This meeting of the House Labor and Commerce Committee will come to order.
The time is 3.18 p.m. on Wednesday, February 4th.
Members present are Representative Carrick, Representative Colomb,
Representative Freer, representative Sadler,
Representative Nelson, co-chair field and myself co chair Hall.
We have a quorum.
Please silence your cell phones and we're asking that staff and members of the audience not approach the table.
If you need to pass a note to committee members, please get the attention of my committee aide Joan Wilkerson and she will handle it.
I'd like to thank Andrew Magnuson, the Labor and Commerce Committee Secretary, and Chloe
Miller from the Juno LAO for their technical and teleconferencing support.
We have two presentations on the agenda today.
Our first presentation will be licensing
for genetic counselors,
followed by a second presentation
on The Rising Cost of Health Care.
And for the public's awareness,
we anticipate the likelihood of having an extended at ease
between the two presentations
due to some time restrictions
with the second presentation.
But up first is the presentation on licensing
for your genetic counselor.
We will hear from Monty Worthington,
Academic Councillor, so Mr. Worthington, please have a seat before the committee,
stage your full name for the record, begin your presentation, and thank you very much for your time today.
We appreciate it.
Speaking of one of these.
Yes, sir.
All right, my name is Monty Wor
And I'm a certified genetic counselor with a master's in human genetics and genetic counseling from Stanford University
On behalf of myself and my colleagues at the Providence Cancer Center
We want to thank the committee for considering a bill and representative fields for sponsoring the bill that would provide requirements for licensure for genetic counselors in Alaska
Appreciate the opportunity to testify in favor of this important legislation as a bit of background. I'd like to
I'll point out that Alaska is currently only one of 12 states that have not passed legislation to establish licensure for genetic counselors.
There are several reasons I would like to highlight that licensured for
genetic counselor in Alaska would be valuable.
These include reductions in harms to patients due to genetic counseling services being provided by unqualified individuals.
increasing access to genetic counseling services for Alaskans and the economic benefits licensure
would bring. Before I talk about licensures itself though, I would like to speak to what
genetic counselors do. I work as a genetic counselor at the Providence Cancer Center where I provide
care to individuals with personal and or family histories of cancer. With these patients,
as it relates to cancer and assess the likelihood of there being a heritable component to this
history. I provide education on familial and hereditary cancer risks and enter into a shared
decision-making with my patients on whether to move forward with genetic testing and if so,
discuss options for genetic test to order and specify the appropriate test for the patient.
and provide up-to-date risk assessment and cancer screening guidelines for patients and their family members.
I provide counseling and psychosocial support to patients during our visits,
particularly as it pertains to the complexity of genetic tests and
their impacts on patients' and families.
I sit on multidisciplinary tumor boards to provide input on appropriate patients to offer genetic testing to
and the potential utility of this genetic test.
cases, results of genetic testing can provide information to proactively manage cancer risk
for patients and their families. And in other cases it can open up treatment modalities
that may be more effective in treating a person's particular cancer than typical standard of care
treatments might. Genetic counselors are employed in a wide range of clinical care,
academic, laboratory, research, and biotech settings.
In human and medical genetics, patient education, psychosocial counseling obtained
through a two years master level program. In the clinical care setting, genetic counselors are
found in the specialties including prenatal, pediatrics, oncology, cardiology, neurology,
and many other specialities. Genetic counselors
are key players in appropriately integrating genetics into health care.
We provide expertise in genetics to patients and also provide this expertise to their other healthcare providers.
Working hand-in-hand with physicians and other health care providers, we can help to identify those individuals most appropriate
for consideration of genetic testing for hereditary conditions
and provide interpretation of test results to help guide their providers in managing identified genetic conditions.
and live in Alaska and at least one genetic counselor who lives here but
provides genetic counseling to patients in other states. These genetic counselors
work providing patient care and specialties including prenatal oncology,
pediatrics, cardiology and some other adult onset conditions. In addition there
are a number of genetic counsellors who work for genetic testing labs or
genetic consultancies who provide care to patient in Alaskan but reside in
By way of example, a single hereditary cancer genetic testing lab has at least 60 genetic counselors who provide these types of services.
Many of them license it in all states that offer licensure, and able to practice in Alaska by default since we lack state licensures.
Currently in Alaskan, there is no legal standard for who can represent themselves as a genetic counselor.
licensure would provide a standard for those who present themselves as genetic counselors
and in doing so would be valuable in several ways. A few of these I would like to highlight
include the following. Firstly, requirements for the licensured genetic
counselors would protect patients from harms by ensuring minimum standards
to provide genetic counseling in terms of academic achievement, clinical experience,
continuing education, and the skills necessary to deliver high quality genetic
As the field of medical genetics grows, there is and will continue to be a need to provide the residents of Alaska with accurate information regarding their genetic risks and accurate interpretation of the results of genetic tests.
While a couple decades ago, genetic information was utilized in only a few healthcare specialties.
Today, it is hard to find an area of where medicine where genetics does not have a role to play.
Likewise, the complexity of genetic tests has continued to increase and step with this growth.
Qualified genetic counselors fill this space in the healthcare field,
providing the expertise to ensure the right patients are offered genetic testing,
the Right Genetic Tests are ordered for these patients,
and the results of these tests are accurately interpreted for patients and their healthcare providers.
A standard that qualifies who can be trusted to ensure this is handled with expertise, significant harms can occur.
The residents of Alaska deserve to have access to professionals who have been deemed qualified by the state to help them understand the potential and
actual impact of genetic information on their health.
Licensure would provide this qualification for genetic counselors in Alaska.
Licensure for genetic counselors would make services provided by genetic
counselors more easily billable and reimbursable through private payers and Medicaid.
In states that lack licensure, like Alaska, genetic
counselors cannot build profies through
private insurance and are only able to build incident services,
making their services largely not worth the effort at reimbursement.
This leaves employment opportunities in these states largely limited to those employers who value the downstream revenue,
institutional expertise, and credentialing,
and community and patient benefit provided through genetic counselors.
Likewise, among states without licensure for genetic counters,
none of the Medicaid programs list genetic cancers as enrolling providers.
Ultimately, these barriers to reimbursement and recognition through lack of licensure
lead to more limited access for Alaska's residents to genetic counseling services.
Recent changes to billing codes for genetic counselors combined with ongoing efforts at
the federal level through the recently reintroduced Access to Genetic Counselor Services Act to
enable genetic accounting services to be reimbursed through Medicare combined
and correspondingly increase access to genetic counseling services for patients in Alaska.
Thirdly, this bill providing genetic licensure for genetic counselors in
Alaska would enable genetic, genetic counselor to order genetic tests.
And yes, you heard that correctly. Currently in
Alaska, Genetic counselors are not
We rely on our physician partners through referrals and other licensed advanced practice providers through
referrals, and orders are placed under these provider's names, even though the tests are
specified by genetic counselors, results are disclosed to patients by
genetic counselor and interpreted for both patients and the referring providers by
genetic counsels.
