Alaska Health Policy Review

Dear Reader:

Establishing an extraordinary public policy precedent, on December 4, 2008, Governor Palin issued Administrative Order No. 246 which created the Alaska Health Care Commission in the Department of Health and Social Services.

The purpose of the commission is to provide recommendations for and foster the development of a statewide plan to address the quality, accessibility, and availability of health care for all citizens of the state.

I have more news to share about this key health policy action. Toward the end of January, Governor Sarah Palin announced her appointments to the Alaska Health Care Commission. A few days ago, I had the pleasure of spending some time with Deborah Erickson, housed in the commissioner's office, who is the newly appointed executive director of the Alaska Health Care Commission.

Deborah noted that the first meeting of the new commission will be held in Juneau, February 27-28. There will be some presentations by experts, but Jay Butler, chair of the commission, wants to encourage discussion among the commission members. Initially, the commission members will receive only two background documents prior to this meeting: a copy of the final report of the Governor's Health Care Strategies Planning Council, which was established by Gov. Palin in 2007, and a copy of the Commonwealth North document, Alaska Primary Health Care: Opportunities and Challenges.

We think an extremely useful new study for the commission to review is Analytic Support for Washington Citizens' Work Group on Health Care: Evaluation of Health Care Reform Proposals. The analysis was authorized by the state legislature to compare four state health reform proposals, including a single-payer plan. In this issue of Alaska Health Policy Review, we present a summary of the plans and key findings, which we think you will find most interesting.

One last, but important thing: Alaska Center for Public Policy, publisher of Alaska Health Policy Review, is a non-profit 501 (c) (3) organization, and is eligible for your donation when you apply online for your Alaska Permanent Dividend Fund (http://www.pfd.alaska.gov/). To donate to us, click on "statewide organizations," and type in "Alaska Center for Public Policy." Thanks so much for helping us pursue our mission of advancing public policy in Alaska that benefits low- and medium-income families.

Lawrence D. Weiss PhD, MS
editor, AHPR
ldweiss@gmail.com

Health Reform Models: Some Better Than Others

At a time when people are wondering whether they should pay for health care or pay the electric bill, the topic of health care reform offers hope to those who are struggling. Health reform in Alaska has received an increasing amount of attention, with two bills in two years from Senator French, both of which propose a health care system where more Alaskans would have coverage. Other states, like Massachusetts, are ahead in the quest for more and better health care coverage. There are many examples to learn from, and a few, like the single-payer system, are ideological misfits for some. Ultimately, an analysis of the many types of health care reform can reveal evidence of more effective, and less effective approaches.

In 2008, the Washington State Legislature passed a bill that called for economic analysis of several health reform bills and the formation of a Citizens' Work Group on Health Care Reform. In fulfillment of the bill's requirements, the Legislature contracted with Mathematica Policy Research, which conducted an evaluation of four health care reform proposals. Mathematica released their findings this January, which summarized and assessed the four proposals using several important criteria.

The four proposals evaluated by Mathematica are:

Reduced Regulations - modifies insurance regulations in Washington State for products sold to small groups and young adults. Health plans would be exempt from state-mandated benefits, and carriers would be allowed to pool the health risk of young adults separately from other enrollees, widening the rate bands for coverage among older adults
The Connector - modeled after the 2006 Massachusetts health care reform, it would merge small groups, small group association, and individual markets. Enrollees would have choice among health plans, but not necessarily among providers
The Health Partnership - similar to the state's Public Employees Benefit Board health insurance program, this proposal would contain tiered premiums and give enrollees choice among networks and a fee-for-service option. The premiums for the lowest-cost plans would be subsidized, and Medicaid eligibility would be expanded.
The Single-Payer Plan - similar to health care reform in Canada, this proposal would establish a single-payer system replacing all nonfederal sources of coverage. Residents would be enrolled automatically, Medicaid eligibility would be expanded, and providers would be reimbursed for Medicaid services at commercial rates.

The following is a summary of the report issued by Mathematica, including an initial analysis of the key findings. How many residents would gain coverage under these plans? Do the plans encourage best practices among providers? Are the plans equitable among all enrollees? Finally, are they cost effective while providing high-quality care? As health care reform discussion increases among legislators in Alaska, this type of policy analysis can provide the clarification and support required to induce real progress.

Key Findings

The Reduced Regulations proposal intends to offer more options for young adults and small groups; however, reducing regulations would have a minimal impact on the number and type of those insured, and would result in more restrictive plan options. Although it would require the least federal and state financial investment of the four proposals evaluated, the plans offered appear to provide minimal coverage at a higher cost per enrollee. The Reduced Regulations plan focuses only on the 19-34 year-old age group, and thus would have no benefit for the increasing number of individuals over 65 years of age. Implementation of this type of proposal would do little, if anything, in improving access to, and coverage for, health care.

The main benefit from the Connector proposal is that it would increase the number of insured individuals. However, the types of plans offered may be too restrictive, and there is the potential for older adult workers to lose their current coverage. Premiums under this proposal would be rated, and the impact on consumer out-of-pocket expenses under a rating system may not be beneficial to all those involved. State and federal monies would be required to subsidize low-income employed adults.

The Health Partnership Plan and the Single-Payer Plan would offer coverage to the greatest number of individuals, as they would enroll all individuals under 65 years of age. In addition, the Single-Payer Plan would increase Medicaid reimbursement rates to providers, which could result in the elimination of hospital charity care for residents under 65 years of age. Both of these plans would result in a substantial increase in federal spending due to the wide range of those covered.

