Senator Hollis French is chair of the Judiciary Committee and a member of eight additional committees and subcommittees. He is the sponsor of SB 160 in the last Legislature and SB 61 in the current Legislature, some of the most far-reaching and innovative proposed health reform legislation in many years in Alaska. In this interview, Senator French candidly discusses why his proposed legislation failed to become law, why the governor is making some serious mistakes in the realm of health policy, and what the central issues of health reform really are. This interview was conducted on October 19, 2010, and has been edited for length and clarity.

Links to selected topics

The most pressing health care system and policy problems
Health care reform efforts in Alaska and nationally
State should at least take federal money to help residents pick a health insurance policy
Parnell should offer an alternative to federal health care legislation
Recent actions of Alaska Primary Care Association and Alaska Health Care Commission
If you get sick I'm going to take care of you, and if I get sick you're going to take care of me

The most pressing health care system and policy problems

French: Thank you for your interest in health care. What's on your mind?

AHPR: So Senator French, looking back at the last few years, you have had an unusually strong interest in health system reform at the state level. Why have you focused on this issue?

French: Because it's one of the glaring needs I think in our state. I mean there's many needs, but this is one of them: 115,000 Alaskans do not have coverage from a health insurance policy. Many of our residents suffer from obvious health needs. Obesity being one example, and so it just seemed to me that getting involved was the right thing to do.

AHPR: What do you believe are the most pressing health care system issues or health policy issues in Alaska today?

French: It's the obvious ones. One, get everyone covered by a health insurance policy, or two, deliver services more completely. You and I've had interesting discussions over the sort of benefits of health insurance policy versus neighborhood health clinic where everyone can go and get taken care of. Frankly, there is no ultimate difference as long as that clinic offers services that a health insurance policy would cover, but I think that we are seeing some progress on both fronts.

I believe he ([Governor Parnell] was aware of it all throughout the increase, and now his veto in my view has sort of poisoned the well.

AHPR: You were, I believe, a co-sponsor of SB 13, which would have restored the income eligibility standard for the Denali KidCare Program from 175 percent to 200 percent of the federal poverty level as it was 12 years ago. What happened to this bill in the last Legislature?

French: It had strong support from the governor. I remember reading a glowing editorial that the Daily News wrote about his position in October before the session even began, October a year ago now, and the bill was passed -- and by both bodies of course -- prime sponsor being Senator Bettye Davis. I was happy to help out and put my name down as a co-sponsor. When the bill got to the governor for his signature, much to our consternation he suddenly decided to veto the increase, reversing himself. I led a press conference railing against that with Senator Davis, Senator Wielechowski, Senator Ellis, and myself pointing out that the governor was asked questions way back when he was the co-chair of the Senate Finance Committee, about the abortion issue and about the fact that when you pay state money in Alaska for health care you are going to have to provide medically necessary abortions under rulings from our Supreme Court.

He was aware of that then. I believe he was aware of it all throughout the increase, and now his veto in my view has sort of poisoned the well. By that I mean when we go and revisit the subject next year in Juneau, we're not going to talk about providing health care to children, we're going to talk about providing abortions to women, and it's just very unfortunate in my view. I plan to look into this more, but where the vast majority of that money goes, I think it goes to health care for children, and the administration could put forward their perspective. Back to selected topics list

Health care reform efforts in Alaska and nationally

AHPR: Thank you. You were the primary sponsor of SB 160 in the 25th Legislature and its successor SB 61 in the 26th Legislature. These bills would have established health reform in Alaska somewhat similar to what has been established in Massachusetts. Neither of these bills became law. Why do you believe that was the case?

French: There is an enormous education process that legislators have to go through to become sort of familiar with the basic mechanism in all those efforts -- the Massachusetts efforts and the two bills that I sponsored -- and with the dominance over the last few years of oil and gas issues in the Legislature, it's simply difficult to get their attention for a sustained period of time. It's also politically difficult to advance a comprehensive, big bill like that without support from the administration because you need to rely on so much of the expertise that resides in the Department of Health and Human Services. There are people there that know vastly more about the subject than I do. I am a legislator who has to handle six or seven topics, sometimes more, and so my knowledge is just enough to get through a bill here, and they have vast amount of knowledge. If you're sort of forced to go up against their resistance you're going to have a very difficult time.

Subsidized private insurance, that's 90 percent of what these bills do. They make private insurance affordable to you through a subsidy, through a voucher and it's tough to get people to understand that.

AHPR: You mentioned education of the legislators. What about education of the people of Alaska? Did you have their support?

