CSSB 253(FIN) - INS.FOR PROSTATE & CERVICAL CANCER TESTS Number 007 CO-CHAIR BUNDE announced that CSSB 253(FIN) was the only bill on the agenda for the meeting. He asked Gene Dau to come forward and testify. Number 097 GENE DAU, Representative, American Association of Retired Persons and Veterans of Foreign Wars testified in support of CSSB 253(FIN). He noted that in the last meeting on CSSB 253(FIN) Co-Chair Toohey had asked him if he would have the PSA test again if he had to pay for it personally. He neglected to report at that time that he is a disabled veteran and the Veteran's Administration pays his medical costs. He recalled the testimony from representatives of the insurance companies at the last meeting indicating this was an experimental procedure. According to conversations with his doctor, it is not an experimental procedure; it is well established and it is within 5 percentage points of being 100 percent. His doctor had also pointed out that with the PSA test, the cancer can be detected much earlier than with the other test. He encouraged committee members to pass this bill out of committee. Number 280 CO-CHAIR TOOHEY commented the test is absolutely no good unless a person gets the test. MR. DAU said that's why people should be encouraged to get the test. He noted that if the Veteran's Administration had not paid for his first PSA test, he may have put it off to the following year. He believed that men would be more inclined to have the first PSA test done if the cost was covered by insurance. Number 368 CAROLE EDWARDS, Certified Oncology Nurse, testified that she has been nationally certified for nine years and serves on a national committee. She stated that last year when her husband had his annual physical, everything was covered by the insurance company except for the PSA testing. She noted he does carry the Supplemental Benefit with the state of Alaska. They contacted Senator Duncan and asked him to look into the matter. Her father- in-law died of prostate cancer at the age of 82. Many men do die with prostate cancer in their advanced years, not of it; however, he happened to die of it. That puts her husband at high risk in that anyone who has a father or brother who has had prostate cancer is considered a high risk patient just as a woman who has a mother, sister or first degree relative is considered at high risk for breast cancer. She pointed out that about seven years ago, Texas was the first state to mandate by law that mammogram screening be paid for according to the American Cancer Society guidelines for women to find breast cancer earlier. Many of the states followed suit and she believed there were now 48 states which mandate by law that mammograms be paid for by insurance companies. Until that time, the insurance companies would pay only if there was a symptom. The same thing is happening with prostate cancer in men and she felt that men have the same right to have early screening for prostate cancer that women have for breast cancer. Her husband just recently had his physical and if Aetna doesn't pay for the PSA test, they will pay for it personally. They are in a position to pay, but the economically disadvantaged and less educated people are not going to make the decision on their own to pay $70 for a test that might well save their lives. In her profession, she administers chemotherapy for people in the advanced stages of cancer and she tries to help these people through it as best she can. She would like to save lives by either preventing cancer by teaching people what they need to do to prevent cancer in the first place, or save lives and money by finding it early before it has metastasized to other body parts. Number 583 CO-CHAIR TOOHEY commented that Ms. Edwards had mentioned the cost of a PSA test was $70; however, according to information she had received the test can be done at Bartlett Memorial Hospital for $26.50. MS. EDWARDS stated she had contacted the lab and was told the cost was $70. CO-CHAIR TOOHEY responded that Bartlett Memorial Hospital contracts with a lab in Seattle and gets tests done for a rate of $26.50 plus carrying and handling charges. Also, the Health Fair charges $30 for a PSA test. MS. EDWARDS didn't know what the handling charges were but she was told $60-$70 for the cost of the test by the lab at the hospital which was the cost last year when her husband had the test. She commented that in an earlier discussion, Co-Chair Toohey had stated that she didn't like to see government get involved and mandate health care. As a health care provider, Ms. Edwards agreed 100 percent but added that health care is being mandated by the insurance companies in what they will or won't pay, not by the doctors according to what they feel is necessary for the patient. In her own personal situation, it is important that her husband have a PSA test annually, but the insurance company is refusing to cover the cost. She commented the test is controversial, but more and more studies are being released which support PSA screening in that it is more accurate, it is decreasing mortality and morbidity and it is more accepted as a stronger and beneficial test. She believed that in the next year or two there will be more research studies; John's Hopkins is very involved in research studies in this area at the present time. MS. EDWARDS concluded that she would like to see it mandated by the state of Alaska that insurance companies pay for the test according to the American Cancer Society guidelines, which would be an annual screening for men over the age of 50, and for men over the age of 40 if they are high risk. CO-CHAIR TOOHEY interjected that was part of the existing contract. There had been previous testimony that if there was suspicion following a digital examination, the insurance companies would cover the cost of the PSA testing. It is not however, offered as an option for a screening at this time. Number 797 CO-CHAIR BUNDE recalled there had been testimony from three individuals who had undergone PSA testing by the same physician and the rate was $25-$30. Based on articles that he had read, it was decided initially that the screening wasn't the "end all/be all," statistically it increased the life expectancy of an individual for only six months and if individuals were scared into or encouraged into surgery, the consequences of the surgery could be devastating. He asked Ms. Edwards to comment. MS. EDWARDS said the background was