Legislature(2009 - 2010)CAPITOL 106

04/08/2010 03:00 PM HEALTH & SOCIAL SERVICES


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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+= SB 10 MEDICAID/INS FOR CANCER CLINICAL TRIALS TELECONFERENCED
Scheduled But Not Heard
+ Bills Previously Heard/Scheduled TELECONFERENCED
+= HB 423 POLICY FOR SECURING HEALTH CARE SERVICES TELECONFERENCED
Moved CSHB 423(HSS) Out of Committee
+= HB 282 NATUROPATHS TELECONFERENCED
Moved CSHB 282(HSS) Out of Committee
        HB 423-POLICY FOR SECURING HEALTH CARE SERVICES                                                                     
                                                                                                                                
3:05:30 PM                                                                                                                    
                                                                                                                                
CO-CHAIR HERRON announced that the  first 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."                                                                                                          
                                                                                                                                
3:06:28 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  GATTO reported  that  he met  with Department  of                                                               
Health and Social Services (DHSS)  and Department of Law (DOL) to                                                               
work  to  address the  concerns  about  school immunizations  and                                                               
involuntary [psychiatric] commitment.                                                                                           
                                                                                                                                
3:07:59 PM                                                                                                                    
                                                                                                                                
The committee took an at-ease from 3:07 p.m. to 3:11 p.m.                                                                       
                                                                                                                                
3:11:08 PM                                                                                                                    
                                                                                                                                
CO-CHAIR HERRON brought the committee back to order.                                                                            
                                                                                                                                
3:11:21 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE CARL GATTO, Alaska  State Legislature, referred to                                                               
a  document   labeled  "Conceptual  Amendments"   and  introduced                                                               
Conceptual   Amendment  1,   which  read   [original  punctuation                                                               
provided]:                                                                                                                      
                                                                                                                                
     Section 3 is amended to read:                                                                                              
                                                                                                                                
     AS 44.99 is amended by  adding a new section to article                                                                    
     2 to read:                                                                                                                 
                                                                                                                                
          Sec. 44.99.130. Declaration of Policy for                                                                           
     Securing Health Care Services                                                                                            
                                                                                                                                
          (a)                                                                                                                   
          (1) The power to require or regulate a person's                                                                   
     choice in  the mode  of securing health  care services,                                                                
     or to  impose a penalty  related thereto, is  not found                                                                
     in the  Constitution of the  United States  of America,                                                                
     and  is  therefore  a  power  reserved  to  the  people                                                                
     pursuant  to the  Ninth Amendment,  and to  the several                                                                
     states pursuant to  the Tenth Amendment.   The state of                                                                
     Alaska hereby exercises its  sovereign power to declare                                                                
     the public policy of the  state of Alaska regarding the                                                                
     right of  all persons residing  in the state  of Alaska                                                                
     in choosing the mode of securing health care services.                                                                 
          (2) It is hereby declared that the public policy                                                                  
     of the state of Alaska  is that every person within the                                                                
     state  of Alaska  is and  shall  be free  to choose  or                                                                
     decline  to choose  any mode  of  securing health  care                                                                
     services  without  penalty  or threat  of  penalty,  as                                                                
     defined in this bill.                                                                                                  
                                                                                                                                
          (b) The policy stated in (a) of this section                                                                          
               (1) does not apply to health care services                                                                   
     required by  the state, a political  subdivision of the                                                                
     state, or a court of the state;                                                                                        
               (2) may not impair a contract right that                                                                     
     provides health care services.                                                                                             
                                                                                                                                
          (c) A public official, employee, or agent of the                                                                      
     state  or its  political subdivisions  may not  impose,                                                                    
     collect, enforce,  or implement  a penalty  contrary to                                                                    
     the policy stated in (a) of this section.                                                                                  
                                                                                                                                
          (d) [THE ATTORNEY GENERAL SHALL EXPEDITIOUSLY                                                                         
     SEEK  INJUNCTIVE   AND  OTHER  APPROPRIATE   RELIEF  TO                                                                    
     PRESERVE THE RIGHTS  OF THE RESIDENTS OF  THE STATE AND                                                                    
     DEFEND  THE STATE  AND  ITS  OFFICIALS, EMPLOYEES,  AND                                                                    
     AGENTS  IF A  LAW IS  ENACTED OR  A REGULATION  ADOPTED                                                                    
     VIOLATING  THE  DECLARATION   OF  POLICY  FOR  SECURING                                                                    
     HEALTH CARE SERVICES UNDER THIS SECTION]                                                                                   
          In this section,                                                                                                      
               (1) "health care services" means a service                                                                       
     or treatment, or  provision of a product,  for the care                                                                    
     of  a  physical  or mental  disease,  illness,  injury,                                                                    
     defect,  or  condition,  or   to  maintain  or  improve                                                                    
     physical or mental health;                                                                                                 
                                                                                                                                
               (2) "mode of securing" means directly                                                                            
     purchasing  health care  services  from  a health  care                                                                    
     provider,  purchasing  insurance covering  health  care                                                                    
     services, [PARTICIPATING IN  AN EMPLOYER OR GOVERNEMENT                                                                    
     SPONSORED  HEALTH  BENEFIT  PLAN]  or  other  means  of                                                                    
     obtaining health care services;                                                                                            
                                                                                                                                
               (3) "penalty" means a fine, tax, [SALARY OR                                                                      
     WAGE    WITHHOLDING]   surcharge,    fee,   or    other                                                                    
     [CONSEQUENCE] monetary charge.                                                                                         
                                                                                                                              
REPRESENTATIVE  GATTO  explained  that subsection  (a)  contained                                                               
"quite a  bit of the Idaho  language has passed legal  muster and                                                               
while it has changed somewhat is  pretty much a copy of the Idaho                                                               
bill."   He said that  subsection (b)  was added for  clarify for                                                               
some issues  raised during an earlier  discussion.  Additionally,                                                               
three definitions  were added.   He  pointed out  that Conceptual                                                               
Amendment 1 is a conceptual amendment.                                                                                          
                                                                                                                                
3:12:40 PM                                                                                                                    
                                                                                                                                
CO-CHAIR KELLER made a motion to adopt Conceptual Amendment 1.                                                                  
                                                                                                                                
CO-CHAIR HERRON objected for purpose of discussion.                                                                             
                                                                                                                                
REPRESENTATIVE SEATON  asked if  proposed Conceptual  Amendment 1                                                               
would be considered as one amendment or as separate amendments.                                                                 
                                                                                                                                
CO-CHAIR  HERRON  offered  his  intention  to  consider  proposed                                                               
Conceptual  Amendment 1  under one  motion.   He referred  to the                                                               
memorandum  dated April  8, 2010  from Representative  Carl Gatto                                                               
titled "Explanation  of Conceptual  Amendment changes in  HB 423,                                                               
Version R" [Included in the committee packets.]                                                                                 
                                                                                                                                
3:14:20 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GATTO, referring  to proposed Conceptual Amendment                                                               
1,  pointed out  that the  amendment contained  new language  for                                                               
Section 3  of HB  423.   He explained that  it "spelled  out" the                                                               
problems of the federal health care  law with the Ninth and Tenth                                                               
Amendments to the Constitution.   He stated that these violations                                                               
required Alaska to defend its constitutional rights.                                                                            
                                                                                                                                
3:15:52 PM                                                                                                                    
                                                                                                                                
THOMAS REIKER,  Staff to Representative Carl  Gatto, Alaska State                                                               
Legislature, explained  that a  concern had  been raised  that HB
423  did not  specifically  address the  Tenth  Amendment or  the                                                               
federal  health care  reform.    He stated  that  a state  cannot                                                               
nullify a federal law, but  it can establish distinct policies if                                                               
a law were found to be  unconstitutional.  He noted that proposed                                                               
Conceptual Amendment 1 specifically  outlined the Tenth Amendment                                                               
problems  with the  federal health  care reform.   He  pointed to                                                               
subsection (a)  (2) of proposed  Conceptual Amendment 1  and said                                                               
that it  was intended to  be in the original  bill.  He  said the                                                               
challenge to the  federal health care reform was  to the mandate.                                                               
He  noted  that  Section  3,   (d)  (3)  of  proposed  Conceptual                                                               
Amendment  1 would  change the  definition of  penalty to  simply                                                               
include a  fine, tax, fee,  surcharge, or other  monetary charge.                                                               
He said  that this conceptual  amendment was crafted  in response                                                               
to  the state  requirement to  accept its  health insurance.   He                                                               
said  that  adoption of  proposed  Conceptual  Amendment 1  would                                                               
define HB  423 as  "the freedom  to choose  or decline  to choose                                                               
without  penalty  or  threat  of  penalty."   He  said  this  new                                                               
definition of  penalty would allow for  involuntary commitment or                                                               
exclusion from school  for refusal of immunization  as they would                                                               
no longer be defined as penalties.   He directed attention to the                                                               
language change contained  in Section 3, (b)  (1), and subsection                                                               
(b) (2)  of proposed Conceptual Amendment  1.  He said  that this                                                               
language  was crafted  by  the  Department of  Law  (DOL) and  is                                                               
intended  to ensure  that HB  423 did  not supersede  any current                                                               
Alaska law.                                                                                                                     
                                                                                                                                