French: You know, that's a good question and I don't know how much we were into the public to sort of test their views of the idea. I know I got good reviews from my district on the subject. They were happy to see me working on this problem and I never encountered a lot of resistance from the public because for the most part the bill helps the public. The bill basically provides subsidized private insurance -- that's the basic mechanism. It's not very difficult and it's been disappointing to me that both the Obama Administration -- and I guess me at some level -- has had a hard time getting that simple fact out to the public. Subsidized private insurance, that's 90 percent of what these bills do. They make private insurance affordable to you through a subsidy, through a voucher and it's tough to get people to understand that.

AHPR: You recently ran for governor, very recently, but during your campaign it appeared to me that you were remarkably quiet about health reform policy. Was my perception correct, and if so, why?

French: It certainly wasn't the number one or two thing we were talking about on the campaign, although it came up in several forums and I was happy to defend both the federal effort and my effort. It came up at one of the first events we did at UAA [University of Alaska Anchorage] in front of the kids where I railed against the governor's lawsuit against the feds. Partly it's due to the fact that there just isn't a lot of media coverage of anything, and certainly not of a primary, so I guess I would concede that it wasn't one of the top things I talked about. Nevertheless, it came up at several events, and I was consistent in my belief that the federal approach is the right way to go. Back to selected topics list

State should at least take federal money to help residents pick a health insurance policy

AHPR: Couple of weeks ago you called upon Governor Parnell to direct his administration to begin implementing provisions of the Federal Patient Protection and Affordable Care Act. Why did you do this?

French: I became aware of the fact through constituent complaints that many of the most popular provisions of the health care reform bill were not going to be implemented. They were going to be implemented slowly for some employees and not at all for others. The people I heard from first were state employee retirees who found that they would not be able to take advantage of one of the most popular reforms, as I said, and that's the ability to keep your older children, your children up to age 26 on your insurance policy.

There was some wiggle room left in the federal bill. The Parnell administration has elected to take advantage of that wiggle room and never make that reform available to retirees. They will make it available to current state employees, but only at the last minute possible. There was some language in the bill that said that you can either do it as of I think September 15th when a lot of national private insurance companies made it available to their [insured customers], or at the next policy year, the next plan year, so for the current state employees that's not going to happen until next July I think 15th.

The Parnell administration has elected to take advantage of that wiggle room [in the federal legislation] and never make that reform [cover children up to age 26] available to retirees.

That's when it will become available to me, for example. My son is graduating from college this year. He is currently covered under my state policy because of a provision that says that if you're a full time college [student] you can stay on my insurance, but he will be thrown off as soon as he graduates and I won't be able to keep him covered under my policy. I would have had the state do like Premera and Aetna did. Those are both private insurance companies operating in the state of Alaska who elected to begin covering their subscribers as soon as possible, but the state elected to wait as long as possible so it is going to be a problem -- and that was one aspect.

The other aspects were sort of pots of federal money that the Parnell administration elected not to avail themselves of. Money for consumer assistance, money for setting up the web exchange where you go to find a policy that works for you in that marketplace where the subsidy takes place, and I just thought that was bad. Their response, of course, is that "we're challenging the whole federal bill and so it seems wrong for us to sort of buy into an idea that we disagree with," but my comeback is this: even if the individual mandate is overturned, even if that central sort of idea which is you and you and you and all private citizens have to go buy insurance, even if that is overturned as being unconstitutional, there are still enormous reform aspects of the bill that will still be on the books. They're not going to outlaw all the other aspects, and the Parnell administration should take advantage of at least money to help consumers to pick a good health insurance policy. What's wrong with that? Back to selected topics list

Parnell should offer an alternative to federal health care legislation

AHPR: Good question. Looking out over the next few years what do you suppose will be the consequences of federal health reform for Alaskans?

French: You know, that's a really interesting question. Many of the reforms are very slow to take hold and so I think there's not going to be any moment when it dawns on the public that we have taken a huge step in the right direction, but it will sort of eventually, I think in 2014, sort of give everyone an affordable health insurance policy. That's a huge step in the right direction. What the outcome is of some of the more technical aspects like the cost containment methods or the Medicare reforms remain to be seen.

... if the governor and other governors who are attacking that individual mandate succeed, I certainly hope they file bills the very next day to provide for a state mechanism exactly identical to the [federal] one they oppose.

AHPR: Given the fact of this massive federal health reform -- you sort of discussed this in your discussion of the governor -- is there much wiggle room for the state to actually make decisions, to make things better, to go beyond federal health reform?

