SENATE BILL NO. 276 "An Act requiring that health care insurers provide coverage for treatment of diabetes." This was the first hearing for this bill in the Senate Finance Committee. SHARON CLARK, Aide to Senator Miller read the sponsor statement into the record. SB 276 would require that health insurers in Alaska provide coverage for diabetes equipment, training and education as deemed necessary by state licensed health care providers. To date, 37 states have enacted legislation providing similar diabetes coverage. Over 30,000 Alaskans are affected by diabetes. Without education or proper treatment, diabetes can lead to kidney failure, amputation, nerve damage, blindness and other associated suffering; and the resulting costs are often avoidable through patient education on proper nutrition, exercise, blood sugar monitoring and medication. Education is the foundation of quality diabetes care. It is the process of providing the person with diabetes the knowledge and skills needed to perform self-care, prevent crisis and make important life style changes required to effectively avoid complications. Through proper education, the diabetic may assume his/her appropriate role as an active participant in the treatment plan. A number of published studies by the American Diabetes Association (ADA) show decreased in health care utilization for people with diabetes receiving appropriate education and access to supplies. A Milliman study for the ADA estimates annual savings of $917 per person with diabetes that translates into savings for the insurance industry as well. SB 276 promotes better health, and ultimately, lower health costs for the people of Alaska. I urge your support of SB 276. She told of Ms. Betsy Turner-Bogren and her son, Max Bogren's visit to Juneau and the Senate Labor and Commerce Committee to testify about Max's experiences with diabetes. She referred to a handout detailing the visit. [Copy on file.] She mentioned two concerns voiced in the previous committee. One dealt with whether the coverage should be mandated and the other was raised by Senator P. Kelly and related to the use of the word "nutrition". She stated the concerns were addressed in two proposed amendments before the Committee. Co-Chair Torgerson stated his intent was not to consider any amendments at this meeting to allow members an opportunity to review them. Senator Leman supported the bill in concept but was concerned that if the coverage is provided, the door is opened for reimbursement of all types of charges without review. Tape: SFC - 00 #53, Side B 9:49 AM Senator Leman mentioned a pump that cost $5,600, as an example. He was also concerned about the amount of time necessary to provide education. He had initially heard that an average of six hours of training per year at $250 would be average, but had since heard that training could go much longer and cost up to $1500. Ms. Clark remembered when the issue was raised in the Senate Labor and Commerce Committee but noted that different patients had different needs, different types of diabetes and therefore, different amounts of training. She agreed there would be situations where some patients would require more training than just six hours per year. She said that Senator Miller thought there would be justification for the additional training for some people. Co-Chair Torgerson thought this was an important bill but also thought the education provision was broad based. He suggested that a patient could go to college to learn about diabetes and the insurance company would have to pay the tuition. Ms. Clark said Senator Miller had stated in the previous committee that he hoped health care providers would be self- limiting and that statute would not impose a limit to the amount of money to reimburse training. She deferred to members in the audience waiting to testify who live with diabetes every day. Co-Chair Torgerson wanted to know how other states and other insurance carriers addressed this issue. DON LOVATNY, Volunteer, American Diabetes Association, Board Member, Pacific Northwest Board of ADA testified that he has had diabetes for 21 years and that diabetes takes a lot of time in one's life. He explained there are two types of diabetes: Type 2 affects about 80 percent of those with the disease and usually requires no insulin treatment and Type 1 does require insulin and also extends hospital stays by an average of one day per visit. He stated that hospitalization costs about $1620 per day in Alaska for a patient with diabetes. His organizations' goals are to keep those people out of the hospital. Mr. Lovatny told the Committee that diabetes is on the rise and is the seventh leading cause of death in Alaska, according to the Bureau of Vital Statistics. He listed percentages of those affected and the costs for treatment. Mr. Lovatny stressed that rationing of services was not the answer and urged the Committee to pass the legislation. CHRIS HOLZWARTH passed out buttons to the Committee members. He spoke of his history with diabetes and how his recently acquired insulin pump has improved his life. He stated that different people require different amounts of care and that the educational needs differ for different patients to learn what they need to know to survive the disease. He stated that Mr. Lovatny had given up much of his time to assist with learning how to use the pump and give general insight on living with the disease. Senator Leman clarified that he was not opposed to funding the education, but warned that without some constraint, the highest costing method of service would always be utilized. He praised Mr. Lovatny for donating his time to Mr. Hollsworth in helping educate Mr. Hollsworth. JULIE BURNS Mother of Chris Hollsworth, talked about Mr. Lovatny's assistance. However, she noted that it was only because of his employment with the provider of the pump that he was able to help them. She stressed that family members need training as well. As the family cook, she said it is important for her to know what to feed her son and the implications his diet has on his health. She then talked about the amount of time diabetics must spend on insurance matters to obtain coverage for daily needs. She went into detail about the supplies, such as syringes and test strips, that are not covered by insurance yet still necessary. MICHELLE CASSANO spoke of her appreciation that 37 other states adopted similar legislation to what was before the Committee. She noted that of these states, there have been no repeals of these statutes. Ms. Cassano stressed that a diabetic has diabetes every day and that there is no cure. She added there have been no reports of abuse of the new laws in other states. She told of studies showing that when a patient properly cares for diabetes, the incidence of related complications is greatly decreased. GORDON EVANS, Lobbyist representing the Health Insurance Association of America (HIAA) testified that his organization opposed any mandate but had since made some concessions. He told of how he proposed to his client, a cap of $250 per person per year. He said he then agreed to a $1000 cap with a sunset clause to review the appropriateness of the amount that but his client said he had spoken out of line and could only offer a maximum of $750. He stated that the average annual cost for these diabetes-related services is $1000 and that his client directed him to meet the amount halfway at $500. He had warned his client that the legislation would be adopted in some form, either with a reasonable cap or no cap at all and insurance would be required to pay the entire amount. Mr. Gordon relayed that the HIAA was in support of the proposed Amendment #2. Co-Chair Torgerson commented that it was not his intent to negotiate a cap amount. He stated that the Committee planned to research the matter, learn what other states allow and discuss the merits of the coverage. Co-Chair Torgerson ordered the bill HELD in Committee.