Alaska Health Policy Review

Dear Reader,

A couple of days ago I sent the following letter, slightly edited here for clarity, to the board of the Alaska Public Health Association through Sandra Woods, president of the board. I am sure the board would be interested in hearing your input on this most important issue. --- ldw

Dear ALPHA board member:

Hotel Employees and Restaurant Employees UNITE HERE Local 878 are in active boycott of the Hilton and the Sheraton hotels in Anchorage, in large part due to occupational injury issues and health insurance changes. I am dismayed to hear that you may be considering contracting for the 2010 Alaska Public Health Association Summit annual conference at the Sheraton despite this.

I urge you to take a principled stand that we must support the health of working people. After all, isn't that at the heart of our chosen profession? Who are we if we do not take this stand, even if it means more work for us, looking further for a venue or venues that will suffice. We need to firmly tell the management at the Sheraton that we cannot do business with them while they treat their employees that way.

I suggest you invite representatives of Local 878 to meet with you, or make a presentation at your next board meeting so you can exchange views. Further, they may well have leads and suggestions about where the summit can meet. I want to extend our services at ACPP, if needed, to help you track down space or help in any way with this issue.

Finally, I recommend you read the two articles referred to here. The first was a presentation at the American Public Health Association last year on this very subject, and the second provides a bit of background on it. Please, let's do the right thing, and let's be true to the principles of our profession.

Thanks so much for the commitment you have made to help guide ALPHA through sometimes rough public health waters.

Lawrence D. Weiss PhD, MS

Editor, AHPR

ldweiss@acpp.info

"Myth Busting" with Jeff Davis, President of Premera Alaska - Part 1

The featured speaker was Jeffrey W. Davis who has served nine years as president of Premera Blue Cross Blue Shield of Alaska, insurer for 180,000 Alaskans statewide. Previous to that, Davis was Premera's vice president of network development in Alaska, Washington, and Oregon. The venue was an early morning Anchorage meeting of the Health Care Action Coalition of the local think tank, Commonwealth North. The meeting was held at the Alaska Native Tribal Health Consortium building near Tudor and Elmore, on February 18, 2010. Alaska Health Policy Review was there with two digital recorders in hand to bring to you the views of Alaska's largest private health insurer. An accompanying PowerPoint presentation is available on line, hosted on the Commonwealth North website. The theme of Davis' presentation is "myth busting," wherein he purports to tackle head-on a number of common criticisms levied against the health insurance industry. Was he successful? Put on your own myth-busting cap as you launch into this presentation, and judge for yourself. Part II of this presentation will follow in a week or two. This transcript has been edited for length and clarity.

Links to selected topics

Who is Premera Blue Cross Blue Shield of Alaska?
Health Insurance Company Profits
You Really Can Buy Coverage
It's Illegal: Dropping Coverage for the Sick
What is, and What isn't, Insurance?
Where Does the Health Care Dollar Go?

Davis: [During the preliminary introductions around the table, Davis notes:] I am the father of a third- year WWAMI student. [He begins talk:] I'm Jeff Davis, and I'm the president of Premera Blue Cross Blue Shield of Alaska. I live here in Anchorage.

I'm going to go through a few things with you today. First, just a little tiny bit about who we are, because there is a great deal of misunderstanding about Blue Cross organizations, who they are, and how they work. I have found that in this conversation it is often important to start with some myth-busting because, in the absence of that, oftentimes people don't hear the message that you are trying to present. Then, I'll talk a little bit about health insurance reform, and really, the heart of the matter, which is cost. Then [I'll] talk about our work, personally and collectively, for the future.

Who is Premera Blue Cross Blue Shield of Alaska?

Who is Premera Blue Cross Blue Shield of Alaska? Not only the company with the longest name, north of Washington state, but ... anyway, we are a division of a company called Premera Blue Cross, which is headquartered in Washington. We've been doing business in Alaska since May 28, 1952. It was fun to go back and find the original certificate of authority, handwritten and stamped. Look at the rates that people paid in 1952. I think it was about four dollars a month. We have about 140,000 members in Alaska. We think there are about 350,000 people who actually have some sort of commercial health insurance in this state. So, it's about somewhere north of 35 percent or so, of market share.

