Legislature(2009 - 2010)BUTROVICH 205

03/02/2009 01:30 PM Senate HEALTH & SOCIAL SERVICES

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Heard & Held
Bills Previously Heard/Scheduled
Moved CSSB 96(HSS) Out of Committee
Moved Out of Committee 2/27/09
          SB  61-MANDATORY UNIVERSAL HEALTH INSURANCE                                                                       
1:38:47 PM                                                                                                                    
CHAIR DAVIS announced consideration of SB 61.                                                                                   
1:39:12 PM                                                                                                                    
SENATOR HOLLIS  FRENCH, sponsor  of SB  61, said  123,000 working                                                               
Alaskans are without health insurance,  and this bill is designed                                                               
to make it affordable  for all of them. They are  not as lucky as                                                               
we  are to  have  health  insurance provided  to  them  as a  job                                                               
benefit,  and they  lack the  economic wherewithal  to afford  an                                                               
increasingly out-of-reach  health insurance policy.  He explained                                                               
that SB 61 keeps the health  insurance landscape much the same as                                                               
it is now - a mix  of private and government insurance and simply                                                               
makes  private  insurance affordable.  If  you  have an  existing                                                               
insurance  policy,  nothing changes;  it  simply  reaches out  to                                                               
those Alaskans without health insurance.                                                                                        
Some people  wonder why the  state should advance this  bill when                                                               
it looks  as if President Obama  is going to fix  this problem in                                                               
Washington.  There are  two  reasons;  one is  that  it would  be                                                               
foolish to  wait for  Washington "to swoop  into the  rescue with                                                               
the other  enormous problems that  confront our nation."  Two, it                                                               
may  very  well  be  that  the  solution  adopted  by  Washington                                                               
requires states  to show initiative  in adopting their  own state                                                               
plan  that  comports  with  a broad  federal  mandate.  So,  it's                                                               
important  for Alaskans  to become  acquainted and  familiar with                                                               
the  basic building  blocks of  insurance reform  so that  we can                                                               
offer an Alaskan solution when the time comes.                                                                                  
SENATOR   FRENCH  said   that  SB   61  is   modeled  after   the                                                               
Massachusetts plan  that passed a  little over two years  ago and                                                               
that has  encouraging results. Many  states are  pursuing similar                                                               
models. For  example, Massachusetts has registered  about 100,000                                                               
new entrants into  the insurance market, and  the dire prediction                                                               
of private  employers dropping their employees  from coverage has                                                               
not occurred. It has led to  a decrease in the number of hospital                                                               
admissions  as people  get primary  care instead  of going  to an                                                               
emergency room,  and looks  in general  looks like  it will  be a                                                               
SENATOR FRENCH  said his staff created  a web site that  has tens                                                               
of thousands  of hits. It has  a calculator for people  to use to                                                               
estimate  what  it  would  cost   them  for  different  insurance                                                               
options. The bill has enjoyed  broad support from the health care                                                               
industry  even   though  there  is  some   trepidation  from  the                                                               
insurance  industry  and  small businesses  about  hidden  costs.                                                               
However, for many small employers there will be no cost at all.                                                                 
The bill has  two technical elements; one is what  is known as an                                                               
individual mandate,  which means  that each  person must  get his                                                               
own insurance  policy. The  reason is  that insurance  works best                                                               
when there are more people in  the pool; this will lower the cost                                                               
for  everyone.  It includes  arrangements  for  young people  who                                                               
don't have the insurance needs of the middle-aged.                                                                              
The  other side  of the  picture is  the guaranty  issue -  every                                                               
person  who presents  themselves  must be  issued  a policy.  The                                                               
insurance industry will  not be able to turn  people away because                                                               
of disqualifying  conditions, but with some  exceptions. The idea                                                               
is  that those  are two  sides  of a  coin -  guaranty issue  and                                                               
individual  mandate.  The insurance  industry  will  get tens  of                                                               
thousands  of healthy  people into  its ranks,  and in  return it                                                               
will  be  required  to  insure those  who  have  some  difficulty                                                               
getting insurance.                                                                                                              
1:46:05 PM                                                                                                                    
ANDY MODEROW, staff to Senator  French, gave a sectional analysis                                                               
of SB  61. Section 1 provides  the findings that go  over many of                                                               
the themes that  Senator French just presented. The  real meat of                                                               
