HB 356-ADVISORY COMMITTEE ON WELLNESS  8:35:59 AM CHAIR LYNN announced that the next order of business was HOUSE BILL NO. 356, "An Act establishing the Advisory Committee on Wellness; and relating to the administration of state group health insurance policies." 8:36:06 AM REPRESENTATIVE PAUL SEATON, Alaska State Legislature, as prime sponsor, presented HB 356. He stated that HB 356 would require the commissioner of the Department of Administration (DOA) to implement procedures for decreasing the incidence of disease in Alaska in order to hold the inflation of healthcare costs. He said the proposed legislation focuses on the prevention of the incidence of disease as opposed to the treatment of disease. It would create an Advisory Committee on Wellness, which would be charged with making recommendations to the commissioner. Representative Seaton relayed that HB 356 would enforce a paradigm shift for DOA, and it would require the agencies to implement policies in Alaska to keep State of Alaska employees and their independents healthy by preventing disease. 8:37:15 AM REPRESENTATIVE SEATON offered a PowerPoint presentation, which he explained would outline a possible plan that would come from the [Advisory Committee on Wellness] to aid in lowering the amount of money paid out by the State of Alaska for health care. He referred to a graph at the beginning of the PowerPoint, which shows the $3.8 billion unfunded liability in the Public Employees Retirement System (PERS) and Teachers Retirement System (TRS) directly related to the increase of health care cost beyond what was originally estimated in 2002. The original estimation was for a long-term escalation in health care costs of 2 percent, but now the escalation is between 4 and 6 percent. He showed the "Why are we here?" slide, which states that there are approximately 17,000 members, including dependents, in the active plan, and approximately 64,000 members in the retiree plan, with a total cost to the state of approximately $600 million [spent in fiscal year 2013 (FY 13)]. He noted that $1.6 million was [Medicaid] related expenditure [in FY 13]. He said these expenses are part of a contractual relationship. REPRESENTATIVE SEATON directed attention to the "What Do Alaska's Health-Care Dollars Buy?" slide, which shows that [31.5] percent of those dollars go to hospital care and 28 percent to doctors and clinical services. He said finding ways to avoid visits to hospitals, doctors' offices, and clinics by means of disease prevention would address the crux of the problem. Referring to information on the next slide, he relayed that currently insurance focuses on constraints to the healthcare providers, including limitations on coverage and limitations on compensation to doctors. He said the Department of Labor established rules to prevent accidents by setting limitations on the length of a working day and requirements for safe working conditions. Representative Seaton stated that the Department of Health and Social Services (DHSS) focuses on childhood vaccination, as well as voluntary lifestyle changes and prescription drug safety. The Department of Environmental Conservation (DEC) [and the Department of Natural Resources (DNR)] address food safety requirements, such as paralytic shellfish poisoning (PSP) testing, requirements for the pasteurization of milk, and restaurant and food processor inspections. The Department of Public Safety (DPS), he said, enforces laws addressing illegal drugs and smoking in close public places. 8:40:13 AM REPRESENTATIVE SEATON turned to "The Question" slide, and he indicated that the question to ask is how to avoid diseases instead of just paying for sick care. He said the ensuing slides show ideas for what can be done in "one little category" and what the economic impact of that would be. The first slide he highlighted shows a list of [health] issues of active care members, and [x's] at the far right indicate which of the conditions could be prevented by taking vitamin D supplements. He said vitamin D deficiency is prevalent in Alaska. He showed the next slide, which is the same chart for retirees. He said 66 percent of the total diseases in the active work force are directly related to vitamin D status, while that number for retirees is 61 percent. REPRESENTATIVE SEATON directed attention to the next slide, showing "Meta-analysis of breast cancer risk." He explained that the graph is set up in quintiles. It shows that those with higher risk for breast cancer are those with lower serum levels of vitamin D. He said the average vitamin D level for the U.S. population is 21 anagrams per milliliter (ng/ml), but the average for Alaskans is generally much lower, because vitamin D is made through exposure to sunshine on the skin, and during Alaska winters, the angle of the sun is so low, that all of the ultraviolet B is absorbed coming through the atmosphere. That means that for seven months of the year in Alaska, a person can be out in the sun and not make any vitamin D. He explained that the graph shows that with a 50 percent reduction in breast cancer [through use of vitamin D] by active and retired employees and their dependents, the state could save $3 million a year. 8:43:14 AM REPRESENTATIVE SEATON directed attention to another meta- analysis graph showing the relation of vitamin D and colorectal cancer. He stated that breast cancer and colorectal cancer are two big cost drivers in Alaska. The graph shows a projected reduction in incidence with 34 ng/ml. He said currently the state has no policy to encourage people to [take vitamin D supplements] to lower the percentage who get colorectal cancer, but doing so could save the state approximately $2 million annually. REPRESENTATIVE SEATON directed