Licensure would enable genetic counseling to more fully perform the scope of practice,
further reducing barriers that limit access and complicate health care for
This legislation is important to Alaska in terms of maintaining a high-quality genetic counseling workforce.
In the current climate, genetic counselors from Alaska may need to seek employment outside of Alaska
in states with licensure, where employment opportunities are greater.
We may also have a hard time attracting new graduates from outside the state to practice here
or may not get the same caliber of graduates as states' with licenses.
We urge you
to enact legislation that would establish requirements
for the licensure of genetic counselors.
This legislation will in turn reduce barriers
to genetic counseling and testing for Alaska residents
while also reducing the incidence of harms
associated with these services.
This legislature will increase job opportunities
for genetic counselor Alaska,
provide economic stimulus through enabling reimbursement
for these service and through licensing fees.
In conclusion,
Me and my genetic counseling colleagues and I in Alaska and many of our physician partners are hopeful that this committee will move forward with this bill to provide genetic
counseling licensure that will ensure the people of Alaska receive quality genetic
counseling services. We believe the People of Alaskan will be well served.
We thank the chairs and this Committee for your attention to this important issue and we offer ourselves as a resource as you move
Thank you very much, Mr. Worthington, for your testimony and presentation.
For the committee's awareness, we do anticipate hearing co-chair fields bill next week.
That is HB 293, that is the bill that Mr Worllington is referencing.
I also want to make a note that on the line we also have Ms. April O'Connor.
She is also a certified genetic counselor, and she has extensive experience being a genetic
counselor in other states.
related to how other states go about their licensure.
She is a resource, and with that, I will turn it over to committee questions.
And I believe we're going to be starting with Representative Sadler.
Thank you, Madam Chair and through the Chair, Mr. Worvinton.
Until I saw this bill come up,
I had never heard of genetic counseling, so I appreciate the little bit you told us about what it is.
So I have two questions, if I may.
what credentials are there in the field of genetic counseling and second how many
genetic counselors are they in Alaska certainly they're not licensed but of
whatever caliber. Sure so at the national level there is certification for genetic
counseling that's done through the the April help me out with the acronym the
She's on the line American board of genetic counseling. Thank you. Yeah, thank you for the record. That was miss April O'Connor. Yes
So that's how we're certified nationally, but there's no state in Alaska. No state licensure
Currently 35 states have licensures established and two others have passed legislation and are in the rulemaking process
My representative Sadler
You know, counselors are there in Alaska.
There's seven of us who work at work in
Alaska and live here.
And there's at least one who lives here,
but provides care for patients in other states.
You said?
Yeah.
That will turn to Representative Carrick.
Thank you through the chair.
I also had not heard.
genetic counseling before today. So I really appreciate the introduction. Are
all of the seven current genetic counselors working in Anchorage or are
they spread around the state a little bit? That's a good that's
a great question.
So three of us work at the Providence Cancer Center together and it includes
April who's on the phone. There is three who provide character to the
I'm trying to remember who this the seventh one is
There is one genetic counselor who lives here in june and provides care to people working people in others of this other states
Thank you follow-up representative karek. Thank You
I probably have a lot of questions on the subject we could say for future hearings of the bill, but just
through the chair
The one question you always ask about licensure is what are some of that?
issues of folks may be practicing without the same kind of certification and credentials that
you and some of your colleagues have, and how prevalent is that sort of outside the certified
practice in Alaska? How prevalent does that? So when you say issues, you mean like what sort
of harms come about because people are practicing, without licensure, or maybe without qualification?
So generally, if we're going to license a profession, I want to know that there's that
there're issues with people or potential issues, with
people operating outside the scope of what we are licensing.
And so I'm just trying to get a sense of, do we have folks calling themselves genetic
In Alaska, has it been a problem in other states?
Just trying to get a sense of that.
Well, I think I might see April has more experience
with licensure and will also work in another state.
I mean, you know, if you have anything to add
to this question, April, and I can chime in if
you don't.
And real quick, before Ms. O'Connor,
you weigh in, Mr. Worthington,
I understand that this is your first time testifying
before a committee.
And so I just want to let you
know if could please follow protocol,
Through the chair through the co-chair. Okay. It's just one of our standard understand procedures
No problem whatsoever. I totally understand it's your first time and with that missile O'Connor are you available to?
Answer representative kerricks question
Yes, certainly. So yes, I have been a genetic counselor practicing for 21 years now, and
I've seen in Alaska in the time that I'd been here for four years practicing the Providence
Cancer Center that we do on a fairly I would say
regular basis come across a scenario where a patient has been misinformed of
potentially the inheritance pattern of a test result or is unclear if the role
of genetics in their care and the concern is that they had misinformation
potentially provided by a different provider not someone who was trained
in the field of Genetics. I've come
across that throughout my career working in other states as well.
I currently also practice cardiology for a hospital in Tennessee and this has been a
concern as well where a test result has misinterpreted and the individual thought that they did
have the disease of concern and they were establishing care and being treated for such
condition when truly based on their genetics they are at risk to develop such condition
And so essentially they were over-treated and risk-benefit scenario there was not appropriate for the care that they had received.
So to answer your question, yes, I have seen this occur throughout my career, where there were concerns for patient
safeties and treatments and establishing appropriate care plans that were not correct for
the patient based off of inappropriate understanding and misinterpretation of genetic test results and inheritance patterns.
Thank you very much.
Thank you, Miss O'Connor next in the queue. We have representative Cologne followed by representative my co-chair fields
Thank You chair through the chair
So I had a couple of questions you can just stop me if I'm going too long
But so I am trying to get my head wrapped around why why does someone get a genetic counselor?
I mean you mentioned cancer
Maybe it's like showing markers for cancer, but can you come you had at the beginning you listed some conditions
Can you tell me like?
why somebody would want genetic counseling,
like what kind of condition they have?
Sure. So through the co-chair,
the way that the medical system and how we're
integrated into works is typically someone's provider,
whether it's their primary care provider or
a specialist is evaluating someone for some condition.
It can be anything. It could be cancer,
it could a cardio condition,
and they recognize there might be
the health condition, the person is experiencing.
And that's when they refer to genetic counseling.
They generally refer
to a genetic counselor and that specialty.
If it's a cardio, they're going to refer
to the cardiogenic counselor.
If we have strong family history of cancer, for instance,
they would refer
to see one of us at the Providence Cancer Center.
And our role is to step in and dig deeper
into that family personal history, better assess,
is there likely to be a heritable component
to this condition and what genetic testing might.
illuminate that and what it might mean for the patient's care and isn't you
know something that's worth the patience considering and doing.
So through the chair so what is so for
the licensed Genet counselors what does your error rate I mean are you pretty
accurate with the testing or is there a percentage that is comes across is that
Through the co-chair, as far as the tests themselves,
those are highly accurate.