the bill  begins on  page 2,  line 24,  where it  establishes the                                                               
program, itself.                                                                                                                
AS  21.54.200  spells  out  the   goals  that  are  going  to  be                                                               
implemented  to  help  fulfill some  of  the  problems  mentioned                                                               
during the  finds. One  is to make  insurance affordable  for all                                                               
residents  of  the  state  and  the other  is  to  get  everybody                                                               
covered. The  real structure of  what the bill creates  begins on                                                               
page 3, line  9, which contains the structure of  the health care                                                               
board. It  will be an  oversight committee under the  Division of                                                               
Insurance, which  implements this plan.  It will have  13 members                                                               
to include  six individuals who  focus more on the  business side                                                               
of health  care transactions, an insurance  producer (someone who                                                               
is more in touch with the  individual policies as they are issued                                                               
to  the consumers),  an  insurance  representative, two  business                                                               
representatives (one from  a large business and one  from a small                                                               
business), two  hospital representatives; from the  consumer side                                                               
it  has   a  labor   organization  representative,   two  Alaskan                                                               
physicians, a  registered nurse,  two consumer advocates  and the                                                               
commissioner of the  Department of Health and  Social Services or                                                               
his designee. This  last individual will cast a  deciding vote if                                                               
Sec. 21.54.220 on page 4, line  5, outlines the powers and duties                                                               
of this  board. It  has the  primary oversight  responsibility of                                                               
the  health care  clearing house  and  the health  care fund.  An                                                               
important function  the board takes  on (page 4, lines  10-15) is                                                               
it  classifies  plans that  are  available  through the  clearing                                                               
house. Part of the goal of  this bill is to encourage competition                                                               
and consumer choice,  and this places plans in more  of an apples                                                               
to apples comparison  for consumers when they go  to the clearing                                                               
house  to  choose  one. The  Massachusetts  Connector  has  three                                                               
different levels  of plans; Alaska  has gold, silver  and bronze.                                                               
These classifications are  based on the fiscal  elements, such as                                                               
deductibles, co-pays,  co-insurance, and  out-of-pocket maximums.                                                               
The  board will  also  recommend essential  health care  services                                                               
that all  plans sold through  the clearing house  should include.                                                               
These recommendations would  then be put in front of  a body such                                                               
as the  legislature where  they could be  fleshed by  a committee                                                               
and discussed for possible implementation.                                                                                      
The financial  criteria of  the plans are  not specified  by this                                                               
bill, and  a lot of  people have  raised concerns. The  bill does                                                               
provide  a  very  broad  definition   of  essential  health  care                                                               
services and everyone will not be  forced to get a $10,000 health                                                               
care  plan  that  has  $100 deductible.  The  only  direction  it                                                               
provides can be  found on page 5, lines 6-8,  which requires that                                                               
"a health  care plan issued  through the clearing house  that can                                                               
protect an insured  from severe financial hardship  caused by the                                                               
cost  of  receiving  care."  The goal  is  to  maximize  consumer                                                               
choice,  not limit  it.  Studies have  shown  that most  personal                                                               
bankruptcies include a medical element.                                                                                         
1:50:40 PM                                                                                                                    
MR. MODEROW  said the board  will also provide procedures  for an                                                               
annual  open  season  where  customers   can  change  their  plan                                                               
choices.  This  season will  reduce  a  moral hazard  of  someone                                                               
buying a  high deductible  plan and then  deciding once  they get                                                               
into a car  accident, which they caused and  therefore their plan                                                               
must cover, from then upgrading to a low deductible plan.                                                                       
The  next section  describes the  health care  clearing house  on                                                               
page  5, line  12. It  will be  the place  where Alaskans  become                                                               
connected with private  health care plans that  suit their needs.                                                               
Two examples exist now -  the Massachusetts Health Care Connector                                                               
that needs a zip code to  work and another example is the Federal                                                               
Employee Health Benefits Plan System.                                                                                           
1:52:23 PM                                                                                                                    