attention to another slide showing results of a clinical trial related to type 2 diabetes. He said the slide shows that the average U.S. population has 8.5 people per 1,000 annually who will be diagnosed with type 2 diabetes. During the clinical trial, 2,200 people got their vitamin D levels up to 48 ng/ml, and the number of people per 1,000 diagnosed annually with type 2 diabetes dropped to [0.9]. He indicated that the cost to an individual to supplement vitamin D is about $10 a year. Representative Seaton said this kind of action could save the state approximately $4.3 million a year. 8:45:42 AM REPRESENTATIVE SEATON turned next to a slide showing results of vitamin D supplementation on pre-term childbirth, which is a focus of the March of Dimes. He explained that pre-term birth not only has negative effects on health, but is also costly. He related that the March of Dimes has been conducting a program in South Carolina, wherein by raising the levels of vitamin D in participants, the number of pre-term births was reduced to 7 percent - 2 percent below the national goal for the March of Dimes for the year 2020. He said, "That's a 32 percent reduction in the number of pre-term births, and for every 25 pre-terms births avoided, that saves about $1.3 million." REPRESENTATIVE SEATON directed attention to a slide showing results from a Canadian study on the effects of vitamin D supplementation on the frequency of occurrence of upper respiratory tract infections in children. He indicated that a comparison was made between those children who were given 30 ng/ml and those that were given 20 ng/ml, and he said, "There's a 70 percent reduction in upper respiratory tract infections, [such] as tuberculosis, pneumonia, bronchitis, influenza, and colds." REPRESENTATIVE SEATON highlighted information on the next slide, which showed the effect of vitamin D supplementation on inflammatory gum disease. He said the study came out of India in 2013. It shows that with a placebo, there was no change in 90 days; with 2,000 IU of vitamin D, people's vitamin D levels were raised to about 50 ng/ml, and there was a reduction in inflammation of more than 80 percent. He stated that gum disease not only results in tooth loss, but when the body is not able to fight inflammation, the result can be a hardening of the arteries. He said that is why gum disease is also related to heart disease. 8:48:00 AM REPRESENTATIVE SEATON indicated that the proposed legislation has one main purpose, outlined in Section 2, which read as follows: *Sec.2. AS 39.30.090(a) is amended by adding a new paragraph to read: (13) To the greatest extent legally and reasonably practicable, the Department of Administration shall work to hold the escalation of health care costs to less than two percent annually by administering policies of group health insurance obtained under this subsection in a manner that is likely to reduce the incidence of disease in the state's population and that facilitates implementation of the recommendations of the Advisory Committee on Wellness established under AS 39.30.093. REPRESENTATIVE SEATON said his goal in presenting HB 356 is to illustrate an example of what the state could be doing. He said he presumes the Committee on Wellness would look at this data and determine whether the State of Alaska could hold down the incidence of disease and save money. He said the State of Alaska is self-insured; therefore, "every dollar that we save is a savings to the State of Alaska." He continued as follows: The bill that establishes this has a minimum of seven members. The Department of Administration selects those members. When they had a voluntary advisory committee, which they do now, previously what they did was they had over 90 people to apply to be on it. This is a non-paid position. But people, members of our employment workforce, do want to save health care, do want to save the issues of health and the pain and suffering that comes to families. REPRESENTATIVE SEATON said HB 356 uses the model of the citizen advisory committee used in relation to Alaska's Child in Need of Aid (CINA); the department would have to answer within six months if and how it would be implementing certain programs. He said the proposed legislation would give "more of a push" and "more authority" for the recommendations of the Advisory Committee on Wellness to be heard. It is all within DOA, and there are three positions. Members could participate in meetings telephonically, so travel would not be required. REPRESENTATIVE SEATON opined that attempting to move the state forward in holding down the escalation of [health care] costs, thereby removing some of the state's unfunded liability in the retirement system is a good goal. He said some things that could cut down on health care costs, such as losing 30 or 40 pounds, are difficult to do; however, other things that the Advisory Committee on Wellness could consider are much easier to accomplish. [Vice Chair Keller handed the gavel back to Chair Lynn.] 8:51:42 AM REPRESENTATIVE KELLER commended Representative Seaton's focus on prevention and wellness. He explained that he had a problem with the intent language, beginning on page 1, line 9, through page 2, line 1. He said he would to like to delete [paragraphs] (2), (3), and (4), which read as follows: (2) the state has not adequately focused state policy on avoiding disease and maintaining good health in the state's population; (3) the state relies on federal one-size- fits-all human health policy recommendations, creating federal overreach into the state's administration of health policy; (4) the state's human health policies have not incorporated peer-reviewed scientific studies that illustrate health-related differences