Alaska Health Policy Review

Dear Reader:

The 2009 session of the Alaska State 26th Legislature started January 20, and formally ends April 19, but as a practical matter is largely finished today, Friday the 17th. Consequently, following this issue of Alaska Health Policy Review we return to a monthly publishing schedule. Our next issue, due early May, will include a wrap-up of health-related legislation for this first session of the 26th Legislature.

The disposition of bills at the end of this session is particularly important since we are in the middle of the 26th Legislature. That means that the second session in 2010 will commence with all bills in the committees that they are in at the end of the current session on April 19.

Moving along to an even bigger policy picture, the Alaska Health Care Commission will hold its second meeting on Friday, May 1 and Saturday, May 2 in Anchorage. You will remember that this is the commission that was established by the Governor's executive order. The draft agenda is now available on the website at http://hss.state.ak.us/healthcommission.

This meeting, the second they have held since inception, is open to the public and will include a public comment period on Saturday for comment specific to the four issues the commissioners will be studying at this meeting:

1. Health Information Technology
2. Health Care Workforce Supply
3. Medicare Patient Access to Primary Care
4. The Role of the Consumer in Health Care

"Be there or be square," as we used to say about 50 years ago. Write deborah.erickson@alaska.gov for more information.

And now for an irregular but wildly popular feature of Alaska Health Policy Review, Stump the Wonk! So here is your question: What kind of health insurance covers more people in Alaska by far than any other kind? We cannot print the answer upside down, so in order to find out the answer to Stump the Wonk! you'll just have to move on to our main feature below, an interview with Chancy Croft ...

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

Interview with Chancy Croft

" ... there's no cap on the amount of what is paid on behalf of the employer, but there is a limit on the amount of the benefits. The limit on what the insurance company pays is the total obligation of the employer."

AHPR: Are there co-payments, deductibles, lifetime caps, that kind of thing -- like there is on typical indemnity health insurance?

Croft: No. There's no time limit, there's no cap on the amount of what is paid on behalf of the employer, but there is a limit on the amount of the benefits. The limit on what the insurance company pays is the total obligation of the employer. The insurance company has to pay that. There are some insurance policies where there is a deductible that the employer pays the first part of any claim and then the insurance company pays the rest.

But any policy of insurance has to be approved by the Division of Insurance to be effective, and the standard policy requires the insurance company to pay everything that the employer would be obligated to pay.

AHPR: I hadn't thought about this before, but it's curious that the Division of Insurance has to evaluate and agree to the insurance policy, but actually the program isn't run by the Division of Insurance.

Croft: [Workers' Compensation] is run by the Department of Labor.

AHPR: Does workers' compensation function as intended, and if not, what are the obstacles to it functioning as effectively and efficiently as it could? Clearly, you're an attorney who gets, I am presuming, the outlier cases -- those cases where the system did not particularly work very well.

Croft: Yes, we get the cases that are controverted. It's hard for an attorney representing either injured workers or insurance companies to really know how well the system's working because we don't see a representative group of people. We see the people that something has happened to, and they are not getting benefits, and they're upset about it.

That's probably less than ten percent, maybe less than five percent of the people that are injured in any given year, have a claim or go to an attorney. I'm not sure we can say how well the system's working except that if it wasn't working fairly well, we'd probably be seeing a lot more people. There'd be a lot more people trying to get attorneys because they were upset with the result.

AHPR: I imagine that one of the criteria for you to accept a case would be that it would be a fairly high-end case in terms of the amount of money involved.

Croft: Actually not. The law is pretty clear. If the insurance company controverts the right of an employee to compensation and it turns out that that controversion was incorrect -- that the injured worker was entitled to benefits -- then the insurance company, in addition to the benefits to the injured worker, has to pay full, reasonable attorney's fees to the attorney.

"Other states allow -- or they don't allow [and] it's done -- the attorneys taking a percentage of what the injured worker gets. That's basically never been the case in Alaska. In fact, it's a crime to take a payment from an injured worker that's not approved by the Workers' Compensation Board."

AHPR: Which are independent of the amount of the claim.

Croft: That's right. Other states allow -- or they don't allow [and] it's done -- the attorneys taking a percentage of what the injured worker gets. That's basically never been the case in Alaska. In fact, it's a crime to take a payment from an injured worker that's not approved by the Workers' Compensation Board.

