Legislature(2009 - 2010)BUTROVICH 205

02/03/2010 01:30 PM Senate HEALTH & SOCIAL SERVICES

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01:33:39 PM Start
01:34:51 PM United Way, 211 Project
01:41:43 PM Alaska Health Care Commission Report
02:28:30 PM SB172
03:02:38 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Joint w/ (H) H&SS
Presentations: United Way - 211 Project
Presentation; Alaska Health Care
Commission Report
Heard & Held
              SB 172-ALASKA HEALTH CARE COMMISSION                                                                          
2:28:30 PM                                                                                                                    
CHAIR DAVIS announced consideration of SB 172.                                                                                  
2:28:47 PM                                                                                                                    
SENATOR  OLSON,  sponsor of  SB  172,  said Alaska  is  currently                                                               
facing serious health care cost,  access, and quality issues. The                                                               
ISER report alluded  to by Deborah Erickson,  stated that between                                                               
1991  and 2005  health care  expenditures in  the state  tripled,                                                               
going  from  $1.6  billion  to  $5.3  billion.  These  costs  are                                                               
expected  to  double  by  2013.  All  levels  of  government  are                                                               
affected; what is more important  is that Alaska's economy cannot                                                               
sustain this inflationary growth.                                                                                               
The issues involved  are broad and complex; they  cannot be dealt                                                               
with unless there is a permanent  body to plan and follow through                                                               
with  long-range  comprehensive  reforms. Both  the  Commonwealth                                                               
North Alaska Health  Care Roundtable group and  the Alaska Health                                                               
Care Strategies  Planning Council have  recommended establishment                                                               
of a permanent body to address the problems Alaska is facing.                                                                   
The  Health  Care  Commission  will   be  established  under  the                                                               
Department of Health and Social  Services and will consist of ten                                                               
members including public officials  and private citizens. It will                                                               
provide recommendations  for the development of  a statewide plan                                                               
to  address  the  quality,  accessibility,  and  availability  of                                                               
health care  to all  residents of the  state of  Alaska. Alaska's                                                               
need for  health care reform is  pressing and must be  dealt with                                                               
thoroughly  and  efficiently,  with   a  long-range  view  toward                                                               
meaningful and lasting change. The  Alaska Health Care Commission                                                               
will  play an  important role  in this  process; it  is essential                                                               
that  the  legislature  make  it a  permanent  component  of  the                                                               
Department  of Health  and Social  Services so  that present,  as                                                               
well as  future issues  with Alaska's health  care can  be better                                                               
anticipated, understood, and addressed.                                                                                         
2:33:36 PM                                                                                                                    
ELLEN ADLAM,  Board Member, Peninsula Community  Health Services,                                                               
Soldotna, Alaska,  said she is  an X-ray technician and  has been                                                               
involved  for a  long  time with  community  health centers.  She                                                               
agreed that health  care is a big problem in  this state and said                                                               
she supports  SB 172, but the  board would like to  see a primary                                                               
care "safety net"  seat established on the  commission to provide                                                               
a voice  for the underinsured and  uninsured. Peninsula Community                                                               
Health Services  is one  of the three  largest health  systems in                                                               
the state, serving 81,000 patients.  It includes 26 organizations                                                               
with 142 sites,  and those sites see Medicare patients,  so it is                                                               
very  important   that  they  be  included.   She  suggested  the                                                               
commission  use a  provider from  a health  center, because  they                                                               
provide not only medical, but  dental and behavioral health. That                                                               
seat  would encompass  the  voice for  the  underinsured and  the                                                               
primary provider.                                                                                                               
2:37:43 PM                                                                                                                    
DR. LARRY STINSON, representing  himself, Anchorage, Alaska, said                                                               
he supports  SB 172 and recognizes  that the there needs  to be a                                                               
balance  between representation  and the  number of  people on  a                                                               
committees  in order  to get  things  done. This  bill creates  a                                                               
manageable  group; it  also keeps  any one  entity from  having a                                                               
majority vote that might dominate the outcome.                                                                                  
2:39:18 PM                                                                                                                    
DEBORAH   ERICKSON,  Executive   Director,  Alaska   Health  Care                                                               
Commission, Anchorage, Alaska, said  this particular bill mirrors                                                               
very  closely Administrative  Order  246,  which established  the                                                               
current  commission and  includes a  transition clause  that will                                                               
automatically appoint  the members  of the current  commission to                                                               
the new one if SB 172 passes  in its current form. She added that                                                               
the  commission's work  during  its first  year  really laid  the                                                               
groundwork  and will  be a  good jumping-off  point if  this bill                                                               
2:42:12 PM                                                                                                                    
WARD  HURLBURT  M.D., MPH,  Chief  Medical  Officer, Division  of                                                               
Public Health,  Department of Health and  Social Services (DHSS);                                                               
Chairman, Alaska Health Care  Commission, Anchorage, Alaska, said                                                               
the  commission  under  this   bill  should  provide  significant                                                               
continuity;  the membership  reflects excellent  professional and                                                             