While the Connector and the Health Partnership plans would offer the most flexibility in coverage options for enrollees, the Single-Payer Plan would create the greatest amount of choice among providers. Thus, enrollees would not be limited when choosing a medical provider and providers would be reimbursed at identical rates for all enrollees. However, flexibility in provider choice could be lost if the single-payer system neglects to focus on integrated systems of health care management.

None of the four proposals evaluated address the issue of improving cost effectiveness and quality directly. However, some fare better than others at fulfilling (or having potential to fulfill) recommended practices for value in health care delivery. The Single-Payer Plan does two things to improve health outcomes: increasing coverage to all residents under the age of 65 and increasing the number of individuals eligible for Medicaid.

Although none of the plans discuss chronic disease management programs, which can be effective in improving health outcomes, the last two proposals have the greatest potential in this area. Because they would operate under one administrative system, providers would be encouraged to communicate throughout the course of care for chronic disease of enrollees. Additionally, this characteristic has the potential to increase the quality of care delivered to enrollees by establishing a financial incentive system that discourages the use of inappropriate care and reinforces high-quality health care delivery. A more detailed analysis of each of the plans follows.

Proposal One: Reduced Regulations

The overall goal of this proposal would be to change the regulations applied to individual health insurance products in an effort to create lower-cost and reduced-benefit plans that are marketable to healthier populations. The changes, which would be specific to small groups and young adults, offer reduced-benefit plans in the individual market. Specifically, this proposal would allow insurance carriers in Washington State to:

Offer reduced-benefit plans to small employers (ERBs), which would be exempt from many mandated conditions, services, and providers currently regulated in Washington State
Offer individual reduced-benefit plans (IRBs) to young adults (19-34 years old); these plans would also be exempt from certain mandated services, including prescription drugs
Alter the rating system of premiums for insurance plans by creating a separate rate class for young adults, for all individual products.
The overall goal is to increase the number of insured young adults by offering plans with limited benefits at a lower cost.

Enrollment and Eligibility

Under the Reduced Regulations proposal, the following individuals would be eligible:

Insured small employer groups of 2-50 employees, including those covered in association plans or enrolled in commercial insurance products or HMOs
Adults aged 19-34 in individual plans
Uninsured small groups and young adults

Those that would not be eligible include self-insured employers, federal and military employees, and large-group employees.

This proposal is projected to have a minimal effect on enrollment. It is not expected that small group employers who currently offer coverage would switch to small-group reduced benefit plans. Thus, initial enrollment in the Employer Reduced-Benefit plans would be very low. Initially, these plans would cover fewer than 3,000 workers and dependents.

Overall, very few young adults would enroll in individual reduced benefit plans. The Reduced Regulations proposal would target just 29 percent of young adults aged 19 to 34 -- those who are uninsured or have individual coverage. Of these, most would remain uninsured or enroll in a standard individual plan or the Washington State Health Insurance Pool (WSHIP). Only two percent would enroll in a reduced-benefit plan.

Changes in Coverage and Impacts on Hospital Charity Care

Low-income young adults would account for a larger proportion of enrollees in individual plans with reduced benefits compared with enrollees in standard individual coverage. Among all adults who would enroll in individual reduced-benefit plans, 61 percent have incomes below 200 percent FPL, compared to 19 percent of all persons and 42 percent of adults aged 19 to 34 who would enroll (or remain enrolled) in standard individual coverage.

Thus, this proposal targets young adults who are most likely uninsured and may be high users of charity care. However, because Reduced Regulations will have a minimal impact on coverage, it is not likely that it will affect current levels of hospital charity care.

Scope of Coverage and Consumer Choice

Reducing regulations in this proposal results in plan options that do not include mandated benefits, such as:

Services from certain licensed providers
Services that target specific conditions, such as diabetes and chemical dependency
Other specific services, such as preventive and diagnostic services, and emergency medical care
Women's health care services; including maternity care, prevention, and follow-up

Additionally, the plans offered to individuals under the age of 35 would not include coverage for chiropractors, prostate screening, colorectal exams, and mental health services. Reducing regulations will do little to offer more provider and treatment options among enrollees. Although the plans offered would be those that are not currently available in the market, the number of employers who would enroll in reduced-benefit plans would be quite low initially. Thus, the available plans do little, if anything, to provide preventive coverage to younger adults.

Sources of Economic Impact

The Reduced Regulations proposal would not affect any federal program nor induce significant new offers of employer-based coverage. Additionally, it would not change enrollment in Medicaid/SCHIP, Basic Health, or the Washington State Health Insurance Pool. Thus, it would have no significant impact on overall state spending or economic activity. Because this proposal would have very little impact on coverage, it also would have little impact on overall spending for health care.

Improving Cost Effectiveness and Quality

This proposal would do little to increase the number of those insured. Thus, reducing regulations would not likely improve health outcomes. Insurance plan changes for young adults would result in more out-of-pocket consumer expenses, while offering plans that do not include preventive services and prescription drugs. Therefore, the plans offered would not likely result in improved health outcomes.

Proposal 2: The Health Insurance Connector

The Health Insurance Connector (i.e. the Connector) proposes many changes to the current system in Washington State. This plan targets smaller groups and the individual market. Residents would choose health plans from among ten different packages, each with many cost-sharing options. Under the Connector, current coverage options like the Washington State Health Insurance Pool and Basic Health would be terminated, and all enrollees would be given the option to enroll in a new plan. Low-income enrollees would be subsidized under this proposal, and there would be a minimal impact on enrollment in state and federal medical assistance programs. This proposal would increase federal spending in the State of Washington by an estimated $370 million.

