The Senate Committee on Commerce and Labor was called to order by Chairman Randolph J. Townsend, at 7:25 a.m., on Thursday, May 13, 1999, in Room 2135 of the Legislative Building, Carson City, Nevada. Exhibit A is the Agenda. Exhibit B is the Attendance Roster. All exhibits are available and on file at the Research Library of the Legislative Counsel Bureau.

COMMITTEE MEMBERS PRESENT:

Senator Randolph J. Townsend, Chairman

Senator Ann O’Connell, Vice Chairman

Senator Mark Amodei

Senator Dean A. Rhoads

Senator Michael A. (Mike) Schneider

Senator Maggie Carlton

COMMITTEE MEMBERS ABSENT:

Senator Raymond C. Shaffer

GUEST LEGISLATORS PRESENT:

STAFF MEMBERS PRESENT:

Scott Young, Committee Policy Analyst

Kathryn Lawrence, Committee Secretary

OTHERS PRESENT:

Stephen D. Hartman, Lobbyist, Quintus Resorts LLC, stated in the passage of this bill current licensees in telemarketing would not be required to obtain another license. He submitted his proposed amendments to the committee (Exhibit C).

Chairman Townsend temporarily closed the hearing on A.B. 283 and opened the hearing on A.B. 60.

Assemblywoman Christina R. Giunchigliani, Clark County Assembly District No. 9, introduced her intern, Jennifer Rains.

Jennifer Rains, Intern, Assemblywoman Christina R. Giunchigliani, read her statement (Exhibit D.). Senator Carlton suggested raising the level of a woman’s childbearing years to be over 44 years in the exhibit.

James T. Breeden, M.D., Obstetrician and Gynecologist, stated this bill is very important for women. He explained family planning is one of the largest issues all women have to face; nobody wants unwanted pregnancies. He stated that most insurance plans consider contraceptives as a choice, yet Viagra was immediately covered under insurance plans. He submitted his statement to the committee (Exhibit E).

Chairman Townsend temporarily closed the hearing on A.B. 60 and opened the hearing on A.B. 515.

Dr. Breeden stated most women consider their obstetrician/gynecologist as their primary physician. He noted most of the insurance plans do allow women to see their gynecologist on a yearly basis, but they are only allowed to do routine exams. He remarked if the physician observes a lesion during the exam, he cannot biopsy that lesion. Dr. Breeden justified the doctor is required to call the primary insurance prior to the visit to get approval. He maintained some plans will not allow same-day approval; therefore the patient has to make another appointment.

Chairman Townsend temporarily closed the hearing on A.B. 515 and reopened the hearing on A.B. 60.

Lawrence P. Matheis, Lobbyist, Nevada State Medical Association, stated he is in support of this bill. He explained hormones and contraceptives should be considered basic benefits for women who have medical insurance.

Alison L. Gaulden, Lobbyist, Planned Parenthood Mar Monte, expressed this bill would allow women to choose the contraceptive suited to her particular needs. She submitted her statement to the committee (Exhibit F).

Laura Deitsch, Regional Director of External Affairs for Planned Parenthood of Southern Nevada, stated her support of this bill.

Jan Gilbert, Lobbyist, League of Women Voters of Nevada, and Progressive Leadership Alliance of Nevada, maintained her support of the bill.

Lisa Appelrouth Guzman, Lobbyist, Nevada Empowered Women’s Project, declared she supported this bill.

Sarah Chvilicek, Chairwoman, Nevada Women’s Lobby, asserted this bill is most important to women and families and deserves to be passed. She submitted her testimony to the committee (Exhibit G).

Louise Bayard-De-Volo, Lobbyist, Sierra Club, read her testimony to the committee (Exhibit H).

Joseph L. Johnson, Lobbyist, Sierra Club, urged his support of the bill.

Dori Owen, President, Soroptimist International of Truckee Meadows, acknowledged her support of this bill.

Alicia Smalley, Lobbyist, National Association of Social Workers, Nevada Chapter, voiced her support of the bill. She stated when she was employed as a state worker, she was surprised when her insurance would pay for the birth of her twins, which amounted to more than to $20,000, but would not pay the $18 a month for oral contraceptives. She concluded she remembered arguing with her insurance company about paying for the contraceptives rather than a high-risk birth. She agreed oral contraceptives are a basic human right.

