ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
February 21, 2012
3:03 p.m.
MEMBERS PRESENT
Representative Wes Keller, Chair
Representative Alan Dick, Vice Chair
Representative Bob Herron
Representative Paul Seaton
Representative Beth Kerttula
Representative Bob Miller
Representative Charisse Millett
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
HOUSE BILL NO. 288
"An Act prohibiting denial or withholding of medical assistance
eligibility or coverage for a prisoner."
- MOVED HB 288 OUT OF COMMITTEE
CS FOR SENATE CONCURRENT RESOLUTION NO. 1(STA)
Designating May of each year as Lupus Awareness Month.
- MOVED CSSCR 1 (STA) OUT OF COMMITTEE
PRESENTATION: CANCER ACTION NETWORK
- HEARD
PREVIOUS COMMITTEE ACTION
BILL: HB 288
SHORT TITLE: MED. ASSISTANCE ELIGIBILITY: PRISONERS
SPONSOR(s): REPRESENTATIVE(s) KELLER
01/17/12 (H) READ THE FIRST TIME - REFERRALS
01/17/12 (H) HSS, FIN
02/21/12 (H) HSS AT 3:00 PM CAPITOL 106
BILL: SCR 1
SHORT TITLE: LUPUS AWARENESS MONTH
SPONSOR(s): SENATOR(s) DAVIS
01/19/11 (S) READ THE FIRST TIME - REFERRALS
01/19/11 (S) STA, HSS
03/01/11 (S) STA AT 9:00 AM BUTROVICH 205
03/01/11 (S) Heard & Held
03/01/11 (S) MINUTE(STA)
03/08/11 (S) STA AT 9:00 AM BUTROVICH 205
03/08/11 (S) Moved CSSCR 1(STA) Out of Committee
03/08/11 (S) MINUTE(STA)
03/09/11 (S) STA RPT CS 5DP NEW TITLE
03/09/11 (S) DP: WIELECHOWSKI, KOOKESH, PASKVAN,
MEYER, GIESSEL
03/14/11 (S) HSS AT 1:30 PM BUTROVICH 205
03/14/11 (S) Moved CSSCR 1(STA) Out of Committee
03/14/11 (S) MINUTE(HSS)
03/16/11 (S) HSS RPT CS(STA) 5DP
03/16/11 (S) DP: DAVIS, MEYER, ELLIS, EGAN, DYSON
04/06/11 (S) TRANSMITTED TO (H)
04/06/11 (S) VERSION: CSSCR 1(STA)
04/07/11 (H) READ THE FIRST TIME - REFERRALS
04/07/11 (H) HSS
04/14/11 (H) HSS AT 3:00 PM CAPITOL 106
04/14/11 (H) -- MEETING CANCELED --
02/21/12 (H) HSS AT 3:00 PM CAPITOL 106
WITNESS REGISTER
JIM POUND, Staff
Representative Wes Keller
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Introduced HB 288 on behalf of the prime
sponsor, Representative Wes Keller.
JON SHERWOOD, Medicaid Special Projects
Office of the Commissioner
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Testified during discussion on HB 288.
LESLIE HOUSTON, Director
Central Office
Division of Administrative Services
Department of Corrections (DOC)
Juneau, Alaska
POSITION STATEMENT: Testified during discussion of HB 288.
CELESTE HODGE, Staff
Senator Bettye Davis
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Introduced SCR 1 on behalf of the prime
sponsor, Senator Bettye Davis.
ANNA TILLMAN, Executive Director
Lupus Foundation of America
Alaska Chapter
Anchorage, Alaska
POSITION STATEMENT: Testified during discussion of Lupus and
SCR 1.
SARA CHANG
Government Relations
Lupus Foundation of America, Inc.
National Office
Washington, D.C.
POSITION STATEMENT: Testified during discussion of Lupus and
SCR 1.
CHRIS HANSEN, President
American Cancer Society
Cancer Action Network
Washington, D.C.
