Legislature(2011 - 2012)HOUSE FINANCE 519
03/02/2012 01:30 PM House FINANCE
| Audio | Topic |
|---|---|
| Start | |
| HB307 | |
| HJR4 | |
| HB78 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HJR 4 | TELECONFERENCED | |
| += | HB 78 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 307 | TELECONFERENCED | |
HOUSE FINANCE COMMITTEE
March 2, 2012
1:37 p.m.
1:37:30 PM
CALL TO ORDER
Co-Chair Thomas called the House Finance Committee meeting
to order at 1:37 p.m.
MEMBERS PRESENT
Representative Bill Stoltze, Co-Chair
Representative Bill Thomas Jr., Co-Chair
Representative Anna Fairclough, Vice-Chair
Representative Mike Doogan
Representative Bryce Edgmon
Representative Les Gara
Representative David Guttenberg
Representative Reggie Joule
Representative Mark Neuman
Representative Tammie Wilson
MEMBERS ABSENT
Representative Mia Costello
ALSO PRESENT
Pete Ecklund, Staff, Representative Bill Thomas; Joan
Brown, Staff, Representative Bill Thomas; James Armstrong,
Staff, Representative Bill Stoltze; Representative Bob
Herron; Representative Dan Saddler; Representative Peggy
Wilson, Sponsor; Rebecca Rooney, Staff, Representative
Peggy Wilson; Joe Michel, Staff, Representative Bill
Stoltze; Representative Bob Herron, Sponsor; Liz Clement,
Staff, Representative Bob Herron; Marie Darlin, American
Association of Retired Persons-Alaska; Patricia Carr,
Director, Health Planning and Systems Development,
Department of Health and Social Services.
PRESENT VIA TELECONFERENCE
Christine Potter, President, Alaska Nurse Practitioner
Association; Debbie Thompson, Executive Director, Alaska
Nurses Association; Mary Sullivan, Alaska Primary Care
Association.
SUMMARY
HJR 4 CONST. AM: TRANSPORTATION FUND
CSHJR 4(FIN) was REPORTED out of committee with a
"no recommendation" and with one new fiscal
impact note from the Office of the Governor and
one new zero note from the House Finance
Committee for the Department of Revenue.
HB 78 INCENTIVES FOR CERTAIN MEDICAL PROVIDERS
HB 78 was HEARD and HELD in Committee for further
consideration.
HB 307 SUPPLEMENTAL/CAPITAL/OTHER APPROPRIATIONS
CSHB 307(FIN) was REPORTED out of committee with
a "do pass" recommendation and with no fiscal
notes.
HOUSE BILL NO. 307
"An Act making supplemental appropriations, capital
appropriations, and other appropriations; amending
appropriations; repealing appropriations; making
appropriations to capitalize funds; and providing for
an effective date."
1:37:51 PM
Co-Chair Stoltze MOVED to ADOPT a proposed committee
substitute for HB 307, Work Draft 27-GH2601\B (Martin,
3/1/12). There being NO OBJECTION, it was so ordered.
PETE ECKLUND, STAFF, REPRESENTATIVE BILL THOMAS pointed to
a ten page document prepared by the Office of Management
and Budget (OMB): "FY12 Supplemental Schedule" (copy on
file). He addressed the operating portion and language
section initially. The following items changed: item 2
included a $50 thousand reduction from the initial $1
million request for the Public Defender Agency.
1:40:50 PM
Mr. Ecklund explained that the four co-chairs from both the
House and Senate Finance Committees worked together to
create the committee substitute. He explained that reduced
or removed items may be funded later in the session using
another vehicle. He stressed that those items that were
removed or reduced might come up again in a later
supplemental request.
Representative Doogan clarified that item 2 remained in HB
307, but was reduced by $50 million.
Mr. Ecklund responded in the affirmative. Item 4 was
reduced by $100 thousand of authority. He mentioned a note
from the Legislative Finance Division (LFD) questioning
whether the full request could be expended in the remainder
of the FY 12 fiscal year, which prompted the reduction.
Item 6, a request for $3,439,800 in general fund receipts
to the Department of Commerce, Community and Economic
Development (DCCED) was removed. Item 7 included a request
for $250 thousand for receipt supported services, which was
granted, but the funding sources were changed. The sources
were split and $210 thousand remained as Receipt Supported
Services (RSS) and $40 thousand consisted of general funds
from corporate business licensing receipts. Item 10
included a request from Department of Education and Early
Development (DEED) for $1 million, and the item was removed
pending further discussions with the subcommittee chair and
LFD.