geographic  diversity   and  has  achieved  momentum   that  will                                                               
continue under SB 172.                                                                                                          
As  was previously  discussed, he  said,  the commission's  major                                                               
focus will be on health care  costs, which now represent about 18                                                               
percent of  the U.S. gross  national product; Alaska  is spending                                                               
about $6  billion per year.  The American Health  Insurance Plans                                                               
Association announced  today that  the expectation  nationally is                                                               
for commercial  health insurance premiums  to go up more  than 10                                                               
percent in 2010, as compared to  a 1.4 percent increase in wages.                                                               
He said Medicaid  is a huge chunk of  the governor's supplemental                                                               
request to the legislature for  funding, and ventured to say that                                                               
every  department, in  every state  in the  country, has  to make                                                               
control of Medicaid costs almost their top priority.                                                                            
DR.  HURLBURT  shared   that  he  is  a  cynic   with  regard  to                                                               
commissions,  but  thinks the  members  on  this commission  have                                                               
worked well  together and that  making it permanent is  the right                                                               
2:47:08 PM                                                                                                                    
BEVERLY  SMITH, Christian  Science Committee  on Publication  for                                                               
the state of Alaska, Juneau, Alaska,  said one of her roles is to                                                               
ensure  the  legislature   has  accurate  information  concerning                                                               
spiritual  healing as  practiced  in Christian  Science, so  this                                                               
cost-effective and  reliable form  of care  is not  overlooked or                                                               
restricted  in  the  state's health  care  reform  efforts.  With                                                               
regard to  SB 172,  she requested that  access to  spiritual care                                                               
for  the  treatment and  cure  of  disease be  given  appropriate                                                               
consideration  during   discussions  of  the  development   of  a                                                               
statewide  health  plan.  To   facilitate  this  discussion,  she                                                               
recommended  that the  bill  mandate  one of  the  duties of  the                                                               
commission be  to recommend  the extent to  which and  under what                                                               
circumstances access to  spiritual care should be  addressed in a                                                               
comprehensive statewide  health care policy. Because  health care                                                               
reform discussions  at the state  and federal levels  have raised                                                               
issues  that could  impact the  insurance coverage  for spiritual                                                               
care, it  is important that these  issues be discussed so  as not                                                               
to create  unintended results that  could limit the  coverage for                                                               
spiritual care.                                                                                                                 
She  said  she  noticed  the  bill  does  not  mandate  insurance                                                               
coverage for all  Alaskans, but asks the commission  to develop a                                                               
strategy  that encourages  acquisition  of  health insurance  and                                                               
that  increases the  number of  insurance  options available  for                                                               
health care services. If Alaskans  pay health insurance premiums,                                                               
they should  be able to  be reimbursed  for the health  care they                                                               
choose, whether that is medical care or spiritual treatment.                                                                    
MS. SMITH referred to page 2  of her memorandum to the committee,                                                               
dated  February  3, 2010,  which  cites  a  number of  state  and                                                               
federal  programs that  offer benefits  for  spiritual care.  She                                                               
pointed out that Alaska does  allow spiritual treatment under the                                                               
state employees'  health insurance plans. Christian  Science care                                                               
can also be  deducted under medical expenses  from federal income                                                               
She closed by saying that  she hopes the commission will preserve                                                               
the insurance  coverage for spiritual care  that Alaska residents                                                               
now enjoy and recommend that  it be expanded to include religious                                                               
non-medical nursing services. If  the commission were directed in                                                               
statute to include  spiritual care in its  discussions of reform,                                                               
it would prevent such access from being overlooked or minimized.                                                                
2:51:34 PM                                                                                                                    
MS. SMITH  thanked the committee  and the sponsor for  their work                                                               
on  health  care  reform and  respectfully  requested  that  this                                                               
commission   have   the   responsibility   for   discussing   and                                                               
recommending how  access to spiritual  treatment and care  can be                                                               
part of the overall health care plan in Alaska.                                                                                 
2:52:10 PM                                                                                                                    
RYAN SMITH,  CEO, Central Peninsula Hospital  and Heritage Place,                                                               
Soldotna,  Alaska,  and  a  member  of  the  Alaska  Health  Care                                                               
Commission, thanked  the committee  and others for  their support                                                               
for health care reform and expressed strong support for SB 172.                                                                 
2:53:53 PM                                                                                                                    
J. KATE BURKHART, Executive Director,  Alaska Mental Health Board                                                               
and the Advisory  Board on Alcoholism and  Drug Abuse, Anchorage,                                                               
Alaska, said both boards were  created by statute, with statutory                                                               
duties  that  include providing  advice  and  advocacy on  issues                                                               
related to  mental health  and substance  abuse to  the executive                                                               
and legislative branches.                                                                                                       
She prefaced  her testimony  by saying  that the  information and                                                               