POSITION STATEMENT: Presented an overview from the American
Cancer Society and the Cancer Action Network.
EMILY NENON, Alaska Government Relations Director
American Cancer Society
Cancer Action Network
Anchorage, Alaska
POSITION STATEMENT: Testified during the presentation from the
Cancer Action Network.
ACTION NARRATIVE
3:03:28 PM
CHAIR WES KELLER called the House Health and Social Services
Standing Committee meeting to order at 3:03 p.m.
Representatives Keller, Seaton, Miller, and Kerttula were
present at the call to order. Representatives Dick, Millett,
and Herron arrived as the meeting was in progress.
HB 288-MED. ASSISTANCE ELIGIBILITY: PRISONERS
3:04:04 PM
CHAIR KELLER announced that the first order of business would be
HOUSE BILL NO. 288, "An Act prohibiting denial or withholding of
medical assistance eligibility or coverage for a prisoner."
3:04:32 PM
JIM POUND, Staff, Representative Wes Keller, Alaska State
Legislature, introduced HB 288, on behalf of the prime sponsor,
Representative Keller. He read from a prepared statement:
House Bill 288 is based on the fact that if an
individual is convicted of a crime, he's sentenced to
jail. The State of Alaska assumes custody ... but we
also assume the medical costs. Some of these can be
extremely expensive, and under our current regulatory
process, we cannot share that cost with anyone,
including Medicaid. Medicaid sharing by inmates is
forbidden by state regulation, not state law. The
regulation is based on a federal understanding of the
rules; in fact there is no federal law that requires
it, either. It's a grey area that says inmates under
state custody cannot receive Medicaid, but the
interpretation of that is rapidly changing in that
several states already seek Medicaid funds for
inmates. For those inmates in facilities in an
infirmary, the rule is essentially the same as in
state custody. Where the condition places the inmate
under the care of a hospital, the rules are different.
Medicaid may be used for that type of care. For the
State of Alaska, up to 50 percent of that money is
federal money. The state needs to look at ways to
save money. This is a golden opportunity for us to
look at a $32 million budget for this coming up fiscal
year. How much we can save will depend on the number
of inmates who qualify. Potential changes in the U.S.
health care laws may also greatly increase that amount
in 2014. We urge your support of this bill; it moves
us in the right direction.
CHAIR KELLER asked the committee if there were any questions.
3:06:41 PM
JON SHERWOOD, Medicaid Special Projects, Office of the
Commissioner, Department of Health and Social Services (DHSS),
explained that, although the area of coverage by Medicaid for
inmates was "somewhat ambiguous," states were able "to cover
inmates when they are staying overnight in in-patient medical
institutions." He expressed a need to move carefully, as this
issue had "a good deal of federal oversight." He commented
that, as Medicaid billing was monthly, the billing of Medicaid
coverage solely for an in-patient setting outside the
correctional facility would be a challenge for the DHSS,
requiring some structural adjustments to the billing system.
3:08:40 PM
CHAIR KELLER reflected on the irony for his introduction of a
bill to expand Medicaid, but, as it was balanced against general
fund funding, he declared "it just seemed like something that
just is the right thing to do."
3:09:18 PM
REPRESENTATIVE MILLER asked for a definition of prisoner, and
when there would be [Medicaid] coverage.
LESLIE HOUSTON, Director, Central Office, Division of
Administrative Services, Department of Corrections (DOC), in
response, stated that the focus was to those people incarcerated
in the state correctional facilities. She admitted that the
proposed bill could include people with electronic monitoring,
as well as those in community residential centers (CRCs).
REPRESENTATIVE SEATON asked for clarification about a person who
was in the custody of the state.
MS. HOUSTON explained that the proposed bill would include
people under electronic monitoring, supervised probation,
residents of half way houses (CRCs), as well as those in DOC
facilities.
3:11:35 PM
REPRESENTATIVE SEATON, noting a difference between her testimony
and the proposed bill, asked to clarify whether, initially, the
state was only going to claim coverage for prisoners in a
correctional institution, and not claim coverage for everyone in
custody.
