Legislature(2007 - 2008)CAPITOL 106

02/26/2008 03:00 PM HEALTH, EDUCATION & SOCIAL SERVICES


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03:07:02 PM Start
03:07:45 PM Presentation: the Alaska Nursing Association|| Sb28
03:56:22 PM HB407
05:13:51 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+= HB 337 HEALTH CARE: PLAN/COMMISSION/FACILITIES TELECONFERENCED
Scheduled But Not Heard
+= HB 345 MEDICAL FACILITY CERTIFICATE OF NEED TELECONFERENCED
Scheduled But Not Heard
*+ HB 407 HEALTH REFORM POLICY COMMISSION TELECONFERENCED
Heard & Held
+ Bills Previously Heard/Scheduled TELECONFERENCED
Presentation by the Alaska Nursing Assoc:
"Nursing in Alaska, 2008"
                    ALASKA STATE LEGISLATURE                                                                                  
 HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE                                                               
                       February 26, 2008                                                                                        
                           3:07 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Peggy Wilson, Chair                                                                                              
Representative Bob Roses, Vice Chair                                                                                            
Representative Wes Keller                                                                                                       
Representative Paul Seaton                                                                                                      
Representative Sharon Cissna                                                                                                    
Representative Berta Gardner                                                                                                    
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Representative Anna Fairclough                                                                                                  
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                              
PRESENTATION: ALASKA NURSING ASSOCIATION                                                                                        
                                                                                                                                
     -HEARD                                                                                                                     
                                                                                                                                
HOUSE BILL NO. 407                                                                                                              
"An Act  establishing the Alaska Health  Reform Policy Commission                                                               
in the  Department of Health  and Social Services;  and providing                                                               
for an effective date."                                                                                                         
                                                                                                                                
     -HEARD AND HELD                                                                                                            
                                                                                                                              
HOUSE BILL NO. 337                                                                                                              
"An Act  establishing the Alaska  Health Care Commission  and the                                                               
Alaska health  care information office;  relating to  health care                                                               
planning  and  information;  repealing the  certificate  of  need                                                               
program for  certain health care  facilities and relating  to the                                                               
repeal;    annulling    certain    regulations    required    for                                                               
implementation  of the  certificate of  need program  for certain                                                               
health care facilities; and providing for an effective date."                                                                   
                                                                                                                                
     -SCHEDULED BUT NOT HEARD                                                                                                   
                                                                                                                                
HOUSE BILL NO. 345                                                                                                              
"An Act amending the certificate  of need requirements to exclude                                                               
expenditures   for  diagnostic   imaging  equipment   in  certain                                                               
circumstances."                                                                                                                 
                                                                                                                                
     -SCHEDULED BUT NOT HEARD                                                                                                   
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: HB 407                                                                                                                  
SHORT TITLE: HEALTH REFORM POLICY COMMISSION                                                                                    
SPONSOR(s): REPRESENTATIVE(s) HAWKER                                                                                            
                                                                                                                                
02/19/08       (H)       READ THE FIRST TIME - REFERRALS                                                                        
02/19/08       (H)       HES, FIN                                                                                               
02/26/08       (H)       HES AT 3:00 PM CAPITOL 106                                                                             
02/26/08       (H)       Bills Previously Heard/Scheduled                                                                       
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
PATRICIA SENNER, Family Nurse Practitioner; Chair                                                                               
Legislative Committee                                                                                                           
Alaska Nurses Association (AaNA)                                                                                                
Anchorage, Alaska                                                                                                               
POSITION  STATEMENT:    Introduced representatives  from  various                                                             
nursing  organizations  during  the presentation  by  the  Alaska                                                               
Nurses Association.                                                                                                             
                                                                                                                                
DIANNE TARRANT, Family Nurse Practitioner; President                                                                            
Alaska Nurse Practitioner Association                                                                                           
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Gave a  presentation representing the Alaska                                                             
Nurse Practitioner Association.                                                                                                 
                                                                                                                                
DEBBIE THOMPSON, Operating Room Nurse; President                                                                                
Alaska Nurses Association                                                                                                       
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Gave a  presentation on the state of nursing                                                             
in Alaska on behalf of the Alaska Nurses Association.                                                                           
                                                                                                                                
CHRIS VAN CLEVE, School Nurse; Alaska Representative                                                                            
National  School  Nurses  Association and  Alaska  School  Nurses                                                               
Association                                                                                                                     
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Gave a  presentation on behalf of the Alaska                                                             
School Nurses Association.                                                                                                      
                                                                                                                                