French: I think at this point I'm going to sort of take a wait-and-see attitude. What's going to happen with the lawsuit, that is number one and I certainly hope that if the governor and other governors who are attacking that individual mandate succeed, I certainly hope they file bills the very next day to provide for a state mechanism exactly identical to the [federal] one they oppose. I certainly hope that's forthcoming, and maybe the governor would be happy to talk about that because it enrages me that he would fight the feds who are trying to cover Alaskans and then not propose his own solution to the problem. That's what I find so frustrating. It's one thing to say that's a bad idea, that's an unconstitutional idea, but then why not do it in a manner that you find acceptable, which would be a bill like SB 61? The governor could file that bill and I'd be his champion. I would go work every day helping him pass that bill. Back to selected topics list

Recent actions of Alaska Primary Care Association and Alaska Health Care Commission

AHPR: The Alaska Primary Care Association board of directors approved a resolution at their September meeting supporting an annual operating budget appropriation from the State of Alaska in the amount of $3 million to assist community health centers to provide direct patient care to Alaskans, and an additional capital budget appropriation amount of $875,000 to assist in the transition to the medical home model. Do you believe that the State of Alaska should consistently provide support to the community health centers, and why?

French: The answer is yes. We should provide support and I think because it's the place where between now and 2014, the average Alaskan who doesn't have a health insurance policy can go and get medical care without going to the emergency room. That's why community health centers are successful. It's because it helps you go get medical care before it is acute and that is exactly what you want to have happen. That's the basic idea behind the insurance policy, which is to let you go see a doctor, a "doc in the box," before you go and see an emergency room doc. It's just the way you provide health care to your citizens in our model, which is fee for service. Until we take a whole of different tack that is going to be the way you go.

AHPR: The newly reconstituted Alaska Health Care Commission has been established and just had its first meeting. In your opinion what role will or can the commission play in the coming years regarding health policy leadership, analysis, and change.

That's why community health centers are successful. It's because it helps you go get medical care before it is acute and that is exactly what you want to have happen.

French: You know, I missed the meetings. I was out of town and I'm sorry that I was because it would have been interesting to go to hear, for example, Mark Foster speak on these subject[s]. He is a very knowledgeable individual and I guess as I was looking over their agenda, I thought that what they probably can do pretty well is describe the landscape and analyze for us the statistical lay of the land. You know, how many people lack insurance policy? What's the rate of obesity in Alaska? Where are we not delivering health care appropriately?

I think those things are probably amenable to their mission or at least something that they are going to succeed in doing -- at least I hope they will. Now their ability to propose policy changes to cure the problem, I think that's going to be where they have a difficult time because you need strong leadership and you need a strong political vision. I will be interested to see what they do on that front -- let's put it that way -- but that is something that I think it will be hard for them to overcome.

AHPR: Thank you.

French: Did you go, by the way, sort of parenthetically, did you go to the meeting?

AHPR: I was not able to go.

French: Right, and did it get any press coverage?

AHPR: I would say almost no coverage at all outside of the health policy community, as far as I can tell.

French: Right, okay, interesting. I wondered. I saw the agenda and wondered about what happened.

AHPR: I really think probably the next meeting will be much, much more important than this one from what I gather.

French: This is the sort of organizational meet and greet sort of thing. Back to selected topics list

If you get sick I'm going to take care of you, and if I get sick you're going to take care of me

AHPR: What health policy legislation will you be pursuing in the upcoming 27th Legislature?

French: You know I was disappointed that Donny Olson's bill [SB 139], which really seem[ed] to be the most comprehensive bill dealing with the recruitment of medical professionals to Alaska [failed to become law]. I remember going to a meeting, I think it was from the Primary Care Association that they sponsored in Juneau, and they looked at the five or six bills that had been proposed, sort of touching on that area, and his just stood out as being comprehensive, far reaching, did more than just attract new graduates. You reached out and got practicing doctors from across America and made it attractive for them to come to Alaska, and that just seemed like a really good idea. That is something that if he isn't going to propose, I would be happy to sponsor and work a little harder on.

AHPR: And finally, do you have any last statements or comments you would like to make as we wrap up this interview?

French: You know, I'm really glad you asked that because I have been thinking more and more about this. I guess it's couched in my trying to understand the Republican opposition to a health care reform in so far as it centers on this idea, a very Republican idea, to provide subsidized private insurance to every citizen and really made me think about if you don't do it that way, what is your idea?