3:20:59 PM                                                                                                                    
                                                                                                                                
MR.  REIKER  added  that proposed  Conceptual  Amendment  1  also                                                               
deleted  Section 3,  (d), since  Section 2  of HB  423 should  be                                                               
sufficient.                                                                                                                     
                                                                                                                                
CO-CHAIR  HERRON suggested  that Section  2 of  HB 423  should be                                                               
deleted as the  attorney general would take action  to defend any                                                               
policy.                                                                                                                         
                                                                                                                                
3:22:27 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GATTO  replied that it  was necessary to  have the                                                               
attorney general act on behalf of the state of Alaska.                                                                          
                                                                                                                                
CO-CHAIR  HERRON  agreed,  but  he questioned  the  necessity  of                                                               
Section 2 as  the attorney general was responsible  to defend any                                                               
legislation.                                                                                                                    
                                                                                                                                
REPRESENTATIVE  GATTO replied  that  the state  was initiating  a                                                               
lawsuit, not defending  one.  He stated that he  would not object                                                               
to this deletion.                                                                                                               
                                                                                                                                
CO-CHAIR HERRON  stated his preference to  deliberate on proposed                                                               
Conceptual Amendment 1  on a section-by-section basis.   He asked                                                               
if there  was any further  discussion on Conceptual  Amendment 1,                                                               
to delete Section 3, subsection (d) and Section 2 of HB 423.                                                                    
                                                                                                                                
3:25:20 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE CISSNA said that she  had received an opinion from                                                               
Legislative Legal  and Research Services.   She expressed  a need                                                               
for more time  to better understand that opinion, as  well as the                                                               
bill itself.   She asked why HB  423 had been queued  in front of                                                               
other legislation.                                                                                                              
                                                                                                                                
CO-CHAIR HERRON agreed  that it was a serious issue,  and that he                                                               
would like  to pursue this  line of  questioning.  He  noted that                                                               
the sponsor had agreed with the  deletions.  He suggested that it                                                               
might be necessary to schedule  extra committee hearings in order                                                               
to hear  other legislation.  He  repeated that he would  prefer a                                                               
section-by-section  discussion.     He  asked  if  Representative                                                               
Cissna  would  share  the  legal   memo  with  the  rest  of  the                                                               
committee.                                                                                                                      
                                                                                                                                
REPRESENTATIVE CISSNA  replied that she had  previously submitted                                                               
it.                                                                                                                             
                                                                                                                                
3:27:49 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  CISSNA,  referring  to   Section  2  and  Section                                                               
3,subsection  (d)  of HB  423,  from  the Legislative  Legal  and                                                               
Research Services memo, which read:                                                                                             
                                                                                                                                
     The  principal   objection  appears  to  be   that  the                                                                    
     legislature   is  proposing   to  direct   the  state's                                                                    
     attorney  general in  the exercise  of  the duties  and                                                                    
     functions of the office.                                                                                                   
                                                                                                                                
CO-CHAIR  HERRON  said that  the  sponsor  had agreed  to  delete                                                               
Section 2.                                                                                                                      
                                                                                                                                
REPRESENTATIVE CISSNA  asked if  both Sections  2 and  Section 3,                                                               
subsection (d) would  be deleted.  She opined that  it could be a                                                               
dilemma to the  attorney general if both the  legislature and the                                                               
governor were "commanding him to do things."                                                                                    
                                                                                                                                
3:30:36 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GATTO agreed to both deletions.                                                                                  
                                                                                                                                
CO-CHAIR HERRON  asked for  other comments  on both  the proposed                                                               
Conceptual Amendment 1 and HB 423.                                                                                              
                                                                                                                                
REPRESENTATIVE SEATON  asked if  this was a  conceptual amendment                                                               
to Conceptual Amendment 1.                                                                                                      
                                                                                                                                
CO-CHAIR HERRON  replied that he  would reserve that  option, but                                                               
agreed that proposed Amendment 1 would be:                                                                                      
                                                                                                                                
     Delete Section 2 of HB 423.                                                                                                
     Delete Section 3, subsection (d).                                                                                          
                                                                                                                                
3:31:31 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  HERRON, in  response  to  Representative Gatto,  agreed                                                               
that  Section  3, subsection  (d)  had  already been  deleted  in                                                               
proposed Conceptual Amendment 1.                                                                                                
                                                                                                                                
3:31:38 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON, referred  to proposed Conceptual Amendment                                                               
1, to Section  3, subsection (a), paragraph (1).   He stated that                                                               
this subsection contained "findings"  and not an actual provision                                                               
of substance for a bill.                                                                                                        
                                                                                                                                
CO-CHAIR HERRON asked  for an opinion from  Legislative Legal and                                                               
Research Services.                                                                                                              
                                                                                                                                
3:32:15 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON  asked for  a legal definition  of proposed                                                               
Conceptual Amendment  1.   He referred  to Section  3, subsection                                                               
(a), paragraph (2), which read in part:                                                                                         
                                                                                                                                
     ..., that a person has the right and is free to choose                                                                     
      or decline any mode of securing health care services                                                                      
     without penalty or threat of penalty,...                                                                                   
                                                                                                                                
3:33:14 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  KELLER asked  if the  sponsor intended  to delete  this                                                               
language.                                                                                                                       
                                                                                                                                
MR. REIKER  explained that  the intent was  to delete  Section 3,                                                               
subsection  (a)  of  HB  423,   and  insert  proposed  Conceptual                                                               
Amendment 1, Section 3, subsection (a).                                                                                         
                                                                                                                                
3:35:10 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE HOLMES opined that Section  3, (a) (1) of proposed                                                               
Conceptual  Amendment 1  appeared to  be language  that describes                                                               
legislative intent and not language for statute.                                                                                
                                                                                                                                
CO-CHAIR  HERRON  agreed  that  this  needed  clarification  from                                                               
Legislative Legal and Research Services.                                                                                        
                                                                                                                                
REPRESENTATIVE  HOLMES  asked  for a  clarification  of  proposed                                                               
Conceptual  Amendment  1, in  Section  3,  (a) (2),  which  read:                                                               
"..., as  defined in  this bill."   She opined  that once  a bill                                                               
becomes a statute,  then it would be confusing  for the reference                                                               
to a bill.                                                                                                                      
                                                                                                                                
CO-CHAIR HERRON  agreed and pointed out  that proposed Conceptual                                                               
Amendment 1 is a conceptual  amendment and the bill drafter would                                                               
appropriately "conform" the language.                                                                                           
                                                                                                                                
3:36:13 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  CISSNA  asked  for   a  definition  of  "mode  of                                                               
securing" and "health care services."                                                                                           
                                                                                                                                
MR. REIKER, in response to  Representative Cissna, said that both                                                               
definitions  were contained  in Section  3, (e)  of HB  423.   He                                                               
clarified  that   proposed  Conceptual  Amendment  1   had  added                                                               
additional  language  to  ensure  that the  definitions  did  not                                                               
impede existing Alaska law.                                                                                                     
                                                                                                                                
3:36:55 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE CISSNA  asked about the implications  to licensure                                                               
and regulations within the state.                                                                                               
                                                                                                                                
REPRESENTATIVE  GATTO referred  to proposed  Conceptual Amendment                                                               
1,  to  Section  3,  (b)(1),  and said  it  would  keep  existing                                                               
language intact.                                                                                                                
                                                                                                                                
MR. REIKER  explained that  the definition  for penalty  had been                                                               
narrowed in  Section 3  of proposed Conceptual  Amendment 1.   He                                                               
related that  Section 3,  (d)(3), and  language added  in Section                                                               
3,(a)(2),  which read,  "without penalty  or threat  of penalty,"                                                               
was done  in conjunction with  Department of Law (DOL)  to ensure                                                               
that existing Alaskan statutes were not affected.                                                                               
                                                                                                                                
