Legislature(2009 - 2010)HOUSE FINANCE 519

04/06/2010 01:30 PM House FINANCE

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Heard & Held
+ Bills Previously Heard/Scheduled TELECONFERENCED
Moved CSHB 168(FIN) Out of Committee
HOUSE BILL NO. 168                                                                                                            
     "An   Act   relating   to   state   certification   and                                                                    
     designation   of    trauma   centers;    creating   the                                                                    
     uncompensated trauma care  fund to offset uncompensated                                                                    
     trauma  care  provided   at  certified  and  designated                                                                    
     trauma centers; and providing for an effective date."                                                                      
1:40:56 PM                                                                                                                    
Co-Chair  Stoltze  noted  that  public  testimony  had  been                                                                    
closed. He solicited amendments to the bill.                                                                                    
1:41:11 PM                                                                                                                    
Co-Chair Stoltze observed the new fiscal note.                                                                                  
CO-CHAIR  MIKE HAWKER  explained  that  the legislation  was                                                                    
ineffective without the associated  funding. He relayed that                                                                    
upon  first introduction,  the bill  had  be accompanied  by                                                                    
request for an appropriation of  $5 million. A parallel bill                                                                    
had moved  through the Senate,  which also had a  $5 million                                                                    
fiscal note  attached to it. Discussions  had concluded that                                                                    
if the bill  were to pass, an appropriation  would be needed                                                                    
in order to  fund the legislation. He thought  that the cost                                                                    
associated  with the  legislation would  become a  long term                                                                    
operating budget  item. The fiscal note  reflected a request                                                                    
of $5  million in FY  11 operating budget, all  future years                                                                    
were  indeterminate.  The  funding  source  was  50  percent                                                                    
federal  receipts, and  50 percent  general funds,  based on                                                                    
the  understanding  that  at those  levels  there  would  be                                                                    
disproportionate  hospital share  authority available  under                                                                    
Co-Chair  Stoltze  agreed  that the  fiscal  note  reflected                                                                    
significant fiscal impact.                                                                                                      
1:46:02 PM                                                                                                                    
Representative  Austerman  expressed  appreciation  for  the                                                                    
candid  discussion concerning  increasing  the  cost of  the                                                                    
operating budget.                                                                                                               
1:46:58 PM                                                                                                                    
Representative Austerman understood the  need for the trauma                                                                    
centers,  but he  felt that  placing an  emphasis on  trauma                                                                    
prevention would be more beneficial.  He thought that adding                                                                    
more troopers  along highways to arrest  drunk drivers would                                                                    
save  lives,  preventing  the   need  for  increased  trauma                                                                    
centers.  He  thought  that   trauma  prevention  should  be                                                                    
addressed as well.                                                                                                              
Representative Foster cited Page 1, Line 14:                                                                                    
     (b) The fund consists of money appropriated to it by                                                                       
the  legislature,  including  donations,  recoveries  of  or                                                                    
reimbursements for  awards made  from activities  under this                                                                    
Representative Foster  asked if  the fund  would need  to be                                                                    
replenished from year-to-year,  and by how much.  He said if                                                                    
each  year 25  percent  of  the fund  was  being spent,  the                                                                    
entire appropriation would  be spent in four  to five years.                                                                    
1:49:48 PM                                                                                                                    
SENATOR  JOHN COGHILL,  SPONSOR,  answered that  he did  not                                                                    
know.  The general  area of  cost was  known due  looking at                                                                    
similar programs  in other states.  He said that  there were                                                                    
federal grants and  local programs that could  be willing to                                                                    
contribute. He  directed attention to  Tab 4 of  the "Trauma                                                                    
Care in Alaska: Creating a  Trauma Care Fund" book. In order                                                                    
for Trauma Level 2 status  to be achieved, alcohol screening                                                                    
and brief  intervention was necessary.  He argued  that this                                                                    
would  create a  system that  had an  intervention component                                                                    
that would provide for teachable  moments in people's lives.                                                                    
He  agreed  that  safety  issues   on  the  road  should  be                                                                    
1:52:46 PM                                                                                                                    
Co-Chair Hawker reminded the  committee that the legislative                                                                    
proposal  had   been  discussed  for  over   two  years.  He                                                                    
expressed concern that the proposal  was expensive to create                                                                    
and maintain,  and could force  the state back  into deficit                                                                    
spending.   However,  he   felt   that   the  proposal   was                                                                    
compelling, and  believed that  the importance  of immediate                                                                    
trauma treatment regardless of  the location of the accident                                                                    
should  be  a priority.  He  agreed  that a  stronger  state                                                                    
trooper presence along the Seward  Highway could be helpful.                                                                    
He stated  that the  goal should be  to build  the resources                                                                    
within  the  state to  care  for  the "innocent  victims  of                                                                    
stupidity". He  offered that Alaska  was a high  risk state,                                                                    
and that simply living here  posed a higher risk than living                                                                    
in other states.   He announced support  for the legislation                                                                    
and acknowledged  the fiscal note associated  with the bill.                                                                    
He believed that  there was a greater good  served by moving                                                                    
the  bill forward  despite  continuing  fiscal concerns.  He                                                                    
felt  that the  public  understood that  the programs  would                                                                    
continue for  only as long  as there was money  available to                                                                    
fund  them.  He  recognized  that  passing  the  bill  would                                                                    
inevitably  create financial  trauma  for the  state in  the                                                                    
1:56:52 PM                                                                                                                    
Representative Kelly expressed concern  that the state would                                                                    
be  accepting liability  for trauma  victims,  and that  the                                                                    
legislation  imposed the  responsibility of  health care  on                                                                    
the  state. He  agreed with  the  concept of  the bill,  but                                                                    
harbored deep concern for the financial responsibility.                                                                         
1:59:47 PM                                                                                                                    
Representative Salmon disagreed. He  believed that the state                                                                    
needed  to   begin  improvements  in  the   area  of  trauma                                                                    
response.  He argued  that lives  in rural  Alaska could  be                                                                    
saved by  establishing trauma centers closer  to villages to                                                                    
assist  in the  "golden  hour". In  emergency medicine,  the                                                                    
"golden hour" refers  to the time period lasting  from a few                                                                    
minutes to  several hours  following traumatic  injury being                                                                    
sustained by a  casualty, during which there  is the highest                                                                    
likelihood  that  prompt   medical  treatment  will  prevent                                                                    
2:01:17 PM                                                                                                                    
Vice-Chair  Thomas MOVED  to report  CS HB  168(FIN) out  of                                                                    
Committee   with   individual    recommendations   and   the                                                                    
accompanying fiscal  note. There being NO  OBJECTION, it was                                                                    
so ordered.                                                                                                                     
CS  HB  168(FIN)  was  REPORTED out  of  Committee  with  no                                                                    
recommendation and with new fiscal  note from the Department                                                                    
of Health and Social  Services and previously published zero                                                                    
fiscal note: FN2 (REV)                                                                                                          
2:01:49 PM     AT EASE                                                                                                        
2:14:44 PM     RECONVENED