Premera Blue Cross is headquartered in Washington state. It has a total of 1.6 million members, and it is one of 39 Blue Plans. This is where it gets confusing to people, because they think of Blue Cross as one company. Actually, it is 39 different companies. The analogy that I have found useful is, you think of Cal Worthington Ford and Kendall Ford. They are both Ford dealerships, but they are separate companies, separate ownerships, separate balance sheet -- although they have standards that they have to meet, that Ford sets for them, and their products are similar.

Blue Cross Blue Shield Association works the same way. There is a Blue Cross Association in Chicago that sets the rules for all 39 of these Blue Plans, and sets how they will work together, service standards, those sorts of things. But then, within each plan there is a lot of variation. And in fact, one of the places where there is variation is some Blue Plans are for-profit, and some Blue Plans are not for-profit. The majority are not-for-profit. Okay, so, let's get into myth-busting. Back to selected topics list

Health Insurance Company Profits

So, the myth is that carriers' profit motive leads to high costs, the high cost of health insurance. Let's talk about the reality. The reality here is Premera Blue Cross Blue Shield of Alaska is a [refers to projected slide with the three options] publicly traded for-profit? Anybody want to go for that? Charitable nonprofit? Or, a taxable nonprofit? You want to go with that? Okay. We are a taxable non-profit.

I'd like to think of that as the worst of all worlds. You are non-profit, you can't raise equity, yet you pay federal taxes, you pay state taxes. But that's the situation we're in. So what does it mean to be a non-profit? It means that any profits of the business go back into the business. And, in our case, that means it goes back to build capability, to serve our members better, because you can't be the same company you were in 1952, in 2011, 2010. You have to continue to improve your capability to serve your members, and you also need to build financial reserves. Because how can we insure our members' future needs, unless we have built those reserves? And our only ability to do that is through an operating margin.

So here's the myth: you may have read this one, you may have heard this one on television [over] the last couple of months. Health insurers make 30 percent profits. Reality is, over the last ten years, Premera Blue Cross had a profit margin of [referring to choices on a projected slide] 0.7 seven percent. That's an average over 10 years. 4.9 percent? A couple. 9.2 percent? A couple. 18.4 percent? Well, some of you are not voting. That's no fun at all. The answer is number one: zero point seven percent average over ten years. So, if we think about the high cost of health insurance, which is a significant problem, maybe, just maybe, at least in this case, it is not because of extraordinary profits as some in Washington D.C. would have you believe.

Okay, here's another one: with more carriers, health insurance would cost less, we'd have more competition, right? Because we have to drive out these extraordinary profits, we have to drive out the administrative waste, because that's what competition does, right? Okay, so the reality -- there are "blank" carriers writing health insurance in Alaska. [Referring to choices on the slide] Seven, who wants to go for seven? 13? 43? 91? There are 91 carriers writing health insurance in Alaska at a significant enough volume that they are subject to assessments for the high-risk pool. So, this is real live Division of Insurance data. This isn't me looking on the Internet and making this up.

Okay, another myth: health insurers consume 30 to 40 percent of the health insurance dollar, you've heard that one. [Referring to choices on a projected slide] In 2009, our administration [was] 4.1 percent? 6.5? Anybody? 14.2? 22.6? 6.5 percent. So, if you think about what, of a dollar, that is spent on health insurance premiums, at least with our company, and these are consistent across basically all the non-profit Blue Plans -- the for-profit plans, the commercials, and the Blues see a profit margin somewhere in the neighborhood of probably 6 percent -- where ours is in the neighborhood of one to two, we wish.

You think of some of the commercials, who have tens of millions of members to spread their administrative costs across, and we're spreading across 1.6 percent. They actually do better on this six and a half on this administrative percentage. But you add that together -- six and a half and point seven -- actually, in 2009 we ended the year with about 1.3 percent, was our operating income. So, we are at 7.8 percent, about eight cents on the dollar, that Premera Blue Cross keeps.

Audience Member: Is that percent based on actually the administrative salaries, or operating costs?

Davis: That's everything that we've spent. So, that is all of our systems, all of our people, our claims processors, customer service, the lawyers, me, salespeople, everything. Everything that we keep, costs, is a total of six and a half cents for every dollar we take in.

Audience Member: The .7 percent, is that, before you talked about earlier reserves, do you take out any estimate of reserve before you come to that number?