that when autopsies were done on men over the age of 90, almost 100 percent had prostate cancer. Therefore, the older a man gets, the more likely he is to have prostate cancer, but will not die from it. However, if a man in his 50s has prostate cancer, there is a very good chance he will die from it, not with it. There is a better chance of saving lives if it is detected early and men in the 50-70 age group have a better chance. She stated the surgery has greatly improved in the last couple of years. There is decreased impotence and incontinence now with the surgery which were issues that impacted the quality of a person's life. Number 945 KRISTINE PELLET, Student Intern for Senator Jim Duncan, testified that Senator Duncan feels the amendment would defeat the purpose of the bill. She noted that it is currently on the list of offerings, so essentially it would do nothing. By making it a mandatory offering, there is no way to encourage men who are unaware of the benefits of early screening and there is no way of educating them of the relevancy of the PSA test. She pointed out that page 2, Section 1(e), does allow for more advanced testing, not just the PSA test. CO-CHAIR TOOHEY questioned the zero fiscal note. MS. PELLET deferred that question to Janet Parker of the Division of Retirement & Benefits. Number 1006 JANET PARKER, Deputy Director, Division of Retirement & Benefits, Department of Administration, explained the state plan already pays for a medically necessary PSA exam. The only PSA exams that are currently not covered are in a routine screening when individuals are having a well-physical exam. The well-physical exam is paid for by state employees themselves under the Supplemental Benefits System (SBS) Option 1 plan. There is no additional cost to the state. CO-CHAIR BUNDE remarked if that's the way things are now, then people who are unaware are not going to be encouraged to take the PSA test. He wondered what would change if the legislation passed as it is written; individuals would still be paying for their well- physical and not covered by insurance. MS. PARKER said if the bill passes, as it is written which mandates PSA coverage, when a person has their well-physical and the doctor includes that PSA test, whether it is requested by the patient or not, it will be covered by their insurance. CO-CHAIR TOOHEY asked if there was no charge? MS. PARKER replied not to the state. She explained a fiscal note is based upon what additional state dollars are required. CO-CHAIR TOOHEY questioned the impact of the inclusion of this provision when the insurance plan is renegotiated. MS. PARKER said there would be no fiscal impact to the state because the entire cost of the well-physical exam is paid by the employee. She explained it was about $20 through an employee's SBS premiums for employee only coverage. Number 1112 CO-CHAIR BUNDE said that's his point exactly. The employees are paying for the well-physical. If this legislation passes and the employee wants a PSA test, they get it but they're still paying for the well-physical. CO-CHAIR TOOHEY inquired why this bill was needed. Number 1135 BOB STALNAKER, Director, Division of Retirement & Benefits, Department of Administration, directed the committee's attention to the analysis of the fiscal note which addresses the fact that it is anticipated to increase the costs of the SBS Option 1 by about $60,000 per year. That's the additional cost of having the PSA test included under the Option 1. The reason the fiscal note is zero on its face is because that cost is picked up by the employees who elect to pay for Option 1. He explained that whether that $60,000 would in fact have any kind of impact on the $50 a month per family or $25 a month for an individual is hard to tell because $60,000 is not a lot of money when it is spread over the thousands of people who select Option 1. Number 1189 CO-CHAIR BUNDE said in reality this bill as it is written is a mandatory offering; it's offered, people can have it, but they pay for it. MR. STALNAKER said, "I think we too often get into what I think in this bill is confusing the state plan with something offered to everybody. The fact that the state plan has through public policy by administrations, the legislature and the unions in collective bargaining, include a lot of things that most plans don't include because it's a good idea. And as I testified before, I may not personally support mandated coverages across-the-board; there are times when it's wise to do it. I think mammograms is a prime case of that and I think statistics will show overall health costs will decrease over time because of that. I think this is another example of that. I think we will find over time that this will detect a disease that every man has at some time in his life. Some people die of it and this will detect it at an earlier, much less costly stage." Number 1262 CO-CHAIR TOOHEY said the pros and cons of these tests are not the discussion, but rather is it government's job to mandate that a person get these tests; who was paying for it. She commented they had spent the last five months cutting the budget by $70 million; how could it be explained they were now raising it by $60,000 because people do not have enough education to spend $30 to get their own PSA test. She questioned whether people really needed to be "spoon fed." MR. STALNAKER understood what Co-Chair Toohey was getting at, but there are times when it is appropriate to "spoon feed" someone because the cost of the test may mean buying a new pair of shoes for the kids or whatever, and they won't do it on their own. CO-CHAIR BUNDE asked if there were further questions or testimony. Hearing none, he closed the meeting to public testimony. He had an amendment making it a mandatory offering, not a mandatory coverage. Number 1370 CO-CHAIR TOOHEY moved to adopt Amendment 1. REPRESENTATIVE ROBINSON objected. CO-CHAIR BUNDE thought the committee understood the philosophical difference between mandatory coverage and mandatory offering. He asked if there was further discussion. Hearing none, he asked for a roll call vote. Voting in favor to adopt Amendment 1 were Representatives Davis, Toohey and Bunde. Voting against Amendment 1 were Representatives Robinson and Brice. Number 1385 REPRESENTATIVE ROBINSON made a motion to pass HCS CSSB 253(HES) with attached fiscal notes and individual recommendations out of committee. Hearing no objection, it was so ordered.