The only ways that you really end up with errors
from the actual test that we receive
is there is a classification of genetic variants
and it ranges from pathogenic, meaning the lab
is very sure it causes a disease.
to benign, meaning they're very sure it doesn't,
but there's also likely pathogenic and likely benign
which they are pretty sure causes disease
and there is even uncertain variants.
So that's with the genetic test themselves,
we always look at those variants,
how confident is the testing lab
in calling that variant and is there evidence strong
that this is a disease causing genetic variant or not.
So the actual result of the test,
the DNA spelling is what it is.
really a hundred percent accurate, how that's interpreted. There is some science behind that
that we always take our training and put the magnifying glass to that, so to speak, to assess
is this quality information that were receiving and is very classified. Right.
Okay, follow up. So, there is an interpretation level there, kind of like reading x-rays or reading,
like sometimes you can get it wrong or it's like it is not just a you don't just put a machine
and they say you have these markers and that's it. That's right there is a level of interpretation
correct. I have another question but I can wait. Okay well we'll definitely come back to you.
Thank you Representative Colomb. Next in the queue we have Representative Fields.
Thank You Thrift Chair. Question for Miss O'Connor or Mr Worthington.
without a sustainable billing model which we lack now because we don't have licensure only the
very largest employers i.e. providence and scf will be able to employ genet counselors and
presumably with licensor with a more sustainable billing model. It could make sense for other
smaller providers to have a genetic counselors that an accurate assumption.
This is mountain where they tend through the coach here. Yeah, I agree it's accurate that it
And I think April could have some good input on this as well if she is interested in responding miss O'Connor
Yes, thank you. This is April O'Connor through the co-chairs. Well, yes, this is true because currently with now having licensure
It is a lot of downstream revenues kind of the revenue that the company would see if they had employed a genetic counselor
To drive other things like if someone is positive on a kinetic test result for hereditary cancer
They may need additional screenings to be appropriate and then at that point they receive those screenings at an institution
So certainly if we can build a professional level then that points there is more revenue
with the genetic counselor, so you are correct in saying them that at licensed states there
are more opportunities for genetic counselors, there are larger roles because of a very wide
range of various entities that can employ us because they can afford to employ as.
Okay, let's go follow up.
Thank you.
So I was wondering if you could elaborate a little bit on the pretty rapid technological
people's genetic information, which, if I understand it,
enables you all as part of a team to provide both better care
and improve health care outcomes,
but also more efficient care.
Could you just talk a little bit more about
what are some of these rapid technological advances
and where does it seem like your field might be going?
Thank you.
May, this is April.
May I take this question, Monty, would that be okay?
Please go ahead, Ms. O'Connor.
Thank you very much through the co-chair. Yes, a lot of the field of genetics is evolving into targeted therapies, pharmacogenomics and genetics.
And so that has opened a very large role for the geneticists and genetic counselors to be able to provide genetic counseling for a patient,
and then based off of what gene may be involved or the specific genetic variant as Monte was alluding to,
and the gene can then drive care. There are some targeted therapeutics where the certain gene is the driver, for example, in hereditary
cardiomyopathies as well as cancer conditions where we use that therapeutic when that gene
is the driving cause of the disease state and the patient.
So therefore our ability to specifically care for this patient have an appropriate care
plan is very much determined by their genetic status, therefore their need for genetics.
Thank you, Ms. O'Connor.
Mr. Worthington, did you have anything you wanted to add?
Sure, through the co-chair I would also say in terms of genetic testing technologies there's a wide array
array of different ways to interrogate the genome,
so to speak, to test for things.
And knowing when you're looking for a particular disease
causing variant in a patient,
which test is appropriate is one of those things
where it is a constant learning curve.
You can't look away from that,
because if you do, you might end up ordering a test
that actually isn't gonna find what you are looking
for in the first place.
And so that's an area where we spend a lot of our time
staying current with the testing technologies
and making sure we are ordering the right test
for the patient.
Thank you, mr. Worthington
Next in the queue. We have representative Sadler followed followed by a representative column. Thank You through the chair, Mr
Montgomery
I'm kind of hung up on the the counselor aspect of the term. I am curious whether and to what degree
Genetic considerations are part of a typical diagnostic exercise the first place and that gets to
Is a counselor who are they counseling and who take responsibility for acting on?
the council
I think Representative Klom said that, you know,
are there x-ray counselors or are
there X-rays diagnostations who make decisions?
And I'm still not quite here in the case
of why genetic counseling deserves its own practice.
Representative Sadler, who is that question directed to?
I said to Mr. Moutington.
Mr Witherington?
Wutherington, pardon me.
So, through the co-chair.
So the title of genetic counselor has been established for more than 50 years
I think it was when the profession of having specialists in the medical field who work with genetics came about they were
Term genetic counselors. We provide our counseling primarily to our patients
Genetic information is complex and it doesn't just involve the individual it also involves their families often and there can be a lot of psychosocial
Concerns that come up and we are trained to address those and to
Sit with a patient and and walk with them through that process
And so I think in my mind that is that the where they counseling role sort of or title is
Is applied in the field
Thank you, mr. Rittington representative column
Thank You cochlear through the coacher
So my other question was so
Do most people that get a genetic counselor, are they adults?
Do they do this with children?
Yeah, this is Monty Worthington through the co-chair.
There are so there are special specialists who work in pediatrics.
When there.
complicated health conditions that are manifest in children,
genetic counseling can often be a part of that as we think of as a diagnostic
odyssey, trying to figure out why maybe a child isn't developing at the same
pace as their peers or something. So that is applied to pediatric conditions at
times. It is also important to know when it's not appropriate. In my
profession in cancer genetics, for instance, most of the genetics I work
on-set cancer risk, not childhood on set cancer risks.
And we can sometimes end up with situations where family members are very keen to test their
children for things that aren't going to manifest and won't change health care to adulthood.
And, we really...
Try to counsel these patients that it's probably not appropriate to test children and to preserve their autonomy might be a more ethical choice
It's not a hard and fast rule families or families and they make their own decisions
But we tried to guide them through the pitfalls and benefits when it isn't going to affect care until this person he reaches adulthood anyway
Thank you
Are there additional questions from the committee?
Representative Sadler, you mentioned that you'll certainly understand the profession or the practice so
Where in the value chain of diagnosis and treatment does a genetic counselor operate?
It sounds like you and your colleagues work for the Cancer Center in Anchorage to be frank.
Who pays you?
How do you get paid?
Who do your work forward?
Who to report to?
Who signed your paycheck?
So, I worked for the Providence, Alaska Medical System, and paid through the
Providence Cancer Center. And because our services are not largely
billable, it's one of the reasons licensure is really important.
I we can't recoup the cost by just billing our visits because most of them are not billable
and if they are they wouldn't be bill for very much. So we literally sit in the overhead of the
cancer center. They provide our services. Some of reasons they do that is it allows them for
credentialing as a as I comprehend some cancer care center requires genetic counseling for them
They're the overhead more or less.
Thank you, Mr. Worthington.
