Legislature(2009 - 2010)CAPITOL 106

04/06/2010 03:00 PM HEALTH & SOCIAL SERVICES


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03:05:15 PM Start
03:05:47 PM HB126
03:16:08 PM Confirmation to State Medical Board
03:22:39 PM HB423
05:02:53 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ Confirmation Hearing: TELECONFERENCED
State Medical Board
*+ HB 423 POLICY FOR SECURING HEALTH CARE SERVICES TELECONFERENCED
Heard & Held
+ SB 10 MEDICAID/INS FOR CANCER CLINICAL TRIALS TELECONFERENCED
Scheduled But Not Heard
+ Bills Previously Heard/Scheduled TELECONFERENCED
+= HB 126 FOSTER CARE/CINA/EDUCATION OF HOMELESS TELECONFERENCED
Moved CSHB 126(HSS) Out of Committee
        HB 423-POLICY FOR SECURING HEALTH CARE SERVICES                                                                     
                                                                                                                                
3:22:39 PM                                                                                                                    
                                                                                                                                
CO-CHAIR KELLER announced  that the next order  of business would                                                               
be  HOUSE BILL  NO. 423,  "An Act  stating a  public policy  that                                                               
allows a person to choose or  decline any mode of securing health                                                               
care services,  and providing for  enforcement of that  policy by                                                               
the attorney general."                                                                                                          
                                                                                                                                
3:23:25 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE CARL GATTO, Alaska  State Legislature, offered his                                                               
belief that  the passage  of the federal  health care  reform was                                                               
unconstitutional.  He  explained that HB 423 was a  means to have                                                               
the U.S. Supreme Court determine  whether the federal health care                                                               
reform act was  a violation of the Tenth Amendment.   He declared                                                               
that he was  a believer in freedom, and he  opined that the Tenth                                                               
Amendment was  written to respect the  rights of each state.   He                                                               
shared his belief of various states  rights issues in Alaska.  He                                                               
said  that  an  infringement  on  state  rights  by  the  federal                                                               
government was a  violation.  He stated that  the Tenth Amendment                                                               
enumerated that whatever was not  declared a right by the federal                                                               
government, became  a state's right.   He listed 14  states which                                                               
were requesting the  states' attorneys general to  pursue this to                                                               
the Supreme  Court.  He noted  that 5 other states  had expressed                                                               
they would not  go to the Supreme  Court.  He opined  that it was                                                               
beneficial for Alaska to pursue  its own interest, by joining the                                                               
other 14 states.  He stated  his desire to have the Supreme Court                                                               
clearly define  the relationship  of the  Tenth Amendment  to the                                                               
federal health care reform.                                                                                                     
                                                                                                                                
3:30:28 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE T. WILSON asked what would be the cost to Alaska.                                                                
                                                                                                                                
3:30:37 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  GATTO replied  that the  Goldwater Institute  had                                                               
offered  to  "defend the  constitutionality  of  the Health  Care                                                               
Freedom Act [HB 423] at no cost to the state."                                                                                  
                                                                                                                                
3:31:31 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE T.  WILSON asked if  the lawsuit would  prohibit a                                                               
choice for government insurance.                                                                                                
                                                                                                                                
3:31:50 PM                                                                                                                    
                                                                                                                                
THOMAS REIKER,  Staff to Representative Carl  Gatto, Alaska State                                                               
Legislature, in  response to Representative T.  Wilson, said that                                                               
HB 423  did not preclude  people from accepting health  care, but                                                               
it barred the federal government  from compelling someone to join                                                               
a health care system which they did not want to join.                                                                           
                                                                                                                                
3:32:17 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  HERRON  asked  the  reason   for  using  the  Goldwater                                                               
Institute.                                                                                                                      
                                                                                                                                
3:32:37 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  GATTO said  that  it  was just  one  option.   He                                                               
pointed to  the analysis  of the fiscal  note, which  stated that                                                               
the fiscal  impact was indeterminate.   He opined that  the "cost                                                               
of  not  doing  something  can  far  exceed  the  cost  of  doing                                                               
something."                                                                                                                     
                                                                                                                                
3:33:34 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  CISSNA asked  if  the  passage of  HB  423 was  a                                                               
choice for  health care, or  was it  removing the option  for the                                                               
state to be a part of the health care plan.                                                                                     
                                                                                                                                
