Legislature(2009 - 2010)CAPITOL 17

04/14/2010 08:30 AM House HEALTH & SOCIAL SERVICES

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08:38:36 AM Start
08:39:34 AM SB172
10:11:46 AM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
-- Please Note Time & Location Change --
Moved HCS CSSB 172(HSS) Out of Committee
+ Bills Previously Heard/Scheduled TELECONFERENCED
8:39:34 AM                                                                                                                    
CO-CHAIR KELLER announced that the  first order of business would                                                               
be CS FOR  SENATE BILL NO. 172(FIN) am, "An  Act establishing the                                                               
Alaska Health  Care Commission  in the  Department of  Health and                                                               
Social Services; and providing for an effective date."                                                                          
8:39:49 AM                                                                                                                    
DENISE  LICCIOLI,  Staff to  Senator  Donny  Olson, Alaska  State                                                               
Legislature, paraphrased  from the sponsor statement,  which read                                                               
as follows [original punctuation provided]:                                                                                     
     Alaska is currently facing serious healthcare cost,                                                                        
     access and quality issues. Between 1991 and 2005,                                                                          
     health care expenditures in our state more than                                                                            
     tripled from $1.6 billion to $5.3 billion. Costs are                                                                       
     expected to double again by 2013 to over $10 billion.                                                                      
     All levels of government - state, local, and federal -                                                                     
     are affected, and Alaska's economy cannot sustain this                                                                     
     inflationary growth. The purpose of SB 172 is to                                                                           
     establish in statute the Alaska Health Care Commission                                                                     
     to address the need for health care reform in our                                                                          
     state. This issue is complex and broad in scope, and                                                                       
     cannot be dealt with adequately unless we have a                                                                           
     permanent body to plan and follow through for long                                                                         
     range comprehensive health care reform.                                                                                    
     The two most recent groups to work on the issue of                                                                         
     health care reform in Alaska, the Alaska Health Care                                                                       
     Roundtable (2005) and the Alaska Health Care                                                                               
     Strategies Planning Council (2007), both recommended                                                                       
     that a permanent body be established to address the                                                                        
     problem of health care reform.  The Roundtable (which                                                                      
     met for 2 years) and the Planning Council (which met                                                                       
     for 6 months) recognized that the problem is too great                                                                     
     to be effectively addressed through a short-term, ad-                                                                      
     hoc body.                                                                                                                  
     The Alaska Health Care Commission would be established                                                                     
     in the Department of Health And Social Services, and                                                                       
     would consist of a ten member body including public                                                                        
     officials and private citizens.  Representatives from                                                                      
     both the executive and legislative branches of state                                                                       
     government are included, as well as citizens                                                                               
     representing the private business sector, the health                                                                       
     care community, and consumers. Three members are to be                                                                     
     ex officio appointees from the legislature and the                                                                         
     governor's office. The composition and small size                                                                          
     would enable efficient and effective teamwork and                                                                          
     decision-making, while bring a balance of viewpoints                                                                       
     and perspectives.                                                                                                          
     The commission would provide its recommendations and                                                                       
     support the development of a statewide plan to address                                                                     
     the quality, accessibility, and availability of health                                                                     
     care for all citizens of the State. A plan for reform                                                                      
     will be based on education, sustainability, management                                                                     
     efficiency, health care effectiveness, private-public                                                                      
     partnerships, research, personal responsibility and                                                                        
     individual choice.                                                                                                         
     Alaska's need for healthcare reform is pressing and                                                                        
     must be dealt with thoroughly and efficiently, with a                                                                      
     long range view towards meaningful and lasting change.                                                                     
     The Alaska Health Care Commission would play an                                                                            
     important role in this process, and it is essential                                                                        
     that we make it a permanent component of the                                                                               
     Department of Health and Social Services, so that                                                                          
     present as well as future issues with Alaska's                                                                             
     healthcare systems can be better anticipated,                                                                              
     understood and addressed.                                                                                                  
8:44:47 AM                                                                                                                    
MS. LICCIOLI  concluded by stating  that the problem  is pressing                                                               
and health  care reform must  address present and  future issues.                                                               
The Alaska  Health Care Commission  would play an  important role                                                               
in that process.                                                                                                                
8:45:28 AM                                                                                                                    
CO-CHAIR  KELLER referred  to page  3, line  23, and  pointed out                                                               
that "insurance"  was added after  "care" which would need  to be                                                               
amended in the bill.                                                                                                            
8:46:19 AM                                                                                                                    
REPRESENTATIVE  HOLMES referred  to  language  in paragraph  (F),                                                               
which read, "one  member who represents the  health care industry                                                               
in the state."                                                                                                                  
MS. LICCIOLI  explained that "care"  was removed  and "insurance"                                                               
was  added  by  an  amendment so  the  language  currently  reads                                                               
"health insurance industry."                                                                                                    
8:46:55 AM                                                                                                                    