Other digital questions from the committee?
Representative Cara.
Thank You through the co-chair.
I also am just really interested in the profession.
Don't know much about it.
Is there a demand for prenatal genetic counseling
potential parents can understand risk factors.
Is that part of the profession too?
And I know you mentioned prenatal counseling,
but just was curious how, you know,
what percentage of genetic counselors, I guess,
in the country without concrete numbers needed?
But what's the general volume of
genetic counselor's working in oncology
versus in, say, prenatal care, or counseling?
related professions. And I know you mentioned the breakdown of those in Alaska, but just trying
to get a broader sense. Through the co-chair, I would offer Miss O'Connor's interest in answering
that she also works as a prenatal genetic counselor. So she might have more thorough insight than me.
Misso Connor.
Thank you. Yes, April O'Connor through the co-chair.
Yes
I have actually worked as a prenatal genetic counselor the entire my entire 21 years of my career
I currently work remotely for maternal fetal medicine specialist in Arizona whom I've worked for since 2008 and others and other
States prior to that and to answer your question
When I graduated in 2005, the majority of genetic counselors were in the prenatal space,
and it was approximately, oh goodness, about 60 to 70 percent of
genetic counselor were prenatal. Oncology was in its infancy then, because the first two
breast cancer genes, BRCA 1 and 2, VRCA 1, and VR CA2, you may have heard of them,
were found in 1994 and 96. So on 05, it is just getting started in
And then pediatrics, as well, was a part of that.
Now that has shifted.
Now, oncology is actually where the majority of genetic
counselors practice across the country.
It is more than 50% of the genetic counseling,
then followed by prenatal, a little.
But cardiology and neurology and pediatrix
have filled out the rest.
So yes, there is a role in prenatal genetics.
The majority the time, we meet with families
who are either increased risk.
My family has free for various hereditary conditions
that could affect a child.
and also the unborn child as well.
And we also discuss risk for things like Down syndrome,
for example, which pregnancies are,
how is it increased risk or based on maternal age
most of the time, and or abnormal ultrasound indications
that come up to counsel patients through,
whether or not we believe the etiology of that
is genetic or non-genetic counseling is appropriate.
We work very closely with maternal
fetal medicine specialists to do that.
Thank you, Ms. O'Connor.
Coach, your fields.
Thank You.
through the chair just to follow up on that.
So my understanding is sometimes maybe an older set of parents
or parents who are worried that they might have a heritable
condition or able to talk with Genet counselors
and actually be able
to have kids because of the guidance from Genent counselors.
Could you explain how that works, Ms. O'Connor?
Yes, definitely. So in states that I've worked where there's licensure,
maternal fetal medicine specialists have made the decision that every patient that they see who are, as you had mentioned, older.
That's typically the age of 35 or older for the mother, age 40 or the older, for
the father, they require them or encourage them to all have genetic counseling to walk through risk benefits and limitations of having a child at that stage in their life.
due to a higher risk of spontaneous,
what we call chromosome abnormalities,
like Down syndrome, for example.
Also to walk through, there is a path
of prenatal genetic counseling that's pre-conception
where IVF or reproductive endocrinologists
will employ genetic counselors to
walk though
Risks for a couple if they are experiencing having a high rate of miscarriage or inability to conceive as about 20% of the time
We do believe that that can have a genetic etiology and American College of Obstetrics and Gynecology does have guidelines that have been in place
Since the 1990s moving forward specifically for genetic testing for couples going through IVF or the prenatal space
So yes, there's a large role that us genetic counselors play there as part of our greater care team in a system patient
in those situations.
Follow-up, co-chair fields?
Yeah, just a statement that one of my motivations
in introducing this bill is as many families have kids.
Little later, I think it's really valuable to have
those resources, and I certainly have friends who
have had a harder time having kids,
and that support is really important.
Thank you, Co-Chairfields.
Thank You.
Are there additional questions from the committee?
Seeing none, thank you very much, Mr. Worthington for your time, and also to you, Ms. O'Connor for years.
We really appreciate your valuable expertise and presentation.
As I mentioned before, we anticipate hearing House Bill 293 next week before the committee.
And with that,
we're going to take probably about a 10 or 15 minute at ease as we get ready for our next presentation, at Ease.
We are back on record house labor and commerce committee. It is
410 p.m. The second presentation we're going to hear today is the rising cost of health care part two
Thank you everybody for your patience during the Addis
We're gonna have several presenters starting with mr. Gary Strand again from Primera who is available on teens and has a
presentation here first. Mr. Strainigan, please introduce yourself for the record and
begin your presentation. And also real quick, for
the committee's awareness, we're going to hear from all the presenters first in hold
questions for
the end.
Mr Stranigan.
Thank you, Madam Chair. Members of the Committee, my name is Gary Strantigan from
Primera is a not-for-profit health carrier that's been in Alaska since
before statehood. Our aim is to make health care work better by placing the
customer at the center of everything we do. Insurance is heavily regulated and
actively regulated on that business.
Our products are reviewed and prices approved before we can sell them.
We're subject to financial and regulatory supervision and accountable for our conduct in the marketplace
and for background
This the history of why insurance commissioners were created is really interesting. I think I'd like to share it briefly
Insurance commissioners. We are created to address a problem in The Wild West where
unscrupulous
Operators would come into a town and sell all kinds of insurance it
you know, basement level prices and never be heard from or seen again. And so insurance companies
were insurance commissioners were put in place to provide some market supervision
in some supervision in the marketplace so that the public would believe that there was something
to the promise that they were buying with their insurance policy. In essence insurance
were created to be sure that insurers were charging enough. That's the principle of actuarial
sufficiency. And when regulators or legislatures
put that over and politicize insurance pricing, especially in the national for-profit carriers,
because it's not possible to do business in a successful way in an
environment like that. So one key role of insurers in the construct of the
United States healthcare marketplace is to put downward pressure on costs. Without
some of our provider partners now and again and suffice it to say that what
outgrowth of this is that we're not terribly sympathetic certainly compared to
them. If we could advance the slide to slide
two at this point I would be grateful.
Okay that's that you've got the pie chart there.
These are Permera dollars reflected in this chart in the small and large group marketplace combined.
And what's interesting is that the insurance side of it is really pretty small.
We pay commissions around four percent taxes a couple of percentage points. There's a little sliver there profit point nine percent
I believe it is
sixty five percent give or take for
Health providers and
Fifteen percent giver take four prescription drugs
the
The reason that I think that this chart is really important is because for decades
lawmakers have been really focusing the bulk of their attention on the 8% of this pie chart.
In terms of your regulatory and financial supervision and rate of returns on
the investments those businesses make,
eight percent of the overall picture. There's not a lot. Certainly there's no
low hanging fruit. there might be some fruit left on the tree, but there is not
a lotta fruit on that tree. And the... when you pan, you know, zoom back, and zoom out
the American health care system, it's about twice as costly as most other industrialized
nations, and the outcomes are not better in most cases, in a few cases they're worse.
