Legislature(1999 - 2000)
03/17/2000 03:25 PM L&C
* first hearing in first committee of referral
= bill was previously heard/scheduled
= bill was previously heard/scheduled
HB 416-PROSTATE CANCER SCREENING CHAIRMAN ROKEBERG announced the next order of business would be HOUSE BILL NO. 416, "An Act relating to insurance coverage for prostate cancer screening." Number 1564 REPRESENTATIVE FRED DYSON, Alaska State Legislature, came forward to testify as the sponsor of HB 416. He said he believes the medical community and insurance companies are realizing that lives can be saved and costs can be reduced if men are screened for prostate cancer sooner. He had agreed to bring this bill forward partly in response to Mike Miller, who is a four-year survivor of prostate cancer. The bill lowers the age at which prostate cancer screening is reimbursed by insurance companies. CHAIRMAN ROKEBERG asked if Representative Dyson knows the cost impacts of the bill. In addition, he wondered what the insurance industry thinks of the bill. REPRESENTATIVE DYSON said a representative from the insurance industry here would be able to answer those questions. Number 1680 MICHAEL H. MILLER came forward to testify on HB 416. He stated: Mr. Chairman, I'd like to thank you and members of the committee for allowing me to come forth. My name is Michael H. Miller.... I am an advanced prostate cancer patient and a prostate cancer advocate.... I became a four-year survivor of prostate cancer on January 17, 2000. At the time of my diagnosis in 1996, I was given 17 to 35 months to live. An aggressive clinical trial program has enabled me to be here today to urge your support for HB 416. In 1996, the legislature passed SB 253 - which was the fourth state to mandate prostate cancer screening, and today there are 22 states that have mandated bills - a bill requiring insurers to cover the cost of annual prostate cancer screening for men 50 years or older. HB 416 would amend that law by requiring this screening be covered at age 40, and at age 35 for men at high risk of contracting this disease. "High risk" is defined in the bill as a person who is an African- American or who has a family history of prostate cancer. According to the American Cancer Society, this year 1.2 million Americans will contract cancer. That's every 25 seconds somebody is diagnosed with cancer and 552,000 will die of the disease, which is every 56 seconds. In our state, an estimated 1,500 Alaskans, or four a day, will contract cancer this year, 200 more people on an annual basis than three years ago. An estimated 700 Alaskans will die of cancer this year, 2 per day, or 58 per month. Prostate cancer accounts for 29 percent of all the male-related cancers and 11 percent of cancer-related deaths in men. This year, approximately 715 men in Alaska will be diagnosed with cancer, nearly one-quarter with prostate cancer. Of the estimated 354 men that will die of cancer this year in Alaska, about five percent will die from prostate cancer. African-American men have a 32 percent higher risk of contracting this disease than others. They have the highest incident rate in the world. Number 1812 In 1979, Dr. Gerald Murphy, a Seattle oncology/urologist, developed the Prostate Specific Blood Antigen [PSA] test to help diagnose prostate cancer...The test became available to all doctors in 1990. A decade old, this test has led to a decrease in the prostate cancer mortality rate. In 1976, there was a 30 percent mortality rate for men with prostate cancer. In 2000, that mortality rate is expected to drop to 17.7 percent, due in large part to the PSA [test]. Today, more and more young men are being diagnosed with prostate cancer. According to the American Cancer Society, 209,900 men in the United States were diagnosed with prostate cancer in 1997, and 41,800 died of the disease. About 23 percent or 47, 600 of those diagnosed that year were under age 65. As a patient who was diagnosed with prostate cancer at age 43, I know that prostate cancer in men under 65 tends to be more aggressive in nature. Early detection, especially for men who are high risk, is the best way to save lives. I have a vested interest in this legislation because my two sons have up to six times a higher risk of contracting prostate cancer because I have the disease. Located in your packet is a page listing statistical information from the 1999 Alaska Cancer Registry which is the third page in, if you could go to that at this time, and also shows the 2000 American Cancer Society- Cancer Facts and Figures indicating the prostate cancer risk by age groupings. Statistics for 1999 and 2000 show that one in 10,000 a man is predicted to contract prostate cancer before age 40. In 1999, statistics for the 40 to 59 age group show one in 57 will contract the disease. The 2000 statistics show a greater occurrence in this age group, with one in 53. Four years ago the statistics in the 40 to 59 age group were one in 59. If this trend continues, in 2008, [men] in this age group will have one in 35 chance of contracting prostate cancer. With an aging Baby Boomer society, more and more men will be diagnosed with prostate cancer. It would be prudent for the State of Alaska and the insurance industry to make an investment in preventative health care maintenance for men starting prostate cancer screening at the age of 35 for those at high risk and age 40 for others. HB 416 will help men be diagnosed at a younger age, saving both lives and money. I do have an attached page that gives you the associated medical costs estimate [included in bill packet] which will show that of the nearly 700 men that were diagnosed, and 72 over a four-year period of time, that's 175 men per year. And 18 men per year pass away from this disease. That leaves 628 men, and over a four-year period of time, the cost is $5,024,00 or $1.26 million per year. Then there's 