Davis: Good question. Dennis is asking, the .7, is that before we have built reserves, or after? That .7 is what goes to build reserves. .7is lower -- that's a ten-year average -- it's lower than where we want to be. We want to be between one and two percent, about one and a half percent is what we need to continue to build reserves, and continue to build capability.

Carriers charge small businesses higher premiums. Well, the reality here is a little entity called the state of Alaska, and it has something called "the Division of Insurance" who reviews and approves all of our rates for individual and small groups. This is not arbitrary. Every year we have to file our rates for individual and small group. We file them with the division. We have to show every single calculation, every single assumption, all of the build up to those rates. The state's actuary goes through those with a fine tooth comb, and argues back and forth with our actuaries, and finally comes to a number. The standard that they are going for is that those rates need to be adequate and not excessive.

The Division of Insurance is worried about two things: They are worried about solvency -- are you going to be there to pay the bill when the claim comes in? [The division is also worried about] protecting the consumer -- are these rates not excessive, are these reasonable, based on the risk that's being assumed? So that's the standard that they use. In the filing that we have just submitted for small group, all of the things that I've just gone through with you will be in there: the administrative expense, the profit, and risk assumption, all of those things, all of our assumptions around trend, around what the expenses have been. This is scrutinized, every single number and every single detail. It usually takes about six weeks of review before the Division of Insurance says "yes" to them. Back to selected topics list

You Really Can Buy Coverage

Another myth: individuals and small groups can't buy coverage. We've heard this often, also over the last few months. The reality, at least in Alaska, is that anyone who wants it and can afford it, can buy health insurance. Anyone. I don't care who you are, how sick you are, you can get it. For [those] over 65, it is a little bit different situation, but anyone under 65. If you're an individual, and you have a health condition, if you are rejected by a carrier, or you have one of the conditions that's on a list, then you have something that's available to you called "the high-risk pool," is what everyone calls it. But it's real name is the Alaska Comprehensive Health Insurance Association [ACHIA].

This was created in Alaska law, in I believe about 1996. If you are a health insurer, to do business in Alaska you have to be "admitted" to Alaska. That's what it's called. You have to have permission from the division. When you are admitted, you automatically become a member of ACHIA, of the Alaska Comprehensive Health Insurance Association. And as a member of ACHIA, you have the privilege of paying your share of the deficit that is run by the high-risk pool.

The high-risk pool is for people who, again, were rejected because of a medical condition. They can buy into the pool, and the plans in the pool reflect the kind of plans that are in the market, so the same kinds of plans are available in the private market as well as for the high-risk pool. But the high-risk pool sets the rates 40 percent higher than market, and that's allowed in law. It can be up to 50 percent higher, but the board chooses to set it at 40 percent higher.

And just to give you kind of a feel for this, there are just over 500 people, Alaskans, in the pool right now, [and] it's growing. You may have seen the ads recently, and that's helped to actually get the word out and grow the pool. The deficit to cover these people who are paying premiums that are about 40 percent higher than market, the deficit in 2009 was $10 million. So it took in three and a half million in premiums, and paid out 13 million in claims, so that the insurers in the state were assessed that $10 million, based on your market share. For us, at about 40 percent market share, it's actually a bit a higher market share than the technically insured business, so we were assessed somewhere about 67 percent of that $10 million.

And guess what? Who actually pays that? Our members pay that, because it gets built into the rates. So, it's a tax, if you will, on people with insurance to pay for those who can't get insurance, but it's public policy that works. It provides coverage for people who otherwise couldn't get coverage, at rates that are reasonably related to their risk.

In Alaska, a small group starts with two, so you are either an individual or you are a group. Starting at two, we have something called "guarantee issue" which means that if you are a legitimate business with at least two employees and you come to any carrier, they have to give you a quote on the same basis they would give any other business. They have established underwriting protocols that say: for a 45-year-old male, these are the rates, etc. etc. This kind of business, blah, blah, blah. So whether you are a group of two, or you are a group of 49, you're rated on the same basis. So, the fact of the matter is there is this "guarantee issue."