MS. HOUSTON, in response, said that it would begin the process
with those incarcerated in facilities, as this was an easier
point to assess eligibility. She agreed that it would be
expanded "to reach every single area possible."
3:12:53 PM
REPRESENTATIVE SEATON asked to clarify that proposed HB 288
allowed DOC and DHSS to narrow or broaden the coverage.
MS. HOUSTON expressed her agreement.
3:13:12 PM
CHAIR KELLER, directing attention to the formula on page 2 of
the memorandum from Legislative Research Services [Included in
members' packets], stated that the savings to the state general
fund would be a minimum of $3 million. He allowed that this
savings did not calculate any cost for administering the
program.
3:15:42 PM
CHAIR KELLER closed public testimony.
3:16:24 PM
REPRESENTATIVE DICK moved to report HB 288 out of committee with
individual recommendations and the accompanying fiscal notes.
There being no objection, HB 288 was reported from the House
Health and Social Services Standing Committee.
3:17:07 PM
The committee took a brief at-ease.
SCR 1-LUPUS AWARENESS MONTH
3:20:14 PM
CHAIR KELLER announced that the next order of business would be
CS FOR SENATE CONCURRENT RESOLUTION NO. 1(STA), Designating May
of each year as Lupus Awareness Month.
3:20:40 PM
CELESTE HODGE, Staff, Senator Bettye Davis, Alaska State
Legislature, reported that proposed SCR 1 designated May as
Lupus Awareness Month, and encouraged Alaskans to observe the
month with appropriate activities which provided education and
support for those diagnosed with the disease. She pointed out
that Lupus was a disease which affected the immune system by
causing inflammation and tissue damage, although there was not
total understanding of the causes and consequences of the
disease. She shared that Lupus can affect any body part, and
can cause seizure, strokes, heart attacks, miscarriages, and
organ failure. She noted that it most often strikes women of
child bearing age, with women of color developing Lupus at 2-3
times the rate of Caucasians. She declared the difficulty for
diagnosis as its symptoms were similar to those of other
illnesses, and that the treatment could have damaging side
effects. She confirmed that each May was designated as Lupus
Awareness Month to show support for the 1.5 million Americans
with Lupus. She stated that more than 3000 Alaskans had been
diagnosed with Lupus. She declared that SCR 1 would join Alaska
with other states in support of an increase for awareness to
Lupus.
3:22:55 PM
REPRESENTATIVE SEATON, directing attention to page 2, line 8,
asked to clarify the age range for Lupus.
3:23:23 PM
MS. HODGE replied that age 10 was more accurate.
3:24:08 PM
REPRESENTATIVE MILLETT asked about treatments for Lupus.
3:24:24 PM
MS. HODGE replied that a representative from the Lupus
Foundation of America would explain the specific treatments.
3:24:44 PM
CHAIR KELLER opened public testimony.
3:24:52 PM
ANNA TILLMAN, Executive Director, Lupus Foundation of America,
Alaska Chapter, stated that Lupus was a breakdown of the immune
system, not allowing the body to fight against viruses,
bacteria, and germs. She stated that Lupus was not contagious,
that 90 percent of those with Lupus were females, and that it
was unpredictable, and potentially fatal. Although the cause
was still unknown, she listed some factors that could trigger
the genes prone to the disease, including infection, ultraviolet
light, extreme stress, certain prescription drugs, and hormones.
She described some of the different types of lupus, including
cutaneous Lupus, drug induced Lupus, and the most common,
systemic Lupus, which affected the internal organs. She listed
people of color as being affected more than twice as often than
Caucasians, with more than 5 percent of offspring of Lupus
suffers also having Lupus. She noted that currently there was
no generic screening test to determine the development of Lupus,
adding that it would often take 3-5 years to diagnose, as the
symptoms could come and go over time. She stated that there was
no single laboratory test to determine Lupus, and that it could
often strike between 15 and 44 years of age. She reported that
the average annual cost to a person with Lupus was $12,643, and
that successful treatment often required a combination of
medications. She noted that fatigue was a symptom in almost 80
percent of cases. She detailed some of the medications to
include: steroids, an anti-malarial, and non-steroidal anti-
inflammatories. She stated that it had taken almost 21 years
for her diagnosis, and that she had permanent damage from Lupus.