Flo Bedrosian, President, American Association of University Women, commented on her support of this bill. She emphasized without the passage of this bill, women will have a double-burden of paying for insurance, and paying for reproductive health that is not covered. She submitted her testimony to the committee (Exhibit I).

Robert A. Ostrovsky, Lobbyist, Nevadans for Affordable Health Care, stated his opposition to the bill. He stressed mandated benefits would be a hardship for the small businesses who choose to offer insurance. He stated you are covering one-third of Nevada’s population when referring to this bill. He urged the committee to consider the cost impact upon passage of the bill.

Larry Hardy, Legislative Chairman, Nevada Association of Health Underwriters, stated he opposed the bill. He explained the state does not currently have affordable health care. He pointed out if there are more mandated benefits to health coverage, more businesses will begin dropping all benefits for their employees; and, as a result, people will have no benefits. Senator O’Connell inquired as to how many small businesses in Nevada have no insurance.

Marie H. Soldo, Lobbyist, Nevada Association of Health Plans, and Sierra Health Services, replied 17 percent of the total small businesses in Nevada have no insurance. She noted a study had been done in the past; and approximately 217,000 people had no insurance. She agreed that there has been too much emphasis on additional benefits as opposed to the population who may have no benefits whatsoever. Senator O’Connell stated she would like additional information on how many women and children are without insurance.

Amy Halley Hill, Lobbyist, Las Vegas Chamber of Commerce, stressed her opposition to this bill. She stated all of these bills have merit, but there needs to be a study of how it would affect small businesses with every mandated benefit. Senator O’Connell asked Ms. Hill is she could obtain information from the Las Vegas Chamber of Commerce on how many businesses go out of business each year and the reasons why.

Patricia A. Glenn, Lobbyist, President, Nevada Right to Life, read her testimony to the committee (Exhibit J). She noted there was no language referring to abortion-inducing drugs or devices.

David L. Howard, Lobbyist, Greater Reno-Sparks Chamber of Commerce, stated he opposed this bill. He agreed it would harm small businesses in affording insurance, making it more difficult for small businesses to lure good potential employees.

Lucille Lusk, Lobbyist, Nevada Concerned Citizens, explained her concern with the fact that this bill has become about women against men. She noted she had problems in the past persuading her insurance company to pay for her husband’s medical problems; so it is not just a problem with which women struggle. She emphasized the question is, who decides about the coverage; the company, the purchaser, or the government. She agreed there could be problems with the government controlling benefits.

Assemblywoman Giunchigliani submitted to the committee an article from the San Francisco Business Times to the committee (Exhibit K).

Janice C. Pine, Lobbyist, Saint Mary’s Health Network, stated that health costs are predicted to rise between 7-10 percent without any mandates. She emphasized the national average of $4,033 per employee in 1998 is expected to rise between $4,315-$4,436 per year.

Roberta A. Gang, Lobbyist, Planned Parenthood of Southern Nevada, submitted an article (Exhibit L). No testimony was given.

Chairwoman Senator O’Connell closed the hearing on A.B. 60 and opened the hearing on A.B. 162.

Assemblywoman Merle A. Berman, Clark County Assembly District No. 2, asserted Nevada needs to provide preventative measures for chronic illnesses. She declared there needs to be health coverage for preventative care. She explained by early testing being performed, bone breakage from osteoporosis could be avoided. She submitted to the committee letters of support for passage of the bill (Exhibit M, Exhibit N and Exhibit O).

Dennis Brown, M.D., Medical Director, Vista Osteoporosis Center, acknowledged he recognized the importance of osteoporosis in his practice. He expressed this is a disease that is vastly unrecognized. He noted there are tests that are very easy to do and very accurate, and treatment can reduce the risk of fractures up to 50 percent. He submitted his chart to the committee (Exhibit P).

Margaret Privett, Concerned Citizen, said when she went to the doctor to have her hormones changed, it was determined through the testing that she had osteoporosis.