So, the point of this slide is that there is access. Now, it's expensive, and that's a whole 'nother issue, in fact that's the crux of the matter, and we will get to that in a little while. But first we have to deal with this notion that people can't buy it. Yes, you can. You may not be able to afford it, but you can buy it. Back to selected topics list

It's Illegal: Dropping Coverage for the Sick

Here's another one: If you or an employee get sick, you will be canceled. I don't know how many times I have heard this through the debate in recent weeks. The fact of the matter is that it is absolutely against the law, and has been against federal law since 1993, I think, the HIPAA [Health Insurance Portability and Accountability Act]. So, "we have to have health care reform, because we can't have people getting their insurance canceled," but yet we've laws that prevent that for 17 years, already in federal law.

Audience member: Is part of that that people's insurance rates go up when they get sick, and they end up not being able to afford it?

Davis: For individuals, that does not happen. It's not like car insurance. I can't speak to all companies, but I can speak to ours. I'm not expert in individual [insurance policies], but maybe Jeff [Ranf, an insurance broker] can weigh in here if I get this wrong. But for individuals, we pool all of them together. We have about 10,000 individual subscribers in Alaska, and it's pooled across the whole pool so you are not rated based on your health experience. We will get to how rating works in a little while.

For groups, there is a piece of your rate that's related to experience -- and I'm talking small groups here -- but it's limited. In Alaska law the rate increase can have no more than 15 percent. If you have a ten percent rate increase, out of that ten percent only 15 percent of that 10 percent can be due to experience. I don't know if that's part of it, but I think what people believed was, it's like car insurance or homeowners insurance, "If you keep having your house burn down, pretty soon no one will insure you," but that's not the case in health insurance. Back to selected topics list

What is, and What isn't, Insurance?

So, what is insurance? I'm going to bust some myths here. This is really dry, but this is really important because this is where I think a lot of the debate goes sideways. It's very interesting. If you read the Anchorage Daily News a few weeks ago, there was an editorial that said, "We believe, basically, both senators are voting their conscience." Well, how can both of our senators be voting their conscience and be voting on two opposite ends of the spectrum of what they believe about what was going on with that particular legislation? And I think it hinges kind of around our understanding of really: what is insurance? Are we talking about insurance, or are we talking about a social program or some kind of entitlement? And whether you are looking at it one way or the other, leads you to a different set of conclusions about what a particular set of legislative events will do.

To be insurance, an event has to have three characteristics. It has to be an undesirable event. If you are going to insure, you can't insure buying a new Mercedes. You can't insure that, because hey, that's kind of cool. I want one of those. Right? Or you can't insure going out to dinner because that's not an undesirable event, that's a desirable event. An insurable event also has to be not predictable to the individual. So, whatever this event is, a house burning down -- I don't want my house to burn down, that's an undesirable event. Can we predict that my house will burn down? No, we can't, and I'd like to hope it won't, but we can't predict that my house will burn down. But can we predict, if we have 100,000 people, how many people will have their house burned down? -- and that's the third characteristic -- yes. It's predictable of a population. To be insurable: an undesirable event, not predictable to the individual, predictable to the population.

So, let's look at a few examples of that. Getting your teeth cleaned. I only had 17 minutes to do this yesterday, because I had to go get my teeth cleaned, so that's why I put this up as an example. Is that an insurable event? This is a quiz. No. Why isn't it?

Audience Member: It's not unforeseeable.

Davis: Okay, it's not unforeseeable. I know I'm going to get my teeth cleaned twice a year, very good. Is it desirable or undesirable? In my case, it's desirable. You know, a nice hygienist, like to have clean teeth. So, it's desirable. So, teeth cleaning is not an insurable event. However, and this is an interesting point: you can buy dental insurance, right? And it includes getting your teeth cleaned. It's not really insurance at that point. It is pre-funding a service that you know you're going to have. A little technical thing there.

An automobile accident, is that an insurable event?

Audience Member: Yes.

Davis: Yes, okay. Because, it is desirable? No. Is it predictable to the individual? Some people, maybe. I won't say anything. But it is predictable to a population, correct? So, Geico, Allstate, whomever, they can look at a population of drivers, and say if we have this many 22-year-olds -- for heaven's sakes, I have a 22-year-old and a 25-year-old -- this is what we predict their rates will be for accidents, and they predict it to a population. How about death? Is that an insurable event? In the end, it's not predictable. Ultimately, it's predictable. So, that's an interesting point. So when I turn 75, how likely is it I'm going to be able to get life insurance? Not very likely except for a short period, and it's going to be very, very expensive.