Enrollment and Eligibility

Those eligible for coverage under the Connector proposal include the following:

Small employer groups with 2-50 employees
Currently insured individuals
Uninsured individuals with no offer of coverage from a large group employer
All Basic Health and WSHIP enrollees, including undocumented adult immigrants
HIS-eligible Native Americans

Those not eligible under this proposal would include self-insured employers, insured large group employers, federal and military employees and personnel with retiree health plans, institutionalized persons, individuals with Medicare and/or over the age of 65, public employees currently covered, and homeless or transient persons.

Under the Connector plan, the number of people with individual coverage would approximately double, and those with small group coverage would increase about 20 percent.

Almost 75 percent of those currently uninsured would have available coverage. The remaining uninsured would be low-income individuals or families exempted from the individual mandate. Employed individuals aged 45 to 64 would account for nearly two-thirds (61 percent) of uninsured workers. Additionally, the percentage of uninsured who are eligible for Medicaid, SCHIP, or Basic Health would decline from 75 percent to 12 percent.

Changes in Coverage and Impacts on Hospital Charity Care

The Connector would have a significant impact on decreasing the number of uninsured individuals, especially those not eligible for Medicaid or SCHIP. However, plans offered to small group employers under this plan could result in a loss of coverage for many older workers whose incomes make them ineligible for subsidization. Thus, the Connector could reduce the use of hospital charity care among younger adults, but increase use or hospital bad debt if more uninsured older residents seek such care.

Scope of Coverage and Consumer Choice

Coverage under the connector is guaranteed issue for individuals, and employees would have unrestricted choice among the ten plans. No minimum contribution from employers would be required, and participating employers would not be permitted to offer an additional type of coverage to eligible employees. Thus, there would be choice among the plans offered, yet not outside of the plans offered through the Connector.

Sources of Economic Impact

The Connector would increase the amount of federal spending in the state of Washington by $370 million. Individual costs among young workers and dependents could decrease, yet premiums are age-rated and each age group would have rated premiums. It is possible that the use of Section 125 plans, which typically allow employees to contribute pre-tax wages to their health premiums, would increase. This would be due to the individual mandate of Section 125 health plans required of employers under the Connector, and would result in more federal tax reiumbursements.

Improving Cost Effectiveness and Quality

Health insurance coverage under the Connector would increase substantially. Almost 75 percent of those currently uninsured would have access through individual or small group plans. Low-income adults would have subsidized coverage. Alternatively, older adults with current coverage may lose their coverage under this plan, resulting in a disproportionate change in health outcomes. Overall, health outcomes may not improve.

Proposal 3: The Health Partnership

The Health Partnership proposal offers comprehensive health coverage to all non-institutionalized residents who are not eligible for a federal or combination federal-state program. The benefits offered under this plan would be similar to those included in the Public Employees Benefit Board (PEBB), a program that would be discontinued under this proposal. The proposal would operate under a fee-for-service plan, available statewide.

Coverage would be guaranteed issue to all eligible applicants. Premiums would be set according to the level of coverage purchased, and the lowest-cost plans would require no premium. Low-income subscribers would be eligible for financial assistance with their shared costs. Financing for the program would be established through an employer tax. Additionally, eligibility requirements for state and federal programs would change to permit those up to 200 percent of the federal poverty level.

Enrollment and Eligibility

The Health Partnership offers coverage to the following:

Adults who have resided in the state for 12 months and intend to remain there
All children under the age of 18 and pregnant women, with no resident requirement and who are not eligible for Medicaid or SCHIP
Public employees and non-Medicare retirees
Employed individuals who are currently covered under bargaining agreements, following the expiration of their current plan
Enrollees in the Basic Health program, which would be terminated
Undocumented immigrants and children
HIS-eligible Native Americans
Homeless and transient persons

Those not eligible under the Health Partnership would include federal and military employees and retirees, institutionalized individuals, and individuals eligible for Medicaid or SCHIP (those at or below 200 percent of the federal poverty level for the state).

Changes in Coverage and Impacts on Hospital Charity Care

Coverage under the Health Partnership would be offered to all residents under the age of 65, and would increase enrollment in Medicaid and SCHIP by changing eligibility requirements. However, the relatively low reimbursement rates in these assistance programs would be retained, and hospital care coverage would not be included. Thus, the Health Partnership proposal would have little, if any, affect on hospital charity care among low-income residents.

Scope of Coverage and Consumer Choice

Plan choices in the Health Partnership proposal would be equivalent to those offered currently under the PEBB plans. Thus, enrollees would have several coverage options. However, Medicaid and SCHIP enrollees might have greater difficulty in finding providers to serve them, as the number of Medicaid and SCHIP enrollees increased and the programs maintained current, low levels of provider reimbursement.

Sources of Economic Impact

The Health Partnership proposal would require the greatest amount of financing from state and federal resources. Increasing Medicaid and SCHIP eligibility would result in an additional $1.6 billion in federal and state funds. Group coverage under this proposal would be eliminated and replaced by participation in the Health Partnership; however, this could leave many residents with high out-of-pocket expenses for the higher-cost plans. Additionally, federal tax expenditures would endure under the assumption that employers would continue to offer Section 125 health plans, yet at a reduced cost to individuals.