292 men that are in the 40 to 64 category which accounts for $2.3 million or $584,000 per year. There are between 40 to 50, which we're addressing in this amendment, 24 men per year times four that's 768, 000 or 192, 000 per year. If this expenditure continues, by the year 2008, it will be $1.5 million. Number 2007 The 1999 Alaska Cancer Registry report show that only two men aged 40 to 44 were diagnosed with prostate cancer in Alaska in 1996, and 10 in the 45 to 49 age group which is in the fourth page marked Age Distribution of Invasive Cancers. I was one of those two men in 1996. At age 43, I was diagnosed with advanced prostate cancer. If the PSA test had been made available to me at age 40, I would probably been diagnosed with early stage prostate cancer and my disease might not have spread. Prostate cancer has left me unable to work. I, like many cancer survivors, [am] receiving Social Security Disability Income and State Disability Retirement. The average cost for prostate cancer treatment is $6,000 to $10,000 annually. My expenses are running $12,000 to $15,000 annually and that's just for medication. It is cost effective to catch and treat this disease early on, rather than pay for long-term cost of treatment at an estimated $48,690 per person. If you turn to the first page of the reference material there's a Pay Now or Pay Later chart that will show you in the second left-hand column that at age 35 to 65 if you eat ten slices of low fat cheese pizza per week, the tomato sauce contains cancer- fighting lycopene, which is a high anti-oxidant, the cost will only be $18,720. I've stated before if you have prostate cancer it will cost $48,690. HB 416 should not cause insurance premiums to increase. Although insurers generally oppose mandate, when SB 253 was passed in 1996, an Aetna representative testified that Aetna would not oppose this bill if the Legislature felt the benefits of the screening would outweigh the small costs. He said an argument can be made that early detection should result in more efficient treatment and ultimately avoid high catastrophic treatment costs. Number 2102 Men dying of prostate cancer are leaving behind spouses, children and many family members and friends. I have a friend of mine that I lost at the age of 41, Mark (indisc.), with advanced prostate cancer, and he left behind a 10-year old daughter, a 14-year old son and a 16-year old son. When I was lobbying back in Washington, D.C. last year with 100 other men, there was little Sebastian Hanson (ph) of Scottsdale, Arizona and his mother, Lisa Hanson (ph). He lost his father at five months... And we're not talking about statistics or numbers. We're talking about a young man like Sebastian Hanson (ph) that never ever will know what his father stood for. At five months old you cannot comprehend that, and, my feeling, that's what we're talking about. While we have made great strides in the United States in cancer treatment research, too many men are still being lost at too young an age. Over the last four years, approximately 700 Alaska men have been diagnosed with prostate cancer. Many of their sons will also contract this disease. Let's give men an opportunity to be diagnosed at an earlier age. Those with a five-year survival rate from this disease, which means that men that were diagnosed in 1995 and now it's the year 2000, have a 100 percent chance they will die of another cause. I would like to leave my two the best possible gift, an opportunity for them to be screened for prostate cancer at an earlier age, because the odds are that they will contract the disease at a younger age. If you notice at the addendum, the cost to the State right now, at the bottom of the first page, FY99 State of Alaska Disability Retirement expenditure amounted to $7.2 million from PERS. In FY90, the PERS disability retirement expenditure was $2.8 million. And that does not count the teachers' retirement system nor the self insured individually or private sector. With the teachers' retirement, I think the figure goes up from $2.8 [million] in FY90 to $5.1 million. And that $7.2 million figure now becomes $11.1 million. I urge your support of HB 416 for the future health and well being of all Alaskan families. Thank you for your time. CHAIRMAN ROKEBERG asked if the amount Mr. Miller referred to with respect to the PERS disability retirement expenditure was the total amount of disability payments for prostate cancer victims. MR. MILLER replied no. He clarified that it was for overall disability retirement. He said: The point that I'm trying to make is that if you have more and more prostate cancer patients, we're going to add to this debt. Cancer has a $107 billion debt annually in the United States; $35 billion in direct medical costs, $11 billion in job loss productivity. I am part of that $11 billion. And $59 billion in premature debts and people that are going to go on some sort of assistance because they've lost a family member, you're going to have a spin-off of that. So, I guess what I'm saying is that, if the State does not take the responsibility, then the State disability retirement costs are going to even climb higher. CHAIRMAN ROKEBERG wondered if these are the disability payments the state is paying out now. MR. MILLER responded yes. He explained that his Social Security disability and state disability have been nearly $219,000 over the last four years. Number 2308 REPRESENTATIVE MURKOWSKI referred to the material Mr. Miller had provided to the committee. She said it appears there is not unanimity within the medical community regarding the recommendations for prostate cancer screening. She pointed out a comment stating that the American Cancer Society promoted prostate cancer screening, but have recently lessened their support and their position now is to promote patient choice and access to screening. Another article