between the population of the state and the populations of other states; REPRESENTATIVE KELLER, regarding paragraph (2), said that may be true, but opined that it would be better to say that the state should focus more, because the state has focused on a state policy on avoiding disease and maintaining good health. Regarding [paragraph] (3), he suggested saying instead that the state relies "in part" on federal policy recommendations. As written, he said the language sounds like federal recommendations are the only thing on which the state's policy is based, which he said he does not believe is true. Regarding [paragraph] (4), he said he would argue that the state certainly has incorporated peer-reviewed studies, at least to some degree. He said he knows this, because he has reviewed the studies and has been involved in the process of making recommendations. He stated that he does not think it would take away from the intent of HB 356 to delete paragraphs (2), (3), and (4), in Section 1. He said he supports the proposed legislation, but would like to hear what the prime sponsor thinks about his recommendations for changes. 8:56:09 AM REPRESENTATIVE ISAACSON recommended instead to leave paragraphs (2)-(4) in the proposed legislation, but to amend the language to reflect that: state policy should focus on avoiding disease and maintaining health, the state relies in part on federal recommendations, and the state's human health policies should always incorporate peer-reviewed studies. He emphasized his support of peer reviewed studies that are made transparent to the public and are opened for public comment. He clarified, "I wouldn't take those out; I would just make them affirmative." 8:57:14 AM REPRESENTATIVE KELLER responded that he had considered that and would be open to it. 8:57:34 AM REPRESENTATIVE SEATON said he fully agrees. He echoed Representative Isaacson's suggestion by recommending "should" replace "has not adequately", on line 9. CHAIR LYNN suggested changing the language to "should focus more". REPRESENTATIVE SEATON suggested the language could read "should focus state policy more on avoiding disease and maintaining good health". He said he thinks the intent of paragraph (4) was being misread, possibly because the language in paragraph (4) begins on one page and ends on the next: "differences between the population of the state and the populations of other states". He said he did not intend for the language to mean that "we" have not looked at peer-reviewed science. He suggested switching the order of the words to emphasize that the studies that have not been incorporated in the state's human health policies are those comparing states. 8:59:10 AM REPRESENTATIVE KELLER asked the prime sponsor what he thought of Representative Isaacson's suggestion to strike "have not" and replace it with "should". REPRESENTATIVE SEATON said that would be fine. 8:59:29 AM REPRESENTATIVE KELLER said he would like the words "in part" to follow "relies", on page 1, line 11, because one-size-fits-all recommendations from the federal government are not the only thing on which the state relies. 8:59:53 AM REPRESENTATIVE KELLER moved to adopt Conceptual Amendment 1, as follows: Page 1, line 9, between "the state" and "state": Delete "has not adequately focused" Insert "should focus" Page 1, line 9, between "policy" and "on": Insert "more" Page 1, line 11, between "relies" and "on": Insert "in part" Page 1, line 13, between "policies" and "incorporated": Delete "have not" Insert "should" 9:01:38 AM The committee took a brief at-ease at 9:02 a.m. 9:02:25 AM REPRESENTATIVE KELLER [moved to adopt an amendment to Conceptual Amendment 1], so that the language on page 1, line 9, would read as follows: "the state policy should focus more on avoiding disease and". [There being no objection, the amendment to Conceptual Amendment 1 was treated as adopted.] 9:03:06 AM CHAIR LYNN announced that there being no objection, Conceptual Amendment 1, [as amended], was adopted. 9:03:22 AM REPRESENTATIVE ISAACSON imparted that he had begun a regimen of taking vitamin D, and has seen improvement in a former pre- diabetes diagnosis; he expressed his hope that the use of vitamin would further improve his test results. He said, "This is not a vitamin D commission, this is a wellness commission." He acknowledged that the prime sponsor had shown one way to improve the health of Alaskans through the use of vitamin D; many more methods exist, including exercising, cutting out certain substances, and moderating smoking and drinking. He asked Representative Seaton if his intent was to instigate an Advisory Committee on Wellness, in order to bring the national discussion on wellness to the administration. 9:04:20 AM REPRESENTATIVE SEATON confirmed that was his intent exactly. He clarified that the proposed legislation would not take over the Health Care Commission, which is a broad, statewide entity that considers the entire population of the state. The committee proposed under HB 356 would focus on individuals with whom the State of Alaska has a contractual relationship as a provider of health insurance. He said the result could be not only a cost savings to the state, but also a relief from pain and suffering by many. He reiterated that the vitamin D aspect was one of many the Advisory Committee on Wellness might consider. 9:06:19 AM REPRESENTATIVE KELLER said a positive approach is a good one, and he does not know anyone who is against vitamin D or wellness. 9:06:48 AM REPRESENTATIVE KELLER moved to report HB 356, as amended, out of committee with individual recommendations and the accompanying fiscal notes. There being no objection, CSHB 356(STA) was reported out of the House State Affairs Standing Committee.