Improving Cost Effectiveness and Quality

Under the Health Partnership option, residents would be guaranteed comprehensive coverage. Out-of-pocket expenses would be capped for low-income families, as a percentage of family income. Expansion of Medicaid and SCHIP coverage would increase access to care for many residents. Each of these factors could contribute to improved health outcomes for residents. Additionally, the Health Partnership proposal requires that carriers of plans demonstrate the use of evidence-based practices among their providers, which could ensure a higher level of quality in care overall.

Proposal 4: The Single-Payer System

The Single-Payer System (Single-Payer Plan, or SPP) targets eligible residents under the age of 65, with automatic enrollment in the program. General state revenues would finance this plan, and coverage would not require premiums from enrollees. Only enrollees in federal programs (Medicare or military coverage, for example) would continue to pay premiums. This plan would essentially eliminate the need for employers to offer additional plans to employees, since every resident under 65 would be eligible for coverage. Benefits included in this plan would be identical to those offered to state employees in the Public Employees Benefit Board (PEBB). Cost per enrollee is estimated to be 2.5 times Medicare's fee-for-service administrative cost, and roughly equal to the administrative cost per enrollee in the PEBB program.

Enrollment and Eligibility

Under the Single-Payer Plan, the following individuals would be eligible for coverage:

Permanent adult residents with at least 12 months or more in the state
IHS-eligible Native Americans
Homeless and transient person
Undocumented adults and children

Those not eligible under the SPP would include Medicare enrollees, federal employees and retirees, and military employees and retirees. All eligible individuals would be automatically enrolled, with no premiums required.

Changes in Coverage and Impacts on Hospital Charity Care

The Single-Payer Plan would cover all residents under age 65, as well as increase reimbursement through Medicaid at commercial rates. Medicaid and SCHIP eligibility would be mandated for populations up to 150 percent of the federal poverty level. As all individuals under 65 would have coverage, this plan would most likely eliminate the use of hospital charity care. Thus, it would have the most substantial impact on hospital charity care among the four plans examined.

Scope of Coverage and Consumer Choice

The Single-Payer Plan (SPP) would eliminate the need for private insurance, as enrollees could seek care from any licensed provider. Providers would be reimbursed using the same rates for all enrollees, including those receiving Medicaid assistance. Thus, under the SPP proposal, individuals would have the most flexibility in their provider and treatment options among the four examined plans. However, unless the single payer system focused on developing regional and state-wide systems of integrated care management, consumers could lose the option to obtain that service.

Sources of Economic Impact

Under the Single-Payer Plan (SPP), federal spending would increase substantially, due to the expansion in eligibility for Medicaid assistance and the increase in provider reimbursement rates. However, the increased amount of federal spending would be less than half that proposed in the Health Partnership plan (Proposal Three), at $704 million. The SPP would result in a decrease in Medicaid enrollment as more residents obtain the proposed coverage. Additionally, residents would no longer receive federal tax reimbursement, as the lack of premiums would eliminate the need for Section 125 health plan payment options.

Improving Cost Effectiveness and Quality

The Single-Payer Plan (SPP) would ensure that every eligible resident is enrolled in a comprehensive health coverage plan. In addition, increasing coverage under Medicaid would increase the number of low-income and vulnerable individuals with coverage and access to care. Thus, it can be expected (if the health care system is capable) that this plan would result in improved health care outcomes for residents. The SPP option has the potential to require evidenced-based practices of providers as a stipulation of reimbursement.

Conclusions

The analysis conducted by Mathematica revealed key characteristics of each of four proposals for Washington State. Some of the proposals yield benefits that are more transparent for a greater number of residents. The Single-Payer Plan, while providing comprehensive coverage to the greatest number of residents, could create the most controversy among legislators. The Connector Proposal could increase the number of insured by almost 75 percent, but might cause older workers to lose their coverage. The Reduced Regulations proposal would result in barely a dent in the number of insured, and would offer little in the realm of comprehensive coverage. The Health Partnership holds promise overall, yet such a plan might face scrutiny because of its high costs.

A thorough discussion of health care reform options requires a systematic policy analysis like that conducted in Washington State. For plans that appear to promise the most benefit but suffer from minor (or even major) glitches, knowing the areas requiring additional "tweaking" can help legislators create more effective policy options. As more states work toward implementing measures that reform the current health care system, additional examples will become available for analysis.

The Alaska Health Commission was established last year, and HB 75 Health Commission/Planning, a bill in the current legislature, proposes a more detailed account of the duties assigned to this commission. Additionally, HB 25 Health Reform Policy Commission calls for the establishment of a committee with tasks similar to those of the analysis done in Washington State. An analysis of health care reform proposals in Alaska may be a critical first item on the agenda of either of these committees, especially as Alaska legislators prepare to debate Senator French's SB 61 Mandatory Universal Health Insurance.

[Source: Mathematica Policy Research, Inc., 2009. Analytic Support for Washington Citizens' Work group on Health Care: Evaluation of Health Care Reform Proposals.
http://www.pnhpwesternwashington.org/PAGES/Mathematica%20Draft.pdf]

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Alaska Health Policy Review is sent to individual and group subscribers for their exclusive use. Please contact us for information regarding significant discounts for multiple subscriptions within a single organization. Distributing copies of the Alaska Health Policy Review is prohibited under copyright restrictions without written permission from the editor; however, we encourage the use of a few sentences from an issue for reviews and other "Fair Use."

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For all related matters, please contact the editor, Lawrence D. Weiss, health.policy.review@gmail.com.

