HB 1-POLICY FOR SECURING HEALTH CARE SERVICES  3:03:20 PM CHAIR KELLER announced that the first order of business would be HOUSE BILL NO. 1, "An Act stating a public policy that allows a person to choose or decline any mode of securing health care services." 3:05:44 PM KAREN SAWYER, Staff, Representative Carl Gatto, Alaska State Legislature, presented HB 1 and stated: This bill is not really about health insurance or health care services, but it's rather about state rights. We allege that the new federal law passed last year, "Patient Protection and Affordable Care Act," otherwise also known as Obamacare, infringes upon the constitutional rights of U.S. individuals by mandating all citizens and legal residents have qualifying health care coverage or pay a tax penalty. By imposing such a mandate, this law exceeds the powers of the United States under the Constitution. We're not challenging the authority of the federal government, they've actually challenged our authority, and it's up to us to defend ourselves. If we don't, this is just the beginning of more federal take-over. Therefore, this bill will codify as state policy that every person in the State of Alaska is and shall continue to be free from federal government force in the selection of health insurance options, and that such liberty is protected by the constitutions of the United States and the State of Alaska. This bill also removes the authority of any state official or employee from enforcing any penalty which violates the policy. 3:07:07 PM MS. SAWYER referred to the handout, titled "HB 1-Explanation of:" [Included in members' packets]. She stated that the sponsor was agreeable to having this explanation included in the bill. CHAIR KELLER clarified that HB 1, Version A, was in front of the committee. MS. SAWYER, referring to the "Patient Protection and Affordable Care Act," reported that nationwide, 40 state legislators had "introduced legislation to limit, alter, or oppose selected federal actions regarding this bill, including single care provisions and mandates that would require purchase of insurance." She asked that Alaska join the seven other states which enacted legislation "to establish the individual's right in their state to be free of federal government force to make their own choice about health care." She quoted a statement by former Supreme Court Justice Sandra Day O'Connor regarding the federal regulation of states. 3:08:58 PM REPRESENTATIVE SEATON offered his belief that HB 1 limited state action, not federal action. As he did not see any naming of the federal government, he opined that the requirement was for the state or within the state. MS. SAWYER replied that HB 1 would put into policy that Alaska guaranteed for individuals to have the right to choose. 3:10:39 PM REPRESENTATIVE SEATON, referring to an initiative for managed care on the Kenai Peninsula, asked if HB 1 would prevent health care by a subdivision of the state. MS. SAWYER offered her belief that HB 1 prevented a mandate for Alaskans to buy health care, except for those provisions listed on page 1, line 12. 3:11:58 PM REPRESENTATIVE MILLER asked to clarify that the bill sponsors deemed the "Patient Protection and Affordable Care Act" as unconstitutional. He stated that of the five court cases regarding this, three had ruled for its constitutionality. He pointed to the recent court ruling in Florida which directed that portions of the federal health care act should be implemented. He asked if HB 1 was a bit premature. MS. SAWYER offered her understanding that the recent Florida ruling was a 7 day stay for appeal. She declared that the sponsors still desired that HB 1 become a state policy "that will protect us." 3:13:55 PM REPRESENTATIVE MILLER asked to clarify that HB 1 stated that Alaskans are free to choose or decline any mode of obtaining health care, but that HB 1 does not apply to health care services that might be required by the State of Alaska. MS. SAWYER concurred, and she directed attention to the handout, "HB 1-Explanation of:" REPRESENTATIVE MILLER opined that HB 1 stated that "the federal government can't mandate anything, but the state still retains its ability to do so." MS. SAWYER concurred. 3:14:50 PM REPRESENTATIVE HERRON asked how HB 1 addressed the problem of uninsured people going to hospital emergency rooms. MS. SAWYER replied that HB 1 did not address any provisions for health care service. She offered her belief that HB 1 was "about just the federal government telling the states, the individuals of our state, that they have to do something, or be taxed." She stated that her limited understanding of the "Patient Protection and Affordable Care Act" was that there would "still be a significant number of individuals who will still not have health care." She opined that many more people would be added to Medicaid. 3:16:23 PM REPRESENTATIVE HERRON, reading from HB 1, summarized that Alaska was creating "a policy of the State of Alaska that [a person has] the right to choose or decline any mode of obtaining health care services without penalty or threat of penalty." Offering an assumption for the passage of HB 1, he inquired to the efficacy for the passage of a policy to stop any chosen federal law or mandate to which some people disagree. MS. SAWYER replied that HB 1 could set an important precedent for future federal mandates. She declared that Alaska was an important state to the federal government. 3:17:43 PM REPRESENTATIVE MILLETT asked how many states had passed similar legislation. MS. SAWYER replied that seven states had similar legislation. REPRESENTATIVE MILLETT asked about any anticipated federal response. MS. SAWYER offered her belief that the federal government "was just waiting to see what's going to happen." She opined that even with passage of the Patient Protection and Affordable Care Act, there was no enforcement to non-compliance. She declared that President Obama had relaxed some of his provisions, allowing states to offer alternative choices. 