1:43:41 PM
Mr. Ecklund continued with items 15 and 16, which had been
funded with alternate funding sources and were moved to the
language section of HB 307. Item 22 on page 3 for $250
thousand to replace unrealized program receipts at Alaska
Vocational Technical Center (AVTEC) was removed. Item 24
included $600,000 for fast ferry litigation. The item was
approved and moved to the language section of the bill and
became a multi-year appropriation encompassing FY 12 and FY
13. Item 25 was approved, but $300,000 was relocated to the
language section and funding was divided into multiple year
increments, again for FY 12 and FY 13. He moved to page 9
of the spreadsheet. Item 78 included a request by
Department of Corrections (DOC) for reappropriation of $100
thousand for the Highland Mountain Center Land Transfer.
The item was removed for further investigation to determine
whether DOC was the correct department to receive the
funds. He pointed to item 80, with a total request of
$20,770,800. He noted that $20 million was removed from
item 80, an optional retirement program for the university.
He stated that the funding was removed to allow for
discussions about alternative funding sources.
1:46:34 PM
Representative Guttenberg asked whether the university
settlement had been finalized.
Mr. Ecklund responded in the affirmative. He elaborated
that the item might be approved in the near future. He
moved on to item 89 on page 10 of the spreadsheet. He
pointed out that a provision existed in the original bill
stating that additional unspent funding was swept into the
budget reserve fund in FY 12. The provision was removed
from the bill, but would be considered in other
appropriation bills. The effective date of the bill changed
to March 15.
JOAN BROWN, STAFF, REPRESENTATIVE BILL THOMAS, discussed
that some "negative" supplemental items were added to the
language section of the bill totaling $715 thousand. The
reason for the negative items was to address funds given to
the agencies for FY12 for new positions. She stated that
DCCED had $84,100 in economic development. The Department
of Health and Social Services (DHSS) lost $200 thousand in
front-line social workers and $250 thousand in nursing for
positions remaining vacant. She noted Department of Law
(DOL) lost $21,100 for vacancy in criminal appeal special
litigation and $53,800 for a new child protection attorney
and paralegal. She mentioned the $96,200 vacancy related to
a fiscal note for SB 58, which passed the prior year. She
noted that the Department of Military and Veterans Affairs
(DMVA), $10 thousand was removed from the legislation in
the army guard maintenance component.
1:49:26 PM
Ms. Brown pointed to other changes in the legislation. The
governor's original supplemental bill included a request
for $2,620,300 to fully fund the Low Income Home Energy
Assistance Program (LIHEAP) appropriations. The request
included two contingency appropriations for FY 12 totaling
$8 million. The contingency language was deemed
ineffective. The supplemental bill repealed the contingency
appropriations and instead appropriated a flat $8.5 million
reducing the supplemental budget by $2 million. The amount
fully funded the department's expected energy assisted
heating costs. She pointed to the disaster relief fund
located in the fund capitalization (Section 14), which
increased from $3 million to $5 million in conjunction with
the governor's amendment received on March 1, 2012. She
pointed out a new repeals section in Section 16, which
included an unworkable LIHEAP contingency appropriation.
The lapse and retroactivity were adjusted accordingly.
Mr. Ecklund explained that the changes discussed were found
in the operating and language sections of the bill. He
pointed out that James Armstrong would detail the capital
portions of the bill.
JAMES ARMSTRONG, STAFF, REPRESENTATIVE BILL STOLTZE,
pointed to pages 7 and 8 of the OMB supplemental
spreadsheet. Projects 55 through 72 were removed from the
bill and would probably be included in the capital budget.
He pointed to page 10 of HB 307, which included capital
budget items. Items 12 through 18 addressed a grant to
Anchorage to replace a fire and rescue station. He
continued that items 16 through 18 included emergency
repairs to the Cordova hospital. He mentioned that lines 28
through 30 were included in the governor's capital budget
for FY 13. He explained that his office received an
amendment from OMB to accelerate the item.
1:53:38 PM
Representative Gara asked about items that had not been
adjusted. He pointed to page 4, item 33 of the spreadsheet.
He surmised that the funds had been received from the Red
Dog Mine and would be spent on the Red Dog Mine.
Mr. Ecklund responded in the affirmative. He stated that
the funds were supplied by an outside entity to the state
for a specific purpose.
Representative Gara directed attention to page 3, line 23.
He expressed that he felt like the item would never end. He
noted that it was less expensive to hire in-house employees
to do the work that had been done by outside attorneys. He
expressed concern about the hourly rates of the attorneys.
