HB 11-COLONOSCOPY: PUB. EMPLOYEE RETIREES  4:43:31 PM CHAIR OLSON announced that the final order of business would be HOUSE BILL NO. 11, "An Act requiring that retiree health insurance coverage offered by the state and by certain local governments include coverage for colorectal screening, including colonoscopies." 4:43:36 PM REPRESENTATIVE LES GARA, Alaska State Legislature, stated that in the State of Alaska, only one group of people is not covered. All people covered by private insurance plans and state employees are covered by law. Thus, the group that needs coverage the most are the Retired Public Employees who are not covered. Colon cancer is the third leading cause of cancer and testing is most important for people over the age of 50. Screening is important since the survival rate for early detection is high, with an approximately 90 percent survival rate for longer than five years. Without screening and early detection the survival rate is 10 percent for over five years. This bill would ask for coverage under the Retired Public Employees plan consistent with the standards adopted by the American Cancer Society. Typically, screening consists of a colonoscopy but could be some other procedure depending on what the doctor and patient agree is necessary. Additionally, the Alaska Native population suffers from colon cancer at a two to one rate over Caucasians. An alternative blood test is especially dangerous to Alaska Natives, which makes the colonoscopy more important. He referred to cost analysis on colonoscopies. He expressed surprised by the fiscal note since the studies show colonoscopies save money. The cost of colonoscopy or other preventive care is offset by cost to treat someone with colon cancer. He referred to a study in members' packets by Buck Consultants, which shows a likely cost savings by screening individuals over the age of 50 as opposed to not providing screening and paying for cancer coverage. He referred to the state's fiscal note which indicates a cost of $4 million to provide a colonoscopy for everyone. He stated that the bill is requesting colonoscopy coverage for those individuals who are retired since the test is not necessary for someone who is 20 or 30 years old. 4:48:47 PM WARD B. HURLBURT, M.D., MPH Director and Chief Medical Officer, Division of Public Health, Department of Health and Social Services (HSS), stated that he is a general surgeon who has dealt with colorectal cancer for many decades. REPRESENTATIVE GARA inquired as to whether he could speak to costs for colonoscopies. He stated that the Department of Administration (DOA) takes the position that it costs more to provide the screening than treatment. DR. HURLBURT stated that he has not performed an analysis on the screening. He said he could not comment since the fiscal note is prepared by another department. He related that he is speaking of colorectal cancer screening in the same sense that Centers for Disease Control (CDC). The CDC colorectal cancer screening for individuals ages 50 to 75. The screening tests include a fecal occult blood test, a flexible sigmoidoscopy every five years, or a colonoscopy every ten years. The colonoscopy is the most expensive test but those in the public health circles subscribe to early intervention for colorectal cancer since early detection and intervention can make a big difference. He recommended preventive efforts to identify lesions such as benign polyps and remove them or identify an early cancer while it is still localized since it greatly increases the odds of survival. He did not have a specific analysis on the immediate costs, but over the long term when considering costs of end of life care it would balance out. He suggested it is reasonable to think in the short run that a program would incur costs but the savings would come "further down the road." 4:52:42 PM BRIAN SWEENEY, SR., Physician, Alaska Correctol Council, stated that he is a member of the American College of Gastroenterology* Alaska Correctol Council He is speaking today on behalf of his son who is a member of the Alaska Correctol Council. He has provided Representative Gara with the American College of Gastroenterology guidelines. The guidelines cover all insurers except the retired State of Alaska (SOA) employees. A number of studies have shown the long term cost effectiveness of colonoscopy cancer screening. One of the dilemmas is that people 65 years and older become Medicare patients so any specific entity making reimbursement payments may not see short term cost effectiveness since the cost benefits accrue later on, he said. Recent studies have shown a 30 percent decline in colon cancer rates which has been attributed to the aggressive screening procedures that began about eight years ago. He reported that gastroenterologists nationwide have been taking a more aggressive approach to screening. Patients identified as high risk with cancerous polyps have had a 90 percent decline in new cancer. The American Cancer Society has developed its guidelines and the legislature has adopted their guidelines for almost everyone in Alaska. He pointed out that patients often know what they should do to maintain good health but if they experience a financial hardship or the procedures are not covered by insurance it makes it difficult. He has seen retired state employees deny themselves their colonoscopy tests due to lack of insurance coverage. He strongly supports coverage for retired SOA employees so they may have parity with other Alaskans. He urged members to pass HB 11. 4:56:16 PM MOLLY MCCAMMON stated that in 1997 she was 45 years old and a SOA employee diagnosed with Stage 1 colorectal cancer following a colonoscopy paid for by her state insurance coverage. She knew her grandfather had died of colon cancer at 45 years old but a grandfather is a second degree relative so she was not too concerned. However, her doctor recommended a colonoscopy. Her symptoms were very minor and she felt confident she would have ignored them if state insurance had not covered the procedure. Fortunately, she was scoped and her tumor was discovered early enough to be surgically removed so she was able to avoid radiation and chemotherapy. She is now 59 and a SOA retiree and screening colonoscopies are not covered under the SOA retiree's health insurance. She said, "This seems totally absurd to me. My body continues to want to make cancer as evidenced by numerous precancerous polyps removed over the last 13 years. If left in place these polyps would have developed into cancerous tumors that would have required extensive treatment at a substantial cost yet this is considered routine screening." She reported that the American Cancer Society recommends routine screening for colorectal cancer starting at age 50 unless a person's family history indicates otherwise. She stated that the ACS recommends that preventing colorectal cancer should be a major reason for getting tested and the best way to test is the colonoscopy. She pointed out that this cancer is so treatable if caught early but the procedure is expensive enough that the tendency is to postpone or avoid the test until a tumor is too large to ignore or the cancer has spread. She concluded that due to screening and improved treatment the U.S. has one million survivors of colorectal cancer including her. She urged members to support HB 11. 