SENATOR THOMAS said  that Massachusetts is small state  and had a                                                               
small population that  wasn't covered by insurance  and asked how                                                               
this  would insure  that Alaska's  remote areas  that don't  even                                                               
have telephone get the clearing house information.                                                                              
MR. MODEROW replied  that is a great question and  is part of the                                                               
reason for leaving the clearing  house decision and fine print up                                                               
to the board to determine.                                                                                                      
SENATOR THOMAS asked the difference  between a licensed insurance                                                               
producer and  somebody who  is licensed  to transact  health care                                                               
insurance in the state.                                                                                                         
MR.  MODEROW replied  that a  producer is  someone who  looks and                                                               
works  with individuals  on  the  ground on  the  specifics of  a                                                               
particular  health care  plan,  and  an insurance  representative                                                               
would be more from the business side aggregate.                                                                                 
1:54:17 PM                                                                                                                    
LINDA  HALL,  Director,  Division  of  Insurance,  Department  of                                                               
Commerce,  Community  &  Economic  Development,  added  that  the                                                               
difference is that  the first one is an insurance  agent, and the                                                               
second is the actual insurance company.                                                                                         
MR. MODEROW directed attention to  Sec. 21.54.240 on page 5, line                                                               
22,   that  created   needs-based  vouchers   and  includes   the                                                               
individual  responsibility clause,  two major  components of  the                                                               
legislation  that make  it possible.  Section  (a) includes  that                                                               
individual   responsibility  clause   which  outlines   that  all                                                               
Alaskans shall  have meaningful  health coverage.  Sec. 21.54.240                                                               
(1)-(7) has  specific examples  of what  will qualify  to fulfill                                                               
that end - individuals who are  covered under an employer plan or                                                               
other publicly  funded options and IHS  recipients are considered                                                               
in compliance  with having health  coverage. Subsection (8)  is a                                                               
religious  exception  that allows  someone  who  has deeply  held                                                               
religious beliefs who  objects to the overall program  to opt out                                                               
health   coverage  altogether.   Massachusetts   has  a   similar                                                               
1:55:34 PM                                                                                                                    
MR. MODEROW said  subsection (g) on page 7,  lines 20-26, mention                                                               
that people who  have health coverage under  (1)-(7) or elsewhere                                                               
will not be eligible to  receive needs-based vouchers to purchase                                                               
health coverage.  The idea is  if you are eligible  for Medicaid,                                                               
that is where you get health  coverage; you don't have the option                                                               
to receive money to buy an additional health coverage plan.                                                                     
SENATOR PASKVAN asked  what the function of  the one-year minimum                                                               
requirement was on page 7, line 26.                                                                                             
MR.  MODEROW  replied the  purpose  of  this legislation  was  to                                                               
reduce  the  impact  of  people  moving to  Alaska  just  to  get                                                               
affordable health coverage.  It is similar to  the Permanent Fund                                                               
He  explained that  under the  needs-based vouchers,  this year's                                                               
federal poverty level has been  set at $13,530 for individuals or                                                               
$27,570 for a family of four.  On page 6, line 28, subsection (c)                                                               
provides a  guaranty that anyone  who falls below that  line will                                                               
not  have  to  pay  for  the health  coverage  they  receive.  He                                                               
explained that  many people who  fall below the poverty  line are                                                               
qualified for  other publicly funded options  like Medicaid. They                                                               
might have co-pays or deductibles,  but this will have to protect                                                               
them from severe financial hardship in the future.                                                                              
On  page 7,  line 3  (d) sets  up a  sliding scale  for vouchers.                                                               
Individuals  who earn  from 100  to  300 percent  of the  federal                                                               
poverty  level will  get  vouchers based  on  earnings with  more                                                               
assistance going to  those who earn less. On page  7, line 10 (e)                                                               
requires all  who earn  over 300 percent  of the  federal poverty                                                               
level  who do  not  fall under  one of  those  exceptions in  (a)                                                               
acquire   health  coverage.   They   won't  receive   needs-based                                                               
vouchers, but  they might receive specified  beneficiary vouchers                                                               
which are provided for later in the bill.                                                                                       