Co-Chair Thomas heard the argument every year. He explained
that the Department of Law (DOL) lost employees and needed
to contract the prior employees with expertise on a
subject. He believed that the labor was contracted only
under limited and special cases.
Representative Gara contended that a new attorney could
integrate the department's knowledge without trouble. He
believed that a new attorney could be trained to continue
litigation.
1:57:14 PM
Mr. Armstrong added that backup for the four sections he
had discussed were included in members' packets.
REPRESENTATIVE BOB HERRON, informed the committee about a
disaster over the winter break regarding the water/sewer
line in Bethel that occurred due to winter weather. He
explained that the cause of the disaster was the winter
weather. He explained that the children did not return to
school until mid-January. He appealed to the governor and
the co-chairs of the finance committees to move the item
into the capital budget.
REPRESENTATIVE DAN SADDLER, explained that excessive winter
snow had caused damage to the roof of the fire station,
high density housing, and schools in the Eagle River area.
He asked for committee consideration of the capital budget
request, which was crucial to his community.
Co-Chair Thomas stressed the immediate need for attention
to the projects discussed by Representatives Herron and
Saddler.
Co-Chair Stoltze remarked on the intentional nature of the
decision to include the emergency nature items. Non-
emergency items were moved to the FY 13 capital budget.
Co-Chair Thomas explained that the communities should not
wait for the funding for emergency items.
2:01:32 PM
Co-Chair Thomas CLOSED public testimony.
Co-Chair Thomas asked whether there were any amendments.
Co-Chair Stoltze MOVED to report CSHB 307(FIN) out of
committee with individual recommendations.
Representative Gara OBJECTED for purpose of discussion. He
pointed to page 1, line 2 of the bill. He discussed the
Office of Public Advocacy and would like to see funding
restored for the $50 thousand requested in item 2.
Co-Chair Thomas explained that funding had been requested.
He detailed that the Office of Public Advocacy was fully
funded and that the new position was filled.
Representative Gara WITHDREW his OBJECTION. There being NO
further OBJECTION, it was so ordered.
CSHB 307(FIN) was REPORTED out of committee with a "do
pass" recommendation and with no fiscal notes.
2:04:43 PM
AT EASE
2:23:03 PM
RECONVENED
HOUSE JOINT RESOLUTION NO. 4
Proposing amendments to the Constitution of the State
of Alaska creating a transportation infrastructure
fund.
2:23:20 PM
Co-Chair Stoltze discussed that Vice-chair Fairclough
chaired the subcommittee on HJR 4.
Vice-chair Fairclough explained that the committee sent
three bills to subcommittee in the prior year. The members
held hearings throughout Alaska. The bill received support
from residents for the dedication of transportation funds.
She explained that subcommittee suggestions were
incorporated into a CS that was labeled "finance."
Vice-chair Fairclough MOVED to ADOPT a proposed committee
substitute for HJR 4, Work Draft 27-LS0197\T (Martin,
3/1/12).
Co-Chair Stoltze OBJECTED for discussion.
2:24:57 PM
REPRESENTATIVE PEGGY WILSON, SPONSOR, asked her staff to
review changes in the CS.
REBECCA ROONEY, STAFF, REPRESENTATIVE PEGGY WILSON,
explained that the changes to remove details from the
constitutional amendment; the removed provisions would be
added to the enabling legislation. She noted that the CS
updated specific dates within the legislation and changed
the pay-out rate. She pointed to page 1, line 14, where the
date was changed and updated for the current year. The CS
deleted the following language from page 1, lines 14
through 16 and page 2 lines 1 through 2 after the word
"from":
"any state on fuel used for the propulsion of motor
vehicles, aircraft and water craft, less those
refunds, credits and collection costs that are
provided by law from a registration fee levied for a
motor vehicle, not including special registration fees
as provided by law. She noted that page 2, line 3
after "funds" deleted "designated by the legislature."
Ms. Rooney relayed that on page 2, line 6 after the words
"50 percent of the," the following language was removed
"state fuel tax, registration and driver's license fees,
identification card fees, studded tire taxes and other
designated." She continued with page 2, line 2 and line 8
where "6" was replaced with "7." She added that the
following language was deleted on page 2, line 10 the
following language "designated by law":
"For costs related to motor vehicle licensing and
registration that are designated by law" was deleted.
She noted that page 2, line 5 added a new sentence,
"the legislature shall by law determine which fees and
funds are transportation related under this section."
Co-Chair Stoltze surmised that the changes allowed a
dedicated fund similar to the permanent fund and the change
would allow direct appropriations or a dedication. The
legislature would make the appropriation decisions on how
the fund was implemented.
