Legislature(2005 - 2006)CAPITOL 106

02/22/2005 03:00 PM House HEALTH, EDUCATION & SOCIAL SERVICES


Download Mp3. <- Right click and save file as

Audio Topic
03:08:14 PM Start
03:08:49 PM HJR10
03:30:14 PM University of Alaska Board of Regents
04:04:01 PM Professional Teaching Practices Commission
04:12:30 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ Confirmation Hearings: University of AK TELECONFERENCED
Board of Regents
+ Professional Teaching Practices Comm. TELECONFERENCED
*+ HJR 10 FEDERAL MEDICAL ASSISTANCE REDUCTION TELECONFERENCED
Moved Out of Committee
Bills Previously Heard/Scheduled
                    ALASKA STATE LEGISLATURE                                                                                  
 HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE                                                               
                       February 22, 2005                                                                                        
                           3:08 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Peggy Wilson, Chair                                                                                              
Representative Paul Seaton, Vice Chair                                                                                          
Representative Tom Anderson                                                                                                     
Representative Vic Kohring                                                                                                      
Representative Sharon Cissna                                                                                                    
Representative Berta Gardner                                                                                                    
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Representative Lesil McGuire                                                                                                    
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                              
HOUSE JOINT RESOLUTION NO. 10                                                                                                   
Relating to a proposed reduction in the Federal Medical                                                                         
Assistance Percentage for Alaskans; and urging the United States                                                                
Congress to take action to prevent the reduction.                                                                               
                                                                                                                                
     - MOVED HJR 10 OUT OF COMMITTEE                                                                                            
                                                                                                                                
^CONFIRMATION HEARING(S)                                                                                                        
                                                                                                                                
^University of Alaska Board of Regents                                                                                        
                                                                                                                                
     Carl H. Marrs - Anchorage                                                                                                  
     Robert Martin - Juneau                                                                                                     
     Jeff Staser - Anchorage                                                                                                    
                                                                                                                                
     - CONFIRMATION(S) ADVANCED                                                                                                 
                                                                                                                                
^Professional Teaching Practices Commission                                                                                   
                                                                                                                                
     Karen Macklin - Sitka                                                                                                      
                                                                                                                                
     - CONFIRMATION(S) ADVANCED                                                                                                 
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: HJR 10                                                                                                                  
SHORT TITLE: FEDERAL MEDICAL ASSISTANCE REDUCTION                                                                               
SPONSOR(S): FINANCE                                                                                                             
                                                                                                                                
02/14/05       (H)       READ THE FIRST TIME - REFERRALS                                                                        
02/14/05       (H)       HES, FIN                                                                                               
02/22/05       (H)       HES AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
SUE WRIGHT, Staff                                                                                                               
to Representative Mike Chenault                                                                                                 
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION  STATEMENT: Presented  HJR  10 on  behalf  of the  House                                                               
Finance  Committee, sponsor  by request,  which is  co-chaired by                                                               
Representative Chenault.                                                                                                        
                                                                                                                                
JOEL GILBERTSON, Commissioner                                                                                                   
Alaska Department of Health and Social Services                                                                                 
Juneau, Alaska                                                                                                                  
POSITION  STATEMENT:  Presented  HJR 10  and  answered  questions                                                               
regarding HJR 10.                                                                                                               
                                                                                                                                
CARL MARRS, Appointee                                                                                                           
to the University of Alaska Board of Regents                                                                                    
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified as  appointee to the University of                                                               
Alaska Board of Regents.                                                                                                        
                                                                                                                                
JEFF STASER, Appointee                                                                                                          
to the University of Alaska Board of Regents                                                                                    
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified as  appointee to the University of                                                               
Alaska Board of Regents.                                                                                                        
                                                                                                                                
ROBERT MARTIN, Appointee                                                                                                        
to the University of Alaska Board of Regents                                                                                    
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified as  appointee to the University of                                                               
Alaska Board of Regents.                                                                                                        
                                                                                                                                
KAREN MACKLIN, Appointee                                                                                                        
to the Professional Teaching Practices Commission                                                                               
Sitka, Alaska                                                                                                                   
POSITION STATEMENT:   Testified as appointee  to the Professional                                                               
Teaching Practices Commission.                                                                                                  
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
CHAIR PEGGY WILSON called the  House Health, Education and Social                                                             
Services  Standing  Committee meeting  to  order  at 3:08:14  PM.                                                             
Representatives  Wilson,   Cissna,  Seaton,  and   Anderson  were                                                               
present  at  the call  to  order.   Representatives  Gardner  and                                                               
Kohring arrived as the meeting was in progress.                                                                                 
                                                                                                                                
3:08:49 PM                                                                                                                    
                                                                                                                                
HJR 10-FEDERAL MEDICAL ASSISTANCE REDUCTION                                                                                   
                                                                                                                                
[Contains a brief mention of SJR 6.]                                                                                            
                                                                                                                                
CHAIR WILSON announced that the  first order of business would be                                                               
HOUSE JOINT RESOLUTION NO. 10,  "Relating to a proposed reduction                                                               
in the  Federal Medical Assistance  Percentage for  Alaskans; and                                                               
urging the United  States Congress to take action  to prevent the                                                               
reduction."                