suggests screening at age 45 unless you are at risk. It does not appear to her that there is agreement with respect to the age at which screening should begin. She wondered if Alaska is taking the lead in lowering the age and if this also the direction that other states are taking. MR. MILLER replied: If you go to the third page, I can answer part of that in the numbers and the fact that, if you look at the top, it was put out by the Alaska Cancer Registry in the 40 to 59 [years of age] column, it was one in 57, and I made reference that in 1996 it was one in 59. The Cancer Facts and Figures, put out by the American Cancer Society, shows that it's one in 53. I've directly spoken with and I have worked with Dr. Judd Mau (ph) who is the Director at the Center for Prostate Disease Research, and he e-mailed me and explained that they just completed a Army, Navy serum repository research, and their age reference, that in this study that they are looking at, is between 20 and 45 years of age, so that way they can tell the doctors where that upper limit will be in a young man and where the lower limit will be in a young man. I think it's just going to be a matter of time. The position that the American Cancer Society has taken, it has put a tailspin ... not only in the medical community, but in the survivor community. There are 1,300 Man-to-Man chapters that are sponsored by the American Cancer Society. When the American Cancer Society took the stance that they presently have taken compared to two years ago, they've heard from all 1,300 chapters and all of those men opposed their decision making on taking that stance. REPRESENTATIVE MURKOWSKI asked why the American Cancer Society (indisc. - coughing). Number 2454 MR. MILLER said his belief is that the guideline the American Cancer Society has adopted was made up in 1997 and had just come out in 1999. He thinks there might be various reasons, but cannot pinpoint exactly what it is ...[some testimony not recorded because of tape change.] TAPE 00-30, SIDE B MR. MILLER continued: ... [Tom Bruckman (ph)] from the American Foundation for Urologic Disease. He says it's going to be a matter of time whether it's going to be a one in 35 or a one in 40. ... He said, "You know, I really have to applaud what you're doing." And he said this will set the ... standard for the rest of the country, to answer your other question, that Alaska will take the lead in this. REPRESENTATIVE MURKOWSKI referred to Mr. Miller's summary sheet of the prostate cancer laws throughout the states. She said there is a list of states that mandate screening and various other alternatives the states do. She asked if the ages are similar to what Alaska has now. MR. MILLER said the ages are similar, starting at 40 for those at high risk and 50 for others. As time goes on, more and more younger men will develop prostate cancer. He pointed out that his sons will have a six times greater chance of contracting prostate cancer. He commented that the lesions of prostate cancer start at puberty. Three to four years ago, 9 to 11 million men in the country were walking around with prostate cancer, and the number is increasing. He stressed that the face of prostate cancer is ever-changing. It is difficult for the medical community to keep up with these changes. Four years ago, there was a belief that diet may play a factor, but now they know that diet is a factor. He is simply trying to help the State of Alaska save some money. CHAIRMAN ROKEBERG asked, "Mr. Miller, on your cost estimates,... just to make sure I understand this now, that your survivorship would need treatment at $8,000 a year, is that how you come up to that dollar amount?" MR. MILLER answered, "Between six to ten, and the average would be ... $8,000." CHAIRMAN ROKEBERG wondered whether that is if a man contracted the disease and did not have early intervention. MR. MILLER replied that this is an average cost of a Stage C cancer. Stage D might cost a little more. At early stages, the cost of a radical prostectomy is $20,000. CHAIRMAN ROKEBERG asked if that would be a one-time shot. MR. MILLER responded yes. He referred to a note from Diane Lemmon (ph), who is the head researcher with Dr. Bruce Lowe (ph) at Oregon Health Sciences University. It stated that 95 percent of the men diagnosed with prostate cancer have a radical prostectomy. The percentage of men who stay continent after this procedure is now at 96 percent. Today, 90 percent of the surgeons who perform this procedure have patients who remain continent, but impotence varies from man to man. This is a process a man has to go through to decide which course of treatment is best. He does not believe he would be here if he had not done an aggressive treatment program. CHAIRMAN ROKEBERG said he appreciates Mr. Miller's inclusion of an addendum to his testimony. MR. MILLER indicated he had called around and found out the cost of a PSA in different places in the state. A PSA in Anchorage costs $42.50. In Juneau the cost varies from $63 to $106. The average cost is estimated to be $60. Between July and September, there were nearly 1,000 men screened for prostate cancer. He commented that 90 percent of the time, benign prostatic hyperplasia [BPH] occurs. CHAIRMAN ROKEBERG said this is a pretty clear-cut case based on the facts. From the statistics Mr. Miller provided, he noted that there is public policy and cost-benefit ratio effectiveness in doing prostate cancer screening. Number 0368 GORDON EVANS, Health Insurance Association of America [HIAA], came forward to testify on HB 416. He indicated HIAA has no objection to the bill and does endorse it. Number 0410 REPRESENTATIVE HALCRO made a motion to move [HB 416] out of committee with individual recommendations and the attached two zero fiscal notes. There being no objection, HB 416 moved out of the House Labor and Commerce Standing Committee.