Audience Member: It becomes more predictable.

Davis: It gets much more predictable, exactly, exactly the point. But at 54, I can buy life insurance. It starts to get more and more expensive, but you can buy it. How about treatment of cancer? is that an insurable event? Before the diagnosis, is it an insurable event?

Audience Member: Yes.

Davis: Okay, because you don't want it, it's not predictable to the individual, it is predictable to the population. How about after the diagnosis, is it an insurable event? No, because now it's predictable to the individual, correct? So when we start talking -- and this is the point of this -- about changing laws to say, no longer can you "discriminate" against people who are already ill, are we still talking about insurance, or are we talking about something different? Because we are talking about taking people and giving them insurance, but their events, their health is no longer an insurable event because they already have a pre-existing condition. It has already become predictable to the individual. So this is one of the places where this whole debate around health insurance reform starts to get really rocky. I'm not saying that's not a problem, I'm just saying that if you want to say, "can you insure it or can you not," that's where it starts to diverge. Back to selected topics list

Where Does the Health Care Dollar Go?

Well, I had hoped this [projected slide] would be a little easier for you to see. It illustrates the point that I was making earlier. This says: "Where's the health care dollar go?" And what this says is that 87 cents on the dollar goes to claims payment. This was taken from our small group in Alaska for 2008. Four cents went to taxes and commissions, and we kept nine cents. Eight cents for administration systems programs, one cent for operating profits. So, 2008.

These are from the small group, and these are consistent with the numbers I gave you earlier. Those were total company numbers, [and] this is Alaska small-group numbers. The point of the slide is that 87 percent of the cost is what? Claims. So if you have something that you want to be more affordable, and 87 percent of the cost of that something is driven by claims, and you want to affect the cost of it, what do you have to affect? You have to affect the cost of claims.

Audience member: Is this just Premera, or is this the insurance industry?

Davis: This is just Premera. This is just small group. But again, these numbers aren't inconsistent from an administrative efficiency perspective. The large commercials are even a little more efficient than this. Their profits are going to be four or five percent higher, so that's where there's going to be a difference. So maybe they are paying 82 cents on the dollar, rather than 87 cents on the dollar. But directionally, it's correct.

The point being, if you know, you can take the insurers completely out of the equation, okay? Let's say that there's a for-profit that their combined administrative expense and profit is 12 percent. Take them completely out. Well, with medical inflation being, overall, six percent a year, in two years you've wiped out that advantage. You haven't solved the problem is the point. The problem lies in that 87 cents on the dollar on the claims side, and that's what we need to think about.

Audience Member: And how is that reflected in the rate of say, standard increase in premiums year-by-year? Where in that ball game is the greatest increase in your costs annually?

Davis: Our administrative costs from 2009-2010, on a per member per month basis, absolute dollars, are expected to be flat. We are holding our costs flat by continuing to become more efficient. The taxes are a percentage, so whatever the premium is, it is a percentage of that. Commissions in small group at this point in time, are a percentage. The driver is the 87 cents on the dollar. What we are seeing over the last ten years, on average or so, in small group Alaska is that that the health care claims portion has grown about 15 percent a year. That's the major portion driving the increases in premiums to employers.

Audience Member: Over how many years have you trended that?

Davis: Roughly over the last ten years, that's what the actuaries have looked at. It's consistently right about 15 percent.

Audience member: Is that the number of claims, or the cost of the individual claim?

Davis: It's a combination of both. It's the cost per unit and the number of units. On this slide, that's Alaska. That's Alaska small group. I'm concentrating on small group because that's where the discussion is. If you look at large group, and for us that's a group over 100, pretty much at that point the saying in the industry is, "the claims are the claims." So whatever your claims are, that's what your rates going to get based on, if you are a group over 100. If you are under 100, you are usually pooled with other groups, and it's the claims experience of the pool that drives your rates. Back to selected topics list

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Health Policy Calendar

This calendar of health policy-related meetings is current as of February 25 at 9:00 AM. Please visit the Alaska State Legislature's list of committee hearings for the most current listings, as they are subject to change.