REPRESENTATIVE  HOLMES stated  she generally  supports the  bill.                                                               
She  recalled a  sunset provision  applies to  the Alaska  Health                                                               
Care  Commission  (AHCC)  and  asked  if  it  was  the  sponsor's                                                               
intention to have  the commission to serve  indefinitely, but the                                                               
purpose of the  sunset provision is to provide  a periodic review                                                               
of the commission.                                                                                                              
8:47:35 AM                                                                                                                    
MS. LICCIOLI  referred to page 7,  line 31, to the  June 30, 2014                                                               
sunset provision.                                                                                                               
REPRESENTATIVE  HOLMES  asked  if  the sponsor's  intent  was  to                                                               
reauthorize the AHCC or if it would be a short-term commission.                                                                 
MS.  LICCIOLI answered  that the  prime  sponsor, Senator  Olson,                                                               
does  not necessarily  want  to direct  the  legislature in  this                                                               
matter.   He  recognizes  the task  of  implementing health  care                                                               
reform is a complex issue  and acknowledged the legislature could                                                               
choose  to extend  the  commission.   However,  the sponsor  also                                                               
recognizes that  it is possible  that the AHCC could  be finished                                                               
with its  work by 2014.   Additionally, it is possible  that some                                                               
additional  changes  may be  needed.    Thus, the  prime  sponsor                                                               
wanted a  shorter sunset  date to allow  the legislature  time to                                                               
review and determine the outcome based on events as they unfold.                                                                
8:49:06 AM                                                                                                                    
REPRESENTATIVE  HOLMES pointed  out  that the  proposed AHCC  has                                                               
staggered three-year terms, which indicates  it may be an ongoing                                                               
commission, which she said she did  not have any objection to but                                                               
noted  the staggered  dates  tend  to indicate  the  role may  be                                                               
MS. LICCIOLI surmised  that the prime sponsor  would be surprised                                                               
if work  was completed at  end of sunset  date, which is  why the                                                               
terms  are  staggered terms.    However,  given the  adoption  of                                                               
health care  reform at the national  level, it may take  time for                                                               
policy impacts to  trickle down to Alaska.   The current language                                                               
would  provide  the legislature  the  opportunity  to review  the                                                               
8:50:42 AM                                                                                                                    
REPRESENTATIVE HOLMES referred to page  2, line 3, which she said                                                               
would  give the  department the  ability to  develop, adopt,  and                                                               
implement a  statewide health plan  based on  the recommendations                                                               
of the proposed Alaska Health  Care Commission (AHCC).  She asked                                                               
what the legislature's  role would be and if the  AHCC would make                                                               
recommendations  and the  department would  implement them  or if                                                               
further legislative review would be required.                                                                                   
WARD  B.  HURLBURT, M.D.,  Director  and  Chief Medical  Officer,                                                               
Division of Public Health (DPS),  Department of Health and Social                                                               
Services  (DHSS),  stated  that  the AHCC,  as  it  is  currently                                                               
functions, views itself as  making recommendations to legislature                                                               
and to  the governor  to develop  plans.   Thus, before  a health                                                               
plan would be adopted, the  AHCC would work in collaboration with                                                               
the legislature  and the administration.   He related he  is "one                                                               
of the world's largest skeptics on  commissions."  He said he has                                                               
been impressed  with the AHCC's  work thus  far.  He  thought the                                                               
sunset  provision would  give the  AHCC an  opportunity to  truly                                                               
demonstrate its worth and  if it did not do so,  it should not be                                                               
8:53:32 AM                                                                                                                    
REPRESENTATIVE  HOLMES  pointed  to  page  5,  line  11,  to  the                                                               
disclosure forms required.   She asked if there  are any problems                                                               
with medical ethics  under the required disclosure.   She did not                                                               
want to set up an instance  that caused a medical professional to                                                               
breach their medical ethics.                                                                                                    
DR. HURLBURT  deferred to Representative  Holmes as  an attorney,                                                               
but related from his own experience he did not see any problem.                                                                 
8:55:01 AM                                                                                                                    
REPRESENTATIVE HOLMES referred to page  5, line 24, and asked for                                                               
the definition of enhanced market forces.                                                                                       
DR.  HURLBURT replied  that the  intent would  be to  examine the                                                               
leverage  of purchasing  to  ensure "that  you  get your  money's                                                               
worth at the  $6 billion that we're spending.   The 18 percent of                                                               
the GDP now is  just a huge amount of our  national resource.  We                                                               
would want to make sure the  services that we get for that really                                                               
are   supported  by   the  science;   that  they   are  purchased                                                               
efficiently and effectively."                                                                                                   
REPRESENTATIVE HOLMES reflected that  this commission appeared to                                                               
be a full time job.                                                                                                             
CO-CHAIR KELLER  remarked that  the challenge is  "so huge."   He                                                               
related  that  there is  virtually  no  one  in the  health  care                                                               
industry that  is not concerned.   He  suggested that he  has not                                                               
heard  anything negative  about  actions taken  that address  the                                                               
cost in  a responsible  way and also  increase access  to quality                                                               
care.   He  remarked  that the  commissioners'  passion has  been                                                               
8:57:13 AM                                                                                                                    
REPRESENTATIVE  T.  WILSON  suggested  that  the  department  has                                                               
expertise.   She referred to the  fiscal note and inquired  as to                                                               
whether  anyone currently  performing  the  functions could  take                                                               
over as executive director rather than to hire a new person.                                                                    
DR. HURLBURT responded that the  executive director's position is                                                               