Commentary: Health Care as an Economic Locomotive

By Dr. Uwe Reinhardt

A ... major reason to give a move toward universal health insurance coverage the highest priority now in the Congress is the fact that our health care system has become one of the most powerful locomotives of our entire economy. It [is] now a major job creator in this country. The cover page of the September 26, 2006 issue of Business Week, for example, featured a nurse showing tough biceps, along with the headline: "Since 2001, the health care industry has added 1.7 million jobs. The rest of the private sector? None." ...

Many politicians, media pundits and even some economists who should know better, appear to hold a truly bizarre macroeconomic theory. According to that theory, building more golf courses, luxury homes, gas-guzzling sports utility vehicles and fast-food outlets contribute to economic growth, while providing health care to suffering Americans somehow detracts from it. Perhaps these "theorists" will be surprised to learn that health spending is actually a significant and genuine value-added component of GDP ...

Federal fiscal policy includes both government spending and taxes. There is little doubt that tax cuts can help stimulate the economy, either by putting spendable money into peoples' pockets (Keynesian demand-side stimulus) or by enhancing incentives for economic activity (supply-side stimulus) or both. An important question, however, is on what objects or activities the tax savings yielded by tax cuts are spent.

They could be spent on consumer goods such furnishings for a house, automobiles, fast food, luxury homes or golf course. Many, but not all of these expenditures would create American jobs. But such tax savings could also be spent on goods imported from abroad, or be invested in foreign stocks, bonds and other assets, thereby creating jobs abroad but not in the U.S. The relative size of this leakage abroad will vary over time, depending on who among Americans receives the bulk of the tax cuts, on foreign exchange rates and the prices of imported goods and on the relative profitability of investing in the U.S. or abroad. But there is bound to be such leakage.

By contrast, the health care used by Americans is produced entirely in the United States. Furthermore, added spending on health care diffuses quickly throughout the economy -- even faster than spending on infrastructure projects -- thereby creating new jobs and, for the most part, high value-added output throughout the economy. There is little or no leakage of such spending abroad. It helps explain why the health-care sector has acted as such a powerful economic locomotive in the U.S.

Consider, for example, the earlier recession period 2001-4 ... [D]uring the period 2000 to 2006, annual increases in health spending contributed more to GDP growth than even home building, in spite of the building boom fueled then by easy mortgage credit. Over the period 2000 to 2001, growth in health spending accounted for over a third of the year's growth in GDP. In the subsequent year, the contribution of health spending to GDP growth was close to 40%. By contrast, changes in business investment became a drag on GDP growth during 2000-2002 and did not significantly contribute to GDP growth until 2005. ...

[T]he health-care sector acts as a major economic stabilizer in our economy. Without annual increases in health spending, President Bush would have presided over a much deeper recession in his first term than occurred. It might well have cost him his second term.

The preceding argument is not intended to make the case for simply injecting more money into our health care sector, just for the sake of stimulating the economy. Rather, it is to make the case that spending more public money on health care for hitherto underserved segments of the American public not only adds valuable output to the economy -- thus adding to the growth in valuable GDP -- but in the process also creates jobs and livelihoods for American families.

The proposition is that extending health insurance coverage to the hitherto uninsured ought to be part of any economic stimulus package.

[Source: Excerpt from Statement presented to the U.S. Senate Finance Committee Hearing on "Health Care Reform: An Economic Perspective." November 19, 2008. Dr. Reinhardt holds distinguished positions at the Woodrow Wilson School of Public and International Affairs, and Princeton University. Among other positions he has held, during 1986-1995, Reinhardt served three consecutive three-year terms as a commissioner on the Physician Payment Review Commission (PPRC), established in 1986 by the Congress to advise it on issues related to the payment of physicians.]

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Alaska Health Policy Calendar

This calendar of health policy-related legislative meetings is current as of February 19, 2009 at Noon. Please visit the Alaska State Legislature's list of committee hearings for the most current listings, as they are subject to change.

February 20, 2009, 8:00 AM
What: House Health and Social Services Finance Subcommittee
Where: House Finance 519, Juneau
Other Information: Review governor's budget amendments; Alaska Mental Health Trust; teleconferenced

February 20, 1:30 PM
What: Senate Health and Social Services Standing Committee
Where: Butrovich 205, Juneau
Other Information: Presentation by Alaska Native Tribal Health Consortium; Bills previously heard; teleconferenced

February 23, 8:00 AM
What: House Finance Subcommittee
Where: House Finance 519, Juneau
Other Information: Draft Closeout; teleconferenced

February 24, 3:00 PM
What: House Health and Social Services Standing Committee
Where: Capitol 106, Juneau
Other Information: Telemedicine by Stuart Ferguson, Alaska Native Tribal Health Consortium; teleconferenced

February 25, 8:00 AM
What: House Health and Social Services Finance Subcommittee
Where: House Finance 519, Juneau
Other Information: TBA; teleconferenced

February 26, 1:30 PM
What: Senate Labor and Commerce Standing Committee
Where: Beltz 211, Juneau
Other Information: HB 104 Worker's Comp Medical Treatment Fees (pending referral); teleconferenced

February 26, 3:00 PM
What: House Health and Social Services Standing Committee
Where: Capitol 106, Juneau
Other Information: HB 2 Birth Certificate for Stillbirth; HB 26 Medicaid for Adult Dental Services; teleconferenced

February 27, 8:00 AM
What: House Health and Social Services Finance Subcommittee
Where: House Finance 519, Juneau
Other Information: Closeout; teleconferenced