And so it seems to me that we would be better served to figure out how we can innovate.
to improve upon the system we have.
Being mindful that tremendous investments have been made
and there have tremendous successes
in health improvements.
And so this chart just underscores
where the opportunities lie primarily.
And
That's that's why I thought it really worthwhile to put in front of this committee today
If if we could move on to the next slide, that would be great for
Okay, I'm not able to see that so let me make sure
Here we are now I've got it. Okay. So um
So this charge you're looking at the affordability access to
the gay Medicare slide, it just displays a few common procedures and the
percent, the degree to which they're more expensive in Washington State and
Alaska. Now Primera, we do business in
Washington and Alaska and that's it. We're licensed
a carrier in the Blue Cross Blue Shield Association of America and the BCBSA has a company so much
primarily in every state in that country we call them blue cousins but so I compare Washington
and Alaska because we have all the data in house and so we know exactly how much we're paying
Alaska, Washington, all of it, and so this has been the case for a long time. The charts have looked
just like this for quite some time, but something's changed recently,
and I'd like to go to the next slide.
Okay, if we're on the
new information from the U.S. Bureau of Economic Analysis
this 2024 report of cost of living in every state in the United States.
And surprisingly, it has several states have exceeded Alaska in cost
of the living, and Washington is now 6% higher in
a few years ago, dining in Alaska, I noticed that my goodness,
I could eat at a very nice restaurant for considerably less than a similar restaurant would be in
Washington state. And that actually bore out that the factors pushing this cost of living in
restaurants. We're on the list. So it's really curious how those two things
have flipped and so I think it is important to have this in the back of
your mind when we're talking about the cost of health care and people often
conflate health insurance versus health care and the cost of those things. Health insurance,
as the first the pie chart, that's primarily driven by the costs of health
care. But there's a fine distinction, of course. In Alaska, the affordability is driven
So, what to do?
Let's go to the next slide if we can, please.
That will be my last and final slide.
Maybe you're thinking mercifully.
That recommendation for sustainable affordability.
Now, there's not a lot of proactive things on here.
There's some things that some cautions.
the repeal of the 80th percentile by the Department of Insurance a few years ago has had some positive
effects, especially in the individual market in this data Washington, where there have been reductions
in premium, relatively small, that were mostly concealed by increases in cost of care that
But this year, apart from the advanced premium tax credits
expiring, our premiums actually went down 3%
in the individual market.
Now consumers are seeing higher prices
because Congress chose not to extend those tax
credits.
And if you you might have seen some activity ads in various places and whatnot in op-eds
and the Anchorage Daily News, Primera was a strong supporter of extending those tax credits
and we're disappointed that they didn't because especially in Alaska customers need
So, 80th percentile, there's a few other pieces of legislation that would actually be
harmful as well.
The other is a network adequacy piece that's now actually been merged into Senate Bill
121 over on the other side.
not join networks by setting a very high, artificially setting
a high floor for network reimbursements at 450%.
That would be harmful.
area in which we've taken great strides. Last year, the legislature passed, I think it was unanimous,
a bill that Primera, along with Jared Kosen from the Hospital Association, negotiated and
came to an agreement. And it is a great example of working together on behalf of Alaskans.
And I thing it it, was a good honor of the legislative process as well in a
One that could be modeled by other states
The final one is one that I think bears some examination
incentivized value based care arrangements to align provider provider incentives with good patient outcomes and
Currently our incentives are based around
fever service
You pull the crank you get paid to pull a crank pull it great pull to crank get paint get pay get back and um
That doesn't always align with a good patient outcome.
And so, value-based care arrangements are intended to address the wellness of a patient
and not just the symptoms of the current condition.
And, so I think there's difficulty in convincing providers of signing onto that for a variety
of reasons.
But I think it's something that bears more exploration
as a community of policy thinkers.
That's what I have for you today,
and I'll be happy to hang around
and listen to my co-presenters
and then see if there's any questions
that I might be able to answer for ya later.
Thank you very much, Mr. Strainigan.
Next up, we have
Joseph Fong, who is the administrator at Medical Park Family Care in Anchorage.
Mr. Fung, please introduce yourself and begin your presentation. Thank you for joining us.
Yeah, good afternoon. Through the chair, co-chair, my name is Joe FONG.
I'm the Administrator for MedicalPark Family Chair. I am actually in the room with Dr. Jill Gaskell,
who has been scheduled to present after me, so if we need to do it at the same time we can.
Just a quick introduction for those of you who are not aware,
Medical Park Family Care is a physician-owned, locally owned,
primary care practice in Anchorage that has been in existence
for over 52 years, I believe.
The current owners are all long-time.
Alaskans, Dr. Gaskill went through the WAMI program.
Dr Loffer is actually a second-generation owner of Medical
Park.
And so we've been caring for Alaskans for many years
and would love to continue to be able to do so.
Unfortunately, pressures on both the cost
and reimbursement side of things
have are making it very difficult.
So specifically around health insurance this year.
So our plan year is March to February.
So we're in the process of renewing,
to renew the health insurance plan that we had in 2025 for 2026 was going to be an increase of 37%.
And that, like, not reasonable.
I don't understand sort of the cost containment side of things, how that can be considered a reasonable increase.
what that translates into in terms of dollar figures.
So for medical part,
we actually pay for most of the costs for health insurance.
In prior years, we have paid 82 percent of
the total cost for healthcare.
If the cost of
the insurance for the year was $10,000,
we paid $8,200 of that,
and then the employee pays the rest.
So, for that 37% increase, what that translated into for medical part as an employer would
have been an additional $340,000 just to carry health insurance for our employees.
Then the employees would have experienced the same, so a similar increase.
Not sustainable.
We had to opt for higher deductible health plans and we had
to lower the amount of the total cost that we were paying for.
So we're still, you know, relatively speaking doing quite a bit.
We are paying, for our traditional PPO plan, we are
of the total cost still.
And then for the high deductible plan,
we are still paying about 80% of total costs.
However, because of increase
and even with the higher deductible,
that still ends up doubling the premium cost for employees.
And so you're talking about
for an employee that is
that's covering themselves, you're looking at still a cost of almost $5,000
for the year in premiums, and this is still relative, I know that there are
Other employers in our community health care and non-health care where they have their employees pay the total cost
So the employees are are paying several thousand dollars a month just to get health-care coverage
and
So yeah, I think it's
It's really hard to understand how that can be just a justified increase
provider, I can also share the perspective that we have coming from our patients and then also
as a recipient of payments from insurance companies. So for our
patients, a lot of patients—and this is not just this year, but over the last several years—more
and more patients are coming to us and say, hey, i only want services that are covered at 100%
That's not a good way to provide health care and I'm and Dr. Gaskey will we'll talk more about that, but
Not only is that not it good? Way to? Provide health. Care. It's also really hard to do
period
just because a patient has XYZ insurance
Two patients have XY Z insurance. That doesn't mean they have the same coverage
And so it's it becomes harder and harder to actually know what the plan is and so we've been asking our patients to
unfortunately put more bonus on them and say you know you have to find out from your insurance
company what is covered and what isn't covered. It's not something that we are able to do.