3:34:31 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GATTO  replied that  the federal  plan was  now in                                                               
place until the Supreme Court ruled otherwise.                                                                                  
                                                                                                                                
3:34:38 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  CISSNA  asked  if   this  decision  would  affect                                                               
contagious diseases and quarantines.                                                                                            
                                                                                                                                
3:35:40 PM                                                                                                                    
                                                                                                                                
MR. REIKER  replied that HB 423  gave an individual the  right to                                                               
determine their health care service.                                                                                            
                                                                                                                                
3:36:22 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE CISSNA stated that  her constituents wanted health                                                               
care help, and she asked what the motivation was for HB 423.                                                                    
                                                                                                                                
3:37:11 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GATTO, in response,  replied that his district was                                                               
overwhelmingly against  the federal health  care bill.   He asked                                                               
if  individuals should  be allowed  to choose  their health  care                                                               
option.   He opined  that it  was not  the responsibility  of the                                                               
federal government to change the health care system.                                                                            
                                                                                                                                
3:40:47 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE HOLMES pointed to page  2, line 7, and asked about                                                               
the "injunctive  and other  appropriate relief"  that HB  423 was                                                               
asking the attorney general to seek.                                                                                            
                                                                                                                                
3:41:22 PM                                                                                                                    
REPRESENTATIVE  GATTO  replied  that  the  attorney  general  was                                                               
directed  "to  pursue,  in  court,   whether  or  not  the  Tenth                                                               
Amendment  has  been   violated.    And  if   so,  since  there's                                                               
severability in  the law,  then he  may have  to deal  with which                                                               
parts are in violation."                                                                                                        
                                                                                                                                
3:41:45 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE HOLMES asked what exactly was being protested.                                                                   
                                                                                                                                
3:42:23 PM                                                                                                                    
                                                                                                                                
MR.  REIKER, on  behalf of  Representative Gatto,  said that  the                                                               
Tenth  Amendment  related to  mandate  provisions,  and that  the                                                               
federal  health  care reform  created  unfunded  mandates to  the                                                               
states as part of the Medicaid program.                                                                                         
                                                                                                                                
3:42:53 PM                                                                                                                    
                                                                                                                                
CO-CHAIR KELLER  said that the  committee questioning  was moving                                                               
"outside of  the scope of  the bill."   He directed  attention to                                                               
Section  2  and  Section  3,  and opined  that  HB  423  was  not                                                               
challenging the  entire federal  health care  reform, but  it was                                                               
challenging the right to choose any mode of health care.                                                                        
                                                                                                                                
3:44:16 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE HOLMES replied  that she had asked  the sponsor to                                                               
explain  the  bill  and  that her  questions  were  within  those                                                               
parameters.   She strongly stated  her opinion that the  focus of                                                               
the  bill was  not clear.   She  emphasized that  HB 423  did not                                                               
specifically reference  federal health care reform,  yet it asked                                                               
for specific  action from the  attorney general.  She  asked what                                                               
specific action HB 423 was asking.                                                                                              
                                                                                                                                
3:45:48 PM                                                                                                                    
                                                                                                                                
MR. REIKER,  in response to  Representative Holmes, said  that HB
423 discussed choice and mode of  health care.  He pointed to the                                                               
mandate within  the federal health  care reform as the  target of                                                               
HB 423.  He explained that  this affected people who did not have                                                               
health  care  and  would  be  forced  into  buying  health  care.                                                               
Secondly,  he  noted  that Medicaid  had  enforcement  provisions                                                               
which were  now the  responsibility of the  states.   Finally, he                                                               
shared the concern of whether  the federal government could force                                                               
states  to  impose  state  level regulations.    He  opined  that                                                               
Alaskans should have the choice to participate.                                                                                 
                                                                                                                                
3:47:33 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SEATON reported  that  some  people were  unhappy                                                               
with Medicare,  yet were required to  pay for that.   Pointing to                                                               
page  1, line  14,  he opined  that HB  423  was targeted  toward                                                               
Medicare, and  he asked the  sponsor where the  bill specifically                                                               
directed  the  attorney  general  not  to  seek  liberation  from                                                               
Medicare participation.                                                                                                         
                                                                                                                                