Just like medical benefits are designed to be paid in full on behalf of the injured worker, so are their attorney's fees. On the other hand, there's only so much that you can do, and if somebody wants to litigate over $100 medical bill, as a matter of priority, I'm not going to be interested in it and the claimant's attorneys I know are not interested in it because there are too many other serious things out there.

Frankly, I think most claimant's attorneys get more requests for representation than they take -- maybe only half or less -- [so] if people are receiving compensation, most claimants' attorneys won't get in until the claim has been controverted. That causes some problems, and there are some exceptions when you would take a claim that hasn't been controverted, but as a general rule you won't.

If somebody says, "Well, you know, my union insurance is paying all my bills but I think it should be the work comp carrier paying for it," that's not a very high priority. I mean I'm sympathetic that the union shouldn't be stuck, but they have their own remedies, and they in theory could come in and say, "Look, we shouldn't paying this. This person has a valid work compensation claim. We want the insurance company to pay us for what we've been paying out for the injured worker." So if they already have insurance, and they're back at work and their wife's insurance or their union insurance is paying the medical, we usually won't get involved.

AHPR: Again, as a matter of priority.

Croft: That's correct. Yes.

AHPR: Switching focus a little bit, I notice in the last annual report from the division that over the last few years the reports of injuries and illnesses have dropped substantially, and the total compensation payments have leveled off. I'm wondering how you would explain that.

Croft: I think part of it is a change in the workforce. Timber is one dangerous [occupation]. I've represented quite a few loggers and their statement is: "There were three of us [who] started out logging 20 years ago, and I'm the only one that's still alive" type of thing. The injuries tend to be really serious -- higher [incidence] of fatalities in logging per rate of injury than in other industries. So that's one change.

[There is] a lot less oil production. Construction is still an important part, and it's arduous and heavy [work]. There's some natural risk in construction. It's hard to avoid. But there's just a lot more sedentary work and a lot lower rate of injury and severity of injury by the nature of the workforce.

"They inserted a provision in rehabilitation that really allows people to opt out. It's more a bribe to get injured workers to give up their right to rehabilitation for a very small amount of money."

AHPR: I understand that several years ago -- I think it was 2005 -- there was legislation that significantly altered some aspects of workers' compensation. Would you please clarify what that legislation did and what the consequences have been?

Croft: There was a big change in '05. There are periodic changes, but in '05 the group in the Legislature sought to make some changes. They wanted to set up an appeals commission instead of having decisions by the board reviewed by the Superior Court before they were appealed to the Supreme Court, so they created this appeals commission.

That was challenged on constitutional grounds, and the Supreme Court said it was constitutional to do it, so appeals from board decisions now go to the appeals commission, not to the Superior Court.

They inserted a provision in rehabilitation that really allows people to opt out. It's more a bribe to get injured workers to give up their right to rehabilitation for a very small amount of money. That's been pretty controversial because a lot of injured workers are frankly being screwed by that provision.

Third, it attempted to change the standard of when an injury was due to the job and when it was due to other causes. That has produced a considerable amount of litigation, probably more heat than light in terms of what it means. The Legislature itself was confused about that. It set up the option that employers could select a preferred medical provider, which so far hasn't been anything except the nose of the camel under the tent.

Frankly, right now under the present system -- and what it's been since statehood -- injured workers have the right to choose their doctor. And for the first two years, basically if the treatment is reasonable, the employee and the doctor decide what treatment they get for the injury.

Some of us were worried that it would be the first step to go toward employer-selected medical treatment -- employer-decided as they do in some other states. There were several of the amendments that were passed then. One of the big problems is the impact of opting out of rehabilitation.

AHPR: Why are they opting out of rehabilitation?

Croft: Because they get a small payment. If they waive their right to rehabilitation, they get an immediate payment now. Some of the time people are in the situation where they think they just have to get that immediate payment. They're behind in their bills [or] they are being hounded by people that are trying to collect for it. They think, "Well, maybe I'll just get lucky and I can find another job," and they'll settle for a small amount.

I've never seen a case yet in which it had been to the injured worker's advantage to take that small payment. Granted, it means they won't get the money for some time, but in the long run they will get a lot more money -- usually by going through rehabilitation.

"There has been this dynamic tension between wanting people to have free access to the work comp board and be willing to file a claim, versus a right to know on behalf of the public or employers about the condition."

AHPR: I wanted to talk about a specific bill that is right now in the Legislature. This is SB20. The title is "An Act limiting the release of employee medical and rehabilitation records held or maintained by the state for purposes of the Alaska Workers' Compensation Act."

