also hear complaints or objections to decisions made
by the program or the clearinghouse; it also has a hearing
process for appeals. Section 21.54.230 on page 5 is about the
Alaska health care clearinghouse.
SENATOR FRENCH said Section 21.54.240 establishes the voucher
system and includes the individual responsibility clause. This
section ensures that all Alaskans can afford quality health
coverage. He explained that the individual responsibility clause
puts the responsibility for having an insurance plan on the
individual, and he remarked that in the past many plans have
called for an employer mandate. This also breaks the problem
with individuals who get insurance through their job and then
lose it when they change jobs by making it portable with the
individual; people now change jobs four or five times in their
lifetimes. It also means that individuals have to step up and
take responsibility for their own health care. The flip side is
once every individual buys health insurance, you can tell the
industry it has to offer insurance to people who ask for it. The
idea is by grabbing the 20-30 year olds who do not have health
insurance and will not buy it unless you nudge them into doing
so, you can get the price down for the rest of the consumers. He
said this vast segment of the Alaskan population believes they
are bullet-proof and expects us to take care of their health
care problems when they crash their snow machine, fall into a
crevasse or their boat runs out of gas in Cook Inlet. We spend
all kinds of money to fix them up; so it's only fair to ask them
to contribute something every month to a health insurance
policy.
2:08:17 PM
He said the sliding scale vouchers are described on page 6 in
subsections (b) - (e). Subsection (c) provides that people who
fall below the federal poverty level (FPL) will receive health
insurance at no cost. Subsection (d) provides vouchers on a
sliding scale to individuals in households that earn between
100-300 percent of the FPL. Subsection (e) on page 7 requires
that all individuals over 300 percent of the FPL acquire health
coverage. While they won't be able to receive a needs based
voucher, they will be eligible to receive "specified beneficiary
vouchers" discussed in a later section of the bill.
SENATOR FRENCH said subsection (b) on page 6 was skipped and
that is about how ACHIA, the state's high risk pool, fits in.
Those rates are typically 150 percent of what normal people pay
for their insurance. For ACHIA, the FPL limit is increased to
450 percent to maintain the proportions of going up the scale in
income.
SENATOR BUNDE went to subsection (f) and asked if an illegal
alien would qualify for this program.
SENATOR FRENCH replied no. But if you're a legal alien - yes.
2:11:30 PM
He said that Section 21.54.250 on page 7 defines essential
health care services. They will include coverage for
preventative and primary care, emergency services, inpatient
services and hospital treatment, ambulatory patient services,
prescription drug coverage and mental health services. Section
21.54.260 on page 7 relates to employer provided health
coverage. Here he emphasized that nothing happens under this
bill if a person already has insurance coverage.
SENATOR BUNDE said including mental health services is being
discussed within the industry and this bill requires it. He
asked if someone's private insurance didn't allow mental health
services, would that mean they would now be required to provide
it.
SENATOR FRENCH answered that is a policy decision the
legislature will have to make. "As proposed, the short answer is
yes."
2:13:27 PM
He said Section 21.54.260 relates to employer provided health
coverage; subsections (a) and (b) clarifies that nothing changes
for employer based health coverage for companies that elect to
provide it. Subsections (c) and (d) pertain to the employer levy
which insures that all employers contribute something to the
health of employees around the state. The levy is only put
against employers who don't offer health coverage and the amount
depends on the number of employees they have. There is no levy
for zero to 10 full-time employees.
2:15:40 PM
SENATOR BUNDE asked how the levy would compare to buying health
insurance.
SENATOR FRENCH replied the levy is fairly low. He said that
business is suspicious; the National Federation of Independent
Businesses is very nervous, but when they realize how it works,
they will see it as a big benefit.
He said Section 21.54.270 on page 8 relates to the structure of
the insurance plans available in the clearinghouse. They are
required to provide coverage for essential health care services
as described in Section 21.54.250. Subsection (b) mandates that
an insurance company not turn down an individual looking for
coverage. He commented that once you require everyone to get in
the pool, the insurance industry has to step up to the plate and
issue a policy. "They are not going to turn you down because of
this - because you're a hundred pounds overweight or you smoke
or whatever it is that they try to use to cull individuals out
of the herd."
2:18:26 PM
SENATOR FRENCH said subsection (c) makes clear that the health
insurance plans can have various levels of deductibles, co-pays
and out of pocket maximums. He said that individuals who are
between 18 and 30 can have a specially crafted plan because
there is no sense in them having insurance for prostate exams,
for example.
Subsection 21.54.290 on page 9 covers disputes and appeals;
subsection 21.54.300 on page 10 requires the Health Care Board
to provide an annual report that includes statistics on how the
health reform program is performing and an evaluation and
recommendations on a variety of topics including the use of
electronic health records.
