Legislature(2009 - 2010)BUTROVICH 205
02/03/2010 01:30 PM Senate HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| United Way, 211 Project | |
| Alaska Health Care Commission Report | |
| SB172 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | SB 172 | TELECONFERENCED | |
SB 172-ALASKA HEALTH CARE COMMISSION
2:28:30 PM
CHAIR DAVIS announced consideration of SB 172.
2:28:47 PM
SENATOR OLSON, sponsor of SB 172, said Alaska is currently
facing serious health care cost, access, and quality issues. The
ISER report alluded to by Deborah Erickson, stated that between
1991 and 2005 health care expenditures in the state tripled,
going from $1.6 billion to $5.3 billion. These costs are
expected to double by 2013. All levels of government are
affected; what is more important is that Alaska's economy cannot
sustain this inflationary growth.
The issues involved are broad and complex; they cannot be dealt
with unless there is a permanent body to plan and follow through
with long-range comprehensive reforms. Both the Commonwealth
North Alaska Health Care Roundtable group and the Alaska Health
Care Strategies Planning Council have recommended establishment
of a permanent body to address the problems Alaska is facing.
The Health Care Commission will be established under the
Department of Health and Social Services and will consist of ten
members including public officials and private citizens. It will
provide recommendations for the development of a statewide plan
to address the quality, accessibility, and availability of
health care to all residents of the state of Alaska. Alaska's
need for health care reform is pressing and must be dealt with
thoroughly and efficiently, with a long-range view toward
meaningful and lasting change. The Alaska Health Care Commission
will play an important role in this process; it is essential
that the legislature make it a permanent component of the
Department of Health and Social Services so that present, as
well as future issues with Alaska's health care can be better
anticipated, understood, and addressed.
2:33:36 PM
ELLEN ADLAM, Board Member, Peninsula Community Health Services,
Soldotna, Alaska, said she is an X-ray technician and has been
involved for a long time with community health centers. She
agreed that health care is a big problem in this state and said
she supports SB 172, but the board would like to see a primary
care "safety net" seat established on the commission to provide
a voice for the underinsured and uninsured. Peninsula Community
Health Services is one of the three largest health systems in
the state, serving 81,000 patients. It includes 26 organizations
with 142 sites, and those sites see Medicare patients, so it is
very important that they be included. She suggested the
commission use a provider from a health center, because they
provide not only medical, but dental and behavioral health. That
seat would encompass the voice for the underinsured and the
primary provider.
2:37:43 PM
DR. LARRY STINSON, representing himself, Anchorage, Alaska, said
he supports SB 172 and recognizes that the there needs to be a
balance between representation and the number of people on a
committees in order to get things done. This bill creates a
manageable group; it also keeps any one entity from having a
majority vote that might dominate the outcome.
2:39:18 PM
DEBORAH ERICKSON, Executive Director, Alaska Health Care
Commission, Anchorage, Alaska, said this particular bill mirrors
very closely Administrative Order 246, which established the
current commission and includes a transition clause that will
automatically appoint the members of the current commission to
the new one if SB 172 passes in its current form. She added that
the commission's work during its first year really laid the
groundwork and will be a good jumping-off point if this bill
passes.
2:42:12 PM
WARD HURLBURT M.D., MPH, Chief Medical Officer, Division of
Public Health, Department of Health and Social Services (DHSS);
Chairman, Alaska Health Care Commission, Anchorage, Alaska, said
the commission under this bill should provide significant
continuity; the membership reflects excellent professional and
geographic diversity and has achieved momentum that will
continue under SB 172.
As was previously discussed, he said, the commission's major
focus will be on health care costs, which now represent about 18
percent of the U.S. gross national product; Alaska is spending
about $6 billion per year. The American Health Insurance Plans
Association announced today that the expectation nationally is
for commercial health insurance premiums to go up more than 10
percent in 2010, as compared to a 1.4 percent increase in wages.
He said Medicaid is a huge chunk of the governor's supplemental
request to the legislature for funding, and ventured to say that
every department, in every state in the country, has to make
control of Medicaid costs almost their top priority.
DR. HURLBURT shared that he is a cynic with regard to
commissions, but thinks the members on this commission have
worked well together and that making it permanent is the right
step.
2:47:08 PM
BEVERLY SMITH, Christian Science Committee on Publication for
the state of Alaska, Juneau, Alaska, said one of her roles is to
ensure the legislature has accurate information concerning
spiritual healing as practiced in Christian Science, so this
cost-effective and reliable form of care is not overlooked or
restricted in the state's health care reform efforts. With
regard to SB 172, she requested that access to spiritual care
for the treatment and cure of disease be given appropriate
consideration during discussions of the development of a
statewide health plan. To facilitate this discussion, she
recommended that the bill mandate one of the duties of the
commission be to recommend the extent to which and under what
circumstances access to spiritual care should be addressed in a
comprehensive statewide health care policy. Because health care
reform discussions at the state and federal levels have raised
issues that could impact the insurance coverage for spiritual
care, it is important that these issues be discussed so as not
to create unintended results that could limit the coverage for
spiritual care.
She said she noticed the bill does not mandate insurance
coverage for all Alaskans, but asks the commission to develop a
strategy that encourages acquisition of health insurance and
that increases the number of insurance options available for
health care services. If Alaskans pay health insurance premiums,
they should be able to be reimbursed for the health care they
choose, whether that is medical care or spiritual treatment.
MS. SMITH referred to page 2 of her memorandum to the committee,
dated February 3, 2010, which cites a number of state and
federal programs that offer benefits for spiritual care. She
pointed out that Alaska does allow spiritual treatment under the
state employees' health insurance plans. Christian Science care
can also be deducted under medical expenses from federal income
tax.
She closed by saying that she hopes the commission will preserve
the insurance coverage for spiritual care that Alaska residents
now enjoy and recommend that it be expanded to include religious
non-medical nursing services. If the commission were directed in
statute to include spiritual care in its discussions of reform,
it would prevent such access from being overlooked or minimized.
2:51:34 PM
MS. SMITH thanked the committee and the sponsor for their work
on health care reform and respectfully requested that this
commission have the responsibility for discussing and
recommending how access to spiritual treatment and care can be
part of the overall health care plan in Alaska.
2:52:10 PM
RYAN SMITH, CEO, Central Peninsula Hospital and Heritage Place,
Soldotna, Alaska, and a member of the Alaska Health Care
Commission, thanked the committee and others for their support
for health care reform and expressed strong support for SB 172.
2:53:53 PM
J. KATE BURKHART, Executive Director, Alaska Mental Health Board
and the Advisory Board on Alcoholism and Drug Abuse, Anchorage,
Alaska, said both boards were created by statute, with statutory
duties that include providing advice and advocacy on issues
related to mental health and substance abuse to the executive
and legislative branches.
She prefaced her testimony by saying that the information and
positions she expresses today are those of the boards and not of
the governor's office or the Department of Health and Social
Services. On behalf of both boards, she extended their
appreciation to the Alaska Health Care Commission for the work
it has done and stated that they support the continuation of a
health care commission in whatever form that takes, as long as
it includes representation of the Behavioral Health system.
MS. BURKHART enumerated three reasons that having the
perspective and representation of an active, licensed,
behavioral health professional on the commission is very
important:
1. The state of Alaska invests a substantial amount of money
in the behavioral health system. As Ms. Erickson stated, the
current health system is very fragmented, and to create a
commission that doesn't include representation of a major
health care system will not help to resolve that fragmentation
problem.
2. The issue of co-morbidity when working with populations
that experience a mental health disorder is significant.
Often, people with serious mental illness live 25 years less
than others who do not have a mental illness. Given the
commission's focus on chronic diseases, representation from
the behavioral health field seems appropriate.
3. What is contemplated here is system change. The
commission's report says that the system as it is now is not
sustainable. If the legislature is going to address a
comprehensive system change, all of its health systems should
be represented.
In response to concerns that the commission could become too
large and unwieldy, she suggested AS 18.09.020(1)(e) seems to
contemplate that the health care provider who is not affiliated
with ASHNHA is a primary health care provider. She said she
thinks it is possible to have a seat for a primary care provider
from Alaska's federally qualified health centers and the
providers who serve indigent populations, and another for a
behavioral health professional. She pointed out that there are
movements afoot to integrate primary care and behavioral health.
Examples include Peninsula Community Health and South Central
Foundation.
2:58:42 PM
PAT LUBY, Advocacy Director for AARP, Anchorage, Alaska, said
they are in full support of SB 172. He praised the members of
the Alaska Health Care Commission for the great work they have
done on some targeted issues and for their ability to work
collaboratively for the good of all Alaskans, despite different
backgrounds or political affiliations.
2:59:54 PM
SHELLY HUGHES, Government Affairs Director, Alaska Primary Care
Association, Anchorage, Alaska, said part of reason Governor
Palin and Governor Parnell established the current commission
was due to a report by Commonwealth North, Alaska Health Care
Roundtable Group, titled "Alaska Primary Health Care
Opportunities and Challenges;" She pointed to the words "Primary
Care" and said that primary care is the gateway to health care
and includes behavioral health, dental, and medical care.
Without a designated seat for primary care, she is concerned
that the commission will be missing expertise and input that may
be helpful in working out a statewide plan. She agreed with
previous speakers that the commission could get "two for the
price of one" because, if the legislature adds a primary care
safety-net seat, it will also be getting expertise on the
uninsured problem in this state.
She emphasized that the three largest health systems in the
state are the hospitals, tribal health, and the community health
centers. The first two of these are designated in the bill; the
primary care safety-net or community health centers are not in
the bill. The one provider seat may or may not be a primary care
provider but is a specialist at this time. She encouraged the
committee to consider adding a primary care provider seat. While
she understands the need to keep the commission compact, she
believes this is a key component and something very integral to
working on a statewide plan.
She mentioned that the state Chamber of Commerce passed a
position for this session in agreement with the establishment of
the health care commission, including a seat for primary care.
[SB 172 was held in committee.]
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