positions she expresses today are those  of the boards and not of                                                               
the  governor's office  or the  Department of  Health and  Social                                                               
Services.  On   behalf  of  both   boards,  she   extended  their                                                               
appreciation to  the Alaska Health  Care Commission for  the work                                                               
it has  done and stated that  they support the continuation  of a                                                               
health care  commission in whatever  form that takes, as  long as                                                               
it includes representation of the Behavioral Health system.                                                                     
MS.   BURKHART  enumerated   three   reasons   that  having   the                                                               
perspective   and   representation   of  an   active,   licensed,                                                               
behavioral  health   professional  on  the  commission   is  very                                                               
   1. The state of  Alaska invests a substantial  amount of money                                                               
   in the behavioral health  system. As Ms. Erickson  stated, the                                                               
   current health  system is  very  fragmented, and  to create  a                                                               
   commission that  doesn't  include  representation of  a  major                                                               
   health care system will not help to resolve that fragmentation                                                               
   2. The  issue of  co-morbidity when  working with  populations                                                               
   that experience  a  mental  health  disorder  is  significant.                                                               
   Often, people with serious  mental illness live 25  years less                                                               
   than others  who  do  not have  a  mental  illness. Given  the                                                               
   commission's focus  on chronic  diseases, representation  from                                                               
   the behavioral health field seems appropriate.                                                                               
   3.  What   is  contemplated   here  is   system  change.   The                                                               
   commission's report says that the  system as it is  now is not                                                               
   sustainable.  If  the  legislature  is  going   to  address  a                                                               
   comprehensive system change, all of its  health systems should                                                               
   be represented.                                                                                                              
In  response to  concerns that  the commission  could become  too                                                               
large  and unwieldy,  she suggested  AS 18.09.020(1)(e)  seems to                                                               
contemplate that the  health care provider who  is not affiliated                                                               
with  ASHNHA is  a primary  health  care provider.  She said  she                                                               
thinks it is possible to have  a seat for a primary care provider                                                               
from  Alaska's   federally  qualified  health  centers   and  the                                                               
providers  who  serve indigent  populations,  and  another for  a                                                               
behavioral health  professional. She  pointed out that  there are                                                               
movements afoot to integrate primary  care and behavioral health.                                                               
Examples  include Peninsula  Community Health  and South  Central                                                               
2:58:42 PM                                                                                                                    
PAT  LUBY, Advocacy  Director for  AARP, Anchorage,  Alaska, said                                                               
they are  in full support  of SB 172.  He praised the  members of                                                               
the Alaska  Health Care Commission  for the great work  they have                                                               
done  on some  targeted  issues  and for  their  ability to  work                                                               
collaboratively for  the good of all  Alaskans, despite different                                                               
backgrounds or political affiliations.                                                                                          
2:59:54 PM                                                                                                                    
SHELLY HUGHES,  Government Affairs Director, Alaska  Primary Care                                                               
Association,  Anchorage, Alaska,  said  part  of reason  Governor                                                               
Palin  and Governor  Parnell established  the current  commission                                                               
was due  to a  report by Commonwealth  North, Alaska  Health Care                                                               
Roundtable   Group,   titled    "Alaska   Primary   Health   Care                                                               
Opportunities and Challenges;" She  pointed to the words "Primary                                                               
Care" and  said that primary care  is the gateway to  health care                                                               
and  includes  behavioral  health,   dental,  and  medical  care.                                                               
Without  a designated  seat for  primary care,  she is  concerned                                                               
that the commission will be  missing expertise and input that may                                                               
be  helpful in  working out  a  statewide plan.  She agreed  with                                                               
previous  speakers that  the commission  could get  "two for  the                                                               
price of  one" because,  if the legislature  adds a  primary care                                                               
safety-net  seat,  it  will  also be  getting  expertise  on  the                                                               
uninsured problem in this state.                                                                                                
She  emphasized that  the  three largest  health  systems in  the                                                               
state are the hospitals, tribal  health, and the community health                                                               
centers. The first  two of these are designated in  the bill; the                                                               
primary care  safety-net or community  health centers are  not in                                                               
the bill. The one provider seat may  or may not be a primary care                                                               
provider but  is a  specialist at this  time. She  encouraged the                                                               
committee to consider adding a  primary care provider seat. While                                                               
she  understands the  need to  keep the  commission compact,  she                                                               
believes this is  a key component and something  very integral to                                                               
working on a statewide plan.                                                                                                    
She  mentioned  that  the  state Chamber  of  Commerce  passed  a                                                               
position for this session in  agreement with the establishment of                                                               
the health care commission, including a seat for primary care.                                                                  
[SB 172 was held in committee.]                                                                                                 

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