March 3, 2009, 8:00 AM
What: Senate Health and Social Services Finance Subcommittee
Where: Fahrenkamp 203, Juneau
Other Information: Public Health initiatives; testimony; by invitation only; teleconferenced

March 5, 2009, 8:00 AM Meeting Canceled
What: Senate Health and Social Services Finance Subcommittee
Where: Fahrenkamp 203, Juneau
Other Information: Governor's amendments, Q&A session; testimony; by invitation only; teleconferenced

March 10, 2009, 3:00 PM
What: Senate Health and Social Services Finance Subcommittee
Where: Fahrenkamp 203, Juneau
Other Information: Rescheduled; Governor's amendments, Q&A session; testimony; by invitation only; teleconferenced

March 19, 3:00 PM
What: Senate Health and Social Services Finance Subcommittee
Where: Senate 532, Juneau
Other Information: Budget closeout; testimony; by invitation only; teleconferenced

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Bill Watch: Bills on the Move

As the legislative session moves along, we are seeing more progress among health policy legislation. No new health policy bills were introduced, yet several bills were heard, and some were referred to other committees. Three bills are scheduled to be heard in committee meetings as well.

SB 79 Med Benefits of Disabled Peace Officers was scheduled to be heard (S) State Affairs on February 19. HB 26 Medicaid for Adult Dental Services is scheduled to be heard in (H) HSS on February 26. HB 2 Birth Certificate for Stillbirth is scheduled for a hearing in (H) HSS on February 26.

HB 87 Med Benefits of Disabled Peace Officers was heard and held on February 2 in (H) L&C. HB 83 Approp: Mental Health Budget was heard and held in (H) FIN on February 2.

SB 87 Medical Assistance Eligibility was heard in (S) HSS on February 11, and referred to (S) FIN. HB 104 Worker's Comp. Medical Treatment Fees was heard for the third time and is pending referral to be heard in (H) L & C February 26. HB 63 Council Domestic Violence: Members, Staff was heard and referred to (H) FIN on February 13. SCR 1 Brain Injury Awareness Month March 2009 was referred to (S) Rules on February 13.

Bill Tracking Methodology

Bills listed here were selected based on a series of subjective criteria to determine whether they were "health policy-related" or not. All bills currently sitting in the Senate and House Health, Education, and Social Services committees were examined, and any that obviously dealt with non-health-related education or social services issues were eliminated. Every other House and Senate committee was then examined for health-related bills, which were included in the final list.

After determining the full set of health-related bills still in committee or pre-filed for the new session, they were divided into several general categories. This was done to facilitate finding bills that dealt with certain key health policy issues and to make overall navigation of the list easier. The remaining bills were categorized as "general" health policy related because of the wide range of subjects they covered.

The information listed for each bill includes the bill number, the short title, the primary sponsor or sponsors, the committee in which the last action on the bill took place, and the date on which the last action on the bill took place. A short summary of each bill is also included.

Bills are current as of February 19 at Noon.

Abbreviations have been used for committee names. The committee names and their abbreviations are:

(H) HSS: House Health and Social Services Committee
(S) HSS: Senate Health and Social Services Committee
(H) L&C: House Labor & Commerce Committee
(S) L&C: Senate Labor & Commerce Committee
(H) EDC: House Education Committee
(S) EDC: Senate Education Committee
(H) FIN: House Finance Committee
(S) FIN: Senate Finance Committee
(H) JUD: House Judiciary Committee
(S) JUD: Senate Judiciary Committee
(H) STA: House State Affairs Committee
(S) STA: Senate State Affairs Committee
(S) RLS: Senate Rules Committee

Bill Watch: Drugs

HB 17 PROHIBIT TOBACCO USE UNTIL AGE 21
Sponsor: Representative Crawford
Committee(s) and date of last action: Read and referred to (H) L&C, 01/20/09
Description: This bill requests to change the legal age from 19 to 21 for the purchase, sale, exchange, and possession of tobacco. Specifically, it requests that any statute listing the legal age as 19 for the above activities be amended to the age of 21.

SB 52 SALVIA DIVINORUM AS A CONTROLLED SUBSTANCE
Sponsor: Senator Therriault
Committee(s) and date of last action: Heard and held in (S) HSS Finance Subcommittee, 02/11/09
Description: Salvia divinorum and Salvinorin A are compounds of a plant used for medicinal purposes and with hallucinogenic properties. There has been an increase in its use, and has the potential for misuse and abuse. This bill requests that it be listed as a controlled substance.

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Bill Watch: Education

HB 58 EDUC LOAN REPAYMENT PROGRAM
Sponsors: Representatives Thomas, Wilson, Millett, Harris
Committee(s) and date of last action: Read and referred to (H) EDC, 01/20/09
Description: This bill requests that general funds be set aside for incentive use to recruit individuals in occupations facing a shortage. Dentists and licensed practical nurses are among the occupations listed that would have access to these funds and incentive programs. Allocation of these funds is grouped by geographical location, with more funding available to professionals who are employed in rural areas of the state. A minimum of one year of employment is required for eligibility, and the amount of funding increases incrementally with the number of years of employment.

SB 18 POSTSECONDARY MEDICAL AND OTHER EDUC PROG
Sponsors: Senators Wielecheowski, Thomas, Ellis
Committee(s) and date of last action: Read and referred to (S) HSS, 01/20/09
Description: This bill proposes to raise the number of new students enrolled in medical education through the WWAMI program from 20 to 24 by 2010, and from 24 to 30 by 2012.