NANCY DAVIS, Registered Nurse; Public Health Nurse                                                                              
Department of Health and Social Services                                                                                        
Juneau, Alaska                                                                                                                  
POSITION  STATEMENT:   Gave a  presentation on  behalf of  public                                                             
health nurses.                                                                                                                  
                                                                                                                                
REPRESENTATIVE MIKE HAWKER                                                                                                      
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Introduced HB 407, as the sponsor.                                                                       
                                                                                                                                
KARLEEN JACKSON, Commissioner                                                                                                   
Health and Social Services (DHSS)                                                                                               
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified during the hearing on HB 407.                                                                  
                                                                                                                                
ROD BETIT, President                                                                                                            
Alaska State Hospital and Nursing Home Association                                                                              
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified during the hearing on HB 407.                                                                  
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
CHAIR PEGGY WILSON called the  House Health, Education and Social                                                             
Services  Standing  Committee meeting  to  order  at 3:07:02  PM.                                                             
Representatives  Keller,  Seaton,  Cissna,  Gardner,  Roses,  and                                                               
Wilson were present at the call to order.                                                                                       
                                                                                                                                
^Presentation: The Alaska Nursing Association                                                                                 
                                                                                                                                
[Contains discussion of SB 28.]                                                                                                 
                                                                                                                                
3:07:45 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON announced that the  first order of business would be                                                               
a  presentation   from  the  Alaska  Nurses   Association.    She                                                               
introduced Patricia Senner.                                                                                                     
                                                                                                                                
3:10:29 PM                                                                                                                    
                                                                                                                                
PATRICIA  SENNER, Family  Nurse Practitioner;  Chair, Legislative                                                               
Committee, Alaska  Nurses Association (AaNA),  introduced members                                                               
of the various nursing groups representing nursing in Alaska.                                                                   
                                                                                                                                
3:11:29 PM                                                                                                                    
                                                                                                                                
DIANNE  TARRANT,  Family  Nurse Practitioner;  President,  Alaska                                                               
Nurse Practitioner  Association, informed the committee  that she                                                               
has been an Alaska resident since  1973.  Her experience began as                                                               
a  registered nurse  in 1976  and  she now  teaches family  nurse                                                               
practitioners (NP)s in the graduate  program at the University of                                                               
Alaska  (UA).   She stated  that nurse  practitioners perform  as                                                               
primary  caregivers,  which means  that  they  can prescribe  and                                                               
diagnose   common  acute   and  chronic   problems.  Most   nurse                                                               
practitioners have  master's degrees and  the UA offers  the only                                                               
statewide program to  graduate as a primary care  provider in the                                                               
state.   The  UA graduates  approximately 10  nurse practitioners                                                               
per year and  90 percent of those graduates stay  in the state to                                                               
practice.    Mandated in  2015,  there  will  be an  entry  level                                                               
Doctorate in Nursing Practice available through the UA.                                                                         
                                                                                                                                
3:15:57 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON asked about the mandated program.                                                                                  
                                                                                                                                
MS. TARRANT  re-stated that  the mandated program  is a  NP entry                                                               
level program that  has been directed by the  American College of                                                               
Nursing and Accrediting.                                                                                                        
                                                                                                                                
3:16:05 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE CISSNA  related her personal experience  and noted                                                               
that advanced NP's provide a mid-range  of care.  She opined that                                                               
advanced degrees  will raise the  cost of care and  asked whether                                                               
there  will  be a  lower,  thus  lower  cost,  level of  NP  care                                                               
available.                                                                                                                      
                                                                                                                                
3:17:34 PM                                                                                                                    
                                                                                                                                
MS. TARRANT  stated that the issue  is yet to be  resolved at the                                                               
national level.   The UA charges $300 per unit  and credit, which                                                               
educates the graduate for $25,000.                                                                                              
                                                                                                                                
3:18:41 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON observed  that, in Alaska, advanced NPs  are used as                                                               
providers in  many areas.   In the  process of  further education                                                               
for nurse practitioners,  the cost of health care  in Alaska will                                                               
increase.                                                                                                                       
                                                                                                                                
