Bills on the Move

Committee/date of last action: (S) L&C and (S) FIN, 01/16/08

Committee/date of last action: (H) HES) and (H) L&C, 01/22/08

HB 319 would amend the statute regulating the use of dental radiological equipment. The bill would specify the prohibitions under the statute to include the dentist's "direct or indirect" supervision of the use of such equipment. HB 319 would also extend the "direct or indirect" supervision clause to the grounds for discipline, suspension, or revocation of license. New sections are added to the statute regarding dental assistants, including certain certifications and delegation to dental assistants; and definitions of certain terms used in the legislative language.

HB 329 ABORTION NOTIFICATION

Sponsor: Representative Doogan
Committee/date of last action: (H) HES and (H) JUD, 01/17/08

HB 329 would amend several aspects to the current statute governing parental notification of an abortion on a minor, as well as repeal the judicial bypass provisions relating to abortions. Specifically, the bill would lower the age of notification from 17 to 16, and would more clearly define who is capable of giving consent. The bill would also redefine "medical necessity" for abortions and amends the duties of the Office of Public Advocacy in cases involving minors' abortions.

HJR 26 CONST AM: CONTROL OF MINOR'S MEDICAL CARE
Sponsor: Representatives Coghill and Lynn
Committee/date of last action: (H) HES and (H) JUD, 01/15/08

HJR 26 proposes an amendment to the Alaska Constitution. It would grant a parent or guardian the right to direct and control the medical care and treatment of the parent or guardian's minor child. This right would be subject only to emergency exceptions and judicial bypass. The judicial bypass procedure would be narrowly tailored to protect the rights and health of the minor child and be consistent with standards established by the United States Supreme Court. The proposed amendment would be placed before the voters in the next general election as determined by the state's constitution and election laws.

SB 28 LIMIT OVERTIME FOR REGISTERED NURSES
Sponsor: Senator Davis
Committee/date of last action: (S) FIN, 01/23/08

"SB 28, hereafter also to be known as "The Alaska Safe Nursing and Patient Care Act," prevents Alaska registered and licensed practical nurses from being forced to work mandatory overtime, i.e., compulsory as opposed to voluntary work in excess of an agreed to, predetermined, regularly scheduled shift, and it protects patients from the dangers caused by overworked nurses ... This legislation also protects nurses from discrimination and retaliation by employers who continue to force them into working hours beyond what they believe safe for quality care. SB 28 requires that health care facilities monitor, document, and report overtime semiannually and face penalties for knowing violations." -Sen. Davis

SB 29 MEDICAL PATIENT BILLING DISCLOSURES
Sponsor: Senator Dyson
Committee/date of last action: (S) HES, 01/16/07

SB 29 would affect certain aspects of patient billing disclosures. The bill adds a new section to the existing statute (AS 18.20) that specifies what licensing a hospital must have to be regulated under the proposed law. The bill also adds a new section to the existing statute that specifies what information hospitals that received government money for the purchase, construction, repair, equipping, or operation of the hospital would have to disclose on each patient billing. Several terms that would be related to this information are also defined, including "government money," "hospital," and "patient billing."

SB 98 DENTAL HYGIENISTS
Sponsor: Senator Davis
Committee/date of last action: (S) HES, 02/28/07

"SB 98 allows Alaskans better access to professional training, skills, and technology available to meet their oral health care needs with expanded services provided by dental hygienists licensed under AS 08.32. Many Alaskans either cannot afford regular oral health care, do not understand the need for it, or live in areas or facilities not served by oral health care professionals. SB 98 also will help stem what the Surgeon General reported as a 'silent epidemic of oral diseases ... affecting our most vulnerable citizens ... No one should suffer from oral diseases or conditions that can be effectively prevented and treated.'" -Sen. Davis

SB 107 NATUROPATHS
Sponsor: Senator Davis by request
Committee/date of last action: (S) L&C, 03/07/07

"For purposes of expanding allowed procedures and regulating the growing practice of naturopathic medicine in Alaska, SB 107 establishes required licensing fees, a Naturopathic Advisory Committee, and an Alaska Naturopathic Formulary Council ... New naturopathic procedures under SB 107 allow minor surgery, including operative, electrical, and other methods of repair to superficial lacerations and abrasion or lesions, and removal of foreign bodies in superficial tissues. The bill also allows naturopaths to use antiseptics and local anesthetics in connection with allowed procedures. The law prohibits naturopaths from performing major surgery, and spinal and general anesthetics." -Sen. Davis