I guess I would ask my Republican colleagues, an uninsured person is walking down the street, an uninsured person gets hit by a truck, our system is going to respond and fix that person's medical problems without any questions whatsoever. We don't care where you are from, who your parents are, how much money you have, we're going to scoop you up, take you to the hospital and fix everything that's wrong with you and then we're going to worry about how to pay for that. Why not cover that person with an insurance policy? Why don't we all sort of bind ourselves together as human beings and say, "If you get sick I'm going to take care of you, and if I get sick you're going to take care of me," and go forward under that basic understanding, which we're doing now in a highly inefficient way, and I think would be better if we at least cover each other with an insurance policy.
So that basic transaction and their opposition to that basic idea I just do not understand. Maybe you in your wanderings can find out because I would love to see what it is. So that is my closing thought which is, you know, I am struggling to understand the opposition to the idea that we should all look out for each other health-wise since it is a basic sort of foundational fact of human existence that sooner or later, you get sick.

AHPR: Well, I appreciate that very much. You know, I thought of one other question which I'll spring on you and I'm just curious if in your mind or our reality you see any relationship between energy policy, which you seem to pursue with great vigor, and health policy.

I am struggling to understand the opposition to the idea that we should all look out for each other health-wise since it is a basic sort of foundational fact of human existence that sooner or later, you get sick.

French: Well, I guess it is always easy to say at this moment of change, right, but we are in a moment of change both on a federal and state health care policy service standpoint and in energy policy. We're finding that the old method of just living on oil and gas and using that to heat our homes and business is not going to get it for the future, and we are going through that difficult time of finding the right solution. You don't want to invest in tidal power right now. That just doesn't work out economically, but wind power seems to.

There's communities in Europe, there's communities in America, that are increasingly relying on alternative energy and so you've got to do your homework, you've got to do your research, you've got to figure out what's going to work. It's maybe even easier in energy policy than it is in health care policy, because you can really run the numbers down to the nth degree -- What does it cost to heat a home? What does it cost to spin a turbine? Whereas, it's harder in health care because sooner or later you run into really difficult philosophical issues of what to spend on certain types of conditions and how to modify a really complex system. But it's important that you work on them because you know rural Alaska goes away unless we do something about the energy cost there, and that's a huge portion of our state. You just don't want to have a little rail belt where everybody lives. You want to have a thriving rural Alaska, a thriving entire state, you know, a southeast state, a western state. I don't know that they touch so much as that they both take a lot of energy to understand, and it looks like it is worth doing to me.

AHPR: Thanks very much. Back to selected topics list

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Despite spending the most on health care, the United States continues to lag behind other nations when it comes to gains in life expectancy -- and commonly cited causes for the nation's poor performance are not to blame, a new Commonwealth Fund-supported study finds.

The Health Affairs Web First article, written by Peter Muennig and Sherry Glied of Columbia University, examines health spending, behavioral risk factors like obesity and smoking, and 15-year survival rates for men and women ages 45 and 65 in the U.S. and 12 other advanced nations. The findings reported show that while the U.S. has achieved gains in 15-year survival rates decade by decade between 1975 and 2005, other countries have experienced greater gains, even as per capita health care spending in the U.S. increased at more than twice the rate of the comparison countries. Forty-five year old U.S. white women fared the worst: by 2005, their 15-year survival rates were lower than that of all the other countries. Meanwhile, the U.S. ranking for 15-year life expectancy for 45-year-old men fell from third in 1975 to 12th in 2005.

In comparing risk factors among the 13 countries, the researchers found very little difference in smoking habits between the U.S. and the comparison countries -- in fact, the U.S. had faster declines in smoking between 1975 and 2005 than almost all the other countries. And while people in the U.S. are more likely to be obese, this was also the case in 1975, when the U.S. was not so far behind in life expectancy.

The researchers say that the failure of the U.S. to make greater gains in survival rates despite its greater spending on health care may be attributable to flaws in the overall health care system, specifically the role of unregulated fee-for-service payments and an overreliance on specialty care.

"This study provides stark evidence that the U.S. health care system has been failing Americans for years," said Commonwealth Fund president Karen Davis. "The good news is that the Affordable Care Act will take significant steps to improve our health care system and the health of Americans by expanding health insurance, improving primary care, and holding health care organizations accountable for their patients' overall health."

[Source: excerpted from Commonwealth Fund e-Alert, October 7, 2010]

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Lawrence D. Weiss, PhD, MS, Editor
Angie Shephard, Transcription and editing
Jacqueline Yeagle, Newsletter design and editing

 
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