3:19:44 PM                                                                                                                    
                                                                                                                                
MS.  TARRANT opined  that the  ultimate result  is unknown.   She                                                               
listed the specialties  for NPs and compared the  quality of care                                                               
with  that  of  physicians.   Ms.  Tarrant  listed  studies  that                                                               
indicate that  NPs provide  a quality  of care  equal to  that of                                                               
family physicians  at a  lower cost.   In a  2007 survey,  it was                                                               
found that there are 465 advanced  NPs practicing in Alaska.  She                                                               
opined  that  NPs can  be  invisible,  even though  they  provide                                                               
835,192 primary care  visits per year.   Furthermore, the average                                                               
NP earns  $45 per hour,  7.6 percent of  NPs are the  sole health                                                               
care provider in  their community, and one in four  practice in a                                                               
medically  underserved community.    She then  explained that  76                                                               
percent  of  NPs  accept Medicare  reimbursement,  often  without                                                               
limits,  and  86  percent  will  accept  Medicaid  reimbursement.                                                               
Nurse Practitioners  serve a disproportionate number  of elderly,                                                               
low  income, and  minority groups.   Ms.  Tarrant concluded  that                                                               
Alaskan NPs want to participate  in the discussion of health care                                                               
in the  state and  need the  support of  the legislature  for the                                                               
nurse practitioner  program at the  UA.   She warned that  the UA                                                               
may lose  the psychiatric nurse  practitioner program due  to the                                                               
lack of faculty.                                                                                                                
                                                                                                                                
3:27:56 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  ROSES  asked  for  a  comparison  of  populations                                                               
served in urban, rather than rural, communities.                                                                                
                                                                                                                                
3:28:10 PM                                                                                                                    
                                                                                                                                
CHAIR  WILSON   expressed  her   understanding  of   the  nursing                                                               
profession's  desire  for  advanced education;  however,  further                                                               
education will increase cost, but not the level of service.                                                                     
                                                                                                                                
MS. TARRANT  stated that the goal  of the master's program  is to                                                               
be close to a three-year degree.                                                                                                
                                                                                                                                
3:30:12 PM                                                                                                                    
                                                                                                                                
DEBBIE THOMPSON,  Operating Room Nurse; President,  Alaska Nurses                                                               
Association, stated that SB 28  addresses the matter of mandatory                                                               
overtime.  She  noted that the bill has been  improved by changes                                                               
and bans  mandatory overtime, also  known as mandatory  call, and                                                               
limits working hours for nurses to  fourteen hours per day with a                                                               
rest period of ten hours.   Ms. Thompson turned to the subject of                                                               
nursing demographics  and related the  following:  most  are aged                                                               
51 to  60 years and are  close to retirement; 84.4  percent leave                                                               
their  profession  due  to retirement;  and  nursing  specialties                                                               
include midwives, anesthetists,  clinical specialists, educators,                                                               
administrators, public health nurses  (PHN)s, NPs, office nurses,                                                               
nurse managers and staff nurses.   Ms. Thompson then informed the                                                               
committee  that  the  Alaska  Nurse  Alert  System  (ANAS)  is  a                                                               
volunteer  program  to  mobilize   nurses  during  public  health                                                               
emergencies.   Presently,  there  are over  300  nurses who  have                                                               
volunteered,  and 40  percent  are prepared  to  serve in  remote                                                               
areas.                                                                                                                          
                                                                                                                                
3:35:31 PM                                                                                                                    
                                                                                                                                
CHRIS VAN  CLEVE, School  Nurse; Alaska  Representative, National                                                               
School Nurses  Association and Alaska School  Nurses Association,                                                               
stated that school nurses, principals,  and parents are convinced                                                               
that healthy  kids learn better;  in fact, care by  school nurses                                                               
reduces school absenteeism.  The  majority of school nurses serve                                                               
children  in  Anchorage,  the Mat-Su  Borough,  Kenai  Peninsula,                                                               
Fairbanks, and Juneau;  there are very few school  nurses in Bush                                                               
communities.   Ms. Van  Cleve noted  that the  federal government                                                               
recommends one  registered nurse per every  750 regular education                                                               
students, and a higher ratio for special education students.                                                                    
                                                                                                                                
3:38:27 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  ROSES  observed  that   school  nurses  are  also                                                               
counselors  and serve  in many  other capacities.   A  lack of  a                                                               
nurse can mean that school secretaries administer medications.                                                                  
                                                                                                                                
3:39:11 PM                                                                                                                    
                                                                                                                                
NANCY DAVIS,  Registered Nurse;  Public Health  Nurse, Department                                                               
of  Health  and  Social  Services, informed  the  committee  that                                                               
public  health  nursing  is  a combination  of  nursing  art  and                                                               
science, and  public health science.   One hundred  and fifty-two                                                               
public health  nurses (PHN)s connect with  every community across                                                               
the state  and provide  nursing service to  every village  with a                                                               
school,  and  to  any  location where  there  is  a  communicable                                                               
disease  outbreak.    Public  health   nurses  focus  on  disease                                                               
prevention   and   protection;   health  promotion   and   health                                                               
education;   community   health  assessment;   community   health                                                               
development  and problem  solving  of health  issues; and  timely                                                               
intervention when emergencies occur.   Ms. Davis stated that PHNs                                                               
work  for   the  state,  local  governments   and  tribal  health                                                               
organizations; in  fact, one of  their important functions  is to                                                               
link  the  public to  needed  government  health services.    She                                                               
provided statewide statistics for public nursing services.                                                                      
                                                                                                                                