3:48:51 PM                                                                                                                    
                                                                                                                                
MR.  REIKER  opined  that  you have  the  right  to  supplemental                                                               
private  insurance,  but  that  you   did  not  have  to  receive                                                               
Medicare, even if you pay for it.                                                                                               
                                                                                                                                
3:49:16 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SEATON, addressing  payment  for Medicare,  asked                                                               
whether an  individual should have  to pay, whether they  used it                                                               
or not.   He asked if  HB 423 would allow  individuals to decline                                                               
the charge for any mode of health insurance.                                                                                    
                                                                                                                                
3:50:21 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GATTO said that you  may have to pay for Medicare,                                                               
but you  don't have to  use it.   He pointed to  the restrictions                                                               
imposed by  Medicare.  He  opined that individuals had  the right                                                               
to go to any medical facility and to pay for that service.                                                                      
                                                                                                                                
3:51:24 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON, in response  to Representative Gatto, said                                                               
that the  mandate of the  federal health  care reform was  for an                                                               
individual to have  insurance or pay a fine, but  that it did not                                                               
enforce  use  of the  insurance.    He  asked  how that  was  any                                                               
different than Medicare.                                                                                                        
                                                                                                                                
3:52:20 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GATTO said that individuals  pay for many services                                                               
that  were not  used.   He  said that  HB  423 was  a bill  about                                                               
states' rights, and the right of  refusal as opposed to the right                                                               
of acceptance.                                                                                                                  
                                                                                                                                
3:53:29 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SEATON  replied  that   Medicare  was  a  federal                                                               
program, with  a federal  mandate that an  employee pay  into the                                                               
medical system.   He asked  to clarify  that HB 423  required the                                                               
attorney general  to challenge a  federal insurance program.   He                                                               
asked  about the  difference between  Medicare  and this  federal                                                               
health care program.                                                                                                            
                                                                                                                                
3:54:28 PM                                                                                                                    
                                                                                                                                
MR. REIKER  said that  the federal  health care  program required                                                               
states to implement state level  regulations, although these came                                                               
from the federal government.  He  stated that it also set minimum                                                               
standards  for  the mandated  insurance  and  care, which  was  a                                                               
violation  of the  Tenth Amendment.   He  stressed that  this was                                                               
different from Medicare.                                                                                                        
                                                                                                                                
3:55:13 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  CISSNA,  in  response  to  Representative  Gatto,                                                               
pointed out that Alaskans do not  pay state income tax, hence, do                                                               
not  pay for  roads, but  instead receive  money from  the state.                                                               
She  opined that  there was  not a  state health  plan, but  that                                                               
Medicaid was  a payment  source for  a great  deal of  the health                                                               
care  in Alaska.   She  suggested discussions  with professionals                                                               
who understand the  new federal program to  better understand the                                                               
costs to Alaska.                                                                                                                
                                                                                                                                
3:57:28 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GATTO  replied that  there was  a state  plan [for                                                               
employees of the  state], and that there were private  plans.  He                                                               
stated  that an  individual  could  decline to  be  in the  state                                                               
health plan.   He admitted  that there  were many people  who did                                                               
not have coverage.  He declared  that in his 25 years [working as                                                               
a paramedic] of transporting patients  to emergency rooms, he had                                                               
never  known of  a person  who was  not transported  because they                                                               
could  not pay.    He  declared that  the  issue  of payment  was                                                               
between the  patient and the  hospital.   He said that  "we don't                                                               
have people dying  on the streets, we don't  have people starving                                                               
in corners, we  don't have people begging up and  down the halls,                                                               
we  have plans,  we do  things."   He stated  that the  [federal]                                                               
government did  not have any  money, that  all the money  sent to                                                               
Alaska, came  from Alaskans.   He declared that "we  keep sending                                                               
them money  and they send  us a smaller  percent of it,  over and                                                               
over  and over  again."   He opined  that it  was better  for the                                                               
state to  keep state money  and institute its own  Medicare plan.                                                               
He opined that  the federal government was forcing  Alaska into a                                                               
plan that was not  wanted.  He expressed, "I don't  want it."  He                                                               
stated  "I think  I have  rights  but the  federal government  is                                                               
saying I  don't."   He declared  that this was  the intent  of HB
423.  He explained that HB  423 requested the attorney general to                                                               
represent  similar  thinking  Alaskans  in asking  if  the  Tenth                                                               
Amendment had  been violated.   "It's not  about bills,  it's not                                                               
about health  care, it's about  the Tenth Amendment."   He stated                                                               
that to not  address this on the federal level  was tantamount to                                                               
giving up.   He opined that it was an  overwhelming precedent for                                                               
the federal government  to determine that an  individual must buy                                                               
a product.                                                                                                                      
                                                                                                                                