a  full-time position.    This  person would  serve  as a  public                                                               
entity to  serve to react  to health care reform.   Additionally,                                                               
the  department  does not  have  the  expertise to  provide  some                                                               
analyses on health care reform,  such as a health care economist.                                                               
Some national  analyses will  be available  through organizations                                                               
such  as   Covington  &  Burley   and  Henry  J.   Kaiser  Family                                                               
Foundation,  but  the state  will  also  need to  acquire  state-                                                               
specific analysis to  address health care reform,  which could be                                                               
provided  by  outside  contracts,   such  as  the  University  of                                                               
Alaska's Institute of Social and Economic Research (ISER).                                                                      
8:59:04 AM                                                                                                                    
MS. LICCIOLI  said the AHCC  has "a  lot of work"  to accomplish.                                                               
She was  unsure of their  needs but she  could say that  at least                                                               
one full-time  staff person  would be  necessary, given  that the                                                               
other commission members are doing  other work.  The AHCC members                                                               
are essentially "volunteers."  It is envisioned that one full-                                                                  
time  person  would  conduct  research  and  would  interact  and                                                               
prepare  materials  so  the commission  members'  time  would  be                                                               
minimized.   She related that  it already takes  significant time                                                               
just  to  prepare for  and  attend  meetings.   She  stated  that                                                               
without a dedicated  staff person the commission's  work would be                                                               
9:00:41 AM                                                                                                                    
REPRESENTATIVE  T.  WILSON  said  many issues  will  need  to  be                                                               
addressed.  She suggested that  perhaps a staff member could work                                                               
on the  issues as opposed to  hiring an executive director.   She                                                               
expressed concern about adding another $500,000 to the budget.                                                                  
MS. LICCIOLI related  that the department and  Dr. Hurlburt would                                                               
need to answer with respect to resources.                                                                                       
CO-CHAIR  KELLER said  he would  like to  have them  available to                                                               
answer questions.                                                                                                               
9:01:49 AM                                                                                                                    
REPRESENTATIVE CISSNA  offered her  belief that  the commission's                                                               
work would  cover every department  in the state since  they have                                                               
their  "fingers in  the health  pie."   All  state employees  are                                                               
affected  since they  receive pay  and health  insurance.   Thus,                                                               
"billions  of dollars  are really  impacted by  this commission."                                                               
She  indicated that  data collection  has  been cut  back so  the                                                               
state  cannot compare  itself to  a lot  of other  states.   This                                                               
commission  could  offer  a  financial   savings  to  the  state.                                                               
"Underfunding is usually  the 'kiss of death'  for business", she                                                               
said.   She  stated that  the executive  director needs  to be  a                                                               
person "that keeps the glue in place."                                                                                          
9:04:10 AM                                                                                                                    
DR. HURLBURT  agreed with Representative  Cissna's comments.   He                                                               
said the need  for the commission has become more  acute with the                                                               
passage  of federal  health  care reform.    Health care  impacts                                                               
everyone.  He  stated that the department does  need resources to                                                               
keep the  commission ongoing.   Resources  were not  provided the                                                               
first year  the AHCC operated.   Thus,  it has been  an "unfunded                                                               
mandate."   He suggested that  his division needs to  be involved                                                               
in  preventative health  and needs  to be  held accountable.   He                                                               
speculated that  on a day-to-day  basis the AHCC will  be working                                                               
on  "medical  care  cost  issues"  since  the  bill  charges  the                                                               
commission to develop a strategy  for improving the health of all                                                               
residents of  the state to encourage  personal responsibility for                                                               
disease  prevention, healthy  living, and  acquisition of  health                                                               
9:06:11 AM                                                                                                                    
MS. LICCIOLI said  that the fiscal note shares the  cost with the                                                               
federal  government  so other  federal  programs  will be  billed                                                               
since the programs will benefit  from the commission's work.  The                                                               
full  fiscal  impact  will  not  come  from  general  fund  (GF),                                                               
although more than half the cost is GF funding.                                                                                 
REPRESENTATIVE  T. WILSON  referred  to the  fiscal note  funding                                                               
that indicates $500,000 from the general fund (GF).                                                                             
WILDA LAUGHLIN,  Special Assistant,  Office of  the Commissioner,                                                               
Department of  Health and Social  Services (DHSS),  explained the                                                               
fiscal  note  was updated  on  April  13,  2010 to  show  federal                                                               
receipts of $165,000  and GF match of $335,000.   The fiscal note                                                               
also  reflects the  additional person  to reflect  the additional                                                               
commission membership, which totals 13 members.                                                                                 
9:08:55 AM                                                                                                                    
WAYNE  STEPHENS,  President  and  CEO, Alaska  State  Chamber  Of                                                               
Commerce,  stated  he  has  served  on  the  Alaska  Health  Care                                                               
Commission (AHCC)  for the past  year.  He expressed  support for                                                               
the  AHCC.   He  noted  the increase  in  health  care costs  and                                                               
premiums  has  created a  significant  burden  on businesses  and                                                               
employers.   The  health care  personnel  workforce shortage  has                                                               
reduced access for  seniors and other Alaskans.   Alaska's health                                                               
care system needs adjustments and  there are not any quick fixes.                                                               
The best first step is to  address pressing health care issues is                                                               
to  permanently  establish the  AHCC,  comprised  of experts  and                                                               
representatives of key stakeholders in  the state.  The AHCC will                                                               
make recommendations  to the legislature to  realign and redesign                                                               
the system.  The temporary  AHCC, established by executive order,                                                               
