Legislature(2011 - 2012)CAPITOL 106
03/17/2011 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB78 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| += | HB 78 | TELECONFERENCED | |
HB 78-INCENTIVES FOR CERTAIN MEDICAL PROVIDERS
3:06:26 PM
CHAIR KELLER announced that the only order of business would be
HOUSE BILL NO. 78, "An Act establishing a loan repayment program
and employment incentive program for certain health care
professionals employed in the state; and providing for an
effective date."
[In front of the committee was CSHB 78, Version D, which had
been adopted as the working draft by House Health and Social
Services Standing Committee on March 15, 2011.]
3:06:43 PM
REPRESENTATIVE MILLETT moved to adopt the proposed Committee
Substitute (CS) for HB 78, 27-LS0147\X, Mischel, 3/17/11, as the
working document. There being no objection, Version X was
before the committee.
3:07:10 PM
REPRESENTATIVE HERRON, as the bill sponsor, explained the
changes for Version X. He directed attention to page 3, line 4
of Version X, and stated that "not more than half" was replaced
by "a portion." He noted the additions to Version X on page 3,
line 2, "for deposit in the general fund," and on page 3, line
11, "from money appropriated for the purpose."
3:08:08 PM
REPRESENTATIVE HERRON moved on to page 4 of Version X, and
pointed to the addition of "(i) Direct Incentive payments, loan
repayments, and matching payments shall be made with funds
appropriated by the legislature for that purpose."
3:08:22 PM
REPRESENTATIVE HERRON explained that on page 5, line 2 of
Version X, a new subsection (b) was added:
A loan is eligible for repayment under the program if
the loan was issued by a government or commercial
entity for the payment of actual costs of tuition and
other reasonable educational and living expenses
related to the undergraduate or graduate education of
a participant who is eligible under AS 18.29.035 and
that resulted in a degree required for employment as a
tier I or tier II health care professional under the
program.
REPRESENTATIVE HERRON pointed out that subsection (e) on page 5,
line 17 was added:
A loan or interest on a loan is not eligible for
repayment under this section if the loan or interest
is
(1) to be repaid by another source, including
another loan repayment or forgiveness program or an
employer-sponsored repayment program;
(2) consolidated with a loan that is not eligible
for repayment; or
(3) refinanced.
3:08:52 PM
CHAIR KELLER asked to clarify that both subsections (b) and (e)
on page 5 were definitions for the eligibility of loans for
repayment.
REPRESENTATIVE HERRON concurred.
REPRESENTATIVE HERRON noted the addition of a new subsection
(c), page 5, line 31, which stated:
If sufficient funds are appropriated in a fiscal year,
the department shall prorate payments based on the
number of approved participants in the program.
3:09:29 PM
REPRESENTATIVE HERRON moved on to page 7, line 4, of Version X,
stated that "score" was added, and explained that this would
assign each site a score indicating its level of need during the
needs assessment process. Returning attention to page 6, line
21, he clarified that the change on page 7 related to this
addition: "the needs assessment for the site."
3:10:20 PM
CHAIR KELLER asked if there were any questions.
3:10:32 PM
REPRESENTATIVE MILLER asked to clarify that Version X included
language for making payments directly to the professional. He
asked if these monies could be paid to the originator of the
loans.
3:11:26 PM
PAT CARR, Chief, Health Planning and Infrastructure, Division of
Health Care Services, Department of Health and Social Services,
explained that Version X would allow payments to be made to
either the professional or the loan institution.
REPRESENTATIVE MILLER asked to clarify that this would be
determined by the applicant. He asked about any matching funds.
MS. CARR replied that the matching funds would go to Department
of Health and Social Services, which would make the payments.
3:12:31 PM
REPRESENTATIVE MILLER, referring to page 3, line 1, pointed out
that the employer "may" make the matching payments, and he asked
if this should be changed to "shall" or "will."
MS. CARR replied that a word change would be based on the intent
of the bill sponsor.
3:13:13 PM
REPRESENTATIVE HERRON asked Ms. Carr for her opinion.
MS. CARR replied that, if the payments all came to Department of
Health and Social Services, this would assure all the funds
would be available. She recommended a change of the wording
from "may" to "shall."
REPRESENTATIVE HERRON offered his support to a conceptual
amendment for this change.
3:14:21 PM
REPRESENTATIVE MILLER moved to adopt Conceptual Amendment 1, as
follows:
Page 3, line 1, after "program"
Delete "may"
Insert "shall"
REPRESENTATIVE HERRON offered his support of Conceptual
Amendment 1.
3:14:55 PM
CHAIR KELLER opined that, as the employer in question had chosen
to be in the program, the word should be changed to "shall."
3:15:26 PM
There being no objection, it was so ordered.
3:15:50 PM
REPRESENTATIVE MILLETT moved to report CSHB 78, Version 27-
LS0147\X, Mischel, 3/17/11, as amended, out of committee with
individual recommendations and the accompanying fiscal notes.
3:16:09 PM
CHAIR KELLER objected. He expressed that he was not comfortable
with proposed HB 78. He assured the committee that he would not
delay the bill, as a wide spectrum of respected advisors had
stated the importance of the bill. He opined that HB 78 was
"purely about access to health care," and he directed attention
to page 1, line [8], and read:
to ensure that residents throughout the state,
including recipients of medical assistance and
Medicare, have access to health care and that
residents of rural areas of the state, in particular,
experience improved access to health care...
He opined that this was a "leap of logic" to refer to access and
then "give the Commissioner [Department of Health and Social
Services] I would call it a big check book to pay off loans and
give grants as incentives to get health care professionals to
participate and live in Alaska. The leap of logic to me is that
will solve the access problems." He acknowledged a
relationship, but not a direct connection [for payments and
access.] He agreed that it was necessary to offer financial
incentives to compete, and he agreed that Alaska was facing a
crisis situation if the medical workforce was not expanded. He
reflected that this exposed the underlying problem for the
health care system in Alaska. He stated the difficulty for
comparing the high cost of medical care to the value of the
health care. He offered his support for legislation that "jump
starts the market back into the health care system." He
acknowledged that the market system was not functioning, and he
opined that government intervention had crowded out more
effective and more efficient health care policies that could
exist with a "free market, and free market principles where
financial incentives are really related to supply and demand,
like they are in other things..." He stated his belief that
competition and profit motive provided quality control as well
as cost control. He opined that this would lead to rising
costs. He offered to discuss his ideas for the return of a
functioning market. He stated that HB 78 gave "tremendous power
to the Commissioner of Health and Social Services." He decried
the lack of parameters on the bill, noting that primary care was
a crisis area which was not addressed in the bill. He pointed
to the lack of designation for regional distribution, or
guidelines for providing health care professionals in community
health centers. He stressed the need to solve the "cost
problem" but he stated that HB 78 would not reduce the costs.
3:23:02 PM
CHAIR KELLER removed his objection.
3:23:18 PM
REPRESENTATIVE HERRON acknowledged that Chair Keller's concerns
were genuine, and he expressed his desire to continue to work
toward the resolution of those concerns.
3:23:48 PM
REPRESENTATIVE MILLETT, emphasizing that "no action is bad,"
stated the necessity for innovative solutions which had been
proven to work in other states. She pointed out that these
solutions had worked for those states which were competing for
the same pool of medical professionals as Alaska. She gave
personal examples of her search for health care. She endorsed
HB 78 as a start that would not be regretted. She declared the
need for workable solutions, and stated that "inaction is not a
solution." She offered her belief that this bill was based on
the needs of Alaska.
3:26:02 PM
REPRESENTATIVE MILLER stated his agreement with Representative
Millett. He declared that "it's not a perfect bill, it might
not even be a perfect start, but I think before we can resolve
the real crisis... we've got to have the physicians, we've got
to have the nurses, we've got to have the personnel in state..."
He extended his appreciation to Chair Keller.
3:27:03 PM
CHAIR KELLER pointed out that his statement was not a criticism
of Department of Health and Social Services. He offered his
belief that incentives and concerns could become blurred.
3:27:40 PM
There being no further objections, CSHB 78 (HSS) was reported
from the House Health and Social Services Standing Committee.
| Document Name | Date/Time | Subjects |
|---|---|---|
| 01d - blank CS HB 78 27-LS0147 X.pdf |
HHSS 3/17/2011 3:00:00 PM |
HB 78 |
| 01c - blank CS HB 78 27-LS0147 D.pdf |
HHSS 3/17/2011 3:00:00 PM |
HB 78 |
| HB 078 27-LS0147 changes D to X.pdf |
HHSS 3/17/2011 3:00:00 PM |
HB 78 |