3:39:13 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE HOLMES  cited that she  wanted her health  care to                                                               
be Medicare, Tri-Care,  or Indian Health Care.   Referring to the                                                               
language  in  proposed  Conceptual  Amendment  1  to  Section  3,                                                               
(a)(2), she  posed that the  language enabled her to  qualify for                                                               
any  of  these  health  care   services,  although  she  was  not                                                               
eligible.                                                                                                                       
                                                                                                                                
MR.  REIKER  referenced  DOL  and said  that  federal  law  would                                                               
supersede   state    law,   unless   federal   law    was   found                                                               
unconstitutional.  He pointed out  that should the acts governing                                                               
each of these health care  services be found constitutional, then                                                               
the federal law would govern.                                                                                                   
                                                                                                                                
3:40:23 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  HOLMES  posed  a  scenario in  which  her  father                                                               
wanted health insurance from the State  of Alaska, but he did not                                                               
work for the  state.  She asked if this  language would allow any                                                               
Alaskan the  right to choose  any health  plan, even if  they did                                                               
not qualify.                                                                                                                    
                                                                                                                                
MR REIKER  replied that the  bigger concern  by DOL and  DHSS was                                                               
with the  requirement for  health insurance.   He  explained that                                                               
the  original amendment  was  to have  a  blanket statement  that                                                               
stated  there was  not  an effect  on existing  Alaska  law.   He                                                               
suggested a return  to the language which stated that  HB 423 did                                                               
not supersede existing Alaska law.                                                                                              
                                                                                                                                
3:41:44 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE HOLMES  opined that Conceptual Amendment  1 stated                                                               
that  anyone could  buy  any program  they  wanted, even  without                                                               
meeting the qualifications.                                                                                                     
                                                                                                                                
REPRESENTATIVE T.  WILSON, in response to  Representative Holmes,                                                               
offered  her  belief  that Conceptual  Amendment  1  would  offer                                                               
buyers a choice, but it did  not require the insurance company to                                                               
accept the applicant.                                                                                                           
                                                                                                                                
REPRESENTATIVE GATTO  agreed that  was the intent.   He  said the                                                               
language might only be inferred,  rather than stated.  He offered                                                               
to amend Conceptual Amendment 1, as follows:                                                                                    
                                                                                                                                
     Page 1, subsection (a) paragraph (2):                                                                                      
          Following "free to choose":                                                                                           
          Insert "and qualify for"                                                                                              
                                                                                                                                
3:44:11 PM                                                                                                                    
                                                                                                                                
MR.  REIKER,  referring  to  Section  3  of  proposed  Conceptual                                                               
Amendment 1, to subsection (b)(1),  offered his opinion that this                                                               
did not refer  to health care services required by  the state, as                                                               
the state only required its  state agencies to offer those health                                                               
care  services to  people that  qualify; therefore,  the language                                                               
from subsection (a)(2) is also covered the state programs.                                                                      
                                                                                                                                
3:44:36 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE CISSNA said that the  outcomes were too complex to                                                               
do this  quickly.   She asked  if HB 423  would close  off future                                                               
options and alternatives.  She  asked for testimony regarding any                                                               
future limitations that this bill would create.                                                                                 
                                                                                                                                
CO-CHAIR HERRON agreed that DOL would be asked this question.                                                                   
                                                                                                                                
REPRESENTATIVE GATTO  relayed that there were  two questions: (1)                                                               
What was  the future  of Alaska  with regard  to tort  reform and                                                               
defensive  medicine?; and  (2) What  were the  possible excessive                                                               
costs with  taxes and fees of  the federal health care  plan?  He                                                               
opined that,  as Alaska was  a known  factor, it was  possible to                                                               
address tort  reform and defensive  medicine.  He opined  that it                                                               
was not  possible to  predict federal health  care costs,  but he                                                               
suggested that it was necessary to "deal with it ourselves."                                                                    
                                                                                                                                
3:48:30 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  CISSNA  offered  her  belief  that  the  move  to                                                               
Medicare reflected  a different  state direction.   She  asked if                                                               
the  sponsor's goal  was  to eliminate  any  federal subsidy  for                                                               
health care.                                                                                                                    
                                                                                                                                
REPRESENTATIVE  GATTO  replied  that   Alaska  was  not  able  to                                                               
eliminate the federal  health care programs.  He  stated that the                                                               
reason  for HB  423 was  to ask  the courts  whether the  federal                                                               
government  had  overstepped its  authority  and  caused harm  to                                                               
Alaska.   He offered  his belief  that it  was the  obligation of                                                               
every  state to  pursue  this, instead  of  simply accepting  the                                                               
edict of the federal government.                                                                                                
                                                                                                                                
3:50:15 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE CISSNA noted  that he was talking  about a federal                                                               
action that was not addressed in this bill.                                                                                     
                                                                                                                                
REPRESENTATIVE GATTO, in response  to Representative Cissna, said                                                               
that  both  the Ninth  and  Tenth  Amendments were  mentioned  in                                                               
proposed Conceptual Amendment 1.                                                                                                
                                                                                                                                
MR.  REIKER explained  that Alaska  could not  nullify a  federal                                                               
law, but  it could challenge  the constitutionality of  a federal                                                               
law.   He stated that  Alaska had the  right to assert  its Tenth                                                               
Amendment rights in a federal court.   He pointed out that HB 423                                                               
was a statute, not a  constitutional amendment, and if there were                                                               
unforeseen consequences, the bill could be revised or repealed.                                                                 
                                                                                                                                
3:52:47 PM                                                                                                                    
                                                                                                                                
CO-CHAIR KELLER  asked if  a state  had the  right to  decide not                                                               
participate in Medicaid.                                                                                                        
                                                                                                                                
JON   SHERWOOD,  Medicaid   Special  Projects,   Office  of   the                                                               
Commissioner, Department of Health  and Social Services (HSS), in                                                               
response to Co-Chair Keller, said  that participation in Medicaid                                                               
was voluntary.                                                                                                                  
                                                                                                                                
CO-CHAIR  KELLER asked  if  the federal  health  care reform  had                                                               
changed this aspect.                                                                                                            
                                                                                                                                
MR. SHERWOOD offered his belief  that there was not a requirement                                                               
to maintain the Medicaid program,  but that if it was maintained,                                                               
the state was held to specific requirements.                                                                                    
                                                                                                                                
3:53:54 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE T. WILSON  asked if more people  would qualify for                                                               
Medicaid  after  passage  of  the   federal  health  care  reform                                                               
legislation.                                                                                                                    
                                                                                                                                
MR. SHERWOOD replied that Medicaid  would expand to cover a broad                                                               
range of  individuals who were  not currently eligible  under the                                                               
federal health care reform.                                                                                                     
                                                                                                                                
REPRESENTATIVE  T. WILSON  questioned whether  more people  would                                                               
choose to  sign up with  Medicaid since  it would be  less costly                                                               
than purchasing private health insurance.                                                                                       
                                                                                                                                
MR. SHERWOOD, in response to  Representative T. Wilson, said that                                                               
currently subsidies exist for  low-income individuals to purchase                                                               
health care  insurance.  He stated  that he did not  know all the                                                               
choices available.                                                                                                              
                                                                                                                                
3:55:17 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  T.  WILSON  asked   if  there  were  copays  with                                                               
Medicaid.                                                                                                                       
                                                                                                                                
MR. SHERWOOD replied  that there were not copays  for children or                                                               
pregnant women, but that there were modest copays for adults.                                                                   
                                                                                                                                
REPRESENTATIVE T.  WILSON, reporting  a concern of  other states,                                                               
asked  about the  increased costs  to Medicaid  with the  federal                                                               
health care reform.                                                                                                             
                                                                                                                                
MR. SHERWOOD  replied that he did  not know the cost  impact.  He                                                               
shared  that there  would be  an increased  federal subsidy.   He                                                               
said that he did not know about the increased expenditures.                                                                     
                                                                                                                                
REPRESENTATIVE T.  WILSON said that  other states  were concerned                                                               
with the  increased costs, and  she opined that it  was necessary                                                               
for Alaska to determine the increased expenses.                                                                                 
                                                                                                                                
3:57:20 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE CISSNA  asked if Alaska could  choose the Medicaid                                                               
programs in which to participate.                                                                                               
                                                                                                                                
MR.  SHERWOOD  explained  that   Medicaid  had  requirements  for                                                               
mandatory categories and  services.  He mentioned  that there was                                                               
also  a   wide  range  of   optional  services   and  eligibility                                                               
categories.   He pointed  out that Alaska  had made  its choices,                                                               
which included a  broad range of options, and  these choices were                                                               
submitted  with a  state plan  amendment  which required  federal                                                               
approval.                                                                                                                       
                                                                                                                                
3:58:50 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE CISSNA  asked whether the new  federal health care                                                               
reform had more extensive mandates,  and if so, would these allow                                                               
for choices.                                                                                                                    
                                                                                                                                
MR.  SHERWOOD replied  that  there were  some  new options  being                                                               
analyzed.  He reported that  the most obvious substantial mandate                                                               
required  coverage for  all  individuals with  income  up to  133                                                               
percent  of the  federal poverty  level.   Prior  to the  federal                                                               
health care  reform, eligibility  had been  limited to  the aged,                                                               
blind,  disabled,  pregnant,  and  children  and  their  eligible                                                               
caretaker relatives.                                                                                                            
                                                                                                                                
REPRESENTATIVE CISSNA inquired as to  whether HB 423 would change                                                               
the  program options  to Alaska  for "the  greatest good  for the                                                               
greatest number of people."                                                                                                     
                                                                                                                                
MR. SHERWOOD  replied that  he would defer  to the  Department of                                                               
Law (DOL).                                                                                                                      
                                                                                                                                
4:01:56 PM                                                                                                                    
                                                                                                                                
MIKE  FORD, Assistant  Attorney  General  & Legislative  Liaison,                                                               
Legislation  &  Regulations  Section,  Civil  Division  (Juneau),                                                               
Department of Law, in response  to Representative Cissna, offered                                                               
that the concern  was for the broad nature of  the language of HB
423.   He stated that  he could not  make any assurances,  but he                                                               
reminded   that  the   legislature  had   the  ability   to  make                                                               
amendments.    He  opined  that the  committee  was  not  binding                                                               
itself.   He offered  his belief that  the sponsor  was targeting                                                               
federal  law and  was  working  to narrow  HB  423  to avoid  any                                                               
implications for state law.                                                                                                     
                                                                                                                                
4:03:09 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON  directed attention to  proposed Conceptual                                                               
Amendment 1.   He referred to page  2, to Section 3,  (d)(3).  He                                                               
asked if the  proposed deletions of "salary  or wage withholding"                                                               
and  "consequence"  would still  be  included  under "fine,  tax,                                                               
surcharge, fee, or other monetary charge."                                                                                      
                                                                                                                                
MR. FORD replied, "conceivably."                                                                                                
                                                                                                                                
4:03:58 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON  referred to  page 2, to  Section 3  of the                                                               
proposed Conceptual Amendment  1.  He referred  to subsection (c)                                                               
and asked for clarification.                                                                                                    
                                                                                                                                
MR.  FORD shared  his concern  and stated  that the  language was                                                               
broad.  He  offered that it was not well  written, but it implied                                                               
that an individual could not be  forced to pick a specific health                                                               
care service and could not be penalized for that choice.                                                                        
                                                                                                                                
4:06:15 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON  agreed to ask the  question to Legislative                                                               
Legal and Research Services.                                                                                                    
                                                                                                                                
REPRESENTATIVE  CISSNA  offered  her   belief  that  it  appeared                                                               
someone would not have to pay.                                                                                                  
                                                                                                                                
MR. FORD said  that a public policy was stated  in general terms,                                                               
but that statutory provisions imposed  certain things.  He opined                                                               
that HB 423 was written as a policy, not as statute.                                                                            
                                                                                                                                
DAVE   JONES,  Senior   Assistant  Attorney   General,  Opinions,                                                               
Appeals, & Ethics, Civil Division  (Anchorage), Department of Law                                                               
(DOL), in  response to the  question from  Representative Seaton,                                                               
said that he  had no greater insight to the  meaning or effect of                                                               
the provisions.                                                                                                                 
                                                                                                                                
4:08:51 PM                                                                                                                    
                                                                                                                                
DENNIS BAILEY,  Attorney, Legislative Legal  Counsel, Legislative                                                               
Legal and  Research Services,  Legislative Affairs  Agency (LAA),                                                               
in response to the earlier  question by Representative Seaton, on                                                               
proposed Conceptual  Amendment 1  and to page  2, Section  3 (c),                                                               
and said  that it was a  statement of policy that  also attempted                                                               
to establish  mandatory laws.   He offered  his belief  that this                                                               
leads to  confusion.   He opined  that the  broad meaning  in the                                                               
general  statement combined  with the  more specific  mandates to                                                               
public officials made this difficult to understand.                                                                             
                                                                                                                                
4:11:42 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON  referred to proposed  Conceptual Amendment                                                               
1 to Section 3 (a) (2)  and the language "mode of securing" which                                                               
eliminates "participating in an  employer or government sponsored                                                               
health benefit plan."  He  stated this would refer to "purchasing                                                               
insurance  covering  health care  services"  or  "other means  of                                                               
obtaining health care services."   He asked whether not referring                                                               
to  "government  health benefit  plan"  or  "participating in  an                                                               
employer plan" would negate those  or if those terms are included                                                               
in the phrase "other means of obtaining health care services."                                                                  
                                                                                                                                
MR.  BAILEY answered  that Representative  Seaton  raises a  good                                                               
point, that the additional inclusion  of language "or other means                                                               
of  obtaining  health care  services"  may  also incorporate  the                                                               
language that is struck.                                                                                                        
                                                                                                                                
MR. FORD offered  that the change is an attempt  to be consistent                                                               
with the change on page 2, Section  3 (d) (2).  He explained that                                                               
if the  scope of the  bill is narrow it  does not apply  to state                                                               
policies  or plans  and  this  language should  be  deleted.   He                                                               
suggested the committee may also  want to remove the last phrase,                                                               
"or  other  means  of  obtaining health  care  services"  if  the                                                               
committee wants to narrow the scope.                                                                                            
                                                                                                                                
CO-CHAIR  HERRON   pointed  out  Conceptual  Amendment   1  is  a                                                               
conceptual amendment.                                                                                                           
                                                                                                                                
4:14:02 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE T. WILSON related  her understanding that the bill                                                               
attempts to give  the attorney general direction  to minimize any                                                               
negative impacts  the new health  care may  have on Alaska.   She                                                               
asked  whether  there would  be  any  downside for  the  attorney                                                               
general to "fight it legally to keeping the option open."                                                                       
                                                                                                                                
MR. FORD  responded when the  legislature requests action  by the                                                               
attorney  general  that the  request  is  typically done  with  a                                                               
resolution.    He  related that  passing  statutes  raises  other                                                               
issues, including  separation of  powers.  He  stated that  it is                                                               
really difficult for  the state to predict  positive and negative                                                               
substantive  effects  until  the  final  language  is  thoroughly                                                               
reviewed.   He clarified  that when  the legislature  requests an                                                               
official from  the executive branch  to take certain  action, the                                                               
legislature  is "speaking  as  a  voice" and  the  "voice of  the                                                               
legislature" typically occurs through resolutions.                                                                              
                                                                                                                                
REPRESENTATIVE  T.  WILSON  asked  which  one  sends  a  stronger                                                               
message.                                                                                                                        
                                                                                                                                
MR. FORD  characterized a bill  and a  resolution as "a  bit like                                                               
apples  and  oranges.    They  are both  fruit,  but  they  taste                                                               
differently."  If  the legislature wishes to  clarify an opinion,                                                               
it  speaks through  a resolution.   Sometimes,  the legislature's                                                               
voice  is  expressed in  statute  and  can  be combined  to  some                                                               
degree.  As to which is  more effective, it depends on the topic.                                                               
He offered that  the committee is experiencing  the difficulty of                                                               
using statutes in this realm.                                                                                                   
                                                                                                                                
REPRESENTATIVE T.  WILSON asked why  more states have  decided to                                                               
pass bills instead  of resolutions to address  the federal health                                                               
care reform.                                                                                                                    
                                                                                                                                
MR.  FORD said  could  not answer  questions  about other  states                                                               
since  other states  have different  constitutions.   However, he                                                               
stated that that in Alaska  there are problems in proceeding this                                                               
way.                                                                                                                            
                                                                                                                                