expired  this   year  but  began  to   consider  relevant  issues                                                               
including  coverage, cost,  access, quality,  work force,  health                                                               
information   technology,   primary   care   safety   net,   cost                                                               
transparency, prevention, personal  responsibility, but the short                                                               
timeframe  is inadequate  to address  the complex  issues to  the                                                               
degree needed.   The  Alaska State  Chamber of  Commerce supports                                                               
the   establishment  in   statute  of   the  AHCC   to  recommend                                                               
comprehensive  statewide health  and  health care  policy to  the                                                               
governor  and  legislature that  will  result  in a  health  care                                                               
system that provides quality and affordable access to Alaskans.                                                                 
9:11:16 AM                                                                                                                    
REPRESENTATIVE  T. WILSON  asked how  many members  serve on  the                                                               
MR. STEPHENS replied seven plus the three ex-officio members.                                                                   
9:11:42 AM                                                                                                                    
MR.  BRIAN SAYLOR,  Ph.D., Retired,  stated he  retired from  the                                                               
University of  Alaska Anchorage (UAA)  and has  previously served                                                               
as  the  deputy commissioner,  Department  of  Health and  Social                                                               
Services  (DHSS)   and  as   the  director,   Alaska  Psychiatric                                                               
Institute.  He  spoke in support of SB 172  and in recognition of                                                               
the complexity  of the health care  system.  One element  that he                                                               
thought would  warrant additional attention and  would strengthen                                                               
the bill is the extent to  which the public health enterprise can                                                               
reduce costs and  improve people's health by  reducing the demand                                                               
for services.   He stated  that the  element is suggested  in the                                                               
bill  but  should be  made  very  explicit.   He  commented  that                                                               
Representative  Cissna has  a copy  of an  amendment he  prepared                                                               
that would address  this issue.  He stated  that demand reduction                                                               
that comes as a direct  result of preventive activities of public                                                               
health, which  go beyond individual  responsibility and  are more                                                               
consistent with Article 7, of  the Alaska State Constitution that                                                               
argues we  promote and protect  the public health.   Those things                                                               
have been shown repeatedly to have  a marked effect to reduce the                                                               
demand for  medical care.   He explained that the  bill currently                                                               
focuses more on the delivery  of health services to reduce costs.                                                               
His strong  recommendation is public  health be  explicitly noted                                                               
in  the bill.    He offered  his  belief that  this  would add  a                                                               
welcome  additional  element to  the  study  of our  health  care                                                               
system.   Currently, the  health care  system consists  of health                                                               
care  services delivery  rather than  one that  addresses overall                                                               
health.   He thought the  addition of  public health would  "go a                                                               
long way to correct that."                                                                                                      
9:14:29 AM                                                                                                                    
REPRESENTATIVE CISSNA thanked  Dr. Saylor.  She  recalled a prior                                                               
study  that  suggested  cost  reductions  could  be  achieved  by                                                               
providing care at the point  a person develops a chronic disease,                                                               
to help them to  get better and stop the growth  of disease.  She                                                               
asked  whether  such a  study  could  be  made available  to  the                                                               
legislature and newly-convened commission.                                                                                      
DR. SAYLOR  pointed out that  extensive literature on  the impact                                                               
of  health  promotion  and  disease  reduction,  not  only  among                                                               
corporations, where the return on  investment is astonishing, but                                                               
in the public, in general.   He thought that the commission would                                                               
add attention to public health  infrastructure.  He said he would                                                               
be  happy  to help  in  any  way  he  can to  provide  additional                                                               
9:16:42 AM                                                                                                                    
DEB ERICKSON,  Executive Director, Alaska Health  Care Commission                                                               
(AHCC), explained  that the workload has  substantially increased                                                               
with passage  of the federal health  care laws.  She  recalled an                                                               
overview on  the legislation, which  added over a  thousand pages                                                               
of  federal law.    She  offered her  belief  that  the law  will                                                               
fundamentally change  the method of  delivery for health  care in                                                               
Alaska.   The  AHCC  has  been working  to  more effectively  and                                                               
efficiently  organize  funding and  delivery  of  health care  in                                                               
Alaska.   She related the  AHCC will  work to understand  the new                                                               
federal  law.   She understood  an amendment  may be  considered.                                                               
She offered her  view that a strong delivery system  must rest on                                                               
a foundation  of prevention  and a  strong public  health system.                                                               
As  duties  are added,  it  could  potentially "water  down"  the                                                               
AHCC's mission.  She reiterated  Dr. Hurlburt's comments that the                                                               
Department of  Health and  Social Services  (DHSS) does  not have                                                               
the expertise  it needs  without obtaining  additional resources.                                                               
Her  position was  created as  essentially a  non-permanent fully                                                               
exempt position  that is not in  the budget.  She  suggested that                                                               
if the fiscal note were to  be "stripped" that her position would                                                               
likely disappear.  Prior to  taking this position, she worked for                                                               
about 25 years with the DHSS.   Thus, speaking from experience if                                                               
the bill  passed without funding  the DHSS  would not be  able to                                                               
acquire necessary expertise through  consultants.  She speculated                                                               
that if  that were  to happen,  the level  of work  product would                                                               
suffer.  She speculated that  might translate into the commission                                                               
issuing  a staff  report  and  holding several  "teleconferenced"                                                               
commission  meetings.    She  brought  up  two  things  to  note.                                                               
Supporting the executive director  position created budget issues                                                               