Representative Peggy Wilson replied in the affirmative.
Vice-chair Fairclough clarified that the 7 percent was an
"up-to" amount that would allow flexibility for the
legislature to set statute without revisiting the
constitution. The change would allow the legislature to set
a 4 or 5 percent pay-out rate depending on concurrence of
the body. The constitutional amendment allowed the
dedication of funds and permitted the legislature the
greatest flexibility in management of the fund.
2:29:50 PM
Representative Peggy Wilson read a statement that she
believed would help answer any questions related to the CS:
Like the rest of the country, Alaska is challenged
with maintaining, upgrading and creating new
transportation infrastructure. I think we all can
agree that we have a serious shortfall in funding
which could be exacerbated by the new federal
reauthorization bill. It is rumored to cut Alaska's
federal funding by at least 30%. In 2005 the United
States was ranked as number one in the world for our
transportation system. Now, just 7 short years later,
we are not even in the top 10. As federal funding is
diminishing and our infrastructure is aging Alaska
needs to shoulder more of the responsibility for its
transportation infrastructure.
HJR 4 will put a constitutional amendment to the
Alaska constitution before voters to re-instate a
dedicated fund for Transportation Projects.
Historians write that the drafters of the constitution
were concerned that dedicated funds would impair
future legislatures from responding to evolving public
needs. However, the drafters of our Alaska
Constitution grandfathered in two dedicated
transportation funds. The first was for highways and
the second was for water and harbor facilities. They
recognized the public need for dependable and
efficient transportation and that need has only grown.
Testifiers for this bill have agreed that the state
needs a reliable revenue stream that doesn't fluctuate
from year to year. With a dedicated fund Alaska can
implement a transportation plan that is independent of
the federal government.
In order to implement the Alaska Transportation
Infrastructure Fund (ATIF) there are 3 pieces of
legislation that need to pass. The first, the bill
before you today, is to put this constitutional
amendment on the ballot, second is to set up the
enabling statutes that direct how the fund will be
administered, what revenues will be deposited in the
fund, how those revenues may be spent, and what the
payout rate will be from the fund. It will also define
an entity that will evaluate projects for funding. The
third part will be the bill that will fund the corpus
of the Alaska Transportation Infrastructure Fund with
1 billion dollars.
Today we are hearing HJR 4 the constitutional
amendment to re-instate a dedicated transportation
fund. There is a CS before the committee today that
has 2 substantive changes made. 1) The language has
been modified to make the constitutional amendment
broad enough so that it will be useful 10 years, 20
years and 100 years from today. We have removed all
the details about which funds will be deposited in
ATIF, and what projects can be funded with ATIF. These
detailed provisions will be in the enabling statutes.
In addition to making the constitutional amendment
broader so that it will serve into the future, these
deletions have made the amendment more clear and
concise.
2:33:50 PM
Representative Peggy Wilson continued to read from a
statement:
The second substantive change is the increase in the
maximum payout rate. I believe that the payout rate
for today should be in the neighborhood of 4 to 4.5%
not 7 %. We do not want to chip away at the corpus of
the fund. However, what we don't know is what the
payout rate should be in 20 or 30 years. I think it is
prudent to give the legislature the flexibility to use
the fund and still maintain a small growth rate. 10
years ago it would have not been a bad idea to have
the payout rate at 6 or 7%. We had seen the growth
rate of investments up around the 10% range
consistently. Today's market is not as favorable.
Setting the payout rate in statute with a ceiling in
the constitution will give the legislature the
latitude to manage the fund in future years based on
the market of the day while preserving the corpus of
the fund.
In you packet you have a list of organization who have
voiced their support for the Alaska Transportation
Infrastructure Fund. It is quite a list and they are
the people we can depend on the get this amendment
passed by the voters in November of 2012.
Alaska needs to take action now. The future of the
economic and social well-being of Alaska's citizens is
critically dependent on a reliable transportation
system. This change to the state constitution,
allowing a dedicated transportation fund is needed to
create and maintain a modern, reliable transportation
system for Alaska.
Co-Chair Stoltze WITHDREW his OBJECTION. There being NO
further OBJECTION, Work Draft 27-LS0197\T was ADOPTED.
Representative Neuman asked who would decide which projects
were funded.
Representative Peggy Wilson replied that the enabling
legislation would determine the body responsible for the
decision regarding the funding of projects.
Co-Chair Stoltze understood that the default was the
legislature and its delineation of responsibility.
2:36:19 PM
Representative Gara complimented Representative Wilson on
the drafting of a dedicated fund provision. He believed the
dedicated funds provision in the Alaska Constitution was a
wise decision made initially by the state founders. He
recommended prioritized spending in the future.