On page  6, line 15,  subsection (b) provides larger  vouchers to                                                               
individuals who  only qualify for ACHIA  coverage. Subsection (f)                                                               
insures that  only legal residents  of Alaska will  receive these                                                               
needs-based vouchers.                                                                                                           
1:59:14 PM                                                                                                                    
Sec.  21.54.250  is  where essential  health  care  services  are                                                               
defined; it requires  that all health plans sold  in the clearing                                                               
house include  coverage for certain  things such  as preventative                                                               
and  primary care,  emergency  services,  inpatient services  and                                                               
hospital  treatment,  ambulatory patient  services,  prescription                                                               
drug coverage and mental health services.                                                                                       
MR. MODEROW  said on page  8, line  7, Sec. 21.54.260  begins and                                                               
relates to employer  coverage and the employer levy;  (a) and (b)                                                               
are included  so nothing  has to  change in  employer-based plans                                                               
should an  employer want to keep  those plans going the  way they                                                               
are currently set up.  On page 8, line 13, (c)  and (d) relate to                                                               
employer levy;  the rules are pretty  simple. If you are  a small                                                               
employer who  has a  payroll of  less than  $500,000 there  is no                                                               
levy  required on  the  payroll. For  businesses  with a  payroll                                                               
between $500,000 and  $1,000,000 there will be a  1 percent levy.                                                               
For business  with a payroll  greater than $1,000,000  there will                                                               
be a 2 percent levy.                                                                                                            
He explained that  there are multiple ways that this  levy is not                                                               
actually levied against  a payroll, and if  you provide employees                                                               
with health  coverage, you don't  have to pay it.  The definition                                                               
of being  a providing employer  requires that an  employer either                                                               
offers  to  pay  33  percent   of  the  health  care  premium  or                                                               
successfully  enrolls  25  percent   of  his  employees.  Another                                                               
element on page 8, line 29, (d)  that says if an employer sets up                                                               
a Section  125 account,  a way for  employees to  purchase health                                                               
services  with pre-federal  tax dollars,  they are  exempted from                                                               
levies entirely.                                                                                                                
2:02:10 PM                                                                                                                    
Sec.  21.54.270 on  page 9,  line 5,  discusses the  structure of                                                               
insurance  plans available  in the  clearing house;  (a) outlines                                                               
that plans sold in the  clearing house must meet the requirements                                                               
of this  legislation and  those under  the insurance  statutes in                                                               
Title  21.  This  insures  a   baseline  of  quality  for  plans.                                                               
Subsection (b) mandates that an  insurance company not be able to                                                               
turn down  people looking  for coverage for  a plan  sold through                                                               
the clearing house (the guaranty  part). Subsection (c) clarifies                                                               
that health  insurance plans can  have financial  conditions such                                                               
as  deductibles,   co-pays  and   co-insurance  that   vary;  (d)                                                               
increases  the dependent  age to  25 years  of age  or until  two                                                               
years after the dependent no longer resides with the family.                                                                    
Subsections (e) and  (f) are new elements, and  like the guaranty                                                               
provision, they  are made possible  by getting everyone  into the                                                               
insurance pool.  Both borrow from  current small  group insurance                                                               
regulation in statute.                                                                                                          
On  page   9,  line  25,  subsection   (e)  defines  pre-existing                                                               
condition  exclusions that  are allowable  in plans  sold through                                                               
the health  care clearing  house. They are  patterned off  of the                                                               
currently  applicable  small  group insurance  statutes  in  Sec.                                                               
21.54.110(a)  and they  provide  protections  to individuals  who                                                               
have employment-based coverage to  those in the individual market                                                               
and  plans sold  through  the clearing  house. Subsection  (e)(1)                                                               
requires  that  insurers  consider  no more  than  two  years  of                                                               
medical history  when establishing  that a  preexisting condition                                                               
exists; (e)(2) prohibits the creation  of a preexisting condition                                                               
only  on  the grounds  of  genetic  information; (e)(3)  prevents                                                               
these  exclusions from  extending longer  than 12  months, though                                                               
depending  on  prior  coverage  that  may  be  shortened;  (e)(4)                                                               
prohibits considering pregnancy as a preexisting condition.                                                                     