Tom Wood, Lobbyist, Wyeth-Ayerst Labs Division of American Home Products, stated his support of this bill. He verified that 50 percent of this disease is preventable. He noted in many instances when an individual falls and breaks their hip, most of the time it is because their hip can no longer support their weight from the disease.

Roberta A. Gang, Lobbyist, National Association of Social Workers, Nevada Chapter, submitted a letter to the committee from Gilda Haus (Exhibit Q).

Jan Gilbert, Lobbyist, League of Women Voters of Nevada, commented she would like to challenge the insurers to demonstrate this would not be a cost-savings to the state rather than an expense. Mr. Matheis stated his support of this bill. He drew attention that there are screening tests at various drugstores which cost $25. He noted family physicians are being retrained and seeking medical information for this disease. Senator O’Connell suggested the doctors should be notifying more patients of the testing in drugstores.

Jo Ann Malkin, Concerned Citizen, maintained her support of this bill. She defined if this legislation had been passed 7 years ago; her osteoporosis may not have been recently diagnosed. She testified several years ago, her doctor suggested she be tested for bone loss, but after hearing of the costs, she delayed. She explained she had neither symptoms nor risk factors. She summarized requiring all insurers in Nevada to provide coverage for services related to the diagnosis, treatment and management of this disease can prevent costly medical services in the future.

Chairman Townsend closed the hearing for A.B. 162 and opened the hearing for A.B. 163.

Assemblywoman Berman urged that health care procedures need reform. She recognized Nevada needs to prevent diseases as opposed to only treating them. She stressed 44,000 deaths occur every year in the United States from breast cancer. She emphasized it is estimated that 1,000 new breast cancer cases will be reported in Nevada in 1999; of which 300 of these women will die from breast cancer. She noted a mammogram is the best way to detect and treat breast cancer, and the testing can detect the cancer 1.7 years before a woman can feel the lump herself. She disagreed with Mr. Ostrovsky that adding benefits would be a hardship for small businesses. She expressed as a community, we could not afford to be without these benefits. She submitted a letter from Salley de Lipkau to the committee (Exhibit R).

John Ellerton, M.D., stated he is in favor of the bill. He surmised if you propose a general screening technique, the state would need to be careful to screen women who are at risk of getting the disease.

Sharonanne Dilley, Lobbyist, Nevada Federation of Republican Women, read her statement to the committee (Exhibit S).

Lorie Schlichting, Susan G. Komen Breast Cancer Foundation, mentioned she was diagnosed at age 30 with breast cancer. She agreed younger women do get this disease, especially women at high-risk.

Ms. Gang read a letter to the committee submitted by Brenda Caplan (Exhibit T).

Debbie Young, Susan G. Komen Breast Cancer Foundation, claimed not only are the tests important, but it is also difficult for the employee to take time off of work to be treated. Ms. Guzman noted it is difficult when so many women have to pay for breast cancer exams out of their own pockets. She insisted lower-income women may not be able to pay for these tests.

Ms. Pine remarked she was against this bill. She verified there are 44 million people uninsured in the United States, some of which are women. She pointed out if more benefits are added; it would be harder for the small businesses to keep insurance.

Chairman Townsend closed the hearing on A.B. 163 and reopened the hearing on A.B. 515.

Assemblywoman Marcia de Braga, Churchill, White Pine, Eureka and Lander counties Assembly District No. 35, insisted this bill would allow women to go directly to an obstetrician/gynecologist for medical care without first receiving authorization from the primary care physician. She said this would result in a savings to insurance companies as well as saving the patient time and effort.

Ms. Gang submitted her amendment (Exhibit U) to the committee and stated she supported the bill. Ms. Gaulden testified her support of the bill and noted in studies, experts had stated 75 percent of women’s needs were gynecological. Mr. Matheis noted his support and passage of this bill. Ms. Gilbert defined her support of the bill, noting not only it would it save the patient money in being able to only visit one doctor, but it would save time missed at the workplace. Ms. Bedrosian submitted her statement to the committee (Exhibit V) and stated, for the record, she supported this bill. Ms. Pine noted she supported the bill. Ms. Deitsch voiced her support for the bill. She explained it can be frustrating to be aware of a cancerous condition; having to wait to see a primary care physician, and then being referred to a gynecologist.

Chairman Townsend closed the hearing on A.B. 515 and opened the hearing on A.B. 283.

ASSEMBLY BILL 283: Revises provisions governing solicitation by telephone. (BDR 52-743)

Patricia Jarman-Manning, Commissioner, Consumer Affairs Division, Department of Business and Industry, summarized with passage of this bill, that anybody in Nevada doing solicitation by telephone would be required to obtain a work card. She explained the card would be issued by the sheriff’s office in the county in which the business of the seller is located.

Chairman Townsend closed the hearing on A.B. 283 and opened the hearing on A.B. 470.

Chairman Townsend referred to Exhibit W and stated, for the record, that any benefit changes the committee makes as a body cannot come into effect until June 30, 2000.

Cliff King, Supervisor, Property and Casualty Section, Division of Insurance, Department of Business and Industry, explained the file-and-use system as:

Senator O’Connell commented, "But all of the data information is on the data."

Mr. King replied:

Senator O’Connell questioned, "Okay, so then how is that information translated over into what we are doing in this? I am not putting it together yet and maybe it’s [it is] because of a lot of other things."

Mr. King responded, "Basically, the NCCI makes a filing with us . . . ."

Senator O’Connell declared, "So that would affect, what you are telling me, then, that would affect the rates they have filed."

Mr. King noted:

Senator O’Connell repeated, "Okay, so you are going to look at that with what we are going to open with; with the rates that they are now doing in those classifications, and you are going to do some comparison."

Mr. King restated:

Senator O’Connell urged, "Well, that helps a little. Thank you."

Mr. King clarified:

Samuel P. McMullen, Lobbyist, Las Vegas Chamber of Commerce, clarified the theory is NCCI would collect all the data for the state and develop benchmark rates. He insisted the insurance companies can either accept the rates or they can deviate from that rate. He stated he hoped the rates would have deviations, up and down, being justified.

Lenard Ormsby, General Counsel, Employers Insurance Company of Nevada (EICON), stated the position of EICON remains the same. He stated:

Mr. Ormsby stressed:

Mr. McMullen disagreed with Mr. Ormsby. He noted when A.B. 609 was passed, he was told that price competition would not be available. He explained there has been a choice for EICON to compete as a private mutual insurance company. He noted A.B. 609 was adopted not to transition EICON into a private insurance, but it was a solvency plan that was adopted in 1997; established for the State Industrial Insurance System (SIIS) that would assist the state through the solvency issue into the future.

Robert A. Ostrovsky, Lobbyist, Nevada Resort Association, stated SIIS would exist for a long time. He agreed with Mr. McMullen that the system has changed. He stated the pricing should be as broad as possible so insurance companies have the opportunity to negotiate and get the best price.

Mary F. Lau, Lobbyist, Retail Association of Nevada, stated one of the problems is they do not believe that 6 months would be enough time for sufficient information. She suggested the interim committee review the information by March 31, 2001.

Daryl E. Capurro, Lobbyist, Nevada Motor Transport Association, stated he concurred with Mr. Ormsby. He noted he was opposed to the other attachments. Mr. King stated when NCCI did their rate filing, they did not have the most recent data from EICON. He explained there needs to be data that is mature enough to forecast rates. He maintained a trend could be forecast with 6 months worth of data.

Alice A. Molasky-Arman, Commissioner, Division of Insurance, Department of Business and Industry, stated their consultant took the data from 1996, 1997 and 1998 and made his recommendation.

Tom Wheeler, Marketing Director, Nevada Contractors for Self-Insured Group, stated he had submitted his actuary study for the year. He noted he was concerned about market stability. Mr. McMullen stated the goal is for the businesses to be able to shop for and obtain the best rate possible.

James L. Wadhams, Lobbyist, Nevada Independent Insurance Agents, noted it is important for the committee to determine if the businesses of Nevada will be able to obtain a price that is fair for the insurance they are buying.

Chairman Townsend adjourned the meeting at 10:50 p.m.

RESPECTFULLY SUBMITTED:

Kathryn Lawrence,

Committee Secretary

APPROVED BY:

Senator Randolph J. Townsend, Chairman

DATE: