Legislature(2017 - 2018)CAPITOL 106

03/17/2017 03:15 PM House LABOR & COMMERCE

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<Bill Hearing Canceled>
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<Bill Hearing Rescheduled from 3/15/17>
         HJR 14-FCC: INCREASE RURAL HEALTH CARE BUDGET                                                                      
3:19:49 PM                                                                                                                    
CHAIR KITO  announced that the  first order of business  would be                                                               
HOUSE JOINT RESOLUTION NO. 14,  Urging the Federal Communications                                                               
Commission  to  increase the  Rural  Health  Care Program  budget                                                               
sufficiently to adjust for inflation,  advances in technology and                                                               
the  services   available  with  increased  broadband,   and  the                                                               
increase in  demand for broadband-based services  and provide for                                                               
any unused funds  to be carried forward to  future funding years,                                                               
ensuring that  rural communities  in the  state continue  to have                                                               
access to affordable broadband telehealth services.                                                                             
3:20:25 PM                                                                                                                    
TIM  CLARK,  Staff,  Representative Bryce  Edgmon,  Alaska  State                                                               
Legislature,  advised  that  during  the last  few  years,  rural                                                               
Alaska  has  made  great strides  in  long-distance  delivery  of                                                               
healthcare  via telemedicine.   These  broadband services  expand                                                               
locally available  treatment options for an  increasing number of                                                               
maladies, including  substance abuse  treatment; and  the service                                                               
accelerates  diagnosis,   treatment,  and  assists   Alaskans  in                                                               
avoiding expensive travel for care.   Except, he explained, these                                                               
broadband  services are  about  to hit  a  roadblock because  the                                                               
existence of such services depends  upon support from the Federal                                                               
Communications  Commission  (FCC)  Rural  Health  Care  Universal                                                               
Services Support Program.   The budget for this  program has been                                                               
capped at  the same  level since its  establishment in  1997, and                                                               
the  $400  million  budget  has   been  enough  to  meet  demand.                                                               
Although, he noted, after two  decades of advances in technology,                                                               
increases in  demand, and the  effects of inflation, the  FCC now                                                               
expects that  in 2017 the  demand may  exceed the budget  cap for                                                               
the first  time.  This resolution  urges the FCC to  increase the                                                               
Rural Health Care Universal  Services Support budget sufficiently                                                               
to adjust  for inflation, keep  with advances in  technology, the                                                               
services  available  with  increased   broadband,  and  meet  the                                                               
increase  in  demand  for broadband  based  services  in  Alaska.                                                               
Additionally, he explained, the  resolution encourages the FCC to                                                               
index  the program  budget for  inflation, and  allow any  unused                                                               
funds  to be  carried forward  to future  funding years,  thereby                                                               
allowing  healthcare providers  to continue  improving access  to                                                               
care in rural Alaska.                                                                                                           
3:23:16 PM                                                                                                                    
REPRESENTATIVE SULLIVAN-LEONARD  asked whether  there is  a state                                                               
match on this item for telehealth for the rural areas.                                                                          
MR.  CLARK  responded no,  and  he  said  it is  entirely  funded                                                               
through Universal Services Support program charges.                                                                             
3:23:53 PM                                                                                                                    
JENNIFER  HARRISON,  Chief  Executive Officer,  Eastern  Aleutian                                                               
Tribes,  advised that  this is  a complicated  program as  far as                                                               
submitting   an  application   and   getting   bids  from   local                                                               
telecommunications firms, and it is  quite expensive.  The amount                                                               
of  money  that  the  Eastern Aleutian  Tribes  receives  to  get                                                               
internet  for its  eight clinics  along the  Aleutian Islands  is                                                               
substantial.   Without  this funding,  she  offered, the  Eastern                                                               
Aleutian Tribes would be looking  at possibly closing clinics, so                                                               
the funding is important.  She  stressed that travel costs to the                                                               
Aleutian Islands are approximately  $1,000 round trip, therefore,                                                               
every trip  patients do  not take saves  a substantial  amount of                                                               
money.   Also,  she explained,  not all  patients have  access to                                                               
travel  assistance  provided by  Medicaid  or  the Alaska  Tribal                                                               
Health Compact,  and in the  event this program was  removed, the                                                               