SENATOR FRENCH said language inserted by the HES Committee on
page 10, lines 23 - 26, requires the board to look at expanding
Medicaid every year versus providing vouchers and providing a
cost comparison - because many reformers believe that simply
expanding Medicaid is the way to cover more individuals. Finally
Section 21.54.310 on page 11 establishes some regulations and
definitions and transitional provisions.
2:21:50 PM
LINDA HALL, Director, Division of Insurance, Department of
Commerce, Community & Economic Development (DCCED) said she had
no position on SB 160. She was interested in the first slide on
the percent of gross national product (GDP) spent on health care
and remarked that she saw a similar slide at a national meeting
that was called "a perfect storm" in reference to projects of
how much of our GDP will be used in consuming health care and as
that increases what happens to the other things we spend money
on. "At some point it does become a value judgment."
She said this particular CS all of a sudden puts this program in
Title 21 Insurance, but the Division of Insurance is a
regulatory agency; it doesn't administer programs and she was
concerned about that. She thought there would be a conflict in
her regulatory role in overseeing the health insurance
companies, adjudicating claims, and similar issues, versus
overseeing the health care board and administering a program.
It's not insurmountable, but at this point she couldn't identify
any department that had the expertise to both talk about
administration of programs and look at insurance coverages and
costs. However, she said the discussion needs to happen.
She said the Department of Health and Social Services (DHSS)
received a federal grant to study the uninsured. She was part of
a team that held regional forums talking to the uninsured about
what they were looking for. The people who participated in the
forums wanted to pay, but they couldn't pay a lot; the number
she heard regularly was $100/month.
2:27:20 PM
She said health care costs in Alaska are 30-plus percent more
than in other states even in Washington. So it's clear that the
cost of health has to be realized; it's the major cross driver
in workers' compensation premiums. She said for two years Alaska
was number one in the highest workers' compensation rates in the
country, and she guessed that we are still in the top five even
with two years of rate decreases.
MS. HALL emphasized that last week she approved an almost 32
percent increase in the premium for individual health insurance
policies written by the state's primary carrier. It was based on
increases in two things: cost of health care (which is keeping
track with inflation) and, even more, increased utilization of
going to the doctor. She said the division's actuary works with
these filings. Two years ago the legislature passed standards
for health insurance rates; rates can't be excessive, inadequate
or unfairly discriminatory. She emphasized that they don't want
inadequate rates because they want the insurance company that
sold the policy to be able to pay the claim. Anyhow, her actuary
tried everything that she could find to reduce this rate, but
couldn't. So she approved it.
2:31:23 PM
MS. HALL said she is still stunned by that and suggested that we
begin to look in smaller steps at what other states are doing to
change in conjunction with the goals of this bill. She had a
list of 10 things she saw in other states that we could start
with to look at the cost of health care. She said the National
Association of Insurance Commissioners (NAIC) spends a lot of
time on health insurance issues. She spends a lot of time
listening to them and to what states are doing "because every
state is suffering from this."
2:32:37 PM
One success she has seen is in Utah where insurance providers
send these bills to a clearinghouse, and it pays probably 90
percent of the claims without a problem.
She said much of the cost of health care is not in the actual
health care; it's in the paperwork that is involved in the
health care system. Utah's system is run by a private entity,
but it is supported by state agencies. She stated that Alaska
has a really good record for telemedicine and she thought
electronic medical records could be expanded.
MS. HALL said she could work with the individual responsibility
the bill sponsor talked about - to talk about evidence-based
medicine and optimizing care suggesting alternative treatment or
generic drugs, consumer education and questioning treatments.
Alaska could expand its efforts in those areas to avoid
emergency room visits and to encourage looking over a bill
received from a doctor. She once had an insurance company that
paid you half of what you saved if you found errors in the
doctor bill.
She said they don't put enough emphasis on employer health
insurer wellness programs - for things like preventative
measures, health assessments and health club memberships. She
has asked for increased funding to investigate and prosecute
health care fraud and they need to talk about what fraud costs
all of us.
MS. HALL concluded that access to health care and finding ways
to pay for it is a complex issue for all Alaskans. She had no
position on this bill, but she urged them to find a way to adopt
some initiatives that could immediately make inroads into the
cost of health care as they study these programs.
2:36:26 PM
CHAIR ELLIS asked if she wanted cost containment requirements
added to the bill.
MS. HALL replied that things like that should be adopted before
looking at spending as much as this bill would require. A health
care board could look into those things and other states have.
CHAIR ELLIS asked how many states have rate review authority
inherent in their division of insurance regulation.
MS. HALL replied she didn't know.
CHAIR ELLIS said most states have stronger authority than
Alaska.