for  the  department.    The AHCC  developed  a  detailed  public                                                               
communication  and   engagement  strategy   that  could   not  be                                                               
implemented due  to a  lack of resources.   Thus,  the commission                                                               
was not able  to engage or interact with the  public to a greater                                                               
extent and  was less transparent  than it  could have been  if it                                                               
had been funded.                                                                                                                
9:23:02 AM                                                                                                                    
CO-CHAIR KELLER  stated the AHCC,  which he had the  privilege of                                                               
serving on, was established by  an executive order that also gave                                                               
the commission the  authority to hire an executive  director.  He                                                               
asked to  place on the  record that  he has profound  respect and                                                               
appreciation for  Ms. Erickson's  work.   He said  the commission                                                               
would  not have  been successful  without  her.   He said,  "I've                                                               
become one of your greatest fans."                                                                                              
9:24:14 AM                                                                                                                    
CO-CHAIR KELLER closed public testimony on SB 172.                                                                              
9:24:24 AM                                                                                                                    
REPRESENTATIVE  CISSNA moved  to adopt  Amendment 1,  labeled 26-                                                               
LS0790\CA.1, which read as follows:                                                                                             
     Page 6,  line 4:                                                                                                           
          Delete "and"                                                                                                          
     Page 6, line 6, following "services":                                                                                      
          Insert ";                                                                                                             
               (G)  determines the resources needed by                                                                          
       local and state governments to protect the public                                                                        
     health; and                                                                                                                
               (H)  assesses the effect of improved health                                                                      
     status on the cost of health care"                                                                                         
CO-CHAIR KELLER objected for purpose of discussion.                                                                             
9:25:17 AM                                                                                                                    
REPRESENTATIVE CISSNA  explained that proposed Amendment  1 would                                                               
add two paragraphs to the  services and duties of the commission.                                                               
She   stated  that   it  follows   the  discussion   of  personal                                                               
responsibility and  preventative medicine.   She stated  that the                                                               
constitution  looks at  primary  prevention  and determining  the                                                               
resources needed by  local and state governments.   She suggested                                                               
that  proposed Amendment  1 should  state  "promote and  protect"                                                               
since those terms are in  Alaska's constitution.  She offered her                                                               
belief that state government should  put its efforts into keeping                                                               
people healthy.   Currently, people  often enter the  health care                                                               
system when  they are Medicare  eligible and go to  the emergency                                                               
room for treatment, which is  the most expensive provider.  Thus,                                                               
people  enter  the most  expensive  part  of the  system,  become                                                               
Medicaid  eligible, and  continually are  treated for  illness or                                                               
disease.  This becomes a "huge  driver" of the "huge debt" in the                                                               
state and absorbs the department's  resources.  She advocated for                                                               
Alaska  to review  the needs  and assess  the effect  of improved                                                               
health  status  to  ensure  money  is  spent  in  the  most  cost                                                               
effective  manner  rather  than  waiting until  sick  people  are                                                               
eligible for Medicare before their  problems emerge.  She further                                                               
advocated  striving for  a healthier  population.   This language                                                               
provides  a different  focus and  a more  refined way  of viewing                                                               
health care that "builds health."                                                                                               
9:30:58 AM                                                                                                                    
REPRESENTATIVE HOLMES offered her  support for proposed Amendment                                                               
1.   She agreed that  prevention is  not clearly spelled  out and                                                               
the  need  for  prevention,  such  as  for  immunizations,  anti-                                                               
obesity, and life  style changes and should be in  the purview of                                                               
the AHCC.                                                                                                                       
9:31:47 AM                                                                                                                    
CO-CHAIR  KELLER thought  the comments  were good  comments.   He                                                               
objected to Amendment  1 since it is already included  in SB 172.                                                               
He referred to  page 5, line 19-31, which outlines  the duties of                                                               
the  commission.    He  read  subsection  (a)(2)(A),  "encourages                                                               
personal responsibility  for disease prevention,  healthy living,                                                               
and  acquisition of  health insurance;."    He expressed  concern                                                               
with paragraph  (H) to "assessing  the effect of  improved health                                                               
status..."    He  stated  that   the  state  wants  to  encourage                                                               
prevention for healthy living, which  the AHCC supports and while                                                               
Amendment  1  is  not  harmful,   that  specificity  might  cause                                                               
9:33:43 AM                                                                                                                    
REPRESENTATIVE  CISSNA  said  that  state spends  more  money  on                                                               
getting  people familiar  with  Medicaid than  on  the effort  to                                                               
break learned  habits, some through  expensive advertising.   The                                                               
private sector  has its rights  but the  state's role is  to help                                                               
people break habits.                                                                                                            
CO-CHAIR KELLER maintained  his objection.  He felt  the issue is                                                               
already covered.                                                                                                                
CO-CHAIR KELLER reopened public testimony on SB 172.                                                                            
9:35:20 AM                                                                                                                    
MS. ERICKSON referred  to proposed Amendment 1.   She opined that                                                               
she  agreed  that  paragraph  (H) is  already  addressed  in  the                                                               
current duties on page 5, in  subparagraph (A),(B), and on page 6                                                               
in  subparagraph (C),  which she  reviewed.   The one  thing that                                                               