4:01:49 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  KELLER  clarified  that  the bill  would  go  to  House                                                               
Judiciary Standing Committee for a legal determination.                                                                         
                                                                                                                                
4:02:26 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE T.  WILSON asked  if HB 423  was focused  on those                                                               
individuals who were now required to purchase health care.                                                                      
                                                                                                                                
4:02:57 PM                                                                                                                    
                                                                                                                                
MR. REIKER agreed.                                                                                                              
                                                                                                                                
4:04:16 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE T. WILSON declared  that there was a misconception                                                               
that people  without health  insurance had  others pay  for their                                                               
health care.                                                                                                                    
                                                                                                                                
4:04:48 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GATTO replied that 30  million people did not have                                                               
[health]  insurance,  and he  opined  that  10 million  of  these                                                               
people  were illegally  in the  United  States.   He offered  his                                                               
belief  that many  people considered  it improper  to pay  health                                                               
insurance for illegal residents.                                                                                                
                                                                                                                                
4:05:45 PM                                                                                                                    
                                                                                                                                
CO-CHAIR HERRON  asked if  the Department of  Law (DOL)  had been                                                               
asked to testify.                                                                                                               
                                                                                                                                
4:06:09 PM                                                                                                                    
                                                                                                                                
MR. REIKER said that DOL had not been asked.                                                                                    
                                                                                                                                
4:06:18 PM                                                                                                                    
                                                                                                                                
MR.  REIKER, in  response,  said that  Department  of Health  and                                                               
Social Services (DHSS) was not asked to testify.                                                                                
                                                                                                                                
4:06:34 PM                                                                                                                    
                                                                                                                                
CO-CHAIR HERRON asked why other states had filed lawsuits.                                                                      
                                                                                                                                
4:06:48 PM                                                                                                                    
                                                                                                                                
MR. REIKER replied  that a group of states had  filed the lawsuit                                                               
together, with  the focus on  the mandate  to buy a  private good                                                               
with private funds.  He continued,  and explained that this was a                                                               
violation of the  Tenth Amendment and the Commerce  Clause of the                                                               
U.S.  Constitution.    He  added   that  there  were  significant                                                               
portions of the  lawsuit which pertained to  the unfunded mandate                                                               
for Medicaid.   He pointed out  that there were also  state level                                                               
regulations which  were imposed  by the  federal government.   He                                                               
opined that  the only option given  to the states was  to opt out                                                               
of Medicaid.                                                                                                                    
                                                                                                                                
4:08:04 PM                                                                                                                    
                                                                                                                                
CO-CHAIR HERRON  asked to clarify  that the complaint  focused on                                                               
the financial burden of expanded  Medicaid.  He asked the sponsor                                                               
if he suggested opting out of Medicaid.                                                                                         
                                                                                                                                
4:08:21 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  GATTO   said  that  the  lawsuits   run  parallel                                                               
courses,  and they  all dealt  with the  Tenth Amendment  and the                                                               
Commerce Clause.  He asked for clarification of the question.                                                                   
                                                                                                                                
4:09:03 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  HERRON  asked  if  the   reason  for  HB  423  was  the                                                               
additional financial burden from the expansion of Medicaid.                                                                     
                                                                                                                                
4:09:45 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  GATTO  replied that  the  primary  issue was  the                                                               
mandate, but  that Medicaid, the  Commerce Clause, and  the Tenth                                                               
Amendment were  all part of the  lawsuit.  He opined  that it was                                                               
incumbent on Alaska to do its  share, and be in the forefront for                                                               
states' rights.   He offered his belief that this  was "the time,                                                               
the place,  and the  moment in history  to address  that question                                                               
because never in  history have we had such an  enormous impact on                                                               
our  economy."   He opined  that the  federal health  care reform                                                               
would increase the national debt.                                                                                               
                                                                                                                                