It's currently in Labor and Commerce, and it states in part that, "Medical or rehabilitation records, and the employee's name, address, social security number, electronic mail address, and telephone number contained on any record, in an employee's file maintained by the division or held by the board or the commission are confidential and are not public records subject to public inspection and copying ..."

This calls to mind the natural question: Is this kind of information on injured workers currently and publicly available, and have there been problems with the use of this information in the past?

Croft: It's restricted availability. It's restricted by board policy, and I think a concern of the drafters of that [the bill] is that the policy could change. This would in effect make it more difficult to change that.

There has been this dynamic tension between wanting people to have free access to the work comp board and be willing to file a claim, versus a right to know on behalf of the public or employers about the condition. The Supreme Court has said that when filing a personal injury lawsuit, you waive your right to privacy about the condition over which you're suing. Let's assume that that same principle applies to workers' compensation.

But either intentionally or inadvertently or through zealous defense of a claim, an insurance company can try to insist on obtaining medical information that has nothing to do with a particular injury but could be very embarrassing and not have any relevance to a claim -- [but it could] be embarrassing to the injured worker.

Women who have had breast removal -- it has nothing to do with the fact that they may have broken their leg but it's really awkward to go in front of the board and have that talked about in a hearing. You can think of any number of other medical examples.

There has been and there is in the statute a provision for restricting the release of information, but it requires some pretty prompt action by the injured worker. I think this [SB20] would restrict the public's right to the medical information so that it wouldn't be available.

It might in some cases restrict information that could be of benefit for other purposes: gathering information about what is happening to people overall in terms of diseases or injuries, or treatment and success and the like. It might be a good idea to have some way of making sure that medical information that was not tied to an individual would be available for statistical purposes.

AHPR: Aggregate data.

Croft: Yes.

AHPR: Are there any other bills relating to workers' compensation currently in the hopper that you'd like to comment on?

Croft: No. There are bills that I think should be in the hopper but of the ones in the hopper I don't.

AHPR: What bills do you think ought to be in the hopper?

Croft: I think there ought to be one to restrict the use of the American Medical Association guidelines for the evaluation of impairment. Alaska and other states should not be using those guidelines for workers' compensation's purposes at all. The guidelines that the American Medical Association came up with for evaluating impairment clearly say it's not to be used to determine the amount of compensation somebody receives. But nonetheless, legislatures have been doing that.

They've now had six editions of the guides. The sixth edition that came out last year was full of errors. They've already come out with 50 or more corrections to provisions of it, but the board has already adopted the sixth edition here to be used to evaluate claims, even claims of people that arose when the fifth edition or even the fourth edition were in effect. Our experience so far has been that a lot of injuries receive half of the compensation under the sixth edition that they did under the fifth -- a case or two as low as only a third of it -- so I think that there is a problem with those guidelines.

In addition this opt-out of -- the bribery provision -- of vocational rehabilitation should be changed, eliminated frankly, as well.

AHPR: Anything else?

Croft: Those are two particular ones.

"The adoption of universal health [care] coverage would have a substantial benefit for employers ... I think this [health care] is something that people have a right to, and I think it increasingly makes America businesses at a competitive disadvantage."

AHPR: This is a big picture question. Is there any potential relationship between health reform -- either nationally and/or at the state level -- and workers' compensation and the way that it's currently practiced or implemented?

Croft: Yes. The adoption of universal health [care] coverage would have a substantial benefit for employers. I don't think universal health insurance should be paid by employers.

I think it should come out of the general fund revenue of the government -- income tax -- rather than a tax on employers because I think this [health care] is something that people have a right to, and I think it increasingly makes America businesses at a competitive disadvantage. The automobile manufacturing industry is a classis example where American businesses are trying to compete with Japanese and Korean and German car manufacturers who -- in those countries -- have universal health insurance, and it just is a big problem.

In Alaska, in 1999, the amount of health benefits paid out in workers' compensation was about $70 million. The Alaska Department of Labor Workforce Development reported total workers' compensation health care costs of $70 million in 1999. Now it's projected that in 2008, or at least by 2009, it's going to be about $165 million -- more than double. And it's increasingly a higher percentage of the total benefits paid out.

In the past, it was pretty close to 50-50 health benefits versus the total of all other benefits. There is a projection -- I think it may be a little high but there is a projection -- by the Department of Labor that it could be as high as 70, 72 or 73 percent now of the total benefits paid out in the workers' compensation system -- are medical benefits.