4:16:56 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON referred to  page 1, to proposed Conceptual                                                               
Amendment 1,  to Section 3 (b)(1),  which read:  "does  not apply                                                               
to  health  care services  required  by  the state,  a  political                                                               
subdivision of  the state, or a  court of the state;".   He asked                                                               
whether  that  would  eliminate  Medicare.     He  asked  for  an                                                               
interpretation of whether  this refers to the State  of Alaska or                                                               
a political subdivision.                                                                                                        
                                                                                                                                
MR. FORD  replied that  the intent  is that  this would  apply to                                                               
Alaska  programs  since  the legislature  cannot  change  federal                                                               
programs or federal  programs.  The object is  to eliminate state                                                               
programs  that   may  affected   by  the   bill  by   adding  the                                                               
exclusionary provision.                                                                                                         
                                                                                                                                
4:17:52 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON  asked whether  people would  be authorized                                                               
not to pay  Medicare or could object to the  deduction from their                                                               
wages.                                                                                                                          
                                                                                                                                
MR. FORD  said he could not  answer that question.   He clarified                                                               
that  federal  law has  not  been  changed  and  if there  is  an                                                               
obligation imposed by federal law, the obligation still remains.                                                                
                                                                                                                                
MR. SHERWOOD  said he  did not  have anything to  add.   He noted                                                               
that the definition of penalty  was changed to eliminate specific                                                               
reference to salary  or wage withholding which  would be required                                                               
for  payment  into  Medicare.     He  deferred  to  the  DOL  for                                                               
interpretation of the broader language of the bill.                                                                             
                                                                                                                                
4:19:27 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE CISSNA  related "we are talking  about freedom and                                                               
the  ability  for  people  to   make  the  choices  and  for  the                                                               
administration  of   both  [Department  of]  Health   and  Social                                                               
Services and  the Department  of Law."   She  asked for  ideas of                                                               
ways to address this that would be "clearer and fit."                                                                           
                                                                                                                                
MR. FORD  said that DOL  is currently undertaking an  analysis of                                                               
the legislation  and will explore  the options.  Once  its review                                                               
is  completed  the  DOL  may  have answers.    He  suggested  the                                                               
committee may  wish to attempt  to clarify the language  to avoid                                                               
unintended consequences.   He advised  that he met with  the bill                                                               
sponsor and  raised some issues to  consider and in an  effort to                                                               
address those  issues some additional language  has been crafted,                                                               
but he said  he does not claim  it is the "magic  bullet" for all                                                               
the  concerns.    The  process  will unfold  as  the  bill  moves                                                               
forward.                                                                                                                        
                                                                                                                                
4:22:13 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE HOLMES  referred to page 1  of proposed Conceptual                                                               
Amendment  1,  and   to  Section  3  (b)(1),  and   to  the  word                                                               
"required."   She asked whether  it should be  "provided" instead                                                               
since it seems limiting and would be a narrow exclusion.                                                                        
                                                                                                                                
MR. FORD agreed.  This language  may need fine tuning, he stated.                                                               
He said that  what triggered this issue is how  it would apply to                                                               
the  state  employee  health  plan.     He  reported  that  state                                                               
employees are required to participate in  that plan.  He asked if                                                               
the intent of the bill is to  allow state employees to opt out of                                                               
health care coverage.  He stated  if that is not the intent, some                                                               
method needs  to be developed to  clarify the intent.   He agreed                                                               
other concerns may also need  to be addressed which would require                                                               
the committee to broaden the language.                                                                                          
                                                                                                                                
4:24:45 PM                                                                                                                    
                                                                                                                                
WILDA LAUGHLIN,  Special Assistant,  Office of  the Commissioner,                                                               
Department of Health & Social Services, introduced herself.                                                                     
                                                                                                                                
CO-CHAIR HERRON  referred to the  April 8, 2010,  memorandum from                                                               
Representative Carl  Gatto.  He  asked for comments  to paragraph                                                               
2.                                                                                                                              
                                                                                                                                
MS. LAUGHLIN  began by  noting the sponsor  was open  to amending                                                               
the  bill.   Thus,  the department  reviewed proposed  Conceptual                                                               
Amendment  1  but  is  not  ready to  say  this  amendment  would                                                               
alleviate all of the department's concerns.                                                                                     
                                                                                                                                
4:26:14 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  HERRON  asked to  "tackle"  Conceptual  Amendment 1  by                                                               
breaking  it  down into  individual  amendments.   He  asked  for                                                               
consideration  to  withdraw  Conceptual  Amendment 1.    He  then                                                               
withdrew his objection.                                                                                                         
                                                                                                                                
CO-CHAIR KELLER withdrew Conceptual Amendment 1.                                                                                
                                                                                                                                
CO-CHAIR HERRON  made a motion  to adopt Conceptual  Amendment 1,                                                               
to delete Section 3 (d), and to delete Section 2 of the bill.                                                                   
                                                                                                                                
REPRESENTATIVE T. WILSON objected for purpose of discussion.                                                                    
                                                                                                                                
                                                                                                                                
CO-CHAIR KELLER  suggested that  proposed Conceptual  Amendment 1                                                               
would require a change to the title of the bill.                                                                                
                                                                                                                                
CO-CHAIR  HERRON agreed  and stated  that would  be a  conforming                                                               
amendment  to Conceptual  Amendment  1.   He restated  Conceptual                                                               
Amendment  1, and  referred  to  page 2,  lines  7-11, to  delete                                                               
Section  3  (d)  and to  delete  Section  2  of  the bill.    The                                                               
conforming amendment would remove part of the title, as well.                                                                   
                                                                                                                                
REPRESENTATIVE T. WILSON withdrew her  objection.  There being no                                                               
further objection, Conceptual Amendment 1 was adopted.                                                                          
                                                                                                                                
4:29:27 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  HERRON  referred to  page  1  of the  document  labeled                                                               
"Conceptual Amendments"  to Section 3(a),  which read:   "(1) The                                                               
power to  require or regulate  a person's  choice in the  mode of                                                               
securing health..."   He asked Mr.  Bailey if this would  be part                                                               
of the bill or would constitute a "finding."                                                                                    
                                                                                                                                
MR. BAILEY  answered that the language  of Section 3 (a),  (1) of                                                               
Conceptual  Amendment  1  would  create  statements  of  position                                                               
rather than  of findings.   He related  that findings would  be a                                                               
statement   that  a   problem   exists  or   would  outline   the                                                               
circumstances that justify  the legislation.  Findings  are not a                                                               
preferred  method to  set a  state policy  or law.   It  would be                                                               
preferable  to include  the language  in the  bill itself  rather                                                               
than  create a  findings statement.   He  read, "...The  state of                                                               
Alaska  hereby exercises  its sovereign  power to  declare public                                                               
policy of the state of Alaska  regarding the right of all persons                                                               
residing  in the  state  of  Alaska..."   He  was  not sure  that                                                               
represents a "finding,"  but thought it was more  of a statement.                                                               
He suggested  that if the  topics are listed that  this provision                                                               
should be  redrafted as  a statement of  condition or  a finding.                                                               
He said,  "Again, it  is preferable to  establish what  the basis                                                               
for the bill is, either in  the committee hearings or in the bill                                                               
itself rather than do a findings statement."                                                                                    
                                                                                                                                
4:31:52 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SEATON  asked  whether this  statement  would  be                                                               
appropriate in a resolution.                                                                                                    
                                                                                                                                
MR. BAILEY agreed.                                                                                                              
                                                                                                                                
4:32:23 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  CISSNA asked  the  sponsor if  he would  consider                                                               
introducing a resolution.                                                                                                       
                                                                                                                                
REPRESENTATIVE GATTO said he decided against it.                                                                                
                                                                                                                                
4:32:47 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  HERRON referred  to  the  document labeled  "Conceptual                                                               
Amendments" to Section  3 (a)(2) and asked  whether this language                                                               
is covered elsewhere in bill.                                                                                                   
                                                                                                                                
MR. BAILEY  responded that  the language is  not the  normal bill                                                               
language for  a statement since  it uses terms such  as, "hereby"                                                               
which are  not normally used.   He said Section 3  (a) (2) varies                                                               
somewhat from the  language in the bill, although he  did not see                                                               
substantive changes.  He said  he preferred the existing language                                                               
in  the  bill.    He  referred to  the  language  in  "Conceptual                                                               
Amendments" to Section 3 (a)  (2) and suggested removing "hereby"                                                               
and use  "public policy" instead  of public policy of  the state.                                                               
The  bill has  language "consistent  with the  right of  liberty"                                                               
that  is missing  from  the Conceptual  Amendment  language.   He                                                               
suggested  the  drafting convention  is  to  use "a"  instead  of                                                               
"any."   And, "as defined in  this bill" for the  definition of a                                                               
penalty  is likely  unnecessary, since  the penalty  provision on                                                               
page 2, line 12, Section 3 (e) already applies to the bill.                                                                     
                                                                                                                                