4:11:49 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  HERRON  asked  to clarify  that  the  attorney  general                                                               
should  consider  whether the  U.S.  Congress  had the  power  to                                                               
regulate health insurance, and commerce in Alaska.                                                                              
                                                                                                                                
4:12:18 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  GATTO replied  that  the  federal government  did                                                               
regulate commerce.   He expressed disagreement with  a mandate to                                                               
purchase  a specific  product.   He  stated  that Alaska,  alone,                                                               
could not nullify a federal law.                                                                                                
                                                                                                                                
4:14:00 PM                                                                                                                    
                                                                                                                                
CO-CHAIR HERRON  asked to  clarify whether this  was an  issue of                                                               
states' rights, or a violation of individual rights.                                                                            
                                                                                                                                
4:14:27 PM                                                                                                                    
                                                                                                                                
MR. REIKER replied that it was  both.  He offered his belief that                                                               
the  Tenth Amendment  guaranteed individual  and states'  rights.                                                               
He  opined that  the right  to regulate  insurance was  reserved,                                                               
under  the  Tenth  Amendment,  to  the  states,  as  it  was  not                                                               
specifically  enumerated to  the federal  government.   He opined                                                               
that  purchasing  the  mandated  insurance  was  a  violation  of                                                               
individuals' rights  to control their  own property.   He offered                                                               
his belief that the Alaskan  constitution guaranteed Alaskans the                                                               
right to "fruits of their own labor."                                                                                           
                                                                                                                                
4:15:43 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SEATON  stated that  the  bill  limited what  the                                                               
state was  able to do.   He offered quarantine as  an example and                                                               
asked  if this  bill, which  would  allow the  option for  health                                                               
care,  would supersede  any prior  legislation  that allowed  for                                                               
quarantine.                                                                                                                     
                                                                                                                                
4:16:44 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GATTO replied that,  in the interest of protecting                                                               
the public,  quarantine would happen.   He  said that HB  423 did                                                               
not  address the  right to  enforce quarantine  if an  individual                                                               
declined.                                                                                                                       
                                                                                                                                
4:17:38 PM                                                                                                                    
                                                                                                                                
MR. REIKER  said that the  actual quarantine would not  be health                                                               
care, but that  only the services received  afterward were health                                                               
care.  He  stated that HB 423  would allow a person  the right to                                                               
refuse health care  services and choose death  from a quarantined                                                               
disease, but not to violate the quarantine.                                                                                     
                                                                                                                                
4:18:04 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SEATON   referenced  Alaskan   legislation  which                                                               
allowed the state to quarantine  for health care services, and he                                                               
questioned if HB  423 would supersede that.  He  also asked if HB
423  would supersede  involuntary  commitment  for mental  health                                                               
services.                                                                                                                       
                                                                                                                                
4:18:56 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  KELLER   reflected  that  these  questions   were  best                                                               
answered by  the House Judiciary  Standing Committee.   He opined                                                               
that the central  statement of HB 423 was the  right for Alaskans                                                               
to  choose whether  or not  to have  health care,  and not  to be                                                               
penalized  if they  choose not  to have  it.   He stated  that 41                                                               
states  had legislation  against this  penalty.   He opined  that                                                               
quarantine was  not a  health care issue,  but instead  a disease                                                               
control issue.                                                                                                                  
                                                                                                                                
4:20:05 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON replied that  several bills had been passed                                                               
which were  based on  health care.   He pointed  out that  HB 423                                                               
specifically  stated  that  an  individual  could  decline  those                                                               
services.   He  asked if  HB  423 would  supersede those  earlier                                                               
bills and allow  individuals to "decline any mode  of health care                                                               
service."   He asked  for an opinion  from Legislative  Legal and                                                               
Research Services as to the effect of HB 423.                                                                                   
                                                                                                                                
4:22:00 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON  directed a question to  Dennis Bailey, and                                                               
asked  if  HB 423  would  supersede  previous legislation,  which                                                               
allowed quarantine  for health  reasons, and  "that a  person has                                                               
the right and  is free to choose or decline  any mode of securing                                                               
health care services."                                                                                                          
                                                                                                                                