subparagraph  (H)  addresses that  may  not  be recognized  by  a                                                               
further AHCC  or is not  reflected in  the duties outlined  in SB
172,  is  the role  of  local  and  state government  for  public                                                               
CO-CHAIR KELLER  asked whether the  language in  subparagraph (G)                                                               
would create a burden for the AHCC.                                                                                             
MS. ERICKSON  responded that under  the current fiscal  note, the                                                               
AHCC would  not have resources  to address subparagraph  (G), but                                                               
she imagined the  commission could address in  more general terms                                                               
the role  of local and  state governments with respect  to public                                                               
health.   She remarked that the  task is huge that  this language                                                               
would add one more duty for AHCC to prioritize.                                                                                 
9:38:44 AM                                                                                                                    
REPRESENTATIVE T. WILSON asked for the bill sponsor's comment.                                                                  
MS. LICCIOLI  reported she  discussed a  previous version  of the                                                               
amendment  with  Senator  Olson.    She  said  he  believes  that                                                               
proposed Amendment 1  would not be harmful, but  that the current                                                               
duties are  already covered in the  bill.  She said  he expressed                                                               
slight  concern  with the  language  "resources  needed by  local                                                               
government" since numerous local  governments exist in Alaska and                                                               
the  resource   needs  vary  between  local   governments.    She                                                               
suggested  that  it may  be  better  to  list  "what we  want  to                                                               
accomplish"  and  allow  the  local   and  state  governments  to                                                               
identify the resources.                                                                                                         
REPRESENTATIVE  T. WILSON  commented  that  the commission  could                                                               
always add these requirements at a later date.                                                                                  
9:40:33 AM                                                                                                                    
MS.  LICCIOLI said  she thought  the  sponsor would  agree.   She                                                               
restated  that he  did not  think  the proposed  Amendment 1  was                                                               
harmful,  but  believes  the commission  already  is  working  to                                                               
accomplish the tasks.                                                                                                           
9:40:55 AM                                                                                                                    
CO-CHAIR KELLER reclosed public testimony on SB 172.                                                                            
9:41:05 AM                                                                                                                    
REPRESENTATIVE  CISSNA offered  her strong  support for  proposed                                                               
Amendment 1.   She explained that  she has been a  legislator for                                                               
12 years.   She has  observed illnesses and health  problems move                                                               
from adult  problems to problems that  increasingly affect youth.                                                               
She expressed  concern that the  majority of Alaska's  youth have                                                               
developed  poor  habits  that  will  translate  to  a  diminished                                                               
quality of life as adults.   She said, "That's really frightening                                                               
to me."  She said that  the legislature must think differently if                                                               
it wants  to solve the  problems.  She  pointed out that  she has                                                               
visited 60 communities  and has found that  local governments are                                                               
accessible.  She  offered that having a  commission ask questions                                                               
and having communities know that  someone will listen "would be a                                                               
huge thing."                                                                                                                    
9:43:42 AM                                                                                                                    
CO-CHAIR KELLER maintained his objection.                                                                                       
9:44:03 AM                                                                                                                    
A roll  call vote was  taken.  Representatives Cissna  and Holmes                                                               
voted in favor of Amendment  1.  Representatives T. Wilson, Lynn,                                                               
Keller  voted against  it.   Therefore, Amendment  1 failed  by a                                                               
vote of 3-2.                                                                                                                    
9:44:54 AM                                                                                                                    
CO-CHAIR KELLER opened public testimony on SB 172.                                                                              
LIZ  CLEMENT, Staff  to Representative  Bob Herron,  Alaska State                                                               
Legislature, related  that the amendment  that the  sponsor would                                                               
have  offered is  one that  may be  offered by  Representative T.                                                               
Wilson and not Amendment 1, which failed.                                                                                       
CO-CHAIR KELLER closed public testimony on SB 172.                                                                              
9:45:59 AM                                                                                                                    
REPRESENTATIVE T.  WILSON moved  Conceptual Amendment  2 [labeled                                                               
Amendment #1], which read [original punctuation provided]:                                                                      
     Amend/replace Sec.18/09.040 with:                                                                                          
     "The commission may appoint  an executive director, who                                                                    
     may not  be a member  of the commission, and  who shall                                                                    
     be  current staff  of the  department.   All commission                                                                    
     research  and supplemental  work shall  be accomplished                                                                    
     with  department  resources and  collaboration  between                                                                    
     commission members."                                                                                                       
CO-CHAIR KELLER objected for the purpose of discussion.                                                                         
9:46:15 AM                                                                                                                    
REPRESENTATIVE  T.  WILSON  expressed concern  with  the  initial                                                               
fiscal note that  added an executive director.  She  said she was                                                               
even more  concerned with the  subsequent fiscal note  that added                                                               
two positions.   She re-read proposed Conceptual  Amendment 2 and                                                               
gave  the rationale  for the  amendment.   She  stated that  this                                                               
amendment  would   allow  the   commission  the   flexibility  to                                                               
determine its staffing needs and  workload.  She said she changed                                                               
the language  to "may appoint"  and the commission  can determine                                                               
their needs.   The commission  will utilize the expertise  of the                                                               
department  and  maximize  existing department  resources.    She                                                               
maintained her concern  about "adding more people."   She offered                                                               
her  belief  that  this  commission  is  a  "good  thing."    She                                                               