3:44:10 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE CISSNA recalled  that there were more  PHNs in the                                                               
past.                                                                                                                           
                                                                                                                                
3:44:36 PM                                                                                                                    
                                                                                                                                
MS. DAVIS  said that the number  of nurses stays about  the same,                                                               
although the general population has increased.                                                                                  
                                                                                                                                
3:45:22 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE ROSES  shared his  experience as  a teacher  on TB                                                               
test day.                                                                                                                       
                                                                                                                                
3:45:53 PM                                                                                                                    
                                                                                                                                
MS. SENNER  provided information  about the University  of Alaska                                                               
Anchorage (UAA)  School of Nursing.   She pointed out  that 9,000                                                               
Registered Nurse  (RN) licenses have  been issued in  Alaska, but                                                               
only 6,000 of  those nurses live in Alaska.   In fact, about one-                                                               
third of the  nursing workforce is traveling nurses.   To address                                                               
this shortage, a  task force was convened in 2002,  that made the                                                               
following   recommendations:      double  enrollments   in,   and                                                               
graduations from, the nursing programs;  extend those programs to                                                               
rural   and   frontier   communities;  identify   and   implement                                                               
strategies  to   retain  nurses;  and  financially   support  the                                                               
expansion.   Although the UA  wants to expand, and  is supporting                                                               
expansion  financially,  there  are   limits  to  the  number  of                                                               
instructors  and clinical  sites available.   At  this time,  the                                                               
school  of nursing  has a  two-year waiting  list for  acceptance                                                               
into the  program, and  600 waiting  students who  have completed                                                               
their core courses.                                                                                                             
                                                                                                                                
3:50:30 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GARDNER  advised that many newly  graduated nurses                                                               
are  not getting  jobs due  to  lack of  experience or  specialty                                                               
training.                                                                                                                       
                                                                                                                                
3:51:04 PM                                                                                                                    
                                                                                                                                
MS.  SENNER   recalled  that,  about  20   years  ago,  hospitals                                                               
eliminated many training programs  for new graduates.  Therefore,                                                               
there is a shortage of nurses in that age group.                                                                                
                                                                                                                                
3:51:57 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GARDNER asked whether  training programs have been                                                               
reinstated.                                                                                                                     
                                                                                                                                
MS.  THOMPSON opined  that most  facilities now  have internships                                                               
and  fellowships,  depending on  the  specialty  of the  student.                                                               
Providence Health  finds that new  graduates take four  months to                                                               
two  years  to feel  comfortable  in  their work.    Furthermore,                                                               
technology is  not taught in  nursing school and must  be learned                                                               
with experience.                                                                                                                
                                                                                                                                
3:53:13 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GARDNER asked  whether feeling comfortable equated                                                               
to competence.                                                                                                                  
                                                                                                                                
MS. THOMPSON indicated yes.                                                                                                     
                                                                                                                                
3:55:38 PM                                                                                                                    
                                                                                                                                
HB 407-HEALTH REFORM POLICY COMMISSION                                                                                        
                                                                                                                                
3:56:22 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON announced that the  final order of business would be                                                               
HOUSE  BILL  NO. 407,  "An  Act  establishing the  Alaska  Health                                                               
Reform Policy Commission  in the Department of  Health and Social                                                               
Services; and providing for an effective date."                                                                                 
                                                                                                                                
3:57:01 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  GARDNER  moved  to  adopt  HB  407,  Version  25-                                                               
LS1533\E,  Mischel,  2/22/08, as  the  working  document.   There                                                               
being no objection, Version E was before the committee.                                                                         
                                                                                                                                