Subsection (f) relates to credible  coverage and how that relates                                                               
to the  preexisting condition exclusions  under (e).  Language on                                                               
page  10,  line  5,  requires that  any  pre  existing  condition                                                               
exclusion is  reduced by  periods of credible  coverage if  it is                                                               
applicable. This language is mostly taken from 21.54.110(b).                                                                    
2:05:45 PM                                                                                                                    
Page  10,  lines  5-9,  describe plans  that  count  as  credible                                                               
coverage  under the  bill; these  are essentially  any plan  that                                                               
count as credible coverage under  small group rules plus any plan                                                               
sold through  the health  care clearing  house; it  also includes                                                               
Medicaid recipients.  It requires  that a  pre-existing condition                                                               
exclusion must  be reduced from the  maximum of 12 months  by the                                                               
length of  continuous credible coverage an  individual had before                                                               
they  acquired  new coverage  through  the  health care  clearing                                                               
house.  It requires  that  any  type of  plan  that fulfills  the                                                               
individual mandate  under AS 21.54.240  of this  legislation will                                                               
count  as credible  coverage in  addition to  plans that  fit the                                                               
definition under AS 21.54.120 (current small group regulation).                                                                 
Language  on  page  10,  lines   9-12,  outlines  that  the  term                                                               
"continuous" means  that a 90-day  break in coverage prior  to an                                                               
enrollment date in  a clearing house plan will not  be counted as                                                               
continuous. Lines  14-15 allow  for waiting  periods if  they are                                                               
applicable for a  health plan; the State of Alaska  has a waiting                                                               
period where new employees have  to wait until coverage kicks in,                                                               
and  that  is still  allowable  despite  this new  language.  Mr.                                                               
Moderow  said (e)  and (f)  insure that  people aren't  penalized                                                               
when they switch  from one benefit plan to another  in the health                                                               
care  clearing house  whether  it be  due to  a  change to  their                                                               
employment,  their financial  situation  or  family status.  Many                                                               
other  states include  similar protections  for consumers  and in                                                               
Alaska these requirements  currently do exist in  the small group                                                               
2:07:18 PM                                                                                                                    
SENATOR THOMAS  said that insurance  coverage usually  runs month                                                               
to month,  and a 90-day period  could start or end  in the middle                                                               
of any particular month. Was there  some reason for using 90 days                                                               
versus using calendar months?                                                                                                   
MR.  MODEROW answered  they patterned  this off  the small  group                                                               
statutes and  didn't consider  using a  calendar month.  He would                                                               
look into it for him, though. Other states use days or years.                                                                   
MR. MODEROW said Sec. 21.54.280  on page 10, line 16, establishes                                                               
the  health care  fund and  describes  the specified  beneficiary                                                               
vouchers. The  health fund will be  a separate trust fund  of the                                                               
state  and  will  include state  money  and  appropriations,  any                                                               
federal dollars and the employer levy.  This fund will be used to                                                               
pay out the sliding scale vouchers.                                                                                             
MR.  MODEROW  said subsection  (b)  describes  another source  of                                                               
funding that can  come into the fund, but these  will not be used                                                               
for  the needs-based  vouchers. These  are specified  beneficiary                                                               
vouchers which  give an  employer the option  of providing  a set                                                               
number of dollars  to their employees to  purchase health benefit                                                               
plans. Last  year they heard  testimony from business  owners who                                                               
wanted to contribute something to  an employee's health benefits,                                                               
but they couldn't sponsor an entire  plan. This will give them an                                                               
accountable way  to give  dollars to their  employees to  use for                                                               
the purchase of health coverage.                                                                                                
Sec.  21.54.290  on  page  11, line  7,  discusses  disputes  and                                                               
appeals and  the process that  can go  through. Page 11,  line 16                                                               
relates to  reporting and  provides for an  annual report  by the                                                               
health care  board that includes  statistics relating to  how the                                                               
program  is performing  and it  has other  topics that  should be                                                               
discussed annually to  be presented to the  legislature and other                                                               
bodies  related to  electronic health  records, S-chip  programs,                                                               
