HB 109-SCREENING NEWBORNS FOR HEARING ABILITY CHAIR ANDERSON announced that the final order of business would be HOUSE BILL NO. 109, "An Act relating to establishing a screening, tracking, and intervention program related to the hearing ability of newborns and infants; providing an exemption to licensure as an audiologist for certain persons performing hearing screening tests; relating to insurance coverage for newborn and infant hearing screening; and providing for an effective date." 4:06:35 PM JANE PIERSON, staff for Representative Jay Ramras, announced that she had no other comments add to her testimony from the previous hearing. REPRESENTATIVE ROKEBERG asked if there was any testimony from the insurance industry as to the cost of the mandates under Section 5. MS. PIERSON answered that Mr. Stoops did speak about the history of the mandates and how section 5 may impact insurance rates. REPRESENTATIVE ROKEBERG asked if the sponsor had any discussion regarding offered underwritten coverage versus the managed underwritten coverage. MS. PIERSON deferred to Margaret Lanier-Kossler, who would be a better person to answer this particular question. REPRESENTATIVE ROKEBERG reiterated his question concerning the coverage provided by insurance companies and whether it would be offered versus managed. MARGARET LANIER- KOSSLER, Program Manager, Early Hearing Testing and Intervention Program, regretted to inform the committee that she was not the person who could answer this question. MS. PIERSON explained that this has already been covered by the insurance companies and is included in birthing costs. She said this is not a big leap from the current situation. CHAIR ANDERSON believed that this can be debated. 4:10:13 PM REPRESENTATIVE ROKEBERG announced that there are very important issues. He said that one of the goals of this committee has been to make health insurance more affordable and available for everyone. He then said that the committee today has to be aware of the real issue here. He explained that the difference between the two types of insurance was that the offered coverage is coverage that is offered and the insurance company can charge the individual a premium for it. However, the mandated coverage entails a cost that is spread out throughout the insured community of that company. A vast majority of people are not affected by this bill. Only 20-35 percent of Alaskan people are affected, because the majority of people are under the ERISA program, or are self-insured coverage and they don't pay. 4:11:23 PM REPRESENTATIVE ROKEBERG concluded that all this would do is to make the insurance bill to the small business more unaffordable. 4:11:54 PM CHAIR ANDERSON shared this concern with Representative Rokeberg, and indicated that he felt the same about small businesses absorbing the cost. However, he felt that the tests themselves on the children of the state far outweigh the cost to the small businesses of Alaska. He ended by stating that it would be good to know specifically what the medical costs would be before the bill leaves this committee and goes on to the finance committee. MS. PIERSON said that she believed that such cost information was provided by the March of Dimes. She recounted the number being $420,000 in special education and over $1 million for undetected deafness for each child over a lifetime. CHAIR ANDERSON stated that this was the balancing that we have to assess. REPRESENTATIVE GUTTENBERG pointed out that there were ways to figure out how to measure costs. The larger picture, which is the health of the families and individuals is more important than the ledger book of some company, and needs to be addressed. 4:15:00 PM REPRESENTATIVE CRAWFORD surmised that this legislation doesn't impact any union insurance plans, but rather it only impacts small employers and solitary individuals. REPRESENTATIVE ROKEBERG answered this by stating that some unions are underwritten and administered/insured by major insurance companies. He indicated that there may be one state bargaining unit that may have an underwritten plan, but all of the others are exempt from this mandate. In further explanation, Representative Rokeberg clarified "you're not paying towards the cost it incurs when you mandate the cost into all other policies." The aforementioned is part of the cost shifting that occurs. CHAIR ANDERSON clarified this by stating Representative Rokeberg is saying that by imposing the screening cost, it filtrates to the smaller businesses and not the masses. REPRESENTATIVE CRAWFORD asked whether this legislation mandates that union healthcare plans are required to cover hearing screening. REPRESENTATIVE ROKEBERG answered by stating that these union health plans are federally covered by ERISA, which exempts state regulation of their plans, even though the legislature has mandated hearing screening. REPRESENTATIVE CRAWFORD stipulated then, that the ironworker union's healthcare plan is not required to pay for the mandated hearing screening. REPRESENTATIVE ROKEBERG retorted that this is the inequity of a cost shift. He ended by highlighting that Alaska has a limited number of insurance companies that want to come and write policies here for small groups or insurance for individuals. REPRESENTATIVE LEDOUX asked what the cost of a newborn hearing screening would be for the individual. MS. PIERSON answered that it was between 20-60 dollars. In further response, she informed the committee that it was 10,000 new babies are born in AK every year. REPRESENTATIVE LEDOUX inquired as to the definition of a fraternal benefit society. REPRESENTATIVE ROKEBERG explained that there are certain underwriting groups that are founded on fraternal organizations and that there are Alaska statutes that separate these from actual insurance companies. These special provisions are probably analogous to other insurance groups. REPRESENTATIVE LEDOUX then asked if they are governed by ERISA. She then asked what the rational was in distinguishing between fraternal benefit societies and normal insurance providers. REPRESENTATIVE ROKEBERG explained that the state allows the fraternal organizations a little more flexibility in underwriting criterion that is peculiar to their membership. REPRESENTATIVE LEDOUX stated that it sounds like the committee needed to make a policy decision as to whether or not anyone that offers insurance would be required to be part of the coverage. She revealed that she had a hard time distinguishing between fraternal organizations and any other insurance group. MS. PIERSON recalled the testimony of Reid Stoops at the meeting of the American Association of Health Plans, who said that generally he supported the bill. She also recalled that he said that the American Association of Health plans would rather have a mandated offering rather than a benefit elective insurance. She noted that this only affects 25 percent of people. REPRESENTATIVE GUTTENBERG directed attention to page two, line 13, and asked what the bill is looking to find. The phrase "subject to availability" is ubiquitous in legislation and law making. REPRESENTATIVE ROKEBERG stated that this is not an appropriation bill, and the language is merely intent language. 4:25:22 PM CHAIR ANDERSON announced that public testimony is closed and reminded the committee that a CS was adopted at an earlier juncture. REPRESENTATIVE ROKEBERG said that although he had concerns, he will support moving it out of committee. He expressed a need for a comprehensive examination of costs and benefits, and impacts on both consumers and the insurance companies. He clarified that he absolutely supports the spirit of the bill and the issue behind it. MS. PIERSON related that Mr. Stoops had said that every time the legislature mandates the policies, it costs the individual policy owners an additional $75. 4:27:44 PM CHAIR ANDERSON suggested that further concerns can be addressed on the floor. He then reminded the committee that the sponsor Representative Ramras is a small business owner and is probably keeping this in mind and weighing the issues being discussed today and looking at what the greater good might be in this situation. REPRESENTATIVE GUTTENBERG questioned the societal savings to private industry from these ten or twelve mandated benefits. REPRESENTATIVE LYNN moved to report CSHB 109, Version 24- LS0450\G, Mischel, 2/04/05, out of committee with individual recommendations and the accompanying fiscal notes. There being no objections, CSHB 109(L&C) was reported out of the House Labor and Commerce Standing Committee.