higher  levels   of  care  would   not  be  available   to  these                                                               
individuals  and would  dramatically  decrease  their quality  of                                                               
health.    The  Eastern  Aleutian  Tribes  support  HJR  14,  she                                                               
3:25:39 PM                                                                                                                    
COLIN   UNDERWOOD,    Manag                                                                                                     
Communications,  offered support  for the  legislation and  noted                                                               
that the nationwide healthcare  industry, particularly in Alaska,                                                               
has  seen a  revolution  in  the manner  in  which healthcare  is                                                               
provided.   He  pointed  out  that many  federal  laws have  been                                                               
enacted to incentivize the  digital transformation of healthcare,                                                               
and  while that  is "wonderful,"  no  attention is  made to  this                                                               
program   that  supports   the   vital  backbone   infrastructure                                                               
necessary to  deliver that digital  telehealth network,  he said.                                                               
This resolution  voices support  to the FCC  by pointing  out the                                                               
importance of also funding this  program.  He remarked that while                                                               
the  federal  government  continues to  incentivize  and  provide                                                               
requirements  modernizing moving  to  a digital  platform, it  is                                                               
also important to  continue programs that have  been in existence                                                               
for nearly 20 years unmodified.                                                                                                 
3:26:55 PM                                                                                                                    
REPRESENTATIVE   BIRCH   referred   to  distance   delivery   for                                                               
education, healthcare, and  asked whether there is  a point where                                                               
"you've got enough bandwidth" in a community.                                                                                   
MR.  UNDERWOOD  responded  that  the  FCC  published  an  updated                                                               
national broadband  plan in  2010 that  included a  study showing                                                               
that  for any  community health  center, the  minimum recommended                                                               
bandwidth  was  10  megabits symmetrical,  which  means  10  megs                                                               
downloaded  as  well  as  10   megs  uploaded  to  provide  basic                                                               
healthcare  services.   Unfortunately, he  said, Alaskans  do not                                                               
have the  luxury of many  healthcare specialists in  these remote                                                               
locations  and  many  critical  access  hospitals  and  community                                                               
health centers based in Anchorage  or elsewhere around the state,                                                               
provide  some of  that specialty  care.   He explained  that will                                                               
doing so will;  increase broadband demands "from  that base level                                                               
right there," including video  conferencing, real time telehealth                                                               
services,  and those  types of  opportunities.   Additionally, he                                                               
pointed  out, technology  has increased  in the  healthcare space                                                               
now  with  x-rays and  digital  imagining  for example,  and  the                                                               
quality  has quadrupled  which  also increases  file  sizes.   He                                                               
offered a scenario of a patient  in an emergent situation who may                                                               
require a  64 slice CT  scan, wherein a  few years ago  that scan                                                               
may  have been  8 slices,  but the  result is  now a  much better                                                               
picture and diagnosis.   The FCC has some  minimum guidelines, he                                                               
said, and the  rest is driven by technology  demands in providing                                                               
the best care possible in Alaska.                                                                                               
3:29:45 PM                                                                                                                    
REPRESENTATIVE  BIRCH referred  to 10  megabits symmetrical,  and                                                               
commented that  it did not sound  like much and asked  whether it                                                               
was sufficient for a healthcare center.                                                                                         
MR. UNDERWOOD clarified that that is  the amount the FCC deemed a                                                               
minimum  standard,  however  most community  health  centers  are                                                               
looking to move  to 50 megabytes.  He related  that the hospitals                                                               
Alaska Communications  is serving  today are looking  at hundreds                                                               
of  megabytes,  with  one  customer   closer  to  a  gigabyte  in                                                               
connectivity because  there is a tremendous  demand for broadband                                                               
services to deliver these high-quality healthcare services.                                                                     
3:30:46 PM                                                                                                                    
REPRESENTATIVE BIRCH  referred to his initial  question and asked                                                               
how  much bandwidth  is enough  because he  was trying  to get  a                                                               
sense of  a $400 million cap  and what it provides  to the extent                                                               