effective mandated benefits and other things.                                                                                   
MR. MODEROW  said Sec. 21.54.310  says that any  regulations will                                                               
be established under the Administrative Procedure Act.                                                                          
2:10:43 PM                                                                                                                    
SENATOR THOMAS asked if they  got the idea of people contributing                                                               
to plans from the Massachusetts plan.                                                                                           
MR. MODEROW  replied that Massachusetts has  something like that,                                                               
but this was  requested last year by the owner  of Snow City Café                                                               
whose  owner  actually  contributes  dollars  to  her  employees'                                                               
health care.                                                                                                                    
SENATOR THOMAS  asked if the 2  percent of gross payroll  for the                                                               
sliding scale vouchers goes to the health care fund.                                                                            
MR. MODEROW answered yes.                                                                                                       
CHAIR DAVIS announced the beginning of public testimony.                                                                        
2:12:23 PM                                                                                                                    
MARIE DARLIN, AARP Capital City  Taskforce, supported SB 61. AARP                                                               
wanted to  get something started  that would address  the problem                                                               
of those without  insurance. They are also  concerned that access                                                               
to affordable  coverage is getting increasingly  difficult to get                                                               
particular before  people are  covered by  Medicare in  the 50-64                                                               
age  group;  even those  with  Medicare  have trouble  finding  a                                                               
physician. She  submitted a letter  with questions that  AARP was                                                               
asking, and  said they would be  following the bill and  hope for                                                               
progress this year.                                                                                                             
CHAIR DAVIS said  she also was particularly  concerned about that                                                               
age group as well and that  she would have a subcommittee looking                                                               
at some of these issues.                                                                                                        
2:15:55 PM                                                                                                                    
BEVERLY  SMITH, Christian  Science Committee  on Publication  for                                                               
the  State of  Alaska,  wanted  to make  sure  the committee  had                                                               
accurate information regarding spiritual  healing as practiced in                                                               
Christian Science so  that this cost effective  and reliable form                                                               
of health  care is  not overlooked or  restricted in  the state's                                                               
health care  reform efforts in SB  61. In this regard,  she said,                                                               
it is important  to preserve peoples' choice  to pursue spiritual                                                               
means for the prevention and  cure of disease including Christian                                                               
Science  treatment  and  care  and this  legislation  can  be  an                                                               
important  avenue for  doing  so. She  thanked  the sponsors  for                                                               
including  the opt-out  provision;  however, to  meet the  health                                                               
care  needs  of  all  Alaskans,  they  feel  health  care  reform                                                               
legislation should  include coverage  for spiritual  care similar                                                               
to state and federal government plans which currently do so.                                                                    
To  accomplish  this,  she requested  that  they  incorporate  an                                                               
amendment  that includes  a definition  of "essential  healthcare                                                               
services  as  used   in  Sec.  21.54.250  that   says  "shall  be                                                               
interpreted to  include non-medical healthcare  services provided                                                               
by   a  religious   non-medical   provider  is   defined  in   AS                                                               
21.07.250(15)."  This  definition   says  "religious  non-medical                                                               
provider" means a  person who does not provide  medical care, but                                                               
who  provides only  religious  non-medical  treatment or  nursing                                                               
care for an illness or injury.                                                                                                  
MS.  SMITH   also  provided  an  attachment   called  "Access  to                                                               
Spiritual Care"  which sets forth  the explanation  for including                                                               
religious non-medical  care in SB  61. It says  that prayer-based                                                               
healing has  been a mainstay in  American life for years;  it has                                                               
remained some people's primary means  of health care because they                                                               
trust its  effectiveness, its  completeness and  its reliability.                                                               
Having the option  to choose is important to many  more. She said                                                               
Christian  Science  is  a  method   of  spiritual  care  that  is                                                               
accessible to  everyone. She said that  Christian Science doctors                                                               
provide the prayer  and nurses take care of  daily physical needs                                                               
while the patient prays for healing.                                                                                            
2:20:41 PM                                                                                                                    