It seems to me that it would make a lot of sense to have all of this part of an overall, uniform health care system, instead of trying to make it part of the work comp system.

AHPR: I don't know if you've thought this through this far, but let's say there was some kind of national universal health system here in the United States. Would there be any role at all for worker's compensation?

Croft: In the health part of it?

AHPR: In any part of it.

Croft: You'd still have workers' compensation for the time loss and impairment part of work injuries, but it seems to me across the board it would be better to have a universal health insurance than trying to separate out certain medical conditions that employers have to pay for, or somebody else.

I think the impact of injuries could well be less if there wasn't this fight over whether somebody gets coverage and treatment for their injury by showing that it was due to employer-related condition. They just get the treatment. I think you would likely have a quicker rate of people returning to work because they got the treatment that was necessary to restore them to that condition without having to first litigate over it.

AHPR: Is there any other observations you'd care to make about the relationship between worker's compensation and health reform?

Croft: Depending on the way you do health reform, it gets back to what I think most people would say is the preferred method of health benefits, and that is that it's between the patient and the doctor. Now, somebody's going to have to supervise that overall, but it takes out some third person telling an injured worker what medical treatment [he or she] can get.

That always creates a sort of tension and in certain injuries, psychologically and the like, provides, I think, an impediment to effective treatment when you risk having to publicly reveal your condition in order to get effective treatment.

AHPR: Across the United States there are two paradigms for providing workers' compensation. One is through private insurance companies and one is through the state. One example is the state of Washington. Could you comment on the differences? Does it make a difference whether it's private insurers versus a state-run insurance company?

Croft: I had a case years ago where somebody had also worked quite a bit in Washington and it struck me as strange that under that system, which is [public and therefore] different from the private [workers' compensation insurance in Alaska] that the benefits were higher to the injured worker than they were in Alaska. As a matter of fact, under the Longshore and Harbor Workers [Compensation] Act oftentimes benefits are higher than they are under the state.

So there can be systems in which a government-run system provides higher benefits to injured workers than the private insurance does. I think that is something that ought to be explored. There has been an effort to do that in the past in the Legislature but it's not been successful.

"It's been a disappointment to me that in the last 20 years we've [Alaskans] actually lost our position of leadership. I think in the 70s, if you would go to national conferences, a lot of people would say, "Well, what are they doing in Alaska about effective alcoholism treatment" or telecommunication and the like, because we were really kind of pushing that. I think we've lost that goal of excellence."

AHPR: Finally, is there anything else you'd like to tell the readers of Alaska Health Policy Review, or discuss relative to any of these issues?

Croft: I think one of the great roles for state government is sort of testing areas, experimental areas ... to try out approaches that might eventually be of benefit at the federal level or on a broader level. It's difficult to move the federal government often, but with good ideas coming up out of the states -- trying things out to see it before you commit a tremendous amount of money to it at the federal level -- I think is really important. It's something that I think is often overlooked.

I had hoped when I was in the Alaska Legislature that one of the results of the tremendous increase in wealth in Alaska would allow us to really be on the cutting edge of a lot of social ideas. It's been a disappointment to me that in the last 20 years we've actually lost our position of leadership. I think in the 70s, if you would go to national conferences, a lot of people would say, "Well, what are they doing in Alaska about effective alcoholism treatment" or telecommunication and the like, because we were really kind of pushing that.

I think we've lost that goal of excellence. When the framers of the Constitution met in Fairbanks, their determination was they were going to write the best Constitution that any state had, and there are a lot of scholars that think they succeeded. I hope that we can regain that determination to do the best -- not simply what's adequate.

It seems to me in Alaska we have the potential because we have seen several different ways of providing health benefits, that we could really give the nation a good [unintelligible]. I mean we've seen what happens when you have medical services delivered to the Native population. I'm not saying that that's the way to go, but I am saying that we know what does and doesn't work and what the problems are. We have big corporations, we have the state and the municipalities that often provide health plans, so we've kind of had quite a few different ways to measure and evaluate the success of various programs and I think we ought to come up with -- here -- a good program for comprehensive health coverage.

AHPR: Thank you very much.

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Alaska Health Policy Calendar

This calendar of health policy-related legislative meetings is current as of April 15, 2009 at 11 AM. Please visit the Alaska State Legislature's list of committee hearings for the most current listings, as they are subject to change.