3:30:06 PM
CHAIR KELLER asked for the number of cases in Alaska.
MS. TILLMAN replied that it was estimated to be about 3,000. In
response to Chair Keller, she agreed that the age range for
affliction, 10-87 years, was accurate.
3:31:29 PM
SARA CHANG, Government Relations, Lupus Foundation of America,
Inc., National Office, shared that raising awareness was one of
the largest priorities for the Lupus Foundation. She stated
that almost 1.5 million Americans, about 1 in 181 people, had
some form of Lupus, and almost 90 percent were women. She
reported that Lupus could strike without warning, had
unpredictable effects, and had no known cause or cure, making it
difficult to diagnose. She shared that the average time for
diagnosis was four years. She declared that SCR 1 would be
beneficial for Alaskan education and awareness to the effects of
Lupus. She stated that the direct and indirect cost to America
from Lupus was about $31 billion.
3:35:12 PM
CHAIR KELLER closed public testimony.
3:35:47 PM
REPRESENTATIVE DICK moved to report CSSCR 1(STA) out of
committee with individual recommendations and the accompanying
zero fiscal note. There being no objection, CSSCR 1(STA) was
reported from the House Health and Social Services Standing
Committee.
3:36:29 PM
The committee took a brief at-ease.
^Presentation: Cancer Action Network
Presentation: Cancer Action Network
3:38:44 PM
CHAIR KELLER announced that the final order of business would be
a presentation by the Cancer Action Network.
3:39:13 PM
CHRIS HANSEN, President, American Cancer Society, Cancer Action
Network, stated that the American Cancer Society was the largest
voluntary health organization in the world devoted to cancer,
and, measured by its contributors, it was the largest not-for-
profit organization in the world. He described the Cancer
Action Network (CAN) as a grass roots organization, in existence
for more than 10 years, with 1400 volunteers in Alaska. He
noted that there were more than 1 million CAN volunteers
nationwide, and that CAN was the largest, most powerful, most
successful volunteer-led movement dealing with government
decisions having to do with cancer. He shared that there were
12 million cancer survivors nationwide, noting that the
organization was unique, as it was "trying to put ourselves out
of business." He agreed that a goal of the organization was "to
create birthdays." He declared that 1500 Americans would die
today from cancer, and that 1000 Alaskans and 577,000 Americans
would die this year from cancer. He pointed to the trend lines
indicating that this would double by 2020. He shared that,
while survival rates were up, incidence rates were also up
because of the aging population and the increase in obesity. He
listed pancreatic cancer, kidney cancer, and liver cancer as the
most deadly cancers. He shared that the American Cancer Society
was the largest private funder of cancer research in the world.
He directed attention to polls indicating that cancer was the
most feared disease in the world.
3:44:19 PM
MR. HANSEN stated that 50 percent of all men, and 33 percent of
all women, would have a cancer diagnosis during their lifetime,
and that 1.4 million Americans and 3640 Alaskans would be
diagnosed with cancer this year. He pointed to the toll this
placed on the U.S. economy, almost $226.8 billion for direct and
indirect medical expenses annually. He shared that globally the
economic loss was almost one trillion dollars. He stated that
the American Cancer Society was now working internationally. He
declared that, although smoking rates in the U.S. had leveled
out at 20 percent over the last 6 years, they had increased
around the world. He described that the connections between
obesity and cancer were "numerous and dramatic." He reflected
that when the war on cancer had been declared 40 years prior, it
was thought that a cure could be found, but that it was now
realized that cancer was a family of more than 200 diseases,
with the similarity being they metastasize. He declared that
prevention and early detection were the keys to "beating this
disease." He pointed out that one third of all cancer deaths
were a direct result of tobacco usage. He reported that for any
type of cancer, it was now possible to determine a treatment if
the person's protein specificity was determined.
3:49:28 PM
MR. HANSEN spoke about some recent discoveries, funded by the
National Institute of Health (NIH), which included a look at the
dietary habits of the Yupik. This study showed that a higher
intake of Omega 3 fatty acids helped prevent obesity related
cancers. He gave some background about the work at NIH, and
pointed out that the economic and health benefits from this NIH
research were rewarded with a $300 million increase to its
budget. He declared that budget cuts could affect the life
sciences research at University of Alaska. He pointed out that
cancer screenings, including colonoscopies and pap smears, saved
lives and money, as early detection was cheaper and easier to
deal with. He noted that only one third of the eligible low
income and underserved women were utilizing the breast and
cervical cancer early detection programs. He offered a
complement to the State of Alaska in its role for tobacco
cessation, as Alaska was the first state to have a tobacco
prevention and control program. He referred to the increase to
tobacco taxes in Alaska, which he said were excellent
disincentives for the product, and also generated a lot of
revenue. He noted that every 10 percent increase to tobacco
price was followed by a 7 percent reduction in youth smoking,
and a 4 percent overall reduction in smoking. He referenced
that the Alaska Native youth smoking rate had dropped from 62
percent in 1995 to 43 percent in 2009. He shared that the
national teen smoking rate was 20 percent, compared with the
Alaska teen smoking rate of 16 percent. He pointed out that
this was the only legal product that "when used as directed will
kill you." He reported that Alaska spent $169 million each year
on medical costs to treat tobacco related diseases, with an
additional $170 million of lost productivity for tobacco related
illness; whereas, every pack of cigarettes sold in Alaska
generated $7.89 in health care spending. He declared that the
tobacco companies spent $10.5 billion annually, and $20 million
in Alaska, to "entice kids to pick up the habit." He shared
that the U.S. marketing expenditures by tobacco companies had
doubled since the Tobacco Master Settlement Agreement (MSA) in
1998.
3:55:39 PM
MR. HANSEN shared that 53 percent of Alaskans worked in a smoke
free environment, pointing out that second hand smoke killed
50,000 Americans every year. He pointed to studies which showed
that businesses did better with smoke free environments. He
stated that one third of all cancer deaths were due to
overweight and obesity. He reported that nationally, 67 percent
of adults and 18 percent of children were obese or overweight,
while 65 percent of Alaskan adults and 26 percent of high school
students were obese or overweight. He stated that the rate for
obese Alaskan adults had doubled to 27 percent since 1991, with
overall state health care spending of $459 million for medical
conditions connected to overweight or obese. He lauded that the
obesity prevention and control program was a good investment.
3:57:42 PM
MR. HANSEN spoke about the quality of life initiative, which
brought care and comfort together. He directed attention to the
handout, "Palliative Care at a Glance." [Included in members'
packets.] He discussed legislation being considered, which
would teach physicians more options to give patients for quality
of care.
4:00:14 PM
REPRESENTATIVE SEATON asked if Mr. Hansen was familiar with the
Alaska resolution [House Concurrent Resolution 5] which directed
the State of Alaska to move toward prevention of disease as the
primary model of health care and for education to the need for
sufficient levels of Vitamin D. He declared that the focus of
the House Health and Social Services Standing Committee was for
prevention not for treatment. He asked where ACN was
positioned.
4:01:51 PM
MR. HANSEN replied that he was aware of the resolution, and he
agreed that it was a good direction. He said that CAN was
focused on prevention, noting that preventative care was far
less expensive.
4:02:56 PM
CHAIR KELLER expressed his surprise for the tie in of obesity
with cancer. He asked what legislators could do specifically.
4:03:37 PM
MR. HANSEN replied that the recent understanding of the
relationship between obesity and cancer had occurred when an
epidemiologist had recognized a statistical relationship, and
then compared the physiological causes. He lauded the Obesity
and Prevention Control program in Alaska, and stated the
importance for funding at a level that would allow the program
to progress.
4:05:07 PM
REPRESENTATIVE KERTTULA asked about the connection between
obesity and cancer.
MR. HANSEN replied that there were at least 50 physiological
changes from obesity that caused cancer effects, more likely in
women, especially in reproductive systems and breasts.
REPRESENTATIVE KERTTULA asked for more information about
smokeless tobacco and snuff.
MR. HANSEN emphasized that smokeless tobacco was very dangerous,
as some people believed that this was healthier. He declared
smokeless tobacco to be just another way to keep people hooked
on nicotine, and that nicotine was carcinogenic. He offered his
belief that smokeless tobacco was "a really bad thing to use,
and it's a really bad thing to sell, and it's a really bad thing
to promote." He declared that there was no upside to smokeless
tobacco.
4:07:32 PM
REPRESENTATIVE MILLETT asked if there were other insurance
mandates for preventative care that CAN was working toward.
MR. HANSEN directed attention to colorectal screening, and
stated that it was not covered for retirees by state health
insurance. He declared that colon cancer was far more
aggressive from ages 50 to 65 years. He declared this to be the
worst time not to be covered. He reported that CAN was working
toward a national standard of coverage for screenings. He
shared that while some insurance companies paid for
colonoscopies as a screening, polyp removal was not covered
under the screening, and that CAN was trying to close these
coverage gaps.
4:10:14 PM
REPRESENTATIVE MILLER asked if the federal government was still
subsidizing tobacco, corn, and sugar. He asked if CAN was
involved with any programs to eliminate these subsidies.
MR. HANSEN, in response to Representative Miller, said that corn
subsidies were complex, but that CAN, recognizing the danger of
corn used as a sweetener, had tried to get the public to
understand the dangers of sugar sweetened beverages. He pointed
out that supersized sweetened beverages increased the appetite.
REPRESENTATIVE MILLER declared his desire to see those subsidies
removed.
4:13:31 PM
REPRESENTATIVE HERRON asked about the use of chemical compounds
to make foods taste better.
MR. HANSEN explained that the American Cancer Society was
scientifically evidence based, and although they had concerns,
they would not comment until they had the science evidence for a
conclusion.
4:14:51 PM
REPRESENTATIVE HERRON asked if the federal government would ban
substances such as snus and other nicotine laced products.
MR. HANSEN replied that nicotine was carcinogenic and should not
be in any product.
4:15:44 PM
REPRESENTATIVE SEATON asked if CAN was aware that it was legal
to sell nicotine to minors in Alaska. He offered his belief
that these nicotine products were "a gateway mechanism to get
people set up for tobacco products at a later time."
MR. HANSEN, in response, said that CAN was aware of this.
4:17:03 PM
EMILY NENON, Alaska Government Relations Director, American
Cancer Society, Cancer Action Network, stated that CAN was very
concerned about the emerging tobacco products. Speaking about
the use of these products by kids, she declared that the tobacco
industry should not be allowed to "continue its predatory
practices on our children."
4:18:28 PM
MR. HANSEN shared that he had discussed, with tobacco industry
lobbyists, the business model for finding ways to hook people on
nicotine. He declared that there was nothing good about this.
4:19:22 PM
REPRESENTATIVE MILLER described the use of nicotine to kill mink
on mink farm.
4:20:12 PM
CHAIR KELLER agreed that tobacco was a known carcinogen, but
that the data for the association of cancer with obesity should
not yet be overstated. He offered his belief that obesity was
also associated with other diseases.
4:21:23 PM
MR. HANSEN, in response to Chair Keller, said that
epidemiologists had studied trends with obesity and cancer, and
that any number of cancer causes did come from obesity. He
declared that there was, indeed, a one to one relationship
between obesity and certain body functions which created
cancers. He agreed that not all cancers were caused by obesity,
but that the relationships were very complex, unlike that of
nicotine and cancer.
4:23:42 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 4:23 p.m.