MS.  SMITH   said  she  identified  two   areas  where  statutory                                                               
provisions may  be needed to  achieve public access  to spiritual                                                               
care. One is  that it should be covered by  insurance, and two is                                                               
that  religious  non-medical  care   should  be  accommodated  in                                                               
managed care  insurance plans, which Alaska  is already pursuing.                                                               
If  people  are finding  cures  through  spiritual means  without                                                               
large health care costs, it should be encouraged.                                                                               
2:21:50 PM                                                                                                                    
PATTY BOILY,  representing herself,  Homer, Alaska, said  she has                                                               
worked  in  health care  as  a  certified coding  specialist  for                                                               
physician-based offices  for 25 years,  and that she  hasn't been                                                               
insured since June 2008, and prior  to that she had ACHIA, but it                                                               
became too expensive - at $10,000 per year plus 20 percent.                                                                     
MS. BOILY  said she  supported SB 61.  She supported  a universal                                                               
single payer system,  but didn't see that happening  soon; so she                                                               
thought it  was time  for the  State of  Alaska to  do something.                                                               
People who  are not insured can't  afford to pay their  bills, so                                                               
either they go through bankruptcy  or they go through the poverty                                                               
programs at the hospitals.                                                                                                      
She related  that her  son who is  now 28 years  old had  to have                                                               
urgent open heart surgery about a  year ago. He had no history of                                                               
heart  problems; it  happened suddenly.  Alaska Medicaid  doesn't                                                               
have  anything  for  single  adults  that  don't  have  dependent                                                               
children.  He was  able to  get preemptively  disabled by  Social                                                               
Security, which  made him  eligible for  Medicaid that  picked up                                                               
all his  bills. But  now that the  surgery is over  and he  is no                                                               
longer disabled,  he no longer  has Social Security  or Medicaid.                                                               
He still needs to have an  $1,800 echocardiogram, which he has no                                                               
money for,  and he  is now  uninsurable. She  strongly encouraged                                                               
them to get this bill passed.                                                                                                   
2:25:44 PM                                                                                                                    
CHAIR DAVIS said she agrees that  Alaska has to do something, and                                                               
gave  her   hope  that  the  federal   government  would  address                                                               
situations like her son's this year.                                                                                            
2:26:38 PM                                                                                                                    
CHAIR  DAVIS,  seeing no  further  testimony,  closed the  public                                                               
hearing.  She asked  for  volunteers for  a  subcommittee and  if                                                               
Senator Ellis would be willing to work on it.                                                                                   
SENATOR ELLIS responded that he is  a supporter of the bill as it                                                               
CHAIR DAVIS said  that may be so, but there  are some issues that                                                               
need to be addressed.                                                                                                           
2:28:59 PM                                                                                                                    
SENATOR ELLIS said he would be  happy to serve on a subcommittee;                                                               
Senator Paskvan volunteered as well.                                                                                            
SENATOR  THOMAS asked  what  the penalty  is  for not  purchasing                                                               
2:30:22 PM                                                                                                                    
MR. MODEROW replied  that it isn't specified,  but Senator French                                                               
said he didn't anticipate throwing  people in jail for not having                                                               
health  care   coverage.  This  issue   would  be   addressed  in                                                               
SENATOR THOMAS asked  as more people get into  that system, would                                                               
that   increase  the   number  of   physicians  who   would  take                                                               
Medicaid/Medicare patients.                                                                                                     
MR. MODEROW  replied that  Massachusetts found  that the  time it                                                               
took  to  get  in  to  see  a  primary  care  physician  actually                                                               
increased  after   their  plan   increased  coverage.   This  was                                                               
partially caused by  the fact that there were  new customers able                                                               
to afford primary care for the  first time. It reduced the number                                                               
of people whose needs were not cared for in the first place.                                                                    
2:31:56 PM                                                                                                                    
CHAIR DAVIS  said she would  pass all  the information on  to the                                                               
subcommittee and  get back  to the sponsor  to schedule  the next                                                               
meeting. [SB 61 was held in committee.]                                                                                         

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