Representative Peggy Wilson commented that the fund did
have user fees connected to transportation.
Co-Chair Stoltze acknowledged the gravity of constitutional
amendments.
2:40:18 PM
Representative Doogan agreed that a constitutional
amendment was a large step. He believed that Representative
Peggy Wilson had done the best job possible. He added that
the work of the subcommittee improved the legislation
further. He supported the legislation despite his dislike
for the permanence of dedicated funds.
Co-Chair Thomas referred to the fisherman's fund that was a
dedicated fund; it had been amended from $2500 to $10,000.
He stated that he would vote to move the bill out of the
finance committee.
2:43:42 PM
Representative Tammie Wilson appreciated the subcommittee
for its work over the prior interim. She imagined that
Alaskans might be unaware of the source of transportation
funds. She supposed that constituents might be surprised to
learn that money gained from gas tax and from the Division
of Motor Vehicles went into the general fund, as opposed to
being used directly on road construction. She opined that
the fund would not be necessary if the funding for
infrastructure occurred in the past. She pointed out that
state funding was simpler than federal funding to utilize.
Representative Guttenberg discussed a constitutional
committee called "draft and styling." The committee would
use an approved idea and rewrite it in a succinct manner.
He explained that HJR 4 was well vetted. He expressed
concern that subsequent laws would be written to implement
the process established by HJR 4. He supported the passing
of the bill from the finance committee. He applauded the
sponsor for her work.
2:47:26 PM
Vice-chair Fairclough pointed out that the federal
government was working on a reauthorization bill. She noted
that the new figures appeared to be rising, possibly
leading to the elimination of all metropolitan planning
organizations in Alaska. She clarified that the current
federal legislation retained Alaska's transportation
funding formula.
Co-Chair Stoltze believed that the federal legislation was
a continuing resolution.
Vice-chair Fairclough agreed. She commented that an
additional piece of federal legislation addressed Alaska's
funding formula for transportation.
Co-Chair Stoltze pointed out the uncertainty related to
federal funding.
Representative Edgmon echoed the compliments for
Representative Peggy Wilson and her work on the very
important legislation.
Vice-chair Fairclough clarified that the structure for a
dedicated fund was the sole issue in the committee
discussion. She did not want the issue to be confused with
the figure $1 billion, which was included in a separate
piece of legislation.
Co-Chair Stoltze explained that HJR 4 would establish a
structure that would ensure gradual spending.
2:51:58 PM
Representative Joule pointed out that the Constitutional
Budget Reserve (CBR) required a three-quarter vote. He
wondered whether the bill allowed a mechanism for
expenditures on items other than transportation.
Representative Peggy Wilson replied that the constitutional
amendment did not allow a mechanism for expenditures on
items other than transportation.
Representative Joule understood and compared the process to
that of accessing the Permanent Fund. He pointed out that
potential delays might arise due to the stipulations of
spending.
Representative Gara asked about other dedicated funds.
Representative Peggy Wilson replied that other dedicated
funds dissolved when the fuel gas tax was raised.
Vice-chair Fairclough pointed to fiscal notes and mentioned
the first fiscal note from the Office of the Governor for
elections in FY 13 for $1,500 to add the resolution to the
ballot. She MOVED to strike years FY 14 through FY 18 of
the Department of Revenue fiscal note.
Co-Chair Stoltze concurred as there had not yet been debate
regarding the dedication of funds along with the costs of
administering the funds. The fiscal note for DOR was
"zeroed out."
Vice-chair Fairclough clarified that the fiscal note could
be addressed when an appropriation bill was before the
committee.
Vice-chair Fairclough MOVED to report CSHJR 4(FIN) out of
committee with individual recommendations and the
accompanying fiscal notes. There being NO OBJECTION, it was
so ordered.
Co-Chair Stoltze CLOSED public testimony on HJR 4.
Representative Joule reminded the committee about public
testimony for HJR heard in the prior year.
Co-Chair Stoltze agreed.
CSHJR 4(FIN) was REPORTED out of committee with a "no
recommendation" and with one new fiscal impact note from
the Office of the Governor and one new zero note from the
House Finance Committee for the Department of Revenue.
3:00:28 PM
AT EASE
3:03:38 PM
RECONVENED
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."
3:03:49 PM
Co-Chair Thomas MOVED to ADOPT proposed committee
substitute for HB 78, Work Draft 27-LS0147\O (Mischel,
3/1/12).
Co-Chair Stoltze OBJECTED for discussion.