reiterated  her  concern  that  the  fiscal  note  indicated  the                                                               
commission would hire someone at  $134,000 and a second person at                                                               
$58,000, which is her source of objection.                                                                                      
9:48:04 AM                                                                                                                    
CO-CHAIR KELLER maintained  his objection.  He said  that much of                                                               
the commission's cost is paid for by the federal government.                                                                    
CO-CHAIR KELLER opened public testimony on SB 172.                                                                              
9:48:50 AM                                                                                                                    
The committee took an at-ease from 9:48 a.m. to 9:50 a.m.                                                                       
9:50:05 AM                                                                                                                    
CO-CHAIR KELLER  asked about the language  in proposed Conceptual                                                               
Amendment 2,  to the second  "shall".  He suggested  the language                                                               
read "may".                                                                                                                     
REPRESENTATIVE  T.  WILSON  agreed  to  the  change  to  proposed                                                               
Conceptual  Amendment 2.    She recalled  a  question was  raised                                                               
whether a person  could be hired if the  person currently filling                                                               
the position resigned.  She  answered that the position currently                                                               
exists  and if  the  executive director  resigned the  department                                                               
could fill  the position.   She agreed  that "may"  also provides                                                               
the department with more flexibility.                                                                                           
9:51:13 AM                                                                                                                    
CO-CHAIR  KELLER  asked  for clarification  on  whether  proposed                                                               
Conceptual  Amendment  2,  would  replace  AS  18.09.040  in  its                                                               
Representative T. Wilson answered yes.                                                                                          
CO-CHAIR KELLER  asked whether Representative T.  Wilson intended                                                               
that the "commission shall establish  the duties of the executive                                                               
director."   He said he  did not  see the language  in Conceptual                                                               
Amendment 2.                                                                                                                    
REPRESENTATIVE   HOLMES  suggested   just  replacing   the  first                                                               
9:52:14 AM                                                                                                                    
CO-CHAIR  KELLER  opened public  testimony.    He clarified  that                                                               
Conceptual Amendment  2 would delete  the first sentence  on page                                                               
4,  line  20-21, which  read,  "The  commission shall  employ  an                                                               
executive director, who  may not be a member  of the commission."                                                               
Conceptual  Amendment  2  would  replace sentence  one  with  the                                                               
following:  "The commission  may appoint  an executive  director,                                                               
who may not be a member of  the commission and who may be current                                                               
staff   of  the   department.     All  commission   research  and                                                               
supplemental   work  shall   be   accomplished  with   department                                                               
resources and collaboration between commission members."                                                                        
REPRESENTATIVE T. WILSON agreed.                                                                                                
MS.   LICCIOLI,  stated   that   from  her   experience  in   the                                                               
administration,  that the  existing position  is a  non-permanent                                                               
position since  the department did  not have funding at  the time                                                               
the  commission was  established.   Thus, the  executive director                                                               
position will "go  away."  She recalled  Representative T. Wilson                                                               
mentioning  the  department  "has  a  position."    However,  the                                                               
position  will  only be  temporary  and  without approval  of  an                                                               
additional  position, the  department would  need to  reassign an                                                               
existing position.                                                                                                              
REPRESENTATIVE  T. WILSON  offered her  belief that  changing the                                                               
wording from "shall" to "may"  would allow the position to become                                                               
permanent.  She  said that Conceptual Amendment 2  does not force                                                               
the department to hire an executive director.                                                                                   
9:55:29 AM                                                                                                                    
CO-CHAIR KELLER referred to page 4,  line 20-22.  He related that                                                               
after the  first sentence, following  "member of  the commission"                                                               
that Conceptual Amendment 2 would be inserted, which he read:                                                                   
     The commission  may appoint an executive  director, who                                                                    
     may not  be a member of  the commission and who  may be                                                                    
     current  staff  of  the  department.    All  commission                                                                    
     research  and supplemental  work shall  be accomplished                                                                    
     with  department  resources and  collaboration  between                                                                    
     commission members."                                                                                                       
CO-CHAIR  KELLER asked  whether  the department  approves of  the                                                               
language  in proposed  Conceptual Amendment  2, noting  the short                                                               
MS. LAUGHLIN  replied that she  could not answer and  deferred to                                                               
Dr. Hurlburt.                                                                                                                   
CO-CHAIR  KELLER  asked for  the  impact  of proposed  Conceptual                                                               
Amendment 2 on the fiscal note.                                                                                                 
9:57:19 AM                                                                                                                    
JILL LEWIS, Deputy  Director - Juneau, Division  of Public Health                                                               
(DPS), Department of Health and  Social Services (DHSS), reported                                                               
the  status of  the  current executive  director  position.   She                                                               
explained  that  at  the  time the  commission  was  created  the                                                               
request for  funding for  an executive director  was made  in the                                                               
budget process  and not the  enabling legislation.   The position                                                               
was not  appropriated.  Thus,  the position does  not technically                                                               
exist  and the  DPS  is  absorbing the  cost  for the  unbudgeted                                                               
position.    To  remedy  this issue,  the  legislature  needs  to                                                               
appropriate the  money for the  position and add the  position in                                                               
the fiscal note.   She reiterated that the  DPS currently absorbs                                                               
the cost.                                                                                                                       
9:59:20 AM                                                                                                                    