REPRESENTATIVE MIKE HAWKER,  Alaska State Legislature, introduced                                                               
HB 407,  as the  sponsor.   He informed  the committee  that this                                                               
bill would  establish an Alaska Health  Reform Policy Commission.                                                               
The bill has grown from concerns  about the policies of the state                                                               
health care system, particularly in  the future.  His concern for                                                               
the future  is that the broad  issue of long term  health care is                                                               
one  of the  most significant  issues  facing the  state and  the                                                               
nation  today including;  accessibility,  affordability, and  the                                                               
quality of  care.   In Alaska, our  small population  would allow                                                               
the state to  set the standard to promote a  policy that provides                                                               
the greatest  access to the  best health  care at the  best cost.                                                               
Representative Hawker  acknowledged that the development  of this                                                               
policy will take changes.  All  of the stakeholders would need to                                                               
re-engineer the  issue and  each one's  role.   His study  of the                                                               
issue  led to  the  question of  whether the  state  is ready  to                                                               
pursue  this difficult  and daunting  task.   He recognized  that                                                               
there was  a common  underlying theme  and that  legislators must                                                               
bring  divergent  interests  together,   with  adequate  time  to                                                               
contemplate  decisions  and  find  agreement.   The  health  care                                                               
system is the largest consumer service  in the state and to reach                                                               
consensus on  a mega project  requires that, from  the beginning,                                                               
all  stakeholders and  entities  must be  involved and  competing                                                               
objectives  must be  eliminated.    Representative Hawker  opined                                                               
that HB  407 will bring  the stakeholders together  and eliminate                                                               
competing objectives.   He stopped  his introduction of  the bill                                                               
to explain that  Legislative Legal and Research  has advised that                                                               
to form  a commission with duration  of over three years  a bill,                                                               
rather than a  resolution, should be written.   He then explained                                                               
that HB  407 would  bring all  of the  parties together,  under a                                                               
government  sanctioned  process and  on  the  public record,  and                                                               
would  earn support  at the  executive,  legislative, and  public                                                               
level  along the  way.   Representative  Hawker  stated that  the                                                               
mechanism  of  this  approach  is   a  commission  modeled  on  a                                                               
representative type  of government, with  executive, legislative,                                                               
and  judicial  branches,  and  that   would  be  chaired  by  the                                                               
commissioner of  the DHSS  to establish  the executive  branch as                                                               
the  leader of  the  commission.   In  addition, the  legislative                                                               
branch will  be ten members,  selected from the public  for their                                                               
life   experience   who    have   demonstrated   leadership   and                                                               
accomplishment in  specialized enterprises,  and who  possess the                                                               
unquestionable ability to directly  influence policy direction in                                                               
their field.   The  judiciary component  would be  the ex-officio                                                               
non voting  participation by legislators, who  would evaluate the                                                               
process, but retain the ability to ask questions.                                                                               
                                                                                                                                
4:13:04 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE HAWKER continued to say  that the structure of the                                                               
commission  would provide  a professional  and proper  community.                                                               
In  addition  to  ex-officio   non  voting  advisory  legislative                                                               
members there  would be a  member appointed by the  governor and,                                                               
perhaps, a liaison  to the governor's office.   This would ensure                                                               
that the executive branch, represented  by the DHSS commissioner,                                                               
an  ex-officio   member,  and   a  liaison,   would  sufficiently                                                               
represent the  governor's leadership.   He stressed that  the ten                                                               
professional  members of  the public  would be  appointed by  the                                                               
joint concurrence of  the speaker of the House  and the president                                                               
of  the  Senate.    Furthermore,   recognizing  the  serious  and                                                               
profound changes generated from this  process, the bill calls for                                                               
the authorization  of a  partially exempt,  compensated executive                                                               
director, sited  in the DHSS, and  who serves at the  pleasure of                                                               
the commission.   He cautioned that a lack of  direction is often                                                               
a problem with commissions and pointed  out that there would be a                                                               
report to the  legislature and the governor that  is due annually                                                               
by the  fifteenth of  December of  each year.   The  first report                                                               
must  include  a  five-year   strategic  plan  with  prioritized,                                                               
targeted, and defined objectives as  well as an evaluation of the                                                               
strengths, weaknesses,  and relative  performance of  health care                                                               
services and conditions in Alaska.   Representative Hawker closed                                                               
by reading from Section 1, (b), of the bill, that read:                                                                         
                                                                                                                                
      (b)   The  legislature intends  to mandate  under this                                                                    
     Act, an  evaluation of the  state's health  care needs,                                                                    
     propose reforms,  and improve health care  in Alaska by                                                                    
     establishing   the   Alaska    Health   Reform   Policy                                                                    
     Commission   to   include   all  public   and   private                                                                    
     stakeholders   for   the   purpose  of   developing   a                                                                    
     comprehensive policy that better  meets the current and                                                                    
     long-range healthcare needs in the state.                                                                                  
                                                                                                                                
REPRESENTATIVE  HAWKER then  read from  page  2, line  9, of  the                                                               
bill, that read:                                                                                                                
                                                                                                                                
     The   Alaska  Health   Reform   Policy  Commission   is                                                                    
     established  in the  Department  of  Health and  Social                                                                    
     Services.    The  purpose  of   the  commission  is  to                                                                    
     consider  the entire  spectrum of  health care  related                                                                    
     issues  in   the  state  and  formulate   targeted  and                                                                    
     specific  policy recommendations  to  be considered  by                                                                    
     the legislature and by the executive branch.                                                                               
                                                                                                                                