JOE MICHEL, STAFF, REPRESENTATIVE BILL STOLTZE, discussed
the changes in the CS. He stated that each of the three
changes involved the addition of the term "advanced nurse
practitioner" to the legislation. He explained that the
insertion of the term was made on page 7, Section 2, page
7, Section 3 and finally page 8, Section 5.
Co-Chair Stoltze explained that the legislation did not
increase the pool of money, but instead increased the pool
of eligible people.
3:07:08 PM
Mr. Michel stated that the fiscal note had not changed
along with the CS.
Co-Chair Stoltze WITHDREW his objection. There being NO
further OBJECTION, Work Draft 27-LS0147\O was ADOPTED.
3:07:29 PM
REPRESENTATIVE BOB HERRON, SPONSOR, thanked the committee
for hearing the bill. He spoke about the limited access to
healthcare providers in rural Alaska. He explained that
both rural and urban Alaskans suffered as a result of the
shortage of health care providers. The legislation created
a loan repayment and direct cash incentive program to
attract and retain providers in ten different direct care
professions. He explained that the intent of the
legislation was to capture new graduates as well as
established professionals. He acknowledged the federally
funded programs, but noted their inadequacy. He proposed HB
78, which was designed by Alaskans, for Alaskans. He
pointed out that 47 other states had similar incentive
programs. The legislation allowed for competition with
those other states. He mentioned the abundance of support
received in the form of letters from his constituents and
others around the state.
3:10:23 PM
Representative Neuman talked about creating competitive
opportunities to incentivize an increase in health care
professionals in Alaska. He wondered if the incentive might
lower medical costs paid by Alaskans.
Representative Herron appreciated the question. He admitted
that he did not have the answer to that very large
question.
Representative Neuman expressed his goal of understanding
the investment for Alaska. He pointed out page 2, line 17,
which stated a lifetime maximum period of 12 years for
participation in the program. He asked how the 12-year time
period was selected.
LIZ CLEMENT, STAFF, REPRESENTATIVE BOB HERRON, pointed out
page 3, line 13 stating "the department may approve loaner
payment and direct incentive programs for an initial period
of 3 years," which would allow an applicant to participate
in the program for six years. The number was derived
following conversations with health care providers faced
with recruiting professionals as well as professionals
faced with the repayment of loans. The maximum was six
years, except for very few select individuals who may
return to school for further certification may be eligible
for an additional six years. She provided an example of a
nurse who was eligible for the six-year limit, and then
chose to attend medical school, would be then eligible for
an additional six years.
Representative Neuman asked about page 4, lines 17 through
23, which discussed the amounts of annual payments for
professionals. He assumed that the amount provided
recordable income for the professionals.
Representative Herron replied in the affirmative.
Representative Neuman asked about an opportunity for one
health professional to qualify for more than one section
since some were specialized.
Ms. Clement responded that a professional may chose only
one section at a time. She noted that the bill allowed the
Department of Health and Social Services (DHSS) the
latitude to develop regulations that specified procedures
and eligibility details for the program.
3:16:49 PM
Vice-chair Fairclough asked about the dollar amounts for
loan repayments and how they were constructed. She wondered
how the plan compared to other states offering similar
incentive programs.
Ms. Clement replied that the workgroup responsible for
providing the concept proposal for the legislation
considered factors such as educational cost standards and
pay scale ranges across the nation. She provided examples
of lengthy and expensive educational routes for physicians,
dentists, and pharmacists. She stated that each state's
program was different and tailored to its own needs. The
dollar amounts listed in HB 78 tended to land in the middle
upon comparison to the other states with similar incentive
programs.
Co-Chair Stoltze recalled that the bill nearly passed in
2010, but questions regarding cost retained it in the
finance committee.
Representative Wilson asked about cost of living
adjustments to the amounts listed in the bill.
Represented Herron replied that the amounts were set and
not available for adjustment.
Representative Wilson queried the difference between an
advanced nurse practitioner and a nurse practitioner.
Co-Chair Stoltze asked to defer the question to the nursing
representative scheduled to testify later in the meeting.
Representative Neuman understood the issue regarding
difficulty recruiting medical professionals in Alaska. He
wondered about other state programs addressing the
recruitment of medical professionals. He wondered about
total state spending for the medical field in Alaska.
Ms. Clement responded that the Washington, Alaska, Montana,
and Idaho Medical Education Program (WAMI) and Western
Interstate Commission for Higher Education (WICHE) were two
additional state programs. She noted that a couple of
federally funded programs like the National Health Service
Corps (NHSC) and Indian Health Service (IHS) also existed.