April 17, 2009, 1:30 PM
What: Senate Health and Social Services, Standing Committee
Where: Butrovich 205; Juneau
Other Information: SB 172 Alaska Health Care Commission; Teleconferenced

May 1 & 2, 2009, 8:30 AM - 4:30 PM
What: Alaska Health Care Commission, General Meeting - Open to the Public
Where: Frontier Building, 3601 C Street, Room 890-896; Anchorage
Other Information: Teleconference Number: 1-800-315-6338, Passcode: 2474. Will discuss Health Information Technology, Medicare Patient Access to Primary Care, Workforce (Physician Education and Loan Repayment specifically), and Role of the Consumer. Please see http://hss.state.ak.us/healthcommission for draft agenda.

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Bill Watch: Bills on the Move

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, then (H) FIN, 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: 03/18/09 (S) Referred to Finance
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: 04/01/09 Referred to (H) FIN
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: Referred to (S) FIN on 03/16/09
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

ensures that the confidentiality of individually indentifying health information of a patient is secure and protected;
improves health care quality, reduces medical errors, increases the efficiency of care, and advances the delivery of appropriate, evidence-based health care services;
promotes wellness, disease prevention, and management of chronic illnesses by increasing the availability and transparency of information related to the health care needs of an individual for the benefit of the individual;
ensures that appropriate information needed to make medical decisions is available in a usable form at the time and in the location that the medical service is provided;
produces greater value for health care expenditures by reducing health care costs that result from inefficiency, medical errors, inappropriate care, and incomplete information;
promotes a more effective marketplace, greater competition, greater systems analysis, increased choice, enhanced quality, and improved outcomes in health care services; and
improves the coordination of information and the provision of health care services through an effective infrastructure for the secure and authorized exchange and use of health care information.

SB 139 INCENTIVES FOR CERTAIN MEDICAL PROVIDERS
Sponsors: Senators Olson, Wielechowski, Meyer, Davis
Committee(s) and date of last action: 04/07/09 (S) FIN
Description: "An Act establishing a loan repayment program and employment incentive program for certain health care professionals employed in the state; and providing for an effective date."

SCR 1 BRAIN INJURY AWARENESS MONTH: MARCH 2009
Sponsor: Senator McGuire
Committee(s) and date of last action: Transmitted to the governor on 03/11/09, (S) Legislative Resolve No.2
Description: This bill proposes that the month of March be "Brain Injury Awareness Month," effective for 2009.

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Bill Watch: Medical Assistance and Health Insurance

HB 61 MEDICAL ASSISTANCE COVERAGE
Sponsors: Representatives Cissna and Gruenberg
Committee(s) and date of last action: Read and referred to (H) HSS, then to (H) FIN,
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.

HB 62 MEDICAL ASSISTANCE ELIGIBILITY/PREMIUMS
Sponsors: Representative Hawker
Committee(s) and date of last action: Read and referred to (H) HSS, then to (H) FIN,
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 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, then (H) STA, then (H) FIN,
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.

HB 118 MEDICAL ASSISTANCE ELIGIBILITY
Sponsor: Representative Gara
Committee(s) and date of last action: Referred to (H) HSS, then to (H) FIN, 02/25/09
Description: "An Act expanding, and relating to advertising about, medical assistance coverage for eligible children and pregnant women; relating to the poverty guideline and cost sharing for certain recipients of medical assistance; having the short title of the 'No Child Left Uninsured Act'; and providing for an effective date."

HCR 9 HOME HEALTH AIDES FOR SENIORS
Sponsors: Representatives Cissna and Gruenberg
Committee(s) and date of last action: Introduced and referred to (H) HSS, then to (H) FIN, 02/25/09
Description: This bill promotes the expansion of home health services to older Alaskans and adults with disabilities by requesting that the governor direct the Department of Health and Social Services to apply to the federal government for additional waivers under the home and community-based waiver program to better serve older Alaskans and adults with disabilities through a federally reimbursable service either as a separate service or as a service that may be combined with other waivers.

SB 10 MEDICAID/INS FOR CANCER CLINICAL TRIALS
Sponsor: Senator Davis
Committee(s) and date of last action: Read and referred to (S) FIN, 3/13/09
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: 03/20/09 Referred to (S) L&C, then (S) FIN
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: Committee(s) and date of last action: 04/11/09 (H) HSS, then (H) FIN. (H) HSS 3:00 pm Capitol 106 - HEARING CANCELED
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: 04/14/09 (H) FIN. (H) HSS at 3:00 pm Capitol 106 - HEARING CANCELED
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: 04/06/09 (S) L&C, then FIN
Description: This bill proposes to change language in a previous statute, amending "managed care entity" to "health care insurer."