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Bill Watch: General Health Policy

Bill Watch: Medical Assistance and Health Insurance

SB 79 MED BENEFITS DISABLED PEACE OFFICERS
Sponsors: Senators McGuire, Paskvan
Committee(s) and date of last action: Scheduled to be heard in (S) STA, 02/19/09
Description: This bill proposes waiving payment of premiums for major medical insurance for disabled peace officers who have at least 20 years of credited service as peace officers of the public.

SB 87 MEDICAL ASSISTANCE ELIBILITY
Sponsor: Senator Wielochowski
Committee(s) and date of last action: Referred to (S) FIN, 02/11/09
Description: This bill proposes an additional eligibility category for Medicaid services. Specifically, it adds children, pregnant women, and other specified individuals in families with incomes between 200% and 300% of the federal poverty level. Additionally, individuals in this income category would be required to pay a yearly premium for medical assistance. The premiums would be determined by a sliding scale based on annual income. The range for premiums would be set at no less than $240 per year and no more than $1200 per year.

SB 65 MEDICAID FOR ADULT DENTAL SERVICES
Sponsors: Senators Davis and Ellis
Committee(s) and date of last action: Heard and Held in (S) HSS, 02/02/09
Description: This bill is "An Act repealing the repeal of preventative and restorative adult dental services reimbursement under Medicaid; providing for an effective date by repealing the effective date of sec. 3, ch. 52, SLA 2006; and providing for an effective date."

SB 82 MEDICAID FOR ADULT DENTAL SERVICES
Sponsors: Rules by request of the governor
Committee(s) and date of last action: Referred to (S) HSS Finance, 02/04/09
Description: This bill is "An Act providing for an effective date by delaying the effective date of the change of coverage of adult dental services under Medicaid; and providing for an effective date."

HB 87 MED BENEFITS OF DISABLED PEACE OFFICERS
Sponsors: Representatives Millett, Dahlstrom, Gardner, Gara, Kerttula, Kawasaki
Committee(s) and date of last action: Heard and held in (H) L&C, 02/02/09
Description: This bill proposes waiving payment of premiums for major medical insurance for disabled peace officers who have at least 20 years of credited service as peace officers of the public.

SB 61 MANDATORY UNIVERSAL HEALTH INSURANCE
Sponsors: Senators French, Ellis
Committee(s) and date of last action: Read and referred to (S) HSS, 01/20/09
Description: This bill proposes the establishment of the Alaska Health Care Program (AKCP), a program given the task of ensuring that all Alaskans have access to affordable health care insurance covering all essential services. The AKCP will be monitored and managed by an Alaskan Health Care Board of 13 members, 12 of which are to be appointed by the governor. Similar to SB 160 (25th legislative session), this bill includes

A framework for personal choice: This bill facilitates a relationship between health insurance providers and individuals, and doesn't assume that a one size fits all solution will meet the health care needs of all Alaskans.
A unique voucher system: By pooling money from all stakeholders, a sliding scale voucher system will ensure that every Alaskan can take personal responsibility for acquiring health insurance coverage. The system will also make it easy for multiple entities to contribute towards a health plan for an individual.
A health care clearinghouse: The clearinghouse will disseminate information about quality health care products, assisting Alaskans who are utilizing vouchers under the Alaska health care plan.
The Alaska health care fund: This fund will receive contributions from individuals, businesses and government to ensure that all interested parties contribute to the health of Alaskans

If passed, this bill is to take effect by January 1, 2010.

HB 62 MEDICAL ASSISTANCE ELIGIBILITY/PREMIUMS
Sponsors: Representative Hawker
Committee(s) and date of last action: Read and referred to (H) HSS, 01/20/09
Description: This bill, also known as the "Denali Kid Care Accountability Act," amends a previous Alaska Statute on medical assistance eligibility requirements. Specifically, it adds sections requiring recipients of medical assistance in families whose income is between 175 and 250 of the federal poverty level to pay premiums, on a sliding scale, for medical assistance. The Department of Health and Human Services is required to set the premium at no less than 2% of the recipient's income, and establish a system of collecting premiums from recipients. This bill requests that these changes go into effect following the approved revisions and funding to make these changes.

HB 61 MEDICAL ASSISTANCE COVERAGE
Sponsors: Representatives Cissna and Gruenberg
Committee(s) and date of last action: Read and referred to (H) HSS, 01/20/09
Description: This bill requests many changes to medical assistance eligibility for Alaskans. Among the changes are 1) disabled persons: increasing the eligibility for those in a family whose income does not exceed 250% of the official poverty level for Alaska; 2) individuals under the age of 19: increasing the family income eligibility from 175% to 200% of the federal poverty level for Alaska; 3) pregnant women: increasing the family income eligibility from 175% to 200% of the federal poverty level for Alaska.

SB 10 MEDICAID/INS FOR CANCER CLINICAL TRIALS
Sponsor: Senator Davis
Committee(s) and date of last action: Read and referred to (S) HSS, 01/21/09
Description: This bill requests that a health insurance company be required to provide coverage for any medical expenses incurred during the course of participation in an approved clinical trial.

SB 11 DEPENDENT HEALTH INSURANCE; AGE LIMIT
Sponsor: Senator Davis
Committee(s) and date of last action: Read and referred to (S) HSS, 01/21/09
Description: This bill requests that among health insurance policies covering dependents of enrollees, the defined age for "dependent child" be raised from 23 to 26 years of age.