You know we have 13 in this last year we saw 13,000 individual patients.
It is not possible for us to keep track of that and be able
to continue to provide actual care instead of just this administrative burden.
So, so there's that piece and what we've also started to notice for this year in particular
is seeing that a lot of patients are actually opting not to have health insurance.
So we do an insurance verification before their visits.
And so we have their insurance on file and as we're verifying, we were seeing, I don't
know the percentage off the top of my head, but an increased number aware they had insurance
that plans no longer eligible and patients are opting not to have care or even if they are have
insurance are asking to see if it could pay cash and you know we offer for our uninsured patients
what the insurance reimbursement is,
and with patient deductibles,
if you have a deductible,
then you're paying the full price out of pocket.
And so, it's really hard to understand
and to navigate that for patients,
or employees are patients as well,
to try to advocate that.
And then the last factor is on the reimbursement side.
So, all of these costs continue to rise
having insurance but for us as a provider and building insurance and getting
reimbursed, those reimbursement rates have an increase. We have
an insurance provider who our rates are not changed in almost 10 years and the
ones that we do have have, you know, two or three percent increase a year on
certain codes. So with all of those pressures it is
harder and harder to provide good quality care from a clinical perspective as well as being able to
have a viable business. And so, yeah, I think the, if I can also maybe mention a couple of things
We participate in a couple of value-based care projects.
They have to be designed properly or correctly to really provide value.
But I would also mention that we are part of a clinically integrated network.
And so over 30 practices, primary care, specialty care in Anchorage.
when we have mentioned to Premier, and I just mentioned this to the group, but I know Gary may
not be able to address this. We have mention to say, hey, we individually as Medical Park
participate in the value-based program review, would you extend that to
the entire network? That you'll have a greater pull, greater opportunity to provide quality care
and shared savings. That conversation has gone on for two plus years now and
there's been no movement in that direction.
So again, it's just really hard to sort of understand
how this is a sustainable model
because from our opinion,
it isn't.
That concludes my statements for now.
I'd be happy to answer any questions
unless you wanna hear from Dr. Gaskell first.
Thank you, Mr. Fong. We'd like to move along to hear from Dr. Gaskell, please.
So, Dr Gaskel, if you could please put your name on the record and begin your presentation.
One, two, one.
Yep.
Hi, thank you to the committee for allowing me to speak. I'm Dr. Joe Gaskell.
I am an owner and physician at Medical Park Family Care.
And just to preface this, I have reached out to Representative Hall about a month ago,
primarily as a business owner because I was very concerned as we were trying to make decisions for our employees about
providing health insurance and realizing that we were going from a bill of a million dollars to
our health carrier to they wanted for the same coverage 1.35 million and that is talking about
a business that covers 48 employees and with their families 92 lives. This is not a huge number of
She and I had to have a discussion and she invited me to testify.
Joan covered a lot of the things about the numbers.
Primarily my concern is that small businesses in Anchorage and the private sector really
are struggling to be able to recruit employees as a healthcare provider.
I have to able be to recruiting nursing staff, providers, MAs, all of those people are critical
to being able provide care if you or one of your family members were to come into a clinic
It's not just a physician activity.
There's a number of other people who have to be involved.
And the things that allow us to recruit and retain
are our ability to provide a meaningful salary
and our opportunity to provides meaningful benefits.
Right now, unfortunately, all we can provide
is a health plan that has a $6,000 deductible.
And that's really hard for people if they have.
Simple conditions like migraines or asthma. They need to be able to access
medications and those are all going to becoming out of their pocket until they
hit their $6,000 deductible this year.
You know, the other thing that happened last year is that the state of Alaska did pass a law that
employers need to provide
paid sick leave and we're looking at a situation now where
Health coverage is directly tied to the amount of sick days that patients are going to take or employees are
going take
um
And that hits businesses hard on that end as well. Um, I
I
don't know if people are very aware, but in private sector health care we're losing many
MAs and talented nurses to government payers. So the native health-care system,
sometimes the big hospitals can offer better benefits,
but largely even in the hospitals, they're seeing employees head over to native or head
to the VA, and that's because people can get better
I do want to address the fact that this financial conversation comes directly into the exam room when I'm talking to patients.
As Joe alluded to, people will come in for, you know, a preventive exam that is supposed to be free and outside of their deductible.
But we're pretty hamstrung if we can't talk about the things that are really bothering them.
And we do talk that those things.
physicians are very good at listening to patients and we're not going to cut them off and say,
oh, like you're having this problem, we are just going ignore it because it's not part of this
quote unquote annual preventive exam. So we take care of them but we aren't really able to bill
for it and that's the insurance company getting care for free because of the way they design their
If patients do have things that they want to talk about or conditions that
they come in for, they're very concerned about the cost of testing.
Many people are using free self-pay lab testing services.
They're not free, but low-cost self pay lab
testing service. And what doesn't come with that is any
ability for a provider to review those results.
So they are not getting care. They are getting data.
family physicians. I'm a family physician and in family positions we do act in
that primary care role where
We are diagnosing a lot of cancers, we are managing chronic health conditions like diabetes,
high blood pressure, high cholesterol, all of the things that if left unchecked or untreated
are going to result in very expensive hospital stays on down the road.
As most people are aware, if you catch a cancer early, the treatment is shorter,
That's what we need to be able to do. It's very difficult to put in a position to
you know stay within this box because that's all that is covered outside of somebody's deductible.
I have had patients tell me that they're opting out of insurance, I've had
patients telling me they are opting
out at work, that their taking a voluntary layoff so that
they can go on to Medicaid, not be employed, and have all of their health care
paid for basically for free on the Medicaid system because they do have
enough chronic health conditions that it's
better for them to have the health coverage than it is for
them have a job.
I think that's a really sad state to be in when health
insurance is that expensive, that people are opting not to
work.
I do want to make one other comment.
It has been in the press and has
been stated, I
think even by some of the insurance carriers that
part of the reason for the skyrocketing premiums and cost has to do with people taking weight loss
medications. These GLP1 injections are everywhere. I guess a lot of people are taking them.
But I know very well who pays for them and who doesn't because every single prescription
that I write has to be prior off by me and my nurse and so we know it was covering and
the private health insurance is not covering.
The people who are taking these meds and getting them paid for by insurance are either covered
through the municipality, the state, or federal government.
There are a few very large employers, UPS or some of the national companies that do cover
local businesses like ours do not carry planes that cover GOP ones for weight loss. So it is
it feels very disingenuous to have that be where the the blame is placed or these high costs of
healthcare premiums. I would just really sincerely ask that the committee consider
the way that Alaska businesses are being taken advantage of by private insurance companies
in order to provide meaningful healthcare to our employees. People in the private sector
need to have access to health insurance and we need, we can't just all work for governments.