4:35:46 PM                                                                                                                    
                                                                                                                                
CO-CHAIR HERRON moved to adopt  Conceptual Amendment 2, on page 1                                                               
line 13 to delete "consistent with the right of liberty."                                                                       
                                                                                                                                
REPRESENTATIVE T. WILSON objected for the purpose of discussion.                                                                
                                                                                                                                
4:36:38 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  GATTO said  he did  not object  to the  suggested                                                               
changes by the drafter.                                                                                                         
                                                                                                                                
CO-CHAIR HERRON  related his understanding that  the bill drafter                                                               
advised that the bill language  was similar except for the phrase                                                               
"consistent  with   the  right  of  liberty"   so  deleting  this                                                               
reference  should  make  the  bill   similar  to  the  conceptual                                                               
amendment.                                                                                                                      
                                                                                                                                
4:37:43 PM                                                                                                                    
                                                                                                                                
MR. REIKER  asked about inclusion  of "without penalty  or threat                                                               
of penalty."                                                                                                                    
                                                                                                                                
CO-CHAIR  HERRON characterized  the suggestion  as wanting  "both                                                               
the  belt  and suspenders"  in  this  provision.   He  asked  for                                                               
clarification on  whether "without penalty or  threat of penalty"                                                               
is already contained in HB 423.                                                                                                 
                                                                                                                                
MR. BAILEY  said no,  he did  not believe it  was covered  in the                                                               
original bill  and would be helpful.   He said he  missed that in                                                               
his initial review.                                                                                                             
                                                                                                                                
REPRESENTATIVE SEATON asked whether it  would be easier to delete                                                               
current (a) and insert the new (a) in the bill.                                                                                 
                                                                                                                                
REPRESENTATIVE   T.  WILSON   said   taking   out  the   language                                                               
"consistent  with right  of liberty"  does not  change the  bill.                                                               
She referred to page 1, line 13  of Section 3, and read:  "(a) It                                                               
is the policy of the State of  Alaska that a person has the right                                                               
and is  free to  choose or  decline any  mode of  securing health                                                               
care  services."   She offered  her  belief that  is "what  we're                                                               
really trying  to do in [Section  3] (a) since it  still keeps in                                                               
what we want."   She suggested adding the penalties  in Section 3                                                               
(c).                                                                                                                            
                                                                                                                                
CO-CHAIR  HERRON  related  the  debate is  whether  to  leave  in                                                               
"without penalty  or threat of penalty"  and add that to  the end                                                               
of page 2, line 1.                                                                                                              
                                                                                                                                
4:41:00 PM                                                                                                                    
                                                                                                                                
MR. BAILEY, in response to  Representative T. Wilson, pointed out                                                               
that Section 3 (c) in the bill  is a bit redundant, since it says                                                               
a  "public  official or  agent  of  the  state or  its  political                                                               
subdivision" may not impose a  penalty.  He related that contrary                                                               
to the policy  stated in (a), it would emphasize  that the policy                                                               
is  trying to  establish a  rule.   He suggested  that it  seemed                                                               
preferable to include  the language in Section 3  (a) rather than                                                               
in Section 3 (c).                                                                                                               
                                                                                                                                
4:42:16 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  CISSNA referred  to  "penalty" to  the growth  of                                                               
entitlements.  She  asked for clarity of the meaning  and "are we                                                               
getting free lunch  no matter what?"  She stated  she believed in                                                               
freedom but was unsure of what it meant without penalty.                                                                        
                                                                                                                                
MR.  BAILEY said  that  the point  that is  stated  as policy  is                                                               
intended  to require  that  one  can choose  a  means of  getting                                                               
health insurance  and if you  choose or  do not choose  would not                                                               
result  in a  penalty.   He recalled  that the  penalty would  be                                                               
limited to  a fine, tax,  or surcharge,  which would be  a dollar                                                               
amount.                                                                                                                         
                                                                                                                                
4:44:27 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE HOLMES  related her  understanding that  by adding                                                               
to Section  3 (a)  "without penalty or  threat of  penalty" would                                                               
allow the committee to remove Section 3 (c).                                                                                    
                                                                                                                                
MR. BAILEY advised  that Section 3 (c) essentially  states when a                                                               
penalty could be  imposed by a public official.   That may be the                                                               
source  of some  of  the confusion.   He  suggested  that she  is                                                               
correct, that  adding "without penalty  or threat of  penalty" to                                                               
Section 3 (a) would allow the committee to remove Section 3 (c).                                                                
                                                                                                                                
4:45:43 PM                                                                                                                    
                                                                                                                                
CO-CHAIR HERRON  explained Conceptual Amendment  2.  On  line 13,                                                               
would strike "consistent  with the right of liberty"  and on page                                                               
2, to add "without penalty or  threat of penalty;" and on page 2,                                                               
delete lines 4-6, Section 3 (c).                                                                                                
                                                                                                                                
REPRESENTATIVE CISSNA referred  to page 1, Section 3  (a), and to                                                               
the language "securing health care  services."  She asked whether                                                               
securing  meant  signing up  or  actually  obtaining health  care                                                               
services and if  this language allowed people to  get health care                                                               
without paying for it.                                                                                                          
                                                                                                                                
MR. BAILEY said  that securing may have an  unintended meaning or                                                               
is unclear.   He suggested that  the intent would be  to purchase                                                               
insurance, or purchase  health care services may be  a better way                                                               
to describe it.                                                                                                                 
                                                                                                                                
4:48:05 PM                                                                                                                    
                                                                                                                                
CO-CHAIR HERRON restated Conceptual Amendment  2.  On line 12-13,                                                               
it is  the policy of  the State of Alaska  that a person  has the                                                               
right  and is  free to  choose or  decline any  mode of  securing                                                               
health care services without penalty or  threat of a penalty.  On                                                               
page 2, delete lines 4-6, of Section 3 (c).                                                                                     
                                                                                                                                
CO-CHAIR   KELLER  asked   for  the   reason  the   reference  to                                                               
constitutional rights was removed.                                                                                              
                                                                                                                                
MR. BAILEY  explained that bill  is trying to establish  a policy                                                               
and also a law.  The  statement of policy may include comments to                                                               
state the  purpose of the law  or intentions, but when  passing a                                                               
law, the  goal is describe the  conduct and what is  permitted or                                                               
prohibited.   He related language  superfluous to the  content of                                                               
the rule is best left out of the statutory language.                                                                            
                                                                                                                                
4:50:33 PM                                                                                                                    
                                                                                                                                
CO-CHAIR KELLER asked  whether removing the phrase  would imply a                                                               
new right was being established.                                                                                                
                                                                                                                                
MR.  BAILEY  answered that  it  is  a  debatable question  as  to                                                               
whether  policy  can establish  a  right.    He  said that  is  a                                                               
question that  he cannot answer.   It seemed to him  that on page                                                               
1, subsection (a),  that it the state's policy that  a person has                                                               
a right,  but he does  not know  that the policy  establishes the                                                               
right or if it states that the right already exists.                                                                            
                                                                                                                                
4:51:17 PM                                                                                                                    
                                                                                                                                
CO-CHAIR HERRON restated proposed Conceptual Amendment 2.                                                                       
                                                                                                                                
REPRESENTATIVE T. WILSON removed her objection.                                                                                 
                                                                                                                                
REPRESENTATIVE CISSNA  referred to page  1, Section 3  (a) states                                                               
that person  has a right and  is free to choose,  deals with cash                                                               
and being  able to afford health  care.  She asked  whether "free                                                               
to choose" is statutorily "solid" language.                                                                                     
                                                                                                                                
MR. BAILEY  replied that  "free to choose"  would be  adequate to                                                               
state the  sponsor's intent, but  the preferable language  from a                                                               
drafting  perspective would  be  that a  person  "may" choose  or                                                               
decline rather than "is free to."                                                                                               
                                                                                                                                
REPRESENTATIVE  CISSNA   asked  about  preferable   language  for                                                               
statutory language  and asked whether  a conceptual  amendment to                                                               
the Conceptual Amendment should be considered.                                                                                  
                                                                                                                                
4:53:56 PM                                                                                                                    
                                                                                                                                
There  being no  further  objection, Conceptual  Amendment 2  was                                                               
adopted.                                                                                                                        
                                                                                                                                