4:22:50 PM                                                                                                                    
                                                                                                                                
DENNIS BAILEY,  Attorney, Legislative Legal  Counsel, Legislative                                                               
Legal and Research Services, replied  that the bill was not clear                                                               
on  that issue.   He  opined that  securing health  care services                                                               
could include the quarantine services.                                                                                          
                                                                                                                                
4:23:20 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  KELLER  asked  to clarify  that  securing  health  care                                                               
services was an umbrella which included quarantine.                                                                             
                                                                                                                                
4:23:38 PM                                                                                                                    
                                                                                                                                
MR. BAILEY  replied that HB 423  was unclear as to  a distinction                                                               
between  quarantine  and  the health  care  services  during  the                                                               
quarantine.  He suggested that this be clarified.                                                                               
                                                                                                                                
4:24:07 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  KELLER  replied  that  securing  health  care  services                                                               
implied volition  and individual  choice, whereas  quarantine was                                                               
for the greater good of the community.                                                                                          
                                                                                                                                
4:24:36 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  HOLMES  asked if  the  bill  language would  also                                                               
conflict  with the  requirement  of immunizations  for kids  when                                                               
attending school.                                                                                                               
                                                                                                                                
4:25:11 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   GATTO  replied   that  immunizations   were  not                                                               
required unless  you wanted  to enroll  your children  in school.                                                               
He said  that a variety of  laws declared that an  individual may                                                               
not harm another,  and he declared that  contagious diseases were                                                               
included under these laws.                                                                                                      
                                                                                                                                
4:26:45 PM                                                                                                                    
                                                                                                                                
MR. BAILEY  directed attention  to page  2, Section  3(e)(1), and                                                               
stated that immunization would fall under health care services.                                                                 
                                                                                                                                
4:28:05 PM                                                                                                                    
                                                                                                                                
CO-CHAIR KELLER  asked if  quarantine would  also be  included in                                                               
this definition.                                                                                                                
                                                                                                                                
MR.  BAILEY replied  that it  was not  addressed directly  in the                                                               
bill, and he  was not able to determine whether  quarantine was a                                                               
health care service.                                                                                                            
                                                                                                                                
4:28:37 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   SEATON   asked    if   involuntary   psychiatric                                                               
commitment would also be included in health care services.                                                                      
                                                                                                                                
MR. BAILEY  replied that mental  health care was included  in the                                                               
definition   of  health   care  service;   therefore  involuntary                                                               
psychiatric commitment could not be  excluded from the meaning in                                                               
the bill.                                                                                                                       
                                                                                                                                
4:30:26 PM                                                                                                                    
                                                                                                                                
MR. REIKER said  that this was statute, and could  be amended now                                                               
or in future legislation.                                                                                                       
                                                                                                                                
4:30:52 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE T. WILSON  asked if this bill  language was copied                                                               
from existing statute in another state.                                                                                         
                                                                                                                                
MR.  REIKER replied  that the  bill  language was  from an  Idaho                                                               
statute.                                                                                                                        
                                                                                                                                
4:31:11 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GATTO  read from  AS 18.15.385 which  was entitled                                                               
"Isolation and  quarantine."   He opined  that the  statute dealt                                                               
with quarantine, and that HB 423 did not void state statutes.                                                                   
                                                                                                                                
4:32:06 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON  pointed out that a  subsequent statute did                                                               
modify previous statutes,  so that HB 423  would indeed supersede                                                               
the earlier statutes.                                                                                                           
                                                                                                                                
4:32:46 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  CISSNA remarked  that not  having representatives                                                               
from  the departments  and from  health administration  to answer                                                               
questions made it  difficult for any responsible  decisions to be                                                               
made.  She  asked if department representatives  had reviewed the                                                               
bill and commented on the possible outcome.                                                                                     
                                                                                                                                
4:35:09 PM                                                                                                                    
                                                                                                                                
MR.  REIKER,  in response  to  Representative  Cissna, said  that                                                               
currently under Alaska law, HB 423  has been the de facto policy.                                                               
He  explained that  the federal  health care  reform mandate  had                                                               
changed Alaska law, therefore HB 423 was challenging it.                                                                        
                                                                                                                                