We need these businesses to remain in place for our economy and for a meaningful community.
So I really appreciate it and thank you for your time.
open up for questions and we're going to start with co-chair fields.
Thank you through the chair. Really just a question for the future. So one of my concerns when
Congress gutted Medicaid with HR1 is that ended the enhanced premium tax credits as it would
effectively end access to affordable private insurance and it's interesting that you're
already seeing the effects of that and I guess my request is going forward is
that, you continue to keep us in the loop as you
see those downstream effects of that dismantling of functional federal health care. Thank you.
Are there questions from the committee? For any of the presenters, Representative Sadler?
Yes, Dr. Gasco through the chair. You mentioned MAs, MAS. Is that medical assistance?
Yes. Medical assistance performed a lot of clinical duties and health patient clinics.
Follow-up representing so actually to the mr. Fong question mister fong you mentioned a term of value-based pricing or value based product
I'm not sure what that is. Can you give me a plain English definition what it is, please?
Sure through the chair co-chair a value base program is
It's almost very literal. So the idea as was presented earlier
traditional way of paying for health care is
do something, I get paid for it. Doesn't matter what the outcome is, so a value-based
program is it puts payment based on the value of the care you get. So if I do
something that prevents you from getting something else or prevents
you having future or is around evidence- based, good quality care,
then there's incentive towards that.
So there is incentive to providing that type of care
and then some programs in the back end,
if you show savings, we'll share in some of those savings
between the insurance company and the provider.
Follow-up.
So Mr. Fong, the chair, is it fair to say
value-based programs are pay for results,
not fee for service?
Through the Chair and Co-Chair.
Yeah, that would be a simple way of seeing a value based program is to pay for it is pay
for outcomes not for service.
And I want all this one.
No second question.
Are there additional questions from co-chair fields through the chair?
I appreciate you all being here.
My family goes to medical park and I was curious how many other providers are there
like medical part kind of a local family based primary care health care.
Senator, thank you.
I know that we know the number of clinics in town
off the top of our heads may be around like 10.
But most, so most people in Anchorage
are going to be seeing a clinician in a private practice.
You've got the native system, and you've
got neighborhood house, which is under the federally FQHC
program.
And you have, you know, the hospital, Providence Hospital has some clinics, and they do have
the residency program.
But all of those kind of, so ones that are not quite the, all tend to have kind
of a niche of patients that they serve, whether that's low income or sliding scale, but yeah,
The CIM that Joe was talking about, the Clinical Integrated Network does include many of the
other practices in town, and it's a large number of physicians.
I can't tell you how many are primary care, but we're probably in the neighborhood of
around 50 primary-care physicians that are all working in different practices and encourage
Thank you, dr. Gaskell and a reminder for the committee. We still have mr. Strain again online as well for questions
Representative Sadler, thank you. So through the chair to miter Trangen
Looking at your first slide your 1st about your your pie chart slide that you're trying again
We see percentages. Can you put some hard numbers to what those are?
What's the universe? What 100% of which medical claims represent 69.4%
The short answer is no, I'm sorry, through the chair that presents that,
settler. The shorter answer, is, no. I am not able to do that at this time, but that's
information I could get through you without too much trouble. Is there a specific service
you're interested in? Through the chairs? No, so they're trying to figure out what the
universe of dollars, how many dollars this is? Okay. How many premium dollars do you take in.
Should we understand that operating income 0.9% is are you trying to say that
primarily makes a profit of 0,9%, is that the implication from the slide?
Yes, that's through the chair. That's correct. The profit for so this pie chart represents
our insured group business. So the state regulated business minus the individual market.
So that's what's represented here.
So, that is the data I will get for you.
But that isn't the entire total of the revenue that we get in this state of Alaska.
That also includes our self-insured business.
As well as rounding it out would or would be the individual market and over the so globally
With all all inclusive our
profit for the years
2020 through 2024
Was 1.5%
Thank you to follow up not knowing your business as well. As you some of the terminology used. I'm not quite sure how to
but the state regulated minus the stage.
It didn't quite follow what you mean, Daph,
so if we're a layman to understand what this cover is,
please.
Through the chair.
So the State
does not regulate the self-insured business
because that's not actually insurance.
Those businesses that operate their health plans
for their companies themselves,
and pay the claims themselves are do so under the federal ERISA law and so they're governed by
the U.S. Department of Labor and the other departments. So again to make sense of that so
this chart covers what again and please help me understand how to put this jargon context to that.
fully insured, so we assume the risk of those that claims that the employees of the business bring
so both small group and large group. That's what's included in this chart.
Thank you, Mr. Strenigan. Are there additional questions from the committee for any of
Thank you, Representative Colum.
Through the co-chair to Mr. Strannigan, I think you heard the other presenters.
I'd love for you to respond to the claims that the premiums have gone up so high.
And that it's the insurance that they can't afford the premium.
There wasn't really much mention of the actual cost of care going up.
But the premiums have gone so high that businesses can't get the insurance they need.
Through the chair, thank you for the question, Representative Cologne.
Yes, it's not an uncommon refrain.
And we're hearing it and that's partly why we advocated so aggressively for the extension of the premium tax credits to get help, particularly in the small business market and the individual market that those provide.
the good work that we as part of a much larger coalition than we are achieved in paving the way
for perhaps an extension at a future date. So that's the first time I've heard optimism in the last
Yes, 85% of the cost of
the premium is from health care.
The cost in health-care is sky-high and the Madam,
I'm sorry, your name is not displayed and I can't remember.
She referenced GLP once and yeah,
the plans that we sign up, most of the businesses do not elect to cover GLP ones,
so she was correct in saying that. The ones that do were aware of one, a small business
whose per member per month cost for GL P ones is over $50 per
to put that in the context, we pay about half of that for primary care. And so it's a big expense
when people opt into it. Now, the degree to which it is actually a good risk
is unknown yet. It is having some positive effects on the wide range of people, which is
And but especially in cases of diabetes and in those cases we cover those drugs but not for
weight loss and important to characterize and to qualify that. So the cost of care for those
diabetes patients were optimistic that that might actually make sense on a go-forward basis.
But there are other options that are challenging, like anyway, we'll go into that, but there's a lot of unknowns around GLP ones and from both a clinical perspective as well as an actual one.
I mean, we can blame the tax credit.
We can claim the subsidies not happening anymore.
But I think there's a bigger problem than that.
So the problem was just being maxed by the Tax Credit.
So see if I'm.
If I'm correct in this, if my premium is $100 and I have the tax credit, let's say I
have to pay 50, the insurance company still gets $ 100 for that premium.
And so what I am trying to figure out, okay, so now the government is helping people pay
the premium, but what am I trying figure is, what is driving the premiums up so high?
Why is it staying so hot?