She offered to provide additional information upon further
research. She noted that federal funding included federal
requirements regarding the use of the money.
3:22:04 PM
Representative Gara understood that Alaska required
additional family practice physicians and internists. He
wondered if any aspect of the legislation granted a
priority to those high need professions.
Representative Herron replied that the board would address
the greatest needs.
Representative Gara opined that WAMI was a great program,
although it did not differentiate between high-need
professionals compared to lower-need medical professionals.
He appreciated HB 78 and its focus on the needs of the
state.
Co-Chair Stoltze remarked that the program proposed in HB
78 addressed criteria pertaining to the greatest needs for
service in Alaska.
Representative Herron agreed with Co-Chair Stoltze.
Representative Guttenberg appreciated that WAMI helped
attain tuition for medical school, while HB 78 would
recruit those professionals to Alaska.
3:25:46 PM
Representative Doogan pointed to language on page 5, line
27 "may not exceed 90 participants annually." He requested
further information about the limit.
Representative Herron replied that the limit related to
cost control. The program would face review in 2019.
Co-Chair Stoltze opined that the money proposed in the
fiscal note would not stretch far enough.
3:27:40 PM
CHRISTINE POTTER, PRESIDENT, ALASKA NURSE PRACTITIONER
ASSOCIATION (via teleconference), spoke in support of the
legislation. She explained that there were over 500
licensed nurse practitioners in the state. She pointed out
that 40 percent of Alaskan nurse practitioners work in
medically underserved communities. She added that 70
percent of nurse practitioners accept Medicare for
reimbursement and 88 percent accept Medicaid. She added
that 39 percent of nurse practitioners practice in rural
areas with 8 percent practicing as the sole licensed
providers in their communities. She spoke to the question
regarding differentiation between advanced nurse
practitioners and nurse practitioners. She remarked that
there was very little difference between the two in Alaska.
The two terms tend to be used interchangeably.
Co-Chair Stoltze remarked that ANP sounded better than NP.
Ms. Potter agreed.
DEBBIE THOMPSON, EXECUTIVE DIRECTOR, ALASKA NURSES
ASSOCIATION (via teleconference), spoke in favor of the
legislation. She thanked the committee members for their
time.
MARY SULLIVAN, ALASKA PRIMARY CARE ASSOCIATION (via
teleconference), vocalized support for the legislation.
Co-Chair Stoltze appreciated his meeting with the Alaska
Primary Care Association.
Ms. Sullivan thanked Co-Chair Stoltze.
3:31:11 PM
MARIE DARLIN, AMERICAN ASSOCIATION OF RETIRED PERSONS-
ALASKA, supported the legislation. She reminded the
committee that the estimated economic value of the seniors
was $1.7 billion. She believed that retention of retired
citizens in Alaska would benefit the state.
Co-Chair Stoltze welcomed staff from the Soldotna hospital.
Co-Chair Stoltze CLOSED public testimony.
Vice-chair Fairclough asked whether the bill required a
participant to be an Alaskan resident.
Representative Herron replied no.
Vice-chair Fairclough wondered whether the bill required a
participant to become an Alaskan resident.
Representative Herron did not know.
Vice-chair Fairclough believed that the people benefiting
from the program should be Alaskan residents as opposed to
commuters.
Co-Chair Stoltze wondered if DHSS might have included a
vetting requirement in its proposition.
Representative Guttenberg pointed to page 4, line 2(g)
related to loan repayments, "the department shall prorate
loan repayments and direct incentives under the program
based upon a number of hours of a qualified employment
worked in a quarter." He understood the statement to read
that if a person commuted, their payments might be reduced.
Vice-chair Fairclough remarked that the state was working
to attract qualified health care providers. It was
important that the individuals were residents if the bill
paid $35,000 per year to retire student loans. She queried
the intent of the legislation.
Co-Chair Stoltze requested testimony from the department.
PATRICIA CARR, DIRECTOR, HEALTH PLANNING AND SYSTEMS
DEVELOPMENT, DEPARTMENT OF HEALTH AND SOCIAL SERVICES,
replied that the bill stipulated that the applicant must be
licensed or exempt from state licensing, which might relate
to residency requirements as they relate to licensing.
Vice-chair Fairclough countered that practitioners could be
licensed in multiple states.
3:38:24 PM
Ms. Carr replied in the affirmative. She thought that the
issue could be addressed under the program guidelines.
Co-Chair Stoltze sensed Vice-chair Fairclough's hesitation
and asked if she had further questions.