4:36:04 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  CISSNA asked  if  they had  worked  with DHSS  to                                                               
determine any effects to the state.   She pointed out that HB 423                                                               
was copied from another state's legislation.                                                                                    
                                                                                                                                
4:36:30 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GATTO  replied that  the level  of health  care in                                                               
Alaska "is  what it is" until  the federal mandate to  purchase a                                                               
specific  product.   He declared  that  it was  not necessary  to                                                               
contact  DHSS,   as  the  statute   model  addressed   the  Tenth                                                               
Amendment, not health care.                                                                                                     
                                                                                                                                
4:37:43 PM                                                                                                                    
                                                                                                                                
CO-CHAIR HERRON  asked if  the attorney  general or  the governor                                                               
had  indicated  they  were  going to  move  forward  with  action                                                               
against the federal  government, regardless of the  outcome of HB
423.                                                                                                                            
                                                                                                                                
4:38:14 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  GATTO  replied  that   he  had  talked  with  the                                                               
attorney general,  who "was notably  quiet."  He opined  that the                                                               
attorney general  was not at  liberty to disclose  anything about                                                               
his investigation.                                                                                                              
                                                                                                                                
4:39:19 PM                                                                                                                    
                                                                                                                                
CO-CHAIR KELLER closed public testimony.                                                                                        
                                                                                                                                
4:39:47 PM                                                                                                                    
                                                                                                                                
CO-CHAIR KELLER  opined that HB 423  was not a health  and social                                                               
services bill, but  was a bill about the freedom  to choose where                                                               
an individual received health care service.                                                                                     
                                                                                                                                
4:40:27 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE CISSNA  expressed her  concern, especially  as she                                                               
had  not heard  from  DHSS.   She  declared  that  she still  had                                                               
questions.                                                                                                                      
                                                                                                                                
4:41:37 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  KELLER  asked  to clarify  that  Representative  Cissna                                                               
would  ask  DHSS  if the  attorney  general's  involvement  would                                                               
affect health care.                                                                                                             
                                                                                                                                
4:41:56 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON  said that HB  423 was an  Alaskan statute,                                                               
not federal,  which related to  the freedom to choose  or decline                                                               
health  care services  in Alaska.   He  referred to  Mr. Bailey's                                                               
testimony that it did have  interactions with how health care was                                                               
practiced.  He  expressed the need to hear from  DHSS.  He stated                                                               
that he  was focused on  the impact of HB  423 on Alaska  and its                                                               
health care.                                                                                                                    
                                                                                                                                
4:44:05 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON, in response  to Co-Chair Keller, said that                                                               
the HB 423 language was for  both the freedom to choose to secure                                                               
or choose to decline health care services.                                                                                      
                                                                                                                                
4:44:24 PM                                                                                                                    
                                                                                                                                
CO-CHAIR KELLER  said that health  care services were  defined on                                                               
page  2.   He opined  that it  not take  away the  choice of  the                                                               
individual.                                                                                                                     
                                                                                                                                
4:44:45 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON  emphasized to Co-Chair Keller  that Dennis                                                               
Bailey, attorney,  had stated that  was not correct.   He pointed                                                               
to  Mr.   Bailey's  testimony   which  stated   that  involuntary                                                               
commitment  to  a  mental   health  facility,  vaccinations,  and                                                               
immunizations  were included  in the  bill.   He opined  that the                                                               
bill covered all the health care services offered by the state.                                                                 
                                                                                                                                
4:45:48 PM                                                                                                                    
                                                                                                                                
CO-CHAIR KELLER said that the  health care services definition on                                                               
page 2  was for care  of physical or  mental disease.   He opined                                                               
that this was the care of society,  not the care of a person.  He                                                               
allowed   that   he   had   a   different   interpretation   than                                                               
Representative Seaton.                                                                                                          
                                                                                                                                
4:46:18 PM                                                                                                                    
                                                                                                                                
CO-CHAIR HERRON requested to hold HB 423.                                                                                       
                                                                                                                                
4:46:53 PM                                                                                                                    
                                                                                                                                
CO-CHAIR KELLER requested a vote on HB 423.                                                                                     
                                                                                                                                
