SL&C 2/15/96 SB 193 MANDATORY INSURANCE FOR COSTS OF BIRTH  CHAIRMAN KELLY called the Senate Labor and Commerce Committee meeting to order at 1:34 p.m. and announced SB 193 to be up for consideration. SENATOR SALO, sponsor of SB 193, said she introduced it because a Kenai constituent called her after the birth of her third child and said her insurance company would only allow her to stay in the hospital 24 hours following the birth. SENATOR SALO said she found that this is an increasing problem across the United States, although it's just emerging in Alaska. She followed the guidelines for the American Academy of Obstetrics and Gynecology and the AMA who recommend that 48 hours is a much more appropriate amount of time to be allowed. The trend down south has been to reduce hospital time because of HMO's. She wanted to alter the statutes relative to health insurance rather than health care by saying 48 hours for a normal vaginal birth or 96 hours in the case of a cesarian. She emphasized this is not mandating a longer hospital stay, but is rather saying that amount of coverage would be available should the health care provider and the patient deem it is necessary. SENATOR SALO said in Alaska, unlike in some other states, she did not want to mandate follow-up care and home visits, given the wide variety of health care within the State. One of the reasons health care providers have been interested in this legislation is because in Alaska we have many women who fly to a central area, like Bethel or Nome, to have child and they many be ready for discharge from a hospital, but they may not be ready to travel immediately. Another reason for more time being allowed is even with a normal vaginal birth, there is great variance in how much time is needed afterwards. For the newborn more time is even more important in some cases, PKU tests for example, which aren't effective unless the blood is drawn 24 hours after birth. BRIAN GILBERT, Administrator, Wrangell General Hospital, commented that we have reached a point in health care, where we're allowing insurance companies to make decisions for the physician and patient. He said they have a lot of people coming into Wrangell to have babies and the first day is usually the most expensive day. They usually keep the mother and the baby in the hospital another 24 hour period, usually just a room and board charge, and then just "eat the bill" if people can't pay. GORDON EVANS, Health Insurance Association of America, said they oppose mandatory coverage for maternity stays because they believe that patients and their physicians and not the government can best determine when a mother and her newborn are ready to leave the hospital safely. The Legislature should not be making medical decisions or embodying such decisions in law. State and federal regulations already exist to assure quality health care. State mandated benefits always drive up costs and ultimately limit access to quality care. MR. EVANS said that health plans right now do not discharge mothers and newborns until they are medically ready to leave. He suggested that this bill could be amended to provided that the doctor has the ability to discharge a patient earlier if that is proper and the patient concurs. Number 173 SENATOR SALO responded that was the content of the proposed amendment and is also the content of the bill. The insurance part of the bill simply says that the care has to be offered to the person, not that it has to be used. This bill does not require mandatory coverage and the proposed amendment clarifies that. Number 209 SENATOR SALO said part of the problem stems from the fact that hospitals have different discharge policies. Some hospitals discharge at noon, for instance, and the baby was born at 4:00 a.m. If it's a strict 24 hour rule, you get only eight hours before you have to leave the hospital. MR. EVANS responded that some people think the hospitals are driving this legislation because of the number of beds they have to fill. CAROL CLAUSSON, registered nurse and member of the Alaska Nurses Association, supported SB 193. There are problems associated with early discharge of mothers after the birth of their child. These include mothers not being able to get infants to breast feed properly and therefore shifting to formula, mothers not understanding the teaching that is given to them in the hospital because it occurs too soon after the birth of the child, and infants are developing problems like jaundice, weight loss, and infection which are not identified quickly because they have been discharged. Even nurses have difficulty in getting newborns to nurse properly. Having a baby is a major change and young families in Alaska frequently lack extended family to help with this change. They feel patients should have the option of a 48 hour hospital stay and/or home visits by a maternal child nurse or lactation nurse. PAT SENNER, mother of three children, added that when you have a two year old at home, it's very helpful to have the extra day to recuperate and have that time alone with the new infant before you have to go home and assume your duties there. Number 250 VELETA MURPHY, Infant Learning Specialist, supported SB 193 saying they have a lot of new mothers who are being sent away after 24 hours and they have not had time for bonding and to learn feeding skill. She said if they don't have time with the parent or child they can not identify skills they need that they can provide for them. She knew of babies who would have been much healthier if they had another 24 hours in the hospital so someone could notice their problem. Number 280 DON KOCH, Division of Insurance, said they support this legislation. He had two technical suggestions. On page 1, lines 12 - 13 where there is a reference to the federal statute (ARISA) which includes self insured plans, but his Division has no jurisdiction over those. He wanted it clear that this deals with insured plans. SENATOR SALO replied that she understood the Division's inability to control self-insured plans, but she has the same concern for mothers who are employed under one of those plans and she understands that a lot of people in Alaska are. She asked what legal problems we face with the inclusion. MR. KOCH explained that Chapter 42 deals with insurance contracts and since a self insurer doesn't technically have an insurance contract this will be a piece of language that sits out there intending to do a purpose which it doesn't do. If they create the perception that this is reaching self insured plans when it really doesn't, that tends to mislead people into thinking that some protection is there when it isn't. MR. KOCH's second concern was on page 2, lines 4 and 5 dealing with nursing home administrators. If the intent is to reach entitlement plans, this statute, since it deals with insurance contracts, doesn't accomplish that. If it's dealing with an insured plan, subsection 1 already takes care of that. SENATOR SALO said that her preference would be to leave it alone, because she didn't hear there was some catastrophic problem caused by it being there. She said the first amendment inserts a new subsection, "except as otherwise required to provide coverage specified under A of this section." This section does not affect a payment arrangement entered into between the hospital or physician and an insurer. There is no intent to interfere with the way hospitals and insurance companies deal with each other in terms of business. It is common practice with some insurance companies to have a flat rate they use as reimbursement for a pregnancy. That rate is subject to negotiation between the hospital and the insurer. SENATOR SALO moved to adopt amendment 1. There were no objections and it was so ordered. SENATOR SALO said amendment 2 simply makes it crystal clear the bill is not mandating an hospital stay. SENATOR SALO moved to adopt amendment 2. There were no objections and it was so ordered. Number 367 SENATOR SALO moved to pass SB 193 (am) from Committee with individual recommendations. There were no objections and it was so ordered. #