4:25:11 PM                                                                                                                    
                                                                                                                                
CHAIR  WILSON stated  that this  commission is  to reform  health                                                               
policy in this state.                                                                                                           
                                                                                                                                
4:25:26 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  HAWKER said  yes  and added  that the  commission                                                               
will  also reconsider  and develop  [policy].   He  spoke of  his                                                               
experience as the chair of  the Health and Social Services budget                                                               
subcommittee and related that there  is opposition to many of the                                                               
state's  health care  policies.   He assured  the committee  that                                                               
this approach  has been discussed with  hospital representatives,                                                               
advocacy  representatives,  and providers,  and  that  it has  an                                                               
universal appeal to all.                                                                                                        
                                                                                                                                
4:26:40 PM                                                                                                                    
                                                                                                                                
CHAIR  WILSON asked  for Representative  Hawker's feelings  about                                                               
the  possibility of  a recommendation  from  the commission  that                                                               
would incur a high cost to the state.                                                                                           
                                                                                                                                
4:27:11 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  HAWKER   responded  that  this   commission  will                                                               
provide information as to what it  will cost to run the state for                                                               
the next ten years; the  legislature then makes the choices about                                                               
what  the policies  will  be, as  opposed to  a  one year  budget                                                               
request  with no  plan.   If the  state moves  to a  front loaded                                                               
health care  system, there will be  fewer long term costs  at the                                                               
end of life.   This policy is better for  the humans involved and                                                               
better for  the government, although,  government will  always be                                                               
the  provider of  last  resort.   He  cited  previous long  range                                                               
planning that resulted in more manageable costs.                                                                                
                                                                                                                                
4:29:56 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  ROSES  asked  whether Representative  Hawker  had                                                               
spoken with the  governor's office, or the  commissioner of DHSS,                                                               
about the membership of the commission.                                                                                         
                                                                                                                                
4:30:42 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE HAWKER  stated that, over  the past two  years, he                                                               
has spoken with representatives of  the governor's office and the                                                               
DHSS.    Although  there  are  a  number  of  ways  to  form  the                                                               
commission,  he opined  that legislative  membership is  a better                                                               
idea than members who primarily come from the executive office.                                                                 
                                                                                                                                
4:31:40 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE ROSES agreed and  stated that his initial reaction                                                               
is  that the  governor's bill  creates a  cabinet, rather  than a                                                               
health commission.                                                                                                              
                                                                                                                                
4:32:09 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   KELLER  recalled   that  Representative   Hawker                                                               
testified   that   the   commission  will   eliminate   competing                                                               
objectives.  He asked for an example.                                                                                           
                                                                                                                                
4:32:49 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE HAWKER  pointed out  that there is  always tension                                                               
between  the inherent  self-interests  of  insurers, health  care                                                               
providers, payers, consumers, the  federal government, and tribal                                                               
health care.   Health  policy reform must  include debate  on the                                                               
divergent interests to  move to a consensus of  the best solution                                                               
for the state.                                                                                                                  
                                                                                                                                
4:33:45 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KELLER  further  asked which  interests  will  be                                                               
eliminated.                                                                                                                     
                                                                                                                                
REPRESENTATIVE  HAWKER answered  that  all of  the parties  would                                                               
have a  self-interest element  that would  be compromised  in the                                                               
process.                                                                                                                        
                                                                                                                                
4:34:13 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON shared her experience  on the governor's health care                                                               
council.                                                                                                                        
                                                                                                                                
4:35:07 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   KELLER  assumed,   from   testimony,  that   the                                                               
legislative health policy  committee is not working,  and must be                                                               
redesigned.    He expressed  his  concern  that, after  this  new                                                               
health  care commission  is appointed  by  the leadership,  there                                                               
will  not be  a  minority voice  heard to  bring  out the  entire                                                               
dialog.                                                                                                                         
                                                                                                                                
4:35:55 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE HAWKER  responded that this proposal  is developed                                                               
with  the participation  of  five members  of  the House  Health,                                                               
Education  and Social  Services  Standing Committee.   The  final                                                               
decisions  will  be  made  by   the  legislative  body;  however,                                                               
legislators do not have the time  or the resources to take on the                                                               
monumental task  of examining the  state's long term  health care                                                               
system.  In  addition, to Representative Roses,  he recalled that                                                               
the initial proposal  of HB 407 was presented to  the governor in                                                               
February of 2007.                                                                                                               
                                                                                                                                
4:37:08 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON  agreed that  legislators do not  have the  time for                                                               
this issue during the regular session.                                                                                          
                                                                                                                                