4:47:07 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE T.  WILSON said that  HB 423 allowed a  person the                                                               
right to  choose any mode  of health  care services.   She opined                                                               
that the  bill was about  the right to  choose whether or  not to                                                               
have health  care coverage.  She  declared a desire to  keep that                                                               
option open.  She  said that HB 423 did not  solve the dilemma of                                                               
non-payment for emergency room use.   She offered her belief that                                                               
the attorney general  would determine whether or not  there was a                                                               
case to be made against the  federal government.  She opined that                                                               
HB 423 reflected the concern of Alaskans.                                                                                       
                                                                                                                                
4:49:17 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON,  in response,  emphasized that  nothing in                                                               
HB 423 mentioned the federal government.   He pointed out that it                                                               
stated the attorney general would  take the appropriate action to                                                               
defend HB  423 against the DHSS.   He emphasized that  HB 423 did                                                               
not mention the Tenth Amendment,  or anything against the federal                                                               
government.  He offered his belief  that it was necessary for DOL                                                               
and DHSS  to testify as  to the effect of  HB 423 on  health care                                                               
services in  the state of Alaska.   He opined that  a lawsuit and                                                               
the   imposition    of   the   Tenth   Amendment    were   solely                                                               
interpretations of  the bill, and not  in the bill language.   He                                                               
stated  that  he  could  not   support  HB  423  without  further                                                               
testimony to its implications.                                                                                                  
                                                                                                                                
4:51:16 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE LYNN  said that everyone wanted  good health care,                                                               
but he  opined that  the question  was to  the constitutionality.                                                               
He  opined  that  only  the  US Supreme  Court  could  make  that                                                               
determination,  and  it would  be  necessary  for  a case  to  be                                                               
brought to the Supreme Court.   He urged that HB 423 be forwarded                                                               
to   the  House   Judiciary   Standing   Committee  for   further                                                               
discussion.                                                                                                                     
                                                                                                                                
4:52:52 PM                                                                                                                    
                                                                                                                                
CO-CHAIR KELLER  opined that HB  423 was a very  simple statement                                                               
for the attorney general to defend the right to choose.                                                                         
                                                                                                                                
4:54:00 PM                                                                                                                    
                                                                                                                                
The committee took a brief at ease.                                                                                             
                                                                                                                                
4:55:39 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  LYNN stated  a necessity  to advise  the attorney                                                               
general whether to move forward with a lawsuit.                                                                                 
                                                                                                                                
REPRESENTATIVE  CISSNA expressed  her concern  that, as  this was                                                               
the first  hearing for this  bill, she  had not heard  all sides.                                                               
She stated  the necessity for  knowledgeable testimony  from DHSS                                                               
and she  expressed a  concern for  unintended consequences.   She                                                               
pointed out  that "going  slow is  a good  process in  this where                                                               
we're actually affecting people's lives."                                                                                       
                                                                                                                                
4:57:56 PM                                                                                                                    
                                                                                                                                
CO-CHAIR KELLER  opined that this  was stopping the  process, and                                                               
he was unwilling to do that.                                                                                                    
                                                                                                                                
4:58:41 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  T.   WILSON  offered  her  belief   that  it  was                                                               
necessary to keep the process moving.                                                                                           
                                                                                                                                
4:59:27 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GATTO  said that he  was trying to  be responsible                                                               
and he  offered that it was  appropriate to delay HB  423 for one                                                               
more meeting.                                                                                                                   
                                                                                                                                
5:00:15 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SEATON  agreed, but  he  requested  that DHSS  be                                                               
available for  testimony to the  health care ramifications  of HB
423.  He opined that it was  not a function of the legislature to                                                               
institute a lawsuit.  He emphasized  that a statute had long term                                                               
implications.                                                                                                                   
                                                                                                                                
5:01:46 PM                                                                                                                    
                                                                                                                                
CO-CHAIR KELLER asked that Representative Seaton introduce any                                                                  
amendments to the bill.                                                                                                         
                                                                                                                                
5:02:40 PM                                                                                                                    
                                                                                                                                
[HB 423 was held over.]                                                                                                         
                                                                                                                                

Document Name Date/Time Subjects
HB423pckt.PDF HHSS 4/6/2010 3:00:00 PM
HB 423
SB10pckt.PDF HHSS 4/6/2010 3:00:00 PM
SB 10