SB 13 MEDICAL ASSISTANCE ELIGIBILITY
Sponsor: Senator Davis
Committee(s) and date of last action: Referred to (S) FIN, 02/11/09
Description: This bill requests that the family income eligibility requirements for medical assistance among children and pregnant women be raised from 175% to 200% of the federal poverty level, effective immediately.

SB 32 MEDICAID: HOME/COMMUNITY BASED SERVICES
Sponsor: Senator Ellis
Committee(s) and date of last action: Heard and Held in (S) HSS, 02/04/09
Description: This bill requests an amendment to a previous statute outlining medical assistance among health facilities, adding medical assistance eligibility for home and community-based services.

SB 38 PHARMACY BENEFITS MANAGERS; MANAGED CARE
Sponsor: Senator Elton
Committee(s) and date of last action: Read and referred to (S) HSS, 01/21/09
Description: This bill proposes to change language in a previous statute, amending "managed care entity" to "health care insurer."

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Bill Watch: Mental Health

HB 83 APPROP: MENTAL HEALTH BUDGET
Sponsor: Rules by request of the governor
Committee(s) and date of last action: Heard and held in (H) FIN, 02/02/09
Description: This bill outlines the specific appropriations for each component of the state's mental health program.

HB 52 POST-TRIAL JUROR COUNSELING
Sponsor: Representative Kerttula
Committee(s) and date of last action: Read and referred to (H) JUD, 01/20/09
Description: This bill proposes to make available up to 10 hours of psychological counseling for any juror serving in a criminal trial where graphic images or content are presented.

SB 21 MENTAL HEALTH CARE INSURANCE BENEFIT
Sponsor: Senators Davis and Ellis
Committee(s) and date of last action: Read and referred to (S) HSS, 01/21/09
Description: This bill proposes to implement parity in the types of medical services covered under existing health insurance plans. Specifically, it proposes that health care insurance policies be prohibited from denying coverage or discriminating health care services related to mental health, alcoholism or substance abuse; that there be no difference in coverage between physical and mental health coverage; and that these changes take effect no later than July 1, 2009.

Bill Watch: State Boards and Issues

HB 75 HEALTH COMMISSION/PLANNING
Sponsors: Representatives Cissna and Gruenberg
Committee(s) and date of last action: Read and referred to (H) HSS, 01/20/09
Description: This bill requests the establishment of the Alaska Health Commission, whose purpose is to provide policy recommendations ensuring quality, accessibility, and affordability of health care throughout the state. The commission is to have 15 members, of the following composition: one member from the Alaska Mental Health Trust Authority, one member from the University of Alaska Health Education and Training Program, one member representing the Alaska Native Tribal Health Consortium, one member from the Alaska Primary Care Association, one member from the Alaska State Hospital and Nursing Home Association, one member from the health industry, one member from the Alaska Nurses Association, two health care consumer members/advocates, and six members of the Alaska legislature. This act is to take effect by July 1, 2009.

HB 63 COUNCIL DOMESTIC VIOLENCE: MEMBERS, STAFF
Sponsors: Representatives Fairclough, Holmes, Coghill, and Wilson
Committee(s) and date of last action: Heard and referred to (H) FIN, 02/13/09
Description: This bill requests that the number of members of the Council on Domestic Violence and Sexual Assault be changed from three to four, and that at least one of the four members is a representative of a rural area of the state. In addition, this bill amends the length of term for public members from two to three years of eligible service. Other changes include adding the Department of Corrections as a regular collaborator with the council.

HB 25 HEALTH REFORM POLICY COMMISSION
Sponsor: Representative Hawker
Committee(s) and date of last action: Read and referred to (H) HSS, 01/20/09
Description: This bill proposes that issues related to health care and health care policy be given high priority among government officials. Specifically, it proposes the addition of a new chapter in the Alaska Statute 18, establishing the Alaska Health Reform Policy Commission, outlining the composition and duties of that commission, to be effective immediately.

SB 35 EXTEND SUICIDE PREVENTION COUNCIL
Sponsors: Senator, Davis, Ellis, Therriault
Committee(s) and date of last action: Heard and Held in (S) HSS, 01/26/09
Description: This bill amends a previous act to extend the termination of the Statewide Suicide Prevention Council from June 30, 2009 to June 30, 2013.

SB 40 EXTEND SUICIDE PREVENTION COUNCIL
Sponsor: Senator Therriault
Committee(s) and date of last action: Read and referred to (S) HSS, 01/21/09
Description: This bill is identical to SB 35.

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Bill Watch: Family Health Issues

Bill Watch: Worker's Compensation

HB 104 WORKER'S COMP. MEDICAL TREATMENT FEES
Sponsor: (H) Labor and Commerce
Committee(s) and date of last action: Passed (H) with reconsideration after third reading and awaiting referral to (H) L&C, 02/18/09
Description: This bill is "An act adjusting certain fees for treatment or services under the Alaska Workers' Compensation Act to reflect changes in the Consumer Price Index; and providing for an effective date.

SB 20 WORKER'S COMP MEDICAL/REHAB RECORDS
Sponsors: Senators French and Thomas
Committee(s) and date of last action: Read and referred to (S) L&C, 01/21/09
Description: This bill proposes that any documents containing personal and confidential information of an employee that is receiving, or has received, worker's compensation, are kept in a confidential location away from the public's view.

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AHPR Staff and Contributors

Lawrence D. Weiss, PhD, MS, Editor
Kelby Murphy, Associate Policy Analyst
Keith Liles, Project Coordinator
Jacqueline Yeagle, Newsletter design and editing

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