MS. HALL commented that Washington's Division of Insurance
doesn't do rate review, but its legislature has introduced a
bill today to fix that.
CHAIR ELLIS asked if she was requesting rate review authority.
MS. HALL answered not at this time, but it's important to
understand what the division does and doesn't do.
CHAIR ELLIS asked if she requested funding for more
investigative resources to get to the fraud she thinks exists in
the system.
MS. HALL answered yes. She added that she is seeing a number of
bills with insurance coverage mandates. It's important to
recognize she regulates the private insurance marketplace that
sells to individuals and small groups and that those laws
require guaranteed offer of coverage for groups of 2 to 50. So
they are discussing things the division already does. But, she
said, Alaska has a large population of individuals who are
covered under self insurance plans that are governed by federal
law.
CHAIR ELLIS said she is giving them the impression that she
didn't want this authority, and he asked what she thought about
making it a Department of Health and Social Services issue also
and sharing the responsibility with them.
2:41:28 PM
MS. HALL wanted to ponder that.
2:41:42 PM
SENATOR BUNDE said this bill is modeled after the Massachusetts
experience and he has heard various critiques of that.
MS. HALL replied that she is not familiar with that plan, but
has heard mixed reviews. However, she pointed out it is a new
program.
SENATOR BUNDE said some plans are Volkswagen models, but Senator
French's is a Cadillac plan. He asked where she thought this
plan fell.
2:45:05 PM
MS. HALL answered this is the parameters of a program. Different
plans are structured around the country. For instance, Montana
has a bare-bones program that is geared at preventative care and
going in early, and it costs less than $200/month. It depends on
the goal and what their philosophy is about health care and she
said they need to talk about preventative care and end of life
issues, which gets into moral decisions and value judgments. It
gets down to what is most important with health care, and she
thinks preventative measures, disease management programs and
health education are extremely important.
2:46:36 PM
SENATOR BUNDE asked if the proposed assessment would actually
provide the coverage being mandated.
MS. HALL answered that she hadn't analyzed that.
2:47:31 PM
SENATOR STEVENS asked how this would mesh with the extensive
Native health care system in Alaska.
2:48:26 PM
SENATOR FRENCH went to page 6, lines 4-7, where the bill exempts
those who receive Indian health services. The idea is to not
disrupt that system. Many Native Alaskans already have access to
health care, but they don't have health insurance. If you get
sick in Seattle, you can't go to a hospital say "I'm an Alaska
Native; take care of me." They do have access in Anchorage to
the Alaska Native Medical Center, for instance. This bill, in
essence, says that's pretty good. We're going to leave that
alone because it seems like its working, but it's not a perfect
solution.
SENATOR HOFFMAN remarked he can go to the Indian Health Service
Hospital in Seattle, too.
SENATOR STEVENS was worried that Native Alaskans might feel left
out.
SENATOR FRENCH said he is trying to fill the gap to make access
to health care more like health insurance, but to recognize that
a vast majority of those costs are already being absorbed by a
different system. There is no sense in recreating the wheel.
SENATOR HOFFMAN suggested addressing that issue by allowing them
to be covered as a co-insurer.
2:51:17 PM
LYNN HARTZ, Legislative Committee, Alaska Nurses Association,
said that this association represents the Forensic Nurses of
Alaska, Certified Nurse Anesthetists, Certified Nurse Midwives
and the Alaska Nurse Practitioner Association and it supported
SB 160. She elaborated that they favor innovative legislation
that makes health insurance affordable for businesses and
individuals and this bill meets those goals.
2:53:03 PM
GARVAN BUCARIA, former federal employee representing himself,
was very concerned about "mandatory" universal health care. The
increases in his costs over the last year are greatly affecting
his retirement money. He was very concerned that this proposal
didn't eliminate the emergency medical service treatment for
uninsured residents and that it has no upper limit for the
health care fund. He was also concerned that health care costs
are trending upward. For example, he had a CAT-scan that cost
$5,000, but an ultrasound would have revealed the problem at a
far lower cost. He also mentioned that dental costs vary for
services like teeth cleaning, and he thought this meant there
are some possible savings. He would like to see an advertised
cost per treatment for the various medical services so that
clients could level questions at the health professional. He
felt very strongly that education in preventative maintenance
should have high priority; he did not see the need for mandatory
health programs when we are not effectively providing for this
first.
CHAIR ELLIS remarked that separate legislation is before them
this year about publication of relative medical costs in the
state of Alaska so people can shop around.