4:58:41 PM EMILY NEENAN, Alaska Government Relations Director, American Cancer Society Cancer Action Network, stated she has worked on for six years. In 2006, the state law passed that required a full range of colorectal cancer screening for all state- regulated insurance plans many other plans followed suit for colonoscopy screening including Providence Health Systems. The active state employees already had this coverage. Some union plans did not have coverage but have since added coverage. The SOA retirees are the only group not covered for the 50-64 year age group since Medicare has had coverage for some time for those 65 years of age or older. 5:01:13 PM The committee took an at-ease from 5:01 p.m. to 5:02 p.m. 5:02:25 PM MS. NEENAN related that as of January 1, 2011, Medicare covers screening, including colonoscopies at 100 percent with no copayment. Screening can prevent cancer from ever developing, which is unique to colorectal cancer. She expressed concern with the 2007 Buck Consultants analysis including that the consultant used the terms "screening" and "diagnostic" interchangeably which indicates some confusion. 5:04:12 PM REPRESENTATIVE SADDLER referred to information in members' packets from Buck Consultants and to the relative tests including fecal occult blood test, flexible sigmoidoscopy, barium enema, and colonoscopy. He inquired as to whether it fair to assume that it is a straight cost which is a less effective strategy. He further inquired as to whether there is a hierarchy for the screening tests. MS. NEENAN responded that differences exist in the effectiveness of the screening tests and the decision needs to be made patient and the doctor dependent on the patient's comfort. She reported that the colonoscopy is the most sensitive test since it screens entire colon and can remove precancerous polyps. She recalled earlier testimony that fecal occult blood testing poses some problems in the Alaska Native population due to a high incidence of a stomach lining infection that causes low grade bleeding and should not be used in that population. She offered to provide new facts and figures on colorectal cancer to members from the Alaska Cancer Society. 5:06:45 PM REPRESENTATIVE GARA stated that retired public employees are only covered if the retiree shows symptoms. This is problematic since the whole point of screening is to identify issues prior to symptoms developing. Currently, retirees are eligible for colonoscopies if they exhibit symptoms of cancer such as bleeding. The colonoscopy will remove the polyp before any bleeding exists. Once bleeding occurs it may be too late for the patient to survive. 5:07:38 PM REPRESENTATIVE SADDLER inquired as to whether other tests are covered. REPRESENTATIVE GARA answered that the tests are only covered when symptoms are present. CHAIR OLSON offered to provide additional information. 5:07:48 PM RICHARD BENAVIDES stated that he has been a legislative aide for Senator Bettye Davis. He is in Anchorage receiving cancer treatment for Stage 4 colorectal cancer that metastasized to his liver. His doctor recommended a colonoscopy in 2008 during a routine physical, which he credits for saving his life. The colonoscopy was covered under his state health plan so he had it done. He did not experience any symptoms. He passed all the tests. He was stunned to learn he had any cancer let alone anything as serious as a stage four colorectal cancer. He was told that the average survival rate for his cancer is two years. Since diagnosis he has had two radiation treatments, two major surgeries, five months of chemotherapy, and is now on oral chemotherapy. The point is that without this coverage he would not have known and he would not have had the test done since he felt great. He stated that this bill would offer retirees the same coverage that he attributed to saving his life. He offered his belief that this bill would save thousands of dollars by identifying colorectal cancer before it becomes more serious and by preventing it before it is cancerous. He thought any reduction in colon cancer is a good thing. He thought the bill is a great idea. He urged members to pass HB 11. 5:11:06 PM CHAIR OLSON related he has known Mr. Benavides for some time and urged him to "keep up the battle." 5:11:22 PM BOB DOLL, President, Retired Public Employees of Alaska (RPEA), stated that the Retired Public Employees of Alaska (RPEA) consists of 2,200 individuals who have retired from municipalities and the SOA. He urged members to support HB 11. Each year this issue emerges at the top of the RPEA's agenda. Retirees are aware of the benefit for active employees but are acutely aware of problem of not having it for retirees. It is implied in the coverage for active employees that efficacy is indicated and saves lives. It is a good thing to do. Its absence has implications that dive it to the top of the list. He offered his belief that this is a benefit that would not be abused. No one would undergo the procedure except to maintain good health. He referred to a letter of November 2007 from Buck Consultants. He related that their letter states in four instances that colonoscopy screening benefits is likely to produce a positive return on investment. He referred to pages 1, 3, and 4 as references. He acknowledged that likely does not mean certainty, but it does suggest a trial may be in order. He observed that for us to bemoan the existence of an unfunded liability and yet resist the adoption of a likely cost savings procedure on at least a trial basis is inexplicable. It suggests a bargaining position rather than address good health care. He urged members to support HB 11. 5:14:50 PM MARIE DARLIN, Coordinator, AARP Capital City Task Force, referred to a letter from AARP in members packets. The AARP fully supports HB 11. This bill could save money and save lives for state employees and retirees. [HB 11 was held over.]