SB 181 ANATOMICAL GIFTS
Sponsor: Senator McGuire
Committee/date of last action: (S) HES, 05/15/07

This bill would affect anatomical gifts; donations to the anatomical gift awareness fund; a registry of anatomical gifts; and the organizations that handle the procurement, distribution, or storage of all or a part of an individual's body. The majority of changes proposed in SB 181 are to change the particular Alaska statutes that govern anatomical gifts issues to the most current statutory number. The bill would also add a number of sections to the existing statute in order to address several issues, including who may make an anatomical gift before the donor's death; the manner of making an anatomical gift before the donor's death; and the rights and duties of procurement organizations and others. The bill would also address the need for uniformity of the law with regard to the subject matter, and also defines the terms used in the text. 

SB 224 CONSUMER HEALTH INFORMATION WEBSITE

Sponsor: Senator Dyson
Committee/date of last action: (S) HES and (S) FIN, 01/19/08

SB 224 would establish a consumer health information website to be operated by the Alaska Department of Health and Social Services. Included in the information to be made available would be a list of preferred drugs approved by DHSS for reimbursement; a list of the 100 most commonly prescribed medications in the state and the source and price, updated monthly; available hospital ratings, including the rates of hospital acquired infection and mortality occurring at each hospital in the state; and a list of primary care clinics that cater to uninsured and self-pay patients.

HB 252 LEAVE FOR ORGAN/BONE MARROW DONATIONS
Sponsor: Senator LeDoux
Committee/date of last action: (S) HES, 05/15/07

"The Richard Foster and Alec Cesar Donor Act would require the State of Alaska to grant a paid leave of absence to an employee for the purpose of making a personal organ or bone marrow donation. The employer is not required to provide more than 80 hours of leave, however the leave may not be less than 40 hours unless the employee requests fewer hours. Verification may be required and the State may not retaliate or sanction an employee for requesting this leave." -Rep. LeDoux

Committee/date of last action: (S) HES and (S) FIN, 01/16/08

Committee/date of last action: (S) HES, (S) L&C, and (S) FIN, 01/16/08

Committee/date of last action: (H) HES and (H) FIN, 01/15/08

Committee/date of last action: (H) HES and (H) FIN, 01/15/08

Committee/date of last action: (H) HES and (H) JUD, 01/15/08

A UAF emeritus professor of geophysics, Neil Davis has several fiction and nonfiction works published by the University of Alaska Press and McRoy & Blackburn Publishers. Mired in the Health Care Morass, his newest book (due March 2008), is about the US health care situation and how to fix it. He writes Dose of Reality, a column about health care and insurance, for The Ester Republic. You can read more about his books at his website, www.neildavisalaska.com. We wish to thank Professor Davis and the Ester Republic for giving us permission to republish this commentary. The views expressed by Professor Davis are his own and do not necessarily reflect those of the Alaska Center for Public Policy or the Alaska Health Policy Review.

Touting it as a means to provide all Alaskans with health care insurance, Anchorage Democrat Senator Hollis French (D) has introduced Senate Bill 160, titled "Affordable Health Insurance for All Alaskans." The intent is perhaps commendable, but, if enacted in its present form, this bill will actually increase overall health care costs for Alaskans. It also has the potential to do serious financial damage to the 106,000 Alaskans who now receive Medicaid benefits.

The cost of supplying Alaskans with health care in 2005 was $5.3 billion, an amount equal to one-third the value of North Slope oil exported that year. That is a lot of money, and it amounted to about $8,000 per Alaskan. Of that amount, nearly $1 billion was dispersed to hospitals and other medical providers through the Alaska Medicaid program, almost $10,000 per Medicaid beneficiary.

Medicaid is a joint federal-state public insurance program intended to pay the full cost of health care for eligible low-income parents, children, seniors, and people with disabilities. It is the largest source of funding for medical and health-related services for people with limited income. Medicaid provides insurance coverage for 38 million Americans, including 106,000 Alaskans. The federal government pays about 60 percent of the cost in Alaska, and state government pays the rest.