2:58:52 PM
BEVERLY SMITH, Christian Science Committee on Publication for
Alaska, said she reviews legislation to ensure that it preserves
the choice of Alaskans to pursue spiritual means for the
prevention and cure of disease, including Christian Science
treatment and care, which is cost effective, reliable and
effective. She commended this bill that ensures that everyone
can purchase an affordable health plan that they select to
fulfill their medical needs, but she wanted it to include
coverage for spiritual care similar to the coverage offered by
the federal government and other state plans. In Alaska, she
said, state employees and retirees have insurance coverage that
includes payment to Christian Science practitioners.
MS. SMITH explained that Christian Science is one of the
religious non-medical forms of treatment that is available to
anyone, not just members of the church. It involves reliance on
spiritual means through prayer to heal illness, injuries and
other conditions. It has systematically been practiced quietly
and effectively in many Alaskan families for over 100 years. She
has experience many physical healings through Christian Science.
She said she was not here to take a position on whether health
insurance should be mandated; however any reform discussion
should include an acknowledgment that spiritual care is a
significant part of people's approach to maintaining health and
that costs associated with such care are deserving of inclusion
in health care reform, so that those relying on spiritual means
for healing may have access to their preferred method of
treatment.
She requested that essential health care services as used in
Section 21.54.250 on page 7 be interpreted to include non-
medical health care services for individuals relying on
spiritual means for healing. She provided the committee with the
text of her proposed amendment.
CHAIR ELLIS asked if the state covers Christian Science healing
expenses now.
MS. SMITH replied yes.
SENATOR ELLIS asked if the federal government pays for Christian
Science healing.
MS. SMITH replied that both Medicare and the military benefits
do cover it.
She suggested including language saying "non-medical health care
services for individuals relying solely on spiritual means for
healing in accordance with the practices or tenants of a church
or religious denomination that teaches reliance on spiritual
means through prayer for healing."
3:05:46 PM
PATRICIA BOILY, representing herself, Homer, had some issues
with SB 160. Her impression is that the insurance industry has
had quite a hand in developing much of the criteria in this bill
CHAIR ELLIS remarked "Well, not really."
MS. BOILY said she works in the health care industry and has had
to plead financial bankruptcy because of health care. One of her
concerns was the eligibility to get these services in Section
21.54.240 that excludes people who already have coverage
regardless of how expensive it may be, and it doesn't matter if
the coverage is different. It also excludes anyone who is
already covered by ACHIA, which is a category she falls into,
although reluctantly. She explained that she had group health
for 12 years, but it terminated on 10/31 through no fault of
hers or her employer's and neither she nor her employer could
find affordable health insurance to replace it. In the end he
offered to subsidize individual plans, which was fine for people
who were under 50 without past medical histories.
While at 58 years old, she doesn't consider herself unhealthy,
but she was denied coverage. She further stated that 25 percent
of women over 50 are denied health care insurance. Her only
option to appeal the denial was to send her entire medical
record to them, which to her was an intolerable invasion of
privacy. She settled for the ACHIA plan with the $5000
deductible. So, if she gets sick or injured this year enough to
actually use it, it will start out by costing her $16000. If she
stays well enough that she doesn't make her deductible it will
still cost her almost $10000 - plus up the $5000 deductible.
MS. BOILY said she has worked for the same employer for 20 years
and finding herself in this predicament is unsettling, to say
the very least. But to go without any insurance at all puts her
family and her future at incredible risk.
She said that small businesses in Alaska are having a particular
hard time in today's market. They are not allowed to
discriminate against their employees based on age or sex and
they are required to abide by the Americans with Disabilities
Act. Yet when they purchase insurance for their employees, the
quotes they get back are based entirely on the ages, the sex and
the past medical histories of their employees. She said:
This is wrong and Alaska needs to step up to the plate
and stop the insurance industry from making its
profits off the relatively healthy, while leaving
those with maturity and experience scrambling to
protect their homes, their life savings and their
financial security. Alaska needs to address the dual
standards that force businesses to be equal
opportunity employers yet denies them the ability to
offer their employees affordable health care coverage.
3:09:17 PM
She said SB 160 "needs more tweaking." All Alaskans regardless
of what coverage they have currently should have the option to
improve their situation. She suggested the insurance industry is
practicing discrimination while charging too much for their
products.
MS. BOILY took issue with some of Ms. Hall's statements that
health care premiums are high because of the high cost of health
care. But this is an industry that pays its CEOs millions of
dollars in salaries, stock options and other benefits.
3:12:29 PM
ANDY MODEROW, staff to Senator French, said the website Senator
French created over the summer to share information about the
bill is at www.healthyalaskans.com. In addition to bill
documents, it has an interactive calculator for comparing health
care costs in different states.
CHAIR ELLIS said he would hold SB 160 for a further hearing.
There being no further business to come before the committee, he
adjourned the meeting at 3:15:01 PM.
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