Vice-chair Fairclough replied that she did not wish to hold
the bill in the finance committee. She referred to concern
by current employers to have medical professionals remain
in a community. She understood that the cash incentives
provided that opportunity for medical professionals as
stated in HB 78. She hoped that the professionals
interested in the program would remain in Alaska. She spoke
in favor of an eligibility requirement within the program
ensuring Alaskan citizenship.
Representative Edgmon wondered about the practical
implications of a physician residing in more than one
state.
Ms. Carr replied that the issue would be considered in
terms of the application process. She imagined that the
issue would be vetted in the program guidelines.
3:42:29 PM
Vice-chair Fairclough knew about dentists that commuted
back and forth to rural Alaska. She did not know how
prevalent the occurrence was. She wondered whether the
criteria existed in other states.
Representative Doogan clarified that a considerable amount
of his medical treatment was performed by medical
professionals called "travelers." He thought that the state
may not be in a position to impose a residency requirement
and to attract as many physicians as desired.
Representative Herron elaborated that a technical amendment
could be crafted to represent the effort to have physicians
become residents but not to require it. He agreed that the
intent of the legislation was to incentivize a long-term
commitment from medical professionals. He believed that
continuity of care was an important contribution in medical
care.
3:46:50 PM
Vice-chair Fairclough expressed her interest in working
with Representative Herron on the issue. She respected the
need for additional medical personnel in rural Alaska.
Co-Chair Thomas had grown up in rural Alaska and had seen
IHS doctors that traveled and worked to have their loans
paid off. He expressed concern about the potential for a
provider to receive dual payments from federal and state
sources. He added that newcomers either appreciate the
state and its lifestyle or they choose to leave.
Representative Herron responded that a provider could not
receive dual payments; the practice was prohibited.
3:50:12 PM
Representative Neuman discussed the competitive nature of
the legislation that was limited to 90 people. He opined
that the program intention was sound. He hoped to see the
benefit to the state regarding the potential savings
resulting from the ability for patients to receive medical
care in-state.
Representative Herron replied that a time period of two
years should determine the interest in, and success of the
program. The fiscal note was nearly $2.9 million, with $2.1
million from the general fund. The remainder of the money
would be contributed by providers. The participants seek
out certain candidates and they also contribute funds,
making the bill an unusual vehicle intended to stabilize
the work force in Alaska.
Co-Chair Stoltze preferred to work further on the bill in
committee. He proposed additional efforts to refine the
bill while in house finance, including a well-constructed
amendment.
3:54:30 PM
Representative Edgmon responded to a question by
Representative Neuman related to missions and measures. He
reminded the committee that seniors were the fastest
growing segment of the population. He stressed that caring
for the needs of the seniors was in the state's best
interest.
Representative Doogan recommended that the highest value be
placed on attracting qualified doctors and nurses. He
opined that the value of retaining the qualified
practitioners was secondary.
Co-Chair Stoltze intended to schedule the bill at the
earliest possible time.
3:56:57 PM
Representative Gara had one concern related to the bill. He
discussed a shortage of knee and heart doctors. He
suggested language stating that a rarity of physicians or
nurses with a certain specialty be considered a priority.
Representative Herron looked forward to working with
members on amendments.
HB 78 was HEARD and HELD in Committee for further
consideration.
ADJOURNMENT
4:00:25 PM
The meeting was adjourned at 4:00 PM.
| Document Name | Date/Time | Subjects |
|---|---|---|
| Support Letter HJR4.doc |
HFIN 3/2/2012 1:30:00 PM |
HJR 4 |
| CS HJR4 WORKDRAFT FIN 27-LS0197-T-3.1.12.pdf |
HFIN 3/2/2012 1:30:00 PM |
HJR 4 |
| HJR004CS(TRA)-NEW FN-DOR-TRS-02-28-12.pdf |
HFIN 3/2/2012 1:30:00 PM |
HJR 4 |
| HB307 CS WORKDRAFT B version SUPPLEMENTAL.pdf |
HFIN 3/2/2012 1:30:00 PM |
HB 307 |
| HB307 Repot 3.2.12 Statewide Totals.pdf |
HFIN 3/2/2012 1:30:00 PM |
HB 307 |
| HB 307 SUPPLEMENTAL CS Backup.pdf |
HFIN 3/2/2012 1:30:00 PM |
HB 307 |
| Supplemental_Spreadsheet_1-31-12.pdf |
HFIN 3/2/2012 1:30:00 PM |
HB 307 |
| HB78 CS WORKDRAFT 27-LS0147-O.pdf |
HFIN 3/2/2012 1:30:00 PM |
HB 78 |