Legislature(1999 - 2000)

03/17/2000 03:25 PM L&C

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
txt
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.                                                                             
                                                                                                                                

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