HB 1 - POLICY FOR SECURING HEALTH CARE SERVICES 2:39:24 PM CHAIR GATTO announced that the final 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." [Before the committee was CSHB 1(HSS).] REPRESENTATIVE LYNN mentioned that he is one of HB 1's joint prime sponsors. 2:40:01 PM KAREN SAWYER, Staff, Representative Carl Gatto, Alaska State Legislature, on behalf of Representative Gatto, one of HB 1's joint prime sponsors, said HB 1 is about state's rights, and indicated that the joint prime sponsors are alleging that the federal Patient Protection and Affordable Care Act (PPACA) infringes upon the constitutional rights of U.S. citizens/residents by mandating that everyone either have qualifying healthcare coverage or pay a tax penalty, that this mandate exceeds the federal government's constitutional authority, and that Congress doesn't have the authority under the Commerce Clause to regulate inactivity. The PPACA is challenging Alaska's authority as a state, and thus it is up to Alaska to defend itself from such federal "takeover," she added. House Bill 1 - by establishing in Alaska's uncodified law a state policy that a person has the right to choose or decline any mode of obtaining healthcare services without penalty or threat of penalty - would ensure that everyone in Alaska is and shall continue to be free from federal mandates regarding the selection of health insurance, and would preclude any State of Alaska employee from enforcing any penalty assessed in violation of this policy. MS. SAWYER, referring to a handout in members' packets containing examples, noted that language in HB 1 - specifically in proposed AS 44.99.130(b) - stipulates that the proposed state policy shall not apply to healthcare services provided or required by the state, a political subdivision of the state, or a court of the state, and may not impair a contract right that provides healthcare services. Members' packets also include an explanation of the change incorporated into CSHB 1(HSS), that being the addition of language in proposed AS 44.99.130(c)(3) stipulating that as used in proposed AS 44.99.130, the term, "penalty" is not referring to one's liability for the cost of healthcare services. She offered her understanding that at least 40 states thus far have introduced legislation to limit, alter, or oppose specific federal actions [related to the PPACA] - including that of mandating the purchase of insurance - with the states of Virginia, Idaho, Utah, Georgia, Louisiana, Arizona, [Oklahoma,] Missouri, and North Carolina having already passed [such legislation]. MS. SAWYER, in response to questions, indicated that the aforementioned handout containing examples was derived from material pertaining to similar legislation in another state; and that the exemption provided for in proposed AS 44.99.130(b) would not apply to private employers/employees - in other words, the state policy outlined in proposed AS 44.99.130(a) would apply to private employers/employees. CHAIR GATTO, speaking as one of HB 1's joint prime sponsors, concurred with the latter point. 2:48:05 PM REPRESENTATIVE GRUENBERG indicated that he didn't want HB 1 to be misinterpreted as allowing someone to refuse medical treatment for his/her child, or as allowing someone to refuse to pay for medical treatment. CHAIR GATTO offered his belief that the requirement of a parent to care for his/her child wouldn't be diminished by the bill, and indicated that he would be amenable to amending the bill in order to ensure that that is actually the case. REPRESENTATIVE KELLER observed that proposed AS 44.99.130(a) says in part, "a person has the right to choose or decline any mode of obtaining health care services without penalty or threat of penalty", and that language in proposed AS 44.99.130(c)(2) defines the phrase, "mode of obtaining" to mean either directly purchasing healthcare services from a healthcare provider, or purchasing insurance to cover the cost of healthcare services. House Bill 1, therefore, addresses the purchasing of healthcare services [or the purchasing of insurance to cover healthcare services], not the obtaining of medical treatment. CHAIR GATTO and MS. SAWYER concurred. CHAIR GATTO, in response to a question, offered his belief that under the bill, a union member would have the right to decline any insurance coverage provided by the union, surmising that the other union members would have to absorb any extra cost associated with that member's declination. REPRESENTATIVE HOLMES expressed concern that because the proposed state policy uses the phrase, "a person has the right to choose or decline any mode of obtaining health care services", the bill would allow an employee to dictate which insurance coverage his/her employer must provide him/her with. CHAIR GATTO offered his understanding that the employee could only accept or decline the mode that was being offered. REPRESENTATIVE HOLMES pointed out, though, that the bill doesn't say, "accept" - it instead says, "choose". Furthermore, the proposed state policy doesn't specify that the particular healthcare services being obtained must be legal in Alaska. 2:59:52 PM STACIE KRALY, Chief Assistant Attorney General - Statewide Section Supervisor, Human Services Section, Civil Division (Juneau), Department of Law (DOL), concurred that the word, "choose" has a different connotation than the word, "accept", and indicated that that point ought to be clarified, particularly if the intent of the bill is to address only offered modes of obtaining healthcare services. CHAIR GATTO suggested that they change the word, "choose" to the word, "accept", and add the word "offered". MS. KRALY surmised that such changes would address the concern that under the bill as currently written, an employee could dictate which insurance coverage his/her employer must provide him/her with. On the issue of healthcare services that aren't legal in Alaska, she ventured that this probably isn't going to be a problem because of the definitions of the terms, "health care services" and "penalty" provided for via proposed AS 44.99.130(c)(1) and (3), and because the term, "penalty" as used in the bill pertains to the preclusion of any penalty that might be assessed a person simply because he/she exercised his/her right to choose or decline a mode of obtaining healthcare services. In conclusion, she reiterated her belief that the suggested change would provide clarity. REPRESENTATIVE HOLMES ventured that perhaps they also ought to alter the definitions in proposed subsection (c). She then asked whether the bill would also apply to other federal laws, not just the PPACA. MS. KRALY surmised that HB 1 potentially could apply to other federal laws that address the issue of obtaining healthcare services, since the bill isn't exclusively tagged to or tasked to the PPACA. In response to a question, she offered her belief that under HB 1 as currently written, a person would have the right to accept or decline any mode of obtaining healthcare services, regardless of who offers the mode. REPRESENTATIVE HOLMES disagreed, pointing out that proposed AS 44.99.130(b)(1) stipulates that the proposed state policy shall not apply to healthcare services provided or required by the state, a political subdivision of the state, or a court of the state. MS. KRALY concurred with that clarification. 3:05:44 PM MS. SAWYER, on the issue of healthcare services that aren't legal in Alaska, questioned whether altering proposed AS 44.99.130(c)(1)'s definition of the term, "health care services" by inserting the word, "legal" on page 2, line 2, before the phrase, "service or treatment", would perhaps address members' concerns. MS. KRALY, indicating that she would have to research that issue further, posited that perhaps it would be more important to clarify in the bill that it is intended to allow individuals to choose not to purchase/have healthcare insurance. MS. SAWYER, in response to a question, clarified that the PPACA just mandates that everyone have insurance or be penalized, and that the joint prime sponsors' concern is that they don't want the federal government telling Alaskans that they have to do a particular thing or be penalized for inactivity. In further response, she offered her understanding of what the penalty amount would be under the PPACA, noting that the amount would increase after the first year. REPRESENTATIVE THOMPSON - on the question of whether under the bill, union members would have the right to decline insurance coverage provided by the union - pointed out that [contrary to something mentioned earlier,] proposed AS 44.99.130(b)(2) stipulates that the proposed state policy may not impair a contract right that provides healthcare services. 3:09:37 PM CHAIR GATTO made a motion to adopt Conceptual Amendment 1, to replace the word, "choose" with the word, "accept", on page 1, line 9; and to add the word, "offered" to page 1, line 10. MS. SAWYER observed that the title of the bill should be similarly altered. CHAIR GATTO - noting that the drafter would determine the best placement for the added word, "offered" - clarified that Conceptual Amendment 1 would also make a conforming change to the title on line 1 of page 1. After ascertaining that there were no objections, he announced that Conceptual Amendment 1 was adopted. CHAIR GATTO then relayed that [CSHB 1(HSS), as amended,] would be held over.