it is an  allocation or request.  He asked  Mr. Underwood's sense                                                               
of  the  education  requirement,  whether that  was  a  competing                                                               
interest for  the Universal Services  support funds and  how many                                                               
people were  drawing on the fund.   He assumed, he  said, that it                                                               
was a  share of whatever  people pay  every month on  their phone                                                               
bill, but  asked whether there  are other competing  interests in                                                               
Alaska and other communities.                                                                                                   
MR.  UNDERWOOD answered  that the  universal service  Schools and                                                               
Libraries program (E-Rate) budget  nationwide is $3.9 billion and                                                               
it was  increased again this  year.  That program,  he explained,                                                               
has been  able to adjust  every year  for inflation, and  "We are                                                               
asking  now  for  the  same   consideration  for  the  healthcare                                                               
program."   As  to competition,  he  advised that  the funds  are                                                               
separate in that  healthcare and education are  not competing for                                                               
the same dollars, but are being  pulled out of the same Universal                                                               
Services fund bucket.                                                                                                           
3:32:34 PM                                                                                                                    
REPRESENTATIVE  BIRCH asked  the size  of the  Universal Services                                                               
fund bucket upon which all are collectively drawing.                                                                            
MR. UNDERWOOD  said he would  have to get back  to Representative                                                               
REPRESENTATIVE BIRCH said,  "We are paying a bit  of that, aren't                                                               
MR. UNDERWOOD agreed,  and he said every month funds  come out of                                                               
an  individual's  telephone  bill  which  reads:  "USS  Universal                                                               
Services" or  something similar, and  that charge goes  into that                                                               
nationwide bucket, he said.                                                                                                     
REPRESENTATIVE BIRCH surmised that  this resolution is attempting                                                               
to obtain a larger share for Alaska's rural communities.                                                                        
MR.  UNDERWOOD  agreed,  and  he said  Alaska  uses  the  largest                                                               
percentage of  the program given its  geographic size, diversity,                                                               
and how  each of the  communities are  spread out.   He explained                                                               
that there  are unused  funds in  the Universal  Services program                                                               
and  this resolution  asks  to reallocate  some  of those  unused                                                               
funds to this  program in order to match the  demands the federal                                                               
government  put on  healthcare providers.   Wherein,  he offered,                                                               
the  federal  government requires  that  "You  must transform  to                                                               
digital healthcare and you must  integrate with electronic health                                                               
records."  This  resolution, he reiterated, simply  asks that the                                                               
FCC recognize those federal requirements  and helps support these                                                               
healthcare providers  to continue  providing the  best healthcare                                                               
possible, he said.                                                                                                              
3:34:07 PM                                                                                                                    
REPRESENTATIVE   BIRCH   asked   whether  anything   other   than                                                               
healthcare and education  was fed by the  Universal Services Fund                                                               
that comes to Alaska.                                                                                                           
MR.  UNDERWOOD replied  that there  are two  other programs,  the                                                               
rural healthcare  program, and  E-rate, a  life line  program and                                                               
subsidy for low income families  for mobile or landline dial tone                                                               
service, as well  as the High Cost or Connect  America Fund which                                                               
is  typically geared  toward certain  telecom  providers to  help                                                               
build out in high cost areas.                                                                                                   
REPRESENTATIVE  BIRCH  asked  how   many  dollars  were  involved                                                               
because the rural communities probably  have needs in all four of                                                               
the  areas  being discussed.    He  asked  how many  dollars  the                                                               
coordinated  programs  add  up   to  for  Alaska,  presuming  the                                                               
components  were healthcare,  education, life  line, and  Connect                                                               
MR. UNDERWOOD opined  that for the 2015 fund  year for healthcare                                                               
and  E-Rate,  the State  of  Alaska  received approximately  $100                                                               
million for  rural healthcare subsidies,  and the  E-Rate program                                                               
was closer to $80 million.  As  far as the other two programs, he                                                               
said  he was  unaware of  the amount  of money  brought into  the                                                               
state.  Although, he commented, it  may be important to note that                                                               
