HB 1 - POLICY FOR SECURING HEALTH CARE SERVICES 2:14:03 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), and a proposed committee substitute (CS) for HB 1, Version 27- LS0006\B, Bailey, 4/1/11, which had been adopted as the working document on 4/4/11.] CHAIR GATTO mentioned that he's one of HB 1's joint prime sponsors. 2:14:22 PM KAREN SAWYER, Staff, Representative Carl Gatto, Alaska State Legislature, on behalf of Representative Gatto, one of HB 1's joint prime sponsors, relayed that during the bill's last hearing, a concern was raised about whether the language of the proposed state policy could possibly be interpreted as allowing for something that's contrary to public policy or current law, and offered her belief that language on page 2, lines 5-6 - which defines the term, "mode of obtaining" in part as meaning directly purchasing healthcare services from a healthcare provider - addresses that concern. However, she relayed, members' packets do include a proposed conceptual amendment the second part of which would further clarify that particular issue by adding a reference to the statutory definition of the term, "health care provider" [as its used in Title 9]. Another concern raised during the bill's last hearing revolved around the bill's proposal to establish a short title in uncodified law, and the first part of the aforementioned conceptual amendment would delete the short-title provision located on page 1, lines 4-6 - Section 1 of Version B. The proposed conceptual amendment read [original punctuation provided]: Page 1, Line 4-6 Delete lines 4-6 Page 2, Line 6 Insert after health care provider (AS DEFINED IN SEC. 09.55.560) MS. SAWYER noted that members' packets now also contain a six- page document from the Goldwater Institute that addresses questions pertaining to the model legislation - developed by the American Legislative Exchange Council (ALEC) - upon which HB 1 was modeled. 2:17:03 PM REPRESENTATIVE GRUENBERG [made a motion] that the conceptual amendment be divided into Conceptual Amendment 1 and Conceptual Amendment 2, with Conceptual Amendment 1 being the proposed change to page 1, lines 4-6, and Conceptual Amendment 2 being the proposed change to page 2, line 6. There being no objection, the conceptual amendment was so divided. REPRESENTATIVE GRUENBERG made a motion to adopt Conceptual Amendment 1 [original punctuation provided]: Page 1, Line 4-6 Delete lines 4-6 REPRESENTATIVE KELLER objected. REPRESENTATIVE GRUENBERG said it is generally the legislature's policy not to provide for short titles in uncodified law, and so unless there is a really important reason, regardless of the merits of the bill, he doesn't see a need for providing for a short title for HB 1. REPRESENTATIVE KELLER offered his understanding that this is the first time the legislature has done anything related to healthcare freedom, and shared his belief that to call the bill the [Alaska Health Freedom Act], therefore, implies that there may be more adjustments needed later on. He said it seems like retaining that provision wouldn't cause harm but could help. REPRESENTATIVE GRUENBERG pointed out, though, that if [the bill] is called the Alaska Health Freedom Act, and it is subsequently added to, it could raise questions regarding whether any such addition still falls under the title, because currently it only addresses this one short policy. CHAIR GATTO, indicating agreement with Representative Keller, surmised that if the bill is so added to, its short-title provision could be deleted at a later date. REPRESENTATIVE GRUENBERG argued that the phrase, "Alaska Health Freedom Act" is not a neutral term and connotes that it is Alaska's very best policy for healthcare. So although people might agree with the substance of the bill, they might not agree that they want to have that kind of a slanted definition. Again, very rarely are bills given short titles. In conclusion, he ventured that removal of the short-title provision might render the bill less controversial. 2:22:30 PM A roll call vote was taken. Representative Gruenberg voted in favor of Conceptual Amendment 1. Representatives Lynn, Keller, Pruitt, Thompson, and Gatto voted against it. Therefore, Conceptual Amendment 1 failed by a vote of 1-5. 2:23:26 PM REPRESENTATIVE THOMPSON made a motion to adopt [Conceptual] Amendment 2 [original punctuation provided]: Page 2, Line 6 Insert after health care provider (AS DEFINED IN SEC. 09.55.560) REPRESENTATIVE GRUENBERG objected for the purpose of discussion, and suggested that that definition be made available to members. The committee took an at-ease from 2:24 p.m. to 2:27 p.m. CHAIR GATTO noted that members now have a copy of AS 09.55.560(2), which read: (2) "health care provider" means an acupuncturist licensed under AS 08.06; an audiologist or speech- language pathologist licensed under AS 08.11; a chiropractor licensed under AS 08.20; a dental hygienist licensed under AS 08.32; a dentist licensed under AS 08.36; a nurse licensed under AS 08.68; a dispensing optician licensed under AS 08.71; a naturopath licensed under AS 08.45; an optometrist licensed under AS 08.72; a pharmacist licensed under AS 08.80; a physical therapist or occupational therapist licensed under AS 08.84; a physician or physician assistant licensed under AS 08.64; a podiatrist; a psychologist and a psychological associate licensed under AS 08.86; a hospital as defined in AS 47.32.900, including a governmentally owned or operated hospital; an employee of a health care provider acting within the course and scope of employment; an ambulatory surgical facility and other organizations whose primary purpose is the delivery of health care, including a health maintenance organization, individual practice association, integrated delivery system, preferred provider organization or arrangement, and a physical hospital organization; REPRESENTATIVE GRUENBERG expressed concern that AS 09.55.560(2) doesn't include midwives. MS. SAWYER mentioned that another state used the term, "lawful" when referring to health care providers, rather than referencing a specific definition. REPRESENTATIVE GRUENBERG said he prefers the approach taken by Amendment 2, since what may be considered "lawful" could change. 2:30:07 PM REPRESENTATIVE GRUENBERG, therefore, made a motion to conceptually amend Conceptual Amendment 2 such that it would include midwives. There being no objection, Conceptual Amendment 2 was conceptually amended to that effect. REPRESENTATIVE GRUENBERG then removed his objection to the motion to adopt Conceptual Amendment 2. CHAIR GATTO, noting that there were no further objections, relayed that Conceptual Amendment 2, as conceptually amended, was adopted. REPRESENTATIVE GRUENBERG asked whether HB 1 does anything other than set a policy. MS. SAWYER indicated that the bill is doing just that, setting a policy that the [legislature] believes in the right established by the Tenth Amendment, that being that the state has the right to regulate health insurance and healthcare services. CHAIR GATTO, after ascertaining that no one else wished to testify, closed public testimony on HB 1. 2:32:45 PM REPRESENTATIVE THOMPSON moved to report the proposed committee substitute (CS) for HB 1, Version 27-LS0006\B, Bailey, 4/1/11, as amended, out of committee with individual recommendations and the accompanying fiscal notes. There being no objection, CSHB 1(JUD) was reported from the House Judiciary Standing Committee.