REPRESENTATIVE  HOLMES   advised  that  the  first   sentence  of                                                               
proposed  Conceptual Amendment  2  would give  discretion to  the                                                               
department.   She suggested  that the  second sentence  may cause                                                               
confusion on whether the position could be reauthorized.                                                                        
CO-CHAIR  KELLER   agreed  that  restricting  the   research  and                                                               
supplemental work  to department resources was  problematic since                                                               
the  commission  may  wish  to  use  private  industry  for  some                                                               
REPRESENTATIVE  T.  WILSON  surmised   that  the  department  had                                                               
budgeted funds  for outside research  so it probably has  a means                                                               
to use consultants.                                                                                                             
10:01:25 AM                                                                                                                   
CO-CHAIR  KELLER clarified  that this  refers to  the commission,                                                               
not  the  department.    Thus,  the AHCC  may  wish  to  draw  in                                                               
additional sources.                                                                                                             
REPRESENTATIVE  HOLMES agreed.   She  commented that  it was  not                                                               
likely the intention, but the  proposed language would hamper the                                                               
commission  in  accepting  federal  funding  or  private  funding                                                               
REPRESENTATIVE T. WILSON  interjected that "collaboration between                                                               
commission  members" would  provide flexibility.   She  asked why                                                               
the second staff was requested.                                                                                                 
MS. LEWIS responded  that the executive director of  the AHCC has                                                               
been asked to  be the lead of the  inter-departmental team, which                                                               
will dramatically increase  the workload.  The  position would be                                                               
an ongoing position.                                                                                                            
REPRESENTATIVE T.  WILSON asked whether this  position is outside                                                               
the scope of board.                                                                                                             
MS. LEWIS said it was not, since  it is within the charter of the                                                               
Alaska Health Care Commission.                                                                                                  
10:04:06 AM                                                                                                                   
REPRESENTATIVE  CISSNA remarked  the funding  is coming  from the                                                               
division that  does preventative  work, which means  fewer people                                                               
will be available  to do the work.   She said it  is important to                                                               
keep the DPS budget intact.   She offered her belief that it will                                                               
save enormous amounts of money if the AHCC can do its work.                                                                     
REPRESENTATIVE  T. WILSON  said  she wanted  to  ensure that  the                                                               
department's  talents  are utilized  and  the  intent is  not  to                                                               
"short fund anybody or to say  it's not important, but is to make                                                               
sure we're  utilizing the people  in the  best way that  we can."                                                               
She  said  she  just  wants  to ensure  that  the  state  is  not                                                               
complicating the  matter with  a board  and more  staff involved.                                                               
She agreed that  having the commission in place is  "great."  She                                                               
did not want to stand in the way.                                                                                               
10:06:42 AM                                                                                                                   
CO-CHAIR KELLER asked whether Dr.  Hurlburt would like to comment                                                               
on proposed Conceptual Amendment 2.                                                                                             
DR.  HURLBURT expressed  concerned to  keep the  costs as  low as                                                               
possible  and still  "get the  job done."   He  related that  the                                                               
federal health care reform will  provide some analyses.  However,                                                               
what  is  lacking  in  expertise  and  resources  is  the  health                                                               
economic  analysis.   The commission  will need  to contract  for                                                               
that expertise  and analysis.   Thus, funding  will be  needed to                                                               
provide  expertise on  some  of the  Alaska  specific aspects  of                                                               
health  care reform.   The  AHCC brought  in Dr.  Donald Pathman,                                                               
University of North  Carolina, as a consultant.  He  is an expert                                                               
on  loan repayments  and incentives,  to assist  Alaska to  bring                                                               
providers  into  the  state.    He  related  that  the  state  of                                                               
Wisconsin  established  an  agency  to  respond  to  health  care                                                               
reform.   He remarked  that the department  envisions the  job of                                                               
responding to the federal health care  reform will be a huge job.                                                               
The department hopes that using  the AHCC will bring efficiencies                                                               
to work with  the intra-state government departmental  group.  He                                                               
concluded that the DPH is trying  to be sensitive to the concerns                                                               
that have been expressed.                                                                                                       
10:09:32 AM                                                                                                                   
REPRESENTATIVE T.  WILSON wanted  to clarify that  this is  not a                                                               
new  concept that  the department  contracts  out for  expertise.                                                               
She  said  she  did  not  have  a  problem  dropping  the  second                                                               
sentence.   She reiterated that  issues currently arise  in which                                                               
the department obtains expertise.                                                                                               
10:10:05 AM                                                                                                                   
CO-CHAIR KELLER  explained that  proposed Conceptual  Amendment 2                                                               
would  replace  the  first  sentence of  AS  18.09.040  with  the                                                               
language, "The  commission may employ an  executive director, who                                                               
may not  be a member  of the commission,  and who may  be current                                                               
staff of the department."                                                                                                       
CO-CHAIR KELLER removed his objection.                                                                                          
CO-CHAIR KELLER closed public testimony on SB 172.                                                                              
10:11:02 AM                                                                                                                   
REPRESENTATIVE  HOLMES  moved  to  report CSSB  172(Fin)  am,  as                                                               
amended,  out of  committee with  individual recommendations  and                                                               
the accompanying fiscal notes.                                                                                                  
There being  no objection,  HCS CSSB  172(HSS) was  reported from                                                               
the Health and Social Services Standing Committee.                                                                              

Document Name Date/Time Subjects