34
HOUSE OF REPRESENTATIVES             H.C.R. NO.            H.D. 1
TWENTIETH LEGISLATURE, 1999                                
STATE OF HAWAII                                            
                                                             
________________________________________________________________
________________________________________________________________


                     HOUSE  CONCURRENT
                        RESOLUTION
  REQUESTING THE AUDITOR TO ASSESS THE SOCIAL AND FINANCIAL
    EFFECTS OF REQUIRING HEALTH INSURERS TO OFFER COVERAGE FOR
    BONE MASS MEASUREMENT AND HORMONE REPLACEMENT THERAPY IN
    CONNECTION WITH OSTEOPOROSIS, ANNUAL MAMMOGRAMS FOR WOMEN
    AGED FORTY AND OLDER, CERVICAL CYTOLOGY SCREENING, AND
    TWICE YEARLY DIRECT ACCESS TO OBSTETRIC AND GYNECOLOGICAL
    SERVICES.


 1        WHEREAS, currently, over nineteen million women suffer
 2   from osteoporosis; and
 3   
 4        WHEREAS, early prevention and diagnosis can be effective
 5   combined with hormone replacement or other drug therapies in
 6   reducing the prevalence, devastation, and overall cost of
 7   osteoporosis; and
 8   
 9        WHEREAS, bone mass measurement is non-invasive and
10   painless, and in conjunction with hormone replacement therapy,
11   provides a reliable way to diagnose and treat osteoporosis
12   before costly fractures occur; and
13   
14        WHEREAS, nonetheless, few health insurance plans provide
15   coverage for bone mass measurement or hormone replacement
16   therapy; and
17   
18        WHEREAS, mammography screening is the most effective
19   medical technology available to detect breast cancer in its
20   early stages, where it can be treated most successfully; and
21   
22        WHEREAS, several studies have shown that mammography
23   screening before the age of fifty has reduced breast cancer
24   deaths by thirty per cent; and
25   
26        WHEREAS, current law provides annual mammograms only for
27   women aged fifty and older, rather than at the younger age of
28   forty; and
29   
30        WHEREAS, cervical cytology screening, including a pelvic
31   examination and collection, preparation, and evaluation of a
32   Pap smear has been proven to be an effective method of
33   detecting cervical cancer; and

 
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                                  H.C.R. NO.            H.D. 1
                                                        
                                                        

 
 1   
 2        WHEREAS, the legislature deems it imperative to consider
 3   requiring health insurance coverage for:
 4   
 5        (1)  Bone mass measurement and hormone replacement therapy
 6             in connection with osteoporosis;
 7   
 8        (2)  Annual mammograms for women aged forty and older
 9             (with no co-insurance or deductible payments);
10   
11        (3)  Cervical cytology screening for women aged eighteen
12             and older (with no coinsurance or deductible
13             payments); and
14   
15        (4)  Twice yearly direct access to obstetric and
16             gynecological services;  now, therefore,
17   
18        BE IT RESOLVED by the House of Representatives of the
19   Twentieth Legislature of the State of Hawaii, Regular Session
20   of 1999, the Senate concurring, that the Auditor is requested
21   to study the social and financial impacts of requiring all
22   employer group health policies, contracts, plans, or agreements
23   issued or renewed in Hawaii, on a group or individual basis, to
24   provide coverage for
25   
26        (1)  Bone mass measurement and hormone replacement therapy
27             in connection with osteoporosis;
28   
29        (2)  Annual mammograms for women aged forty and older
30             (with no co-insurance or deductible payments);
31   
32        (3)  Cervical cytology screening for women aged eighteen
33             and older (with no coinsurance or deductible
34             payments); and
35   
36        (4)  Twice yearly direct access to obstetric and
37             gynecological services; 
38   
39   not as an employer option, for the subscriber or any dependent
40   of the subscriber who is covered by the policy; and
41   
42        BE IT FURTHER RESOLVED that the Auditor's study shall
43   encompass the following, to the extent the inquiry is relevant
44   and the information is available:
45   
46        (1)  With regard to the social impact:
47   

 
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                                  H.C.R. NO.            H.D. 1
                                                        
                                                        

 
 1             (A)  The extent to which the treatment or service is
 2                  generally utilized by a significant portion of
 3                  the population;
 4   
 5             (B)  The extent to which such insurance coverage is
 6                  already generally available;
 7   
 8             (C)  If coverage is not generally available, the
 9                  extent to which the lack of coverage results in
10                  persons being unable to obtain necessary health
11                  care treatment;
12   
13             (D)  If the coverage is not generally available, the
14                  extent to which the lack of coverage results in
15                  unreasonable financial hardship on those persons
16                  needing treatment;
17   
18             (E)  The level of public demand for the treatment or
19                  service;
20   
21             (F)  The level of public demand for individual or
22                  group insurance coverage of the treatment or
23                  service;
24   
25             (G)  The level of interest of collective bargaining
26                  organizations in negotiating privately for
27                  inclusion of this coverage in group contracts;
28   
29             (H)  The impact of providing coverage for the
30                  treatment or service (such as morbidity,
31                  mortality, quality of care, change in practice
32                  patterns, provider competition, or related
33                  items); and
34   
35             (I)  The impact of any other indirect costs upon the
36                  costs and benefits of coverage; and in addition,
37   
38        (2)  With respect to the financial impact:
39   
40             (A)  The extent to which insurance coverage of the
41                  kind proposed would increase or decrease the
42                  cost of the treatment or service;
43   
44             (B)  The extent to which the proposed coverage might
45                  increase the use of the treatment or service;
46   
47             (C)  The extent to which the mandated treatment or

 
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                                  H.C.R. NO.            H.D. 1
                                                        
                                                        

 
 1                  service might serve as an alternative for more
 2                  expensive treatment or service;
 3   
 4             (D)  The extent to which insurance coverage of the
 5                  health care service or provider can be
 6                  reasonably expected to increase or decrease the
 7                  insurance premium and administrative expenses of
 8                  policyholders; and
 9   
10             (E)  The impact of this coverage on the total cost of
11                  health care.
12   
13        BE IT FURTHER RESOLVED that the Auditor is requested to
14   submit to the Legislature a report of findings and
15   recommendations pursuant to this Concurrent Resolution prior to
16   the convening of the 2000 Regular Session; and
17   
18        BE IT FURTHER RESOLVED that certified copies of this
19   Concurrent Resolution be transmitted to the Auditor, the
20   Director of Health, and to the Insurance Commissioner, who in
21   turn is requested to transmit copies to each insurer,
22   individual and group hospital or medical service association,
23   and health maintenance organization in the State that issues
24   health insurance policies or provides health coverage.