The Alaska Medicaid insurance program is highly efficient in that its administrative cost is only about three percent; that is, about 97 percent of the program money goes directly to pay for medical care. Of that 97 percent, 62 percent pays for acute medical care, 37 percent pays for long-term care, and 1 percent goes to what are called "Disproportionate Share Hospital (DSH) Payments." The DSH payments, amounting to about $7 million in fiscal year 2006, go to hospitals serving more than usual numbers of low-income and uninsured patients. So the purpose of the DSH funds is to go beyond just paying directly for care to Medicaid beneficiaries; it provides general support to certain hospitals located in areas where incomes are low and have abnormal uninsured populations. Because of the state's higher average salaries, Alaska does not fare as well in the distribution of DSH payments as other parts of the country. On average, DSH payments amount to six percent of the total Medicaid payout, but Alaska gets only one percent.

Now, in addition to those 106,000 Alaskans covered by Medicaid insurance, there are another 114,000 Alaskans not eligible for Medicaid and who do not have other insurance. The stated purpose of Senate Bill 160 is to provide those people with insurance issued by the private insurance industry. The bill will require every Alaskan to have some form of insurance. Those already insured will be able to keep the insurance they already have if they choose, but if they have none they will, by law, be forced to buy health insurance from the insurance industry, whether they want to or not.

The idea is to require participating Alaskans (those who have no other insurance) to buy vouchers to be used only to purchase health insurance--not to purchase health care. To help low-income Alaska residents pay for the insurance vouchers, the bill calls for subsidies using funds from various sources. These sources include required contributions from employers, legislative appropriations, federal funds, premiums, contributions, and "state money appropriated to subsidize uncompensated care."

What is that last-mentioned source; that is, what money does Alaska appropriate to subsidize uncompensated care? Senate Bill 160 is vague on this point but bill sponsor Senator Hollis French, in an article published in the Anchorage Daily News on March 16, 2007, stated that the intent was "to take the Medicaid dollars currently being spent to reimburse hospitals and other providers for the free care they provide to the uninsured, and use the money instead to subsidize health insurance for those who cannot afford it ... Take the money spent on hospital bills each year for the uninsured, and buy health insurance instead."

Reading that statement, warning bells clanged in my head. Did Senator French mean that Senate Bill 160 would raid Medicaid of all its funding and use it to help buy health insurance? Was he considering the Alaskans on Medicaid to be uninsured? No, not at all, Senator French responded when I queried him about this; I had the wrong idea altogether, he said. He meant that only the Medicaid Disproportionate Share Hospital (DSH) funds would be taken away from Medicaid.

That is an interesting thought when one looks at the Alaska DSH payments in 2006: $7 million. Of that amount, the state appropriates only 40 percent, just under $3 million. That's coffee money compared to the $5 billion cost of health care for Alaskans, or even the $1 billion in the Alaska Medicaid program. Yet, Senator French featured this source over all others in his newspaper article promoting Senate bill 160.

The truth is that any money diverted from government health insurance to private insurance drives up overall health care costs. That is because so much private insurance money is consumed by administrative costs, advertising costs, and shareholder profit. Government programs like Medicaid and Medicare pay 96 to 97 percent of the money taken in directly to health care providers, whereas the payout from the private insurance industry averages only 73 percent, and some policies pay out as low as 45 percent.

Senate Bill 160 as now written is a boon to the private insurance industry, but of questionable value to the 114,000 uninsured Alaskans it supposedly helps. They will, by law, have to buy some form of health insurance, but they will also be stuck with the deductibles and co-pays required by the policies they buy. On top of that, they will themselves have to pay for any health care not covered by the policies. For those persons needing the most health care, that extra cost will be substantial and in many cases unbearable.

It would be a different matter if SB 160 called for providing uninsured Alaskans with vouchers that would buy health care rather than just health insurance policies that pay only part of the cost of health care. That could bring down the overall cost of health care for all Alaskans while simultaneously improving access to needed health care for Alaskans now uninsured.

An incorrect word was published in the interview with Rosalie Nadeau in the January 14, 2008 issue. The last sentence of the answer following the question, "Is this the FMAP?" should have stated:

We did not increase the funding to those programs dramatically, what we did was supplement general fund money with Medicaid money.

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