3:19:54 PM REPRESENTATIVE MILLETT asked to clarify that greater opposition to the federal health care act would lead to removal of the more stringent requirements. MS. SAWYER offered her belief that a majority of the country was opposed to the mandate, and that would make a difference. 3:21:02 PM REPRESENTATIVE MILLER asked whether there was a state requirement for vaccines to children attending public school. MS. SAWYER offered her belief that it was a requirement, and, in response to Representative Miller, she relayed that the vaccines would still be required. She emphasized the importance of the list on the handout. 3:21:45 PM REPRESENTATIVE MILLER, referencing the vaccines, asked if there were any health mandates that came from federal legislation. MS. SAWYER replied that she would look into it. 3:22:24 PM REPRESENTATIVE MILLER, referring to the mandatory vaccine for smallpox in 1969, opined that HB 1 would allow him to now decline anything similar. MS. SAWYER, referring to (9) of the handout, said that the committee could include something to cover this. 3:23:30 PM REPRESENTATIVE MILLER offered his belief that vaccines for any naturally occurring diseases, listing HIV, tuberculosis, polio, malaria, or dengue fever, would not be mandatory under HB 1. MS. SAWYER opined that vaccinations were not mandatory for Alaskans. REPRESENTATIVE MILLER agreed, stating that HB 1 would enforce that, no matter whether public health was threatened. 3:24:37 PM MS. SAWYER declared that even knowingly having a disease still did not mandate a vaccination. REPRESENTATIVE MILLER, directing attention to page 2, line 3, suggested the addition of prevention. 3:25:14 PM CHAIR KELLER opened public testimony. 3:26:17 PM PAT LUBY, Advocacy Director, AARP, declared that "many well meaning people have completely opposite positions on the federal health care reform bill, especially the individual mandate." He pointed out that people had declined health insurance for many years. He noted that many others, including older people, wanted health insurance but could not secure it. He stated that 19 percent of Alaskans between 50 and 64 were uninsured. He reported that the uninsured ended up in the emergency room, which was paid for by those who had insurance. He estimated that every Alaskan family spent $1900 annually toward people without insurance. He emphasized that the State of Alaska, and private employers who provided insurance, among others, paid for the uninsured, as the costs were shifted to those with coverage. He pointed out that proposed HB 1 would continue the practice of cost shifting. 3:28:33 PM MR. LUBY relayed the story of an accident to a 54 year old with no health insurance. He defined cost shifting as the payment for these incidences by those who did have health insurance. He declared that HB 1 had nothing to do with freedom of choice, it had to do with cost shifting. He established that the Patient Protection and Affordable Care Act would subsidize those who could not afford health insurance. He affirmed that HB 1 would continue cost shifting to those who did have insurance. 3:30:06 PM CHAIR KELLER asked which was more important, choice or paying your own way. He offered his belief that it was unprecedented for any government to declare that it was mandatory to buy a commodity or a service. MR. LUBY compared the federal health care act to social security, and stated that it provided for retirement or disability. He noted that it was mandatory, and it ensured that the public would not have to provide for an individual. He indicated that this was the basis for the Patient Protection and Affordable Care Act. 3:31:56 PM REPRESENTATIVE SEATON asked to clarify that if an individual declined health insurance, they would be responsible for any costs incurred. MR. LUBY replied that the Supreme Court had ruled that an individual had to be treated; however, the cost would be paid by those with insurance. 3:33:13 PM REPRESENTATIVE SEATON, pointing to line 10, referred to "without penalty or threat of penalty," and asked if this could include personal liability as an individual consequence. MR. LUBY determined that the only exclusion within the Patient Protection and Affordable Care Act was to decline the purchase of insurance for religious reasons. He explained the sliding scale for payment of basic health coverage, and confirmed that there was a tax penalty for failure to purchase health insurance. He declared that even the payment of a tax penalty would still require hospital payment by someone else. 3:35:27 PM REPRESENTATIVE SEATON declared that proposed HB 1 concerned itself with a policy of the state, and not with the Patient Protection and Affordable Care Act. He questioned whether HB 1 removed personal liability for an individual who refused health insurance. He asked Mr. Luby if inclusion of personal liability would address some of the AARP concerns. MR. LUBY opined that the health exchange would offer many choices, and that some individuals would choose to pay the penalty and pay for their own health care costs. 3:38:09 PM REPRESENTATIVE HERRON asked if proposed HB 1 would affect federal law. He questioned whether a lawsuit would be a substitute for the bill. 3:38:39 PM SIGNE ANDERSON, Chief Assistant Attorney General - Statewide Section Supervisor, Commercial/Fair Business Section, Civil Division (Anchorage), Department of Law (DOL), replied that the state was already a party to a lawsuit challenging the Patient Protection and Affordable Care Act. She offered her belief that proposed HB 1 was a policy statement in support of the lawsuit. 3:39:00 PM REPRESENTATIVE SEATON, referring to page 1, line 9, asked if "decline any mode of obtaining health care services without penalty or threat of penalty" could be amended to ensure personal liability for the costs associated with health care service. MS. ANDERSON replied that HB 1 could be amended. She stated that the definition of "penalty" only included a fine, tax, surcharge fee, or similar. She declared that all ambiguity could be removed with an amendment. 3:40:25 PM CHAIR KELLER closed public testimony. 3:40:49 PM CHAIR KELLER commented that HB 1 "is so easy to understand" if individuals take responsibility for paying for their own health care. [HB 1 was held over.]