February 26, 2010, 1:00 PM
What: House Judiciary Standing Committee
Where: Capital 120, Juneau
Other Information: HB 52 Post-Trial Juror Counseling; Other Bills Scheduled; Teleconferenced

February 26, 2010, 1:30 PM
What: House Finance Standing Committee
Where: House Finance 519
Other Information: HB 302 Mental Health Budget; Other Bills Scheduled, Teleconferenced

March 1, 2010, 1:00 PM
What: House Judiciary Standing Committee
Where: Capital 120, Juneau
Other Information: HB 283 Purchase/Consumption of Alcohol; Others Bills Scheduled, Teleconferenced

March 1, 2010, 1:30 PM
What: Senate Health and Social Services Standing Committee
Where: Butrovich 205, Juneau
Other Information: Presentations: Anchorage Urban League - Seeds of Change; Division of Alaska Pioneer Homes; Bills Previously Heard/Scheduled; Teleconferenced

March 1, 2010, 3:15 PM
What: House Labor & Commerce Standing Committee
Where: Barnes 124, Juneau
Other Information: HB 282 Naturopaths; Other Bills Scheduled; Teleconferenced

April 28-30, 2010
What: The 4th Biennial Alaska Rural Health Conference
Where: Sheraton Anchorage Hotel
Other Information: "Planning for the Decade Ahead;" Access additional information and register here.

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Bill Watch: Bills on the Move

There was quite a bit of legislative activity regarding health policy this past week. Several new pieces of legislation were introduced, many bills were heard and moved out of committees, and two were passed and and transmitted to the Senate.

HJR 46 Supporting Denali Commission was introduced on February 19, heard and passed in the House and transmitted to the Senate on February 24. SB 296 Long-Term Care Insurance was introduced and referred to (S) L&C on February 24. SCR 13 Supporting Senior Caregivers was introduced and referred to (S) HSS on February 24. HB 354 Alaska Capstone Avionics Revolving Loan Fund was introduced and referred to (H) L&C on February 19. This bill would create additional funding options for owners and lessees of aircraft to improve their capabilities, including medevac transportation vehicles.

HB 346 Workers' Compensation Advisory Board was heard in (H) L&C on February 26. HB 282 Naturopaths is scheduled to be heard in (H) L&C on March 1. HB 302 Mental Health Budget is scheduled to be heard in (H) FIN on February 24 and 25.

HB 314 Workers' Compensation was heard in (H) JUD on February 24. HB 71 Advance Health Care Directives Registry was heard in (H) JUD on February 24.

HB 292 Grants to Disaster Victims was moved to (H)FIN on February 19. HB 110 Psychologists' Licensing and Practice passed in the House and was transmitted to the Senate on February 24. SB 163 Maximum Benefit from Fishermen's Fund was heard in (S) FIN on February 23 and moved to (S) RLS on February 24.

HB 259 Adult Public Assistance Eligibility was heard in (H) HSS on February 25. HB 265 Medicaid Coverage for Dentures was heard and held in (H) HSS on February 23. SB 199 Medicaid Coverage for Dentures was heard in (S) FIN on February 23 and was moved to (S) RLS on February 24.

HB 52 Post-Trial Juror Counseling is scheduled to be heard in (H) JUD on February 26. SB 168 Trauma Care Centers/Fund was heard in (S) HSS on February 23 and was moved to (S) FIN on February 24. HB 283 Purchase/Consumption of Alcohol was heard and held in (H) JUD on February 11 and is scheduled to be heard again on March 1.

The following is a list of all health-related bills recently proposed or sitting in various legislative committees. For a description of the process of selecting and tracking health policy bills, as well as the full names of committees and their abbreviations, refer to the end of the Bill Watch section.

Bill information is current as of February 25 at 10:00 AM.

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Bill Watch: Drugs

Bill Watch: Health Professional Workforce and Health Education

Bill Watch: Medical Assistance and Health Insurance

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.

Bill Watch: Mental Health

HB 52 Post-Trial Juror Counseling
Sponsor: Rep. Kerttula
Committee(s) and date of last action: Scheduled to be heard (H) JUD, 02/26/10
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, 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.

SB 66 Mental Health Patient Grievances
Sponsor: Sen. Davis
Committee(s) and date of last action: (S) HSS, 01/21/09
Description: This bill proposes new regulations related to patient grievances in a mental health setting. Specifically, it aims to streamline the grievance process so as to ensure that patients' rights are honored and are not deterred by the grievance filing process.