the  education and  healthcare entities  in communities  serve as                                                               
the  "anchor   tenant"  and  provide   a  lot  of   the  backbone                                                               
connectivity  into  those  communities.   That  connectivity,  he                                                               
explained, could  later provide  additional services  and without                                                               
healthcare  and education  there  was not  the  business case  to                                                               
build a lot of the infrastructure out there.                                                                                    
3:37:10 PM                                                                                                                    
JON  ZASADA, Director,  Policy Integration,  Alaska Primary  Care                                                               
Association  (APCA),   advised  that  the  Alaska   Primary  Care                                                               
Association  (APCA)  supports  the  work  of  Alaska's  federally                                                               
qualified community  health centers.   He offered that 25  of its                                                               
29 members benefit  from the Rural Health Care  Program (RHC) and                                                               
receive almost  $38 million  per year  in subsidies  for internet                                                               
service.    Passage  of this  resolution  would  assist  Alaska's                                                               
federal  delegation  in  its negotiations  in  raising  the  cap,                                                               
modernizing this  program, and instituting  an inflation-proofing                                                               
component so  this does not happen  in the future, he  said.  The                                                               
APCA members are  fearful that if the cap is  not raised and pro-                                                               
rated billing is implemented, many  will move from paying roughly                                                               
$500  per  month,  to  $5  or  $10,000  per  month  for  internet                                                               
services.   Clearly, he commented,  that would  negatively affect                                                               
their sustainability  and ability  to serve patients.   Reverting                                                               
back to  low bandwidth or  undedicated internet service is  not a                                                               
possibility for  providers who use  the service to  operate their                                                               
[audio difficulties]  based electronic health records  to support                                                               
telemedicine and  have images reviewed  by specialists  far away,                                                               
he  stressed.   The APCA  would  appreciate the  support of  this                                                               
3:39:39 PM                                                                                                                    
CHAIR KITO opened public testimony on HJR 14.                                                                                   
3:39:53 PM                                                                                                                    
VERNE  BOERNER,   President/CEO,  Alaska  Native   Health  Board,                                                               
advised  that the  Alaska Native  Health Board  is the  statewide                                                               
voice  on  Alaska  Native  Health   issues,  it  is  a  28-member                                                               
organization  representing   tribes  from   [audio  difficulties]                                                               
organizations carrying out  health services on behalf  of the 229                                                               
federally  recognized tribes  in Alaska  and over  158,000 Alaska                                                               
Native people.  Additionally, she  said, the Alaska Native Health                                                               
System  serves  as a  critical  component  of the  Alaska  Public                                                               
Health  System by  providing care  and services  to thousands  of                                                               
non-Alaska  Native people  and Alaskan  veterans.   She expressed                                                               
that  this  resolution helps  to  improve  access to  telehealth,                                                               
thereby  improving  quality of  life  by  reducing travel  costs,                                                               
intervening earlier  at a  lower cost  and with  greater success.                                                               
The   January  28,   2016   Broadband   Progress  Report   showed                                                               
significant  improvements   by  digital   divide  from   the  FCC                                                               
persists, she said.  The  report stated that the benchmark speeds                                                               
of  25 megabits  per second  per  downloads, and  3 megabits  per                                                               
second uploads  remains a problem,  and that the divide  in rural                                                               
Alaska is  quite extreme.   The February  15, 2015  report showed                                                               
that  81 percent  of  rural  areas do  not  have  access to  that                                                               
minimum benchmark  of 25 megabits  per second for download  and 3                                                               
megabits for  upload, and this  program is crucial  in protecting                                                               
early access to care in rural communities.                                                                                      
3:42:34 PM                                                                                                                    
CHAIR KITO advised  that public testimony would be  left open for                                                               
HJR 14.                                                                                                                         
[HJR 14 was held over.]                                                                                                         

Document Name Date/Time Subjects
CSHB132 (TRA) Fiscal Note-DOA-DMV 3.10.17.pdf HL&C 3/17/2017 3:15:00 PM
HB 132
HB132 Supporting Documents - Letters of Support 3.17.17.pdf HL&C 3/17/2017 3:15:00 PM
HB 132
HB132 Supporting Documents - Mercatus Farren TNC Preemption Testimony 3.17.17.pdf HL&C 3/17/2017 3:15:00 PM
HB 132
HB132 Supporting Documents - Letters of Opposition 3.17.17.pdf HL&C 3/17/2017 3:15:00 PM
HB 132
HB132 Supporting Documents Index 3.17.17.pdf HL&C 3/17/2017 3:15:00 PM
HB 132