REPRESENTATIVE CISSNA referred  to page 1 of HB  423, which read:                                                               
"free to  choose or  decline any mode  of purchasing  health care                                                               
services."                                                                                                                      
                                                                                                                                
REPRESENTATIVE  CISSNA   made  a   motion  to   adopt  Conceptual                                                               
Amendment 3, as follows:                                                                                                        
                                                                                                                                
     On line 14:                                                                                                                
                                                                                                                                
     Delete "is free to" and following "has the right and"                                                                      
     Insert "may"                                                                                                               
                                                                                                                                
     On line 14:                                                                                                                
                                                                                                                                
     Delete "securing" and following "decline any mode of"                                                                      
     Insert "purchasing"                                                                                                        
                                                                                                                                
4:55:24 PM                                                                                                                    
                                                                                                                                
CO-CHAIR HERRON restated Conceptual Amendment 3.                                                                                
                                                                                                                                
On line 14:                                                                                                                     
Delete "is free to" and following "has the right and"                                                                           
Insert "may"                                                                                                                    
                                                                                                                                
Delete "securing" and following "any mode of"                                                                                   
Insert "purchasing"                                                                                                             
                                                                                                                                
REPRESENTATIVE T. WILSON objected.                                                                                              
                                                                                                                                
REPRESENTATIVE HOLMES  asked whether it would  be more consistent                                                               
to eliminate "has the  right and is free to" or  "is free to" and                                                               
to substitute the word "may."                                                                                                   
MR. BAILEY asked Representative Holmes to repeat the question.                                                                  
                                                                                                                                
CO-CHAIR HERRON  said he  would attempt  to repeat  the suggested                                                               
language.  On line 14,                                                                                                          
                                                                                                                                
     Delete "has the right and is free to" and                                                                                  
     Insert "may"                                                                                                               
                                                                                                                                
                                                                                                                                
MR. BAILEY suggested that "and" has to stay in.                                                                                 
                                                                                                                                
CO-CHAIR HERRON said no.  On line 14,                                                                                           
                                                                                                                                
     Delete:  "has the right and is free to"                                                                                    
     Insert:  "may"                                                                                                             
                                                                                                                                
MR. BAILEY replied that is certainly an option.                                                                                 
                                                                                                                                
CO-CHAIR  HERRON  asked  if  it  was  an  option  or  a  drafting                                                               
preference.                                                                                                                     
                                                                                                                                
MR.  BAILEY noted  that to  some  degree "may"  would change  the                                                               
content so it would not only be  a drafting change.  He noted the                                                               
conflict between  stating policy  and establishing  a right.   He                                                               
thought it may  clarify the matter to say, "It's  the policy that                                                               
a person  may choose" and avoid  the issue of whether  the person                                                               
has a right or does not have a right.                                                                                           
                                                                                                                                
REPRESENTATIVE GATTO agreed to the  change to delete "is free to"                                                               
and substitute "may."  He said, "has the right" should remain.                                                                  
                                                                                                                                
CO-CHAIR   HERRON  restated   for  clarification   that  proposed                                                               
Conceptual Amendment 3.                                                                                                         
                                                                                                                                
     On line 14:                                                                                                                
                                                                                                                                
     Delete "is free to" and                                                                                                    
     Insert "may"                                                                                                               
                                                                                                                                
REPRESENTATIVE HOLMES added there is a second portion.                                                                          
                                                                                                                                
CO-CHAIR  HERRON agreed.    He  acknowledged proposed  Conceptual                                                               
Amendment 3 also included:                                                                                                      
                                                                                                                                
     On line 14:                                                                                                                
                                                                                                                                
     Delete "securing" and following "any mode of"                                                                              
     Insert "purchasing"                                                                                                        
                                                                                                                                
4:58:26 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE T.  WILSON suggested  that a  person working  at a                                                               
store is not "purchasing" but is "securing" health care.                                                                        
                                                                                                                                
REPRESENTATIVE HOLMES asked whether  a better alternative existed                                                               
to "securing."                                                                                                                  
                                                                                                                                
MR. BAILEY suggested using "purchasing"  or "obtaining" since any                                                               
mode of getting health insurance.                                                                                               
                                                                                                                                
4:59:53 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  HERRON restated  proposed  Conceptual  Amendment 3,  as                                                               
follows:                                                                                                                        
                                                                                                                                
     On line 14:                                                                                                                
     Delete "is free to" and                                                                                                    
     Insert "may"                                                                                                               
                                                                                                                                
     Delete "securing" and                                                                                                      
     Insert "obtaining"                                                                                                         
                                                                                                                                
REPRESENTATIVE T. WILSON withdrew her  objection.  There being no                                                               
further objection, Conceptual Amendment 3 was adopted.                                                                          
                                                                                                                                
5:00:37 PM                                                                                                                    
                                                                                                                                
CO-CHAIR HERRON  moved to page  2 and asked for  clarification on                                                               
the language for the next conceptual amendment.                                                                                 
                                                                                                                                
MR.  REIKER stated  that  the language  for  the next  conceptual                                                               
amendment came from the assistant attorney general, Mike Ford.                                                                  
                                                                                                                                
MR. JONES said  he was unfamiliar with the  language, but assumed                                                               
the intent  is to make certain  this did not to  apply to state's                                                               
health insurance or to political subdivisions.                                                                                  
                                                                                                                                
5:02:14 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  HOLMES  asked  about   the  term  "required"  and                                                               
whether "provided" could be substituted.                                                                                        
                                                                                                                                
MR.  JONES replied  that the  terms  are aimed  at two  different                                                               
things.    One of  the  concerns  raised  at the  last  committee                                                               
meeting  was that  the prior  version of  the bill  may keep  the                                                               
state from  providing immunizations, quarantines,  or involuntary                                                               
committals, which are required health  care services.  He offered                                                               
his belief  that this language  was designed to also  address the                                                               
state's  ability  to  require its  employees  to  participate  in                                                               
health care  services.  He  suggested one method to  address this                                                               
is  to refer  to  "modes  of securing  or  obtaining health  care                                                               
services provided  by the  state, a  political subdivision,  or a                                                               
court of the state, in  addition to health care services required                                                               
by them."                                                                                                                       
                                                                                                                                
5:04:13 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  HOLMES turned  to Conceptual  Amendment 4  of the                                                               
"Conceptual  Amendments" to  Version R.    She made  a motion  to                                                               
amend   Section  3   (b)(1),  by   adding  "provided   or"  after                                                               
"services."   Thus, proposed Conceptual  Amendment 4  would read,                                                               
as follows:                                                                                                                     
                                                                                                                                
     (b) The policy stated in (a) of this section                                                                               
           (1) does not apply to health care services                                                                           
         provided or required by the state, a political                                                                         
     subdivision of the state, or a court of the state;                                                                         
                                                                                                                                
REPRESENTATIVE T. WILSON objected for purpose of discussion.                                                                    
                                                                                                                                
CO-CHAIR KELLER asked  for clarification if the  motion read "or"                                                               
or "and."                                                                                                                       
                                                                                                                                
MR. BAILEY replied it should be "or."                                                                                           
                                                                                                                                
5:06:42 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  HERRON  stated  that proposed  Conceptual  Amendment  4                                                               
would be "conformed" by the drafter.                                                                                            
                                                                                                                                
REPRESENTATIVE HOLMES related  that proposed Conceptual Amendment                                                               
4  would be  inserted  on  page 2,  line  2  after "section"  and                                                               
subsection (b) would read:                                                                                                      
                                                                                                                                
     (b) The policy stated in (a) of this section                                                                               
           (1) does not apply to health care services                                                                           
         provided or required by the state, a political                                                                         
     subdivision of the state, or a court of the state;                                                                         
       (2) may not impair a contract right that provides                                                                        
     health care services.                                                                                                      
                                                                                                                                
REPRESENTATIVE T. WILSON removed her objection.                                                                                 
                                                                                                                                
There  being no  further  objection, Conceptual  Amendment 4  was                                                               
adopted.                                                                                                                        
                                                                                                                                
5:07:54 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  HERRON  made  a motion  to  adopt  proposed  Conceptual                                                               
Amendment  5,  to  delete  language   on  line  18,  as  follows:                                                               
"participating  in an  employer  or  government sponsored  health                                                               
benefit plan."                                                                                                                  
                                                                                                                                
REPRESENTATIVE T. WILSON objected.                                                                                              
                                                                                                                                
MR. RIEKER suggested that the  language "mode of securing" should                                                               
also be changed to "mode of obtaining."                                                                                         
                                                                                                                                
CO-CHAIR  HERRON  agreed,  stating  that would  be  a  conforming                                                               
amendment.                                                                                                                      
                                                                                                                                
5:09:01 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  HOLMES  expressed  concern that  leaving  in  the                                                               
language "or  other means of  obtaining health care  services" in                                                               
HB 423 might be interpreted  as including the language deleted in                                                               
proposed Conceptual  Amendment 5.   Thus, what  would be  left in                                                               
the  bill  would  be  the following,  "mode  of  securing"  means                                                               
directly  purchasing  health care  services  from  a health  care                                                               
provider, purchasing insurance covering  health care services, or                                                               
other means of  obtaining health care services;."   She explained                                                               
that "or  other means  of obtaining  health care  services" would                                                               
also  include   "participating  in  an  employer   or  government                                                               
sponsored health benefit plan."                                                                                                 
                                                                                                                                
5:09:50 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  HERRON  amended  proposed Conceptual  Amendment  5,  to                                                               
delete lines 18 and 19, which read:                                                                                             
                                                                                                                                
     "participating in an employer or government sponsored                                                                      
     health benefit plan or other means of obtaining health                                                                     
     care services;"                                                                                                            
                                                                                                                                
REPRESENTATIVE T. WILSON  removed her objection.   There being no                                                               
further  objection,  Conceptual  Amendment  5,  as  amended,  was                                                               
adopted.                                                                                                                        
                                                                                                                                
5:10:15 PM                                                                                                                    
                                                                                                                                
CO-CHAIR HERRON  made a motion  to adopt Conceptual  Amendment 6,                                                               
on  page 2,  lines 20  and 21,  which read  as follows  [original                                                               
punctuation provided]:                                                                                                          
                                                                                                                                
        (3) "penalty" means a fine, tax [SALARY OR WAGE                                                                         
      WITHHOLDING] surcharge, fee, or other [CONSEQUENCE]                                                                       
     monetary charge.                                                                                                           
                                                                                                                                
REPRESENTATIVE T. WILSON objected.                                                                                              
                                                                                                                                
REPRESENTATIVE T. WILSON  removed her objection.   There being no                                                               
further objection, Conceptual Amendment 6 was adopted.                                                                          
                                                                                                                                
5:10:50 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE T. WILSON moved to  report HB 423, as amended, out                                                               
of   committee   with    individual   recommendations   and   the                                                               
accompanying fiscal notes.                                                                                                      
                                                                                                                                
REPRESENTATIVE HOLMES objected.                                                                                                 
                                                                                                                                
5:11:33 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  CISSNA  expressed  concern that  the  process  of                                                               
working on  complex issues and  passing the  bill out in  a short                                                               
time without fully  understanding the outcomes is  a very serious                                                               
problem in  the state legislature.   She offered her  belief that                                                               
moving so quickly on complex  issues does the state a disservice.                                                               
Thus, she said she will vote no.                                                                                                
                                                                                                                                
REPRESENTATIVE   HOLMES    reiterated   Representative   Cissna's                                                               
comments.   She appreciated that  the committee took  a difficult                                                               
issue  and worked  through it.   She  commended the  work by  the                                                               
parties  involved.   She said  she will  also vote  no on  HB 423                                                               
since she  is troubled  by the  concerns raised  by the  DHSS and                                                               
DOL.  She thought that the  eagerness to react to action taken at                                                               
the federal level could have  unintended consequences.  She said,                                                               
"A  resolution  is  one  thing;   this  is  actual  law,  so  I'm                                                               
troubled..."   She related  that this bill  will come  before the                                                               
House  Judiciary Committee  so she  will have  another chance  to                                                               
review the bill.                                                                                                                
                                                                                                                                
5:14:07 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE T. WILSON  said she wished there was  more time to                                                               
work  on this  bill, but  she did  not think  the state  has more                                                               
time.   She offered  her belief that  the federal  government has                                                               
put the state  in the position.  She said  reviewed actions other                                                               
states have taken  and their interpretations.   She suggested the                                                               
state should  take a stand that  other states have taken  on this                                                               
issue  since the  federal government  has  mandated changes  that                                                               
will "cost the states."  She  offered that she is willing to move                                                               
the  bill   forward  and  allow  the   House  Judiciary  Standing                                                               
Committee to review  it.  She related her  constituents are upset                                                               
with how the health care bill  may affect them.  She concluded by                                                               
stating that she does not have faith in the federal system.                                                                     
                                                                                                                                
5:16:02 PM                                                                                                                    
                                                                                                                                
CO-CHAIR KELLER expressed  his outrage at the  federal law, which                                                               
he  said  has  impugned  Alaskan  rights and  "a  takeover  of  a                                                               
system."   He said one-sixth of  the economy is regulated  at the                                                               
federal level.  He agreed  with Mike Ford, the assistant attorney                                                               
general that the  committee may be reacting more  quickly to make                                                               
this bill  "perfect."  He pointed  out that any health  bill will                                                               
have a  level of uncertainty, but  he also reserves the  right to                                                               
revisit  the policy  issue of  this bill,  just as  the committee                                                               
does with  any other  bill it passes.   He  expressed frustration                                                               
that the  intent of  the reform  is to  redistribute wealth.   He                                                               
said he would be a strong yes  vote.  He thinks the discussion is                                                               
healthy.                                                                                                                        
                                                                                                                                
REPRESENTATIVE SEATON  remarked that  health care  is one  of the                                                               
most critical things for the State  of Alaska.  Alaska has a poor                                                               
record in many  of the health care situations.   He said, "I find                                                               
it ironic that under the auspices  of this bill, if this had been                                                               
a single payer  government program, there would  be no objection,                                                               
because  the objection  to  this  is that  we  are using  private                                                               
industry and  private insurance.   And we  have the  objection to                                                               
this bill  from the people who  would not have the  objection for                                                               
but  a single  payer  government sponsored  "all  in one"  health                                                               
care.   So I find  it ironic in  that way."   He said he  did not                                                               
think  the  legislature  has enough  information  about  the  new                                                               
system or the  implications.  He said,  "I'm a do not  pass."  He                                                               
did not  think it is  good public policy  and would be  much more                                                               
appropriate as  a resolution.  He  stated that he would  not hold                                                               
the bill up.                                                                                                                    
                                                                                                                                
REPRESENTATIVE  LYNN expressed  concerns  with health  care.   He                                                               
stated that he  personally is fortunate to  have state, Medicare,                                                               
and military  health benefits.   He related  that as  people age,                                                               
their  health care  needs  are more  substantial.   He  expressed                                                               
concern  for  people  who  cannot  afford  medicine  and  routine                                                               
prescriptions  are very  expensive.   He  related  that the  U.S.                                                               
needs good  health care and  the federal government has  passed a                                                               
very comprehensive bill.   This bill is to accept  or reject that                                                               
federal bill.   He stated the  importance to have the  liberty to                                                               
accept or reject  this reform, which is a personal  decision.  He                                                               
speculated  that the  debate will  ensue  over a  long period  of                                                               
time.  This bill provides that  avenue and serves a good purpose.                                                               
He offered  his belief  that ultimately  the courts  will decide.                                                               
He said, "I'm a yes vote on this."                                                                                              
                                                                                                                                
5:23:29 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  HERRON  said  it  is important  issue.    He  expressed                                                               
concern with some  parts of federal law, but  he also appreciated                                                               
most  parts of  it.   His constituents  will enjoy  the permanent                                                               
reauthorization of  Indian Health Service (IHS).   He appreciated                                                               
the  sponsor bringing  this issue  forward.   He stated  that the                                                               
committee  rewrote the  bill so  that  it is  now an  appropriate                                                               
health care  policy.  Next,  it will go through  a constitutional                                                               
debate in the House Judiciary Standing Committee.                                                                               
                                                                                                                                
REPRESENTATIVE HOLMES maintained her objection.                                                                                 
                                                                                                                                
A roll  call vote  was taken.   Representatives Lynn,  Seaton, T.                                                               
Wilson, Keller,  and Herron voted  in favor of reporting  HB 423,                                                               
as amended,  from the House  Health and Social  Services Standing                                                               
Committee.   Representatives Cissna and Holmes  voted against it.                                                               
Therefore,  the  CSHB 423(HSS)  was  reported  out of  the  House                                                               
Health and Social Services Standing Committee by a vote of 5-2.                                                                 
                                                                                                                                

Document Name Date/Time Subjects