SB 61 MANDATORY UNIVERSAL HEALTH INSURANCE
Sponsors: Senators French, Ellis
Committee(s) and date of last action: 04/09/09 Heard & Held, (S) L&C at 1:00 pm Beltz 211, then to (S) FIN
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.

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 79 MED BENEFITS DISABLED PEACE OFFICERS
Sponsors: Senators McGuire, Paskvan
Committee(s) and date of last action: Referred to (S) FIN, 03/05/09
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 82 MEDICAID FOR ADULT DENTAL SERVICES
Sponsors: Rules by request of the governor
Committee(s) and date of last action: Referred to (S) FIN, 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."

SB 87 MEDICAL ASSISTANCE ELIBILITY
Sponsor: Senator Wielochowski
Committee(s) and date of last action: 02/25/09 (S) FIN
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 155 MEDICAL ASSIST FOR COGNITIVE DISABILITIES
Sponsor: Senator McGuire
Committee(s) and date of last action: 03/18/09 (S) Referred to (S) HSS, then to (S) FIN
Description: "The department shall establish in regulation a system for setting medical assistance reimbursement rates based on the functional level of care needed by an eligible recipient with a diagnosed cognitive disability, regardless of the recipient's need for medical or personal care support. The system must address eligible recipients' needs for appropriate assessment, rehabilitation, case management, ongoing support and respite or companion services, regardless of whether the services are provided in a health care facility or under a home and community-based waiver granted under 13 AS 47.07.045."

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Bill Watch: Mental Health

HB 52 POST-TRIAL JUROR COUNSELING
Sponsor: Representative Kerttula
Committee(s) and date of last action: 01/20/09 (H) JUD, then (H) FIN
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.

HB 83 APPROP: MENTAL HEALTH BUDGET
Sponsor: Rules by request of the governor
Committee(s) and date of last action: 04/15/09 (H) HB 83 at 8:00 am Senate Finance 532 - MEETING CANCELED
Description: This bill outlines the specific appropriations for each component of the state's mental health program.

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, then (S) L&C, then (S) FIN, 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.

HJR 10 VETERANS' HEALTH CARE
Sponsor: Representatives Guttenberg Kawasaki, Salmon, Kerttula, Gruenberg, Cissna, Lynn, Wilson, Tuck, Dahlstrom, Doogan, Herron, Gara, Austerman, Johnson
Committee(s) and date of last action: 4/14/09 (S) STA at 9:00 am Beltz 211. (S) CSHJR 10 (HSS) Moved out of committee, to (S) RLS
Description: This bill urges the United States Congress to improve health care for veterans.

Bill Watch: State Boards and Issues

HB 25 HEALTH REFORM POLICY COMMISSION
Sponsor: Representative Hawker
Committee(s) and date of last action: Read and referred to (H) HSS, then (H) FIN),
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.

HB 63 COUNCIL DOMESTIC VIOLENCE: MEMBERS, STAFF
Sponsors: Representatives Fairclough, Holmes, Coghill, and Wilson
Committee(s) and date of last action: 03/20/09 (S) Referred to Finance
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 75 HEALTH COMMISSION/PLANNING
Sponsors: Representatives Cissna and Gruenberg
Committee(s) and date of last action: Read and referred to (H) HSS, then (H) FIN,
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 123 EXTEND SUICIDE PREVENTION COUNCIL
Sponsor: Representative Flairclough
Committee(s) and date of last action: 04/13/09 (S) FIN
Description: This bill proposes to extend the Suicide Prevention Council to June 30, 2013, effective immediately.

SB 35 EXTEND SUICIDE PREVENTION COUNCIL
Sponsors: Senator, Davis, Ellis, Therriault
Committee(s) and date of last action: 04/11/09 (S) RLS
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, then to (S) FIN,
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: Signed into Law, CHAPTER 4 SLA 09
03/30/09
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, then (S) JUD,
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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Bill Watch: Bill Tracking Explanation and Acronyms

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.

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

AHPR Staff and Contributors

Lawrence D. Weiss, PhD, MS, Editor
Lisa McGuire MPH, Consulting Policy Analyst
Jacqueline Yeagle, Newsletter design and editing

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