It's been unmasked because the government's not helping, but it's
been high for a while. So I'm just wondering,
if you had any thoughts around that? Through the chair, yeah, absolutely. We
have some thoughts on that. And it, uh, we would suggest that
the, any changes in the price of health insurance are not associated
health insurance companies, they're associated with the cost of care. We've had countless virtually
every hospital system we have trained to in negotiation with. They come at us with a 15 percent
per year price increase request. That's a 50 percent increase over three years over already
outrageously high prices. And so yes, we had some thoughts about what's behind it and it is the
Prescription drugs does figure into it absolutely, but the hospital side of it is the biggest piece
Okay, that's helpful. Thank you.
Thank You Representative Klom. I have a question. This is co-chair Hall
I'm having a hard time squaring up, and I think I need a little bit of education here where
Mr. Strandigan you're saying that the increases are associated with the cost of care
One, I'd love to hear from Dr. Gaskell or Mr. Fong about that.
There are opinions and comments on that, but then also if the providers are not receiving
increases in the reimbursement rates and if it's flat over a number of years, can I
think Mr Strandigan, could you opine on this?
So, maybe Dr. Gasko, would you maybe start?
Yes, please, through the chair.
So when it comes to the reimbursements to primary care, those have been flat.
So we have not received any of this increase in health care over the last decade.
The dollar amounts that are coming into our practice are the same from, and we'll specify
It's not as though we're seeing similar numbers of patients, maybe even fewer patients.
So there's another way to do that math where you would be able to say, oh, well actually
you are getting paid more.
What we have been engaging in with other payers is some value-based contracting through clinically
integrated networks, particularly with on-boy and from era has not been interested in participating
to date. I'm not maybe there may be a negotiation going on that I don't know about but what we see
from our side is you know higher costs, tighter plans with higher deductibles for our patients
and wherever that money is being funneled is not for primary care. Unfortunately there is
good evidence when you look at the literature and studies that have been done if if
Health care costs are funneled more toward primary care.
You actually can't achieve a reduction
overall health care cost, funneling learning
to the top tier of the most expensive patients
is usually not the way to do that, for what I have seen.
Thank you, Dr. Gaskell.
And Mr. Strandigan, do you have comments to offer?
Through the chair, please forgive me.
I was really interested in some of those
Please get refreshed on the question to me.
Sure, I guess, well, first, can you provide some insight
as far as why the reimbursements to primary care
have remained flat?
Oh, through the chair, represent Cole.
This is co-chair hall.
Co- chair hall,
I'm sorry, going back there.
I don't have anything terribly illuminating on the flat reimbursements for primary care,
and I would agree with those comments around primary
care helping to address health care cost inflation.
Interesting study I came across recently indicated that for people who have a relationship with
And so, you're absolutely right, and it's actually something that we've begun to try
and prioritize the primary care.
And we have a network of primary-care clinics in Washington state, 17 of them that
because there is a remains a primary care crisis in this state,
very, you know, people waiting six months for a visit with their primary
care physician. But relative to the flat reimbursements
that you've experienced, number one, sorry,
It's something that we need to look at. I think the broader cost of care, the 85% or the 69% on
that chart for medical care is those are not fabricated numbers. Those are real numbers and
I would suspect that most of the cost increases have come from
private equity firms that have built up large practices,
bought up some practices that's combining to make bigger
practices. It's gone to ESRD care and stage
renal disease care, but mostly to hospitals.
And that is where we've seen the growth, the 69% of that pie chart.
Coach air hall again. I appreciate the references to Washington state and what's happening with primary care there
Our focus and the focus of this committee is on what is happening in Alaska
We care most about Alaska Alaskans, Alaska businesses and providers and so
I do hope that you take a look and really narrow down and figure out what is going on
with these reimbursements, these flat reimbursemen that are being sent to the primary care providers.
Because primary is very important when it comes to just overall health in general, but
then also trying to figure is there a looming health issue that is just going to get worse
if it's not taken care of.
make sure that we are doing what we can to support those primary care providers.
With that, Representative Sadler, do you still have a question?
I can't do it. And by this time of the day, it's going to be a little rhetorical through the chair.
You know, I have heard the presentations. We've heard from a lot of folks that
certainly health insurance costs are going up, premiums are rising, people are accepting
P under the walnut shell, shell game, pointing who's responsible?
The doc says insurance insurance has the cost of health care.
We say it's the lack of the enhanced premium.
But if I were to try and tell my constituent watching this after this,
why are there health insurance premiums going up?
What would the two sentence answer be from each of you three people?
Why are health and insurance costs and health
insurance going on?
I think I heard Mr. Schranger say, it is the greedy private equity
people buying practices.
then Mr. Fong and this uh a gascal, Dr. Gaskell.
It's not because it's coming to me. I mean all I can
surmise is that there is very expensive care in that acute and hyper acute setting
that um is being prioritized over the preventive side of things.
Could you say that again a little bit planar for me at least?
Yeah, the question is, why are health care premiums going so high?
I can't answer that plainly, I just can tell you it's not because it is coming into primary
care outpatient medicine, that is not where the expense is.
If there is high expense, it comes at the highest levels of care in the hospitals, ICU's
and procedural settings.
High dollar things are not happening in primary care offices.
Great, thank you. Mr. Fong. Thank you Dr. Yassil says that the increasing cost is not
coming from primary care from preventative services. It's coming
from the specialty tiers. All right, Thank You.
Thank, Mr Fung. Um Mr Strandigan, do you have any comments or thoughts on
With chair represents Adler. I would say it's the cost of care
It's also important to note that and truth companies are regulated all of our books are checked
Then our prices and products are approved before we can sell them
none of those things that I just said are true about the provider side the
largest share of that pie
Mr. Strandingan, would you concur with Dr. Gaskell and Mr Fong that the increased costs
are due to the specialty care?
I think there's truth in that, absolutely, through the chair,
absolutely.
Thank you.
Representative Sadler.
Thank You.
Through the Chair to probe that when you say the cost of care, I
think it's a little bit of things cost a lot because they're expensive.
What do you mean by the cost of care and medical services provided by physicians?
Please expand on what you need by cost and care, please.
Through the chair, Representative Sandler, it runs the gamut. It's medical
services, whether they're critical care services. Heroic services whatever they are.
The price of those services is going up on a unit cost basis and in 2025 a utilization.
So a number of widgets and the cost of those widgets both went up in 2025.
The what, I'm sorry, the liquidity,
the what? I didn't articulate very well.
Forgive me. I went to the kind of a base level.
The number the widgets went
up and cost the widget's which it's gotcha.
Okay. There was a Latin term I hadn't heard before, but okay, got you.
Yeah. That one.
Are there additional questions from the committee?
Seeing and hearing none, thank you very much, Mr. Strandigan and Mr
Fong and Dr. Gaskell for making yourselves
available this afternoon. We certainly appreciate it. It's been rather enlightening.
This will conclude our business for today. The House Labor and Commerce Committee will meet again on Friday, February 6th at 3.15 p.m.
This meeting is adjourned at 5.05 p-m