HB 302 Mental Health Budget
Sponsor: Rules by request of the Governor
Committee(s) and date of last action: Scheduled to be heard in (H) FIN, 02/26/10 at 1:30 PM
Description: Appropriates $195 million to mental health, with a $161 million operating budget from the general fund, $2 million from federal funds, and $33 million from other sources of funding.

SB 231 Mental Health Budget
Sponsor: Rules by request of the Governor
Committee(s) and date of last action: Heard in (S) FIN, 02/10/10
Description: This is the companion bill for HB 302.

SB 263 Extend Board of Professional Counselors
Sponsor: Rules by Request of Leg Budget and Audit
Committee(s) and date of last action: Read and referred to (S) L&C, 02/08/10
Description: This bill proposes to extend the termination date of the Board of Professional Counselors by ten years, from June 30, 2010 to June 30, 2018, to take effect immediately upon signature.

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Bill Watch: State Boards and Issues

HB 25 Health Reform Policy Commission
Sponsor: Rep. 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 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.

SB 35 Extend Suicide Prevention Council
Sponsors: Senators Davis, Ellis, and Therriault
Committee(s) and date of last action: (S) RLS, 04/11/09
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: Sen. 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.

SB 172 Alaska Health Care Commission
Sponsor: Sen. Olson
Committee(s) and date of last action: Heard and held in (S) HSS, 02/03/10
Description: This bill establishes the Alaska Health Care Commission as a permanent entity.

SB 247 Extending Board of Pharmacy
Sponsor: Sen. Olson
Committee(s) and date of last action: Referred to (S) FIN, 02/24/10
Other Information: This bill proposes to extend the Board of Pharmacy to June 30, 2018, to take effect immediately.

SB 248 Extend Bd of Marital & Family Therapy
Sponsor: Sen. Olson
Committee(s) and date of last action: Referred to (S) FIN, 02/24/10
Other Information: This bill proposes to extend the Board of Marital and Family Therapy to June 30, 2014, to take effect immediately.

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Bill Watch: Family Health Issues

Bill Watch: Worker's Compensation

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.

HB 314 Workers' Compensation
Sponsor: Labor and Commerce Committee
Committee(s) and date of last action: Heard in (H) JUD, 02/24/10
Description: This bill is "An Act relating to fees and charges for medical treatment or services, the crime of unsworn falsification, investigations, and penalties as they relate to workers' compensation; and providing for an effective date.

HB 346 Workers' Compensation Advisory Board
Sponsor: Rep. Olson
Committee(s) and date of last action: Heard in (H) L&C, 02/24/10
Other Information: This bill proposes that a Workers' Compensation Advisory Board be established, with a variety of members who would be required to meet every six months. If established, the bill would take effect immediately, and the Board would be in place until June 30, 2015.

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Bill Watch: General Health Policy

HR 14 Oppose Federal Health Reform Bills
Sponsor: Rep. Chenault
Committee(s) and date of last action: Introduced and referred to (H) HSS, 02/17/10
Other Information: This bill proposes a list of negative consequences to Alaska, and suggests "that the House of Representatives urges the Alaska Congressional delegation to vote against the current health care reform bills and to develop health care reform that is affordable and accessible to all legal residents," and "that the House of Representatives urges Governor Parnell and the Administration to review the constitutionality of the special deal for other states contained in the current federal health care reform bills." Once passed, it is requested that the resolution be sent to President Obama.

HJR 46 Supporting Denali Commission
Sponsor: Community and Regional Affairs committee (CRA)
Committee(s) and date of last action: Introduced on 02/19/10, Heard and Passed in the House and transmitted to the Senate, 02/24/10
Other Information: This bill urges Congressional support of the Denali Commission.

HB 71 Advance Health Care Directives Registry

Bill Watch: Bill Tracking Methodology

Bills listed here were selected based on a series of subjective criteria to determine whether they were "health-policy related." All bills currently sitting in the Senate and House Health 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
Kelby Murphy, Senior Policy Analyst
Jacqueline Yeagle, Newsletter design and editing

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A standard 12-month subscription to Alaska Health Policy Review is available for $850. Please inquire about discount rates for multiple recipients in the same organization, legislators, and small nonprofit organizations.

Don't miss an issue! Send orders, comments, and inquiries to Lawrence D. Weiss at health.policy.review@gmail.com, or call (907) 276-2277.

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