4:38:38 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KELLER then  asked about  the five-year  term for                                                               
members  of the  commission.   He noted  that a  political change                                                               
could  disrupt the  leadership, and  all  of the  members of  the                                                               
commission.                                                                                                                     
                                                                                                                                
REPRESENTATIVE HAWKER expressed his  faith in the public process.                                                               
He  stressed the  importance of  establishing  a durable  process                                                               
that would withstand executive  and legislative political change.                                                               
The  commission  must  have  a   longer,  and  stable,  political                                                               
horizon.                                                                                                                        
                                                                                                                                
4:41:16 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KELLER  expressed  his  further  concern  that  a                                                               
commission that is  operating in the DHSS, and  influenced by the                                                               
executive branch, would give up legislative power.                                                                              
                                                                                                                                
4:42:35 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  HAWKER  assured  the  committee  that  there  was                                                               
nothing  in  the proposed  legislation  that  would diminish  the                                                               
legislature's  constitutional authority  or  responsibility.   He                                                               
expressed his belief that the  structure of the commission, which                                                               
involves  the  professional  community   and  the  executive  and                                                               
legislative  branches  of  government,   is  essential  to  build                                                               
consensus  from  the  beginning.     Having  these  three  groups                                                               
involved will eliminate competing  objectives and build consensus                                                               
to  work  out problems  before  proposals  get to  the  political                                                               
level.                                                                                                                          
                                                                                                                                
4:44:10 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KELLER  then  asked  whether the  creation  of  a                                                               
commission would add a barrier  to constituents whose legislators                                                               
are not serving on the commission.                                                                                              
                                                                                                                                
REPRESENTATIVE HAWKER  informed the committee that  the reason to                                                               
form the commission  was to insulate the  decision making process                                                               
from the influence of one  powerful legislator.  Constituents and                                                               
organizations will not  be left out; there will  always be public                                                               
hearings, testimony, and public participation.                                                                                  
                                                                                                                                
4:47:33 PM.                                                                                                                   
                                                                                                                                
REPRESENTATIVE  ROSES  pointed  out that  ex-officio  legislative                                                               
members  retain  oversight  and   a  participatory  role  in  the                                                               
committee.    He  opined  that  this will  be  an  enhanced,  not                                                               
diminished, position for legislators.                                                                                           
                                                                                                                                
4:48:39 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KELLER  expressed his  worry  that  one group  of                                                               
people could eliminate  objectives that should be  discussed.  He                                                               
gave an example and stated that    this would be a failure of the                                                               
commission.                                                                                                                     
                                                                                                                                
REPRESENTATIVE GARDNER recalled  Representative Hawker's previous                                                               
testimony   on  a   different  issue   that  supported   a  large                                                               
legislative presence on a task  force, or commission, in order to                                                               
ensure its  success.   She asked  for an  explanation on  why the                                                               
committee  should support  lesser  legislative representation  on                                                               
the health care commission.                                                                                                     
                                                                                                                                
4:51:37 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  HAWKER stated  that the  difference is  that this                                                               
commission   is  charged   with   the  task   to  re-assess   the                                                               
difficulties  with   health  care  statewide,  and   develop  new                                                               
policies in  an arena that  requires highly qualified  persons to                                                               
engineer the solution.                                                                                                          
                                                                                                                                
4:53:23 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON asked for the  effect of a change of administration,                                                               
and of the DHSS commissioner, on the commission.                                                                                
                                                                                                                                
REPRESENTATIVE HAWKER pointed out that  the bill directs that the                                                               
chair of the commission is the  commissioner of the DHSS.  As the                                                               
commissioner  is  appointed by  the  governor,  the will  of  the                                                               
people would be reflected in  the appointment and thereby, on the                                                               
commission.    In  addition,  the  professional  members  of  the                                                               
commission  remain   unchanged,  thus  there  would   be  minimal                                                               
disruption of the process.                                                                                                      
                                                                                                                                
4:55:56 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON opined that  the proposed legislation seems                                                               
like a mandate,  with a focus on findings and  intent, instead of                                                               
the purpose of  the commission, which is  to make recommendations                                                               
of  policy  changes  to  the  legislature.    He  encouraged  the                                                               
committee  to  remember  that  the  commission's  recommendations                                                               
would  be amended  and changed  through  the regular  legislative                                                               
process.                                                                                                                        
                                                                                                                                
4:57:43 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE CISSNA  stated her appreciation  of Representative                                                               
Hawker's work on the bill.   She opined that the proposal may not                                                               
be a  mandate, but the  purpose of making recommendations  to the                                                               
legislature, with  the participation  of the  administration, the                                                               
legislature,      and  most  importantly, the  public sector,  is                                                               
critical.    She  said  that  she  liked  the  structure  of  the                                                               
commission;   however,  she   stated  the   importance  of   more                                                               
participation  by legislators,  who can  bring to  the discussion                                                               
their  concerns  as policy  makers,  and  the concerns  of  their                                                               
constituents  statewide.     Also,   the  selection   process  is                                                               
acceptable, but  she suggested the possibility  of staggering the                                                               
terms  of the  membership.   Representative Cissna  spoke of  the                                                               
enormity of the problem and her general support of the bill.                                                                    
                                                                                                                                
REPRESENTATIVE  HAWKER concluded  that  the advisory  legislative                                                               
members on  the commission,  although non  voting, are  fully and                                                               
completely participating members.                                                                                               
                                                                                                                                
5:03:38 PM                                                                                                                    
                                                                                                                                
KARLEEN JACKSON,  Commissioner, Department  of Health  and Social                                                               
Services  (DHSS), concurred  that  there are  many components  in                                                               
this  bill that  are in  another  bill that  has been  previously                                                               
heard.   She  recommended that  the bills  should be  compared to                                                               
avoid  duplications.    She  offered  her  belief  that  how  the                                                               
membership  is  structured  will  determine the  success  of  the                                                               
commission; if  the commission is overbalanced  towards industry,                                                               
the legislature,  or the administration,  or, if  politics become                                                               
an  issue,  there will  be  very  little success.    Commissioner                                                               
Jackson  opined that  there is  agreement that  Alaska must  have                                                               
some kind of  health care board or commission  because the health                                                               
care industry  is changing day  by day.  A  successful commission                                                               
is one  that has  a balance  of input  from the  legislature, the                                                               
administration, consumers,  and providers from across  the state.                                                               
Her concern with HB 407 is  that it proposes that the legislature                                                               
serves on  the commission and  also appoints the  public members,                                                               
thus  the  administration  would  appoint  two  members  and  the                                                               
legislature would have influence over  the ten expert members, as                                                               
well as its members  on the commission.  So her  fear is that the                                                               
public's  perception would  be that  the  recommendations of  the                                                               
commission  will be  skewed depending  upon who  is in  political                                                               
power  within the  legislature.    Commissioner Jackson  strongly                                                               
suggested,  therefore, balancing  the  commission  by having  the                                                               
legislature  and  the governor  choose  the  ten public  members.                                                               
Finally, she  stated that she  agrees with  Representative Keller                                                               
that another  issue could  be tension  between the  House Health,                                                               
Education  and Social  Services  Standing  Committee, the  Senate                                                               
Health,  Education and  Social Services  Standing Committee,  the                                                               
health care commission, and the administration.                                                                                 
                                                                                                                                
5:08:41 PM                                                                                                                    
                                                                                                                                
ROD  BETIT, President,  Alaska State  Hospital  and Nursing  Home                                                               
Association, characterized the bill  as a pretty strong proposal,                                                               
noting that  he has  sat on  the commission  for seven  years and                                                               
believes  that Alaska  needs to  take control  of the  situation.                                                               
One concern  is how to  obtain a balance  of the membership.   He                                                               
supported the addition of legislators  as commission members.  He                                                               
also  suggested  that  the  governor  could  appoint  the  public                                                               
members  with subsequent  confirmation by  the legislature.   Mr.                                                               
Betit summarized  by saying that HB  407 is a great  bill, but he                                                               
pointed out that  legislators bring good skills to  the table and                                                               
should be voting members.  He  opined that ex officio members are                                                               
not really part  of the process because they  can not participate                                                               
in the discussion.  The  balance is of particular importance, and                                                               
so  Mr. Betit  expressed  his  hope that  the  result  is a  fair                                                               
proposal  that  the  governor, the  legislature,  and  all  other                                                               
interested parties can support.                                                                                                 
                                                                                                                                
5:13:51 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON advised that the  committee would combine components                                                               
from the various bills into the  governor's bill.  In response to                                                               
a question, she closed public testimony  on HB 407.  She said she                                                               
was  anticipating having  a  proposed  committee substitute  (CS)                                                               
before the  committee very soon,  and was looking  for amendments                                                               
from members.                                                                                                                   
                                                                                                                                
[Following  was a  brief discussion  regarding how  the committee                                                               
would be proceeding with regard to forthcoming amendments.]                                                                     
                                                                                                                                
CHAIR WILSON said she wants to do what is right for Alaskans.                                                                   
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no  further business before the  committee, the House                                                               
Health, Education and Social  Services Standing Committee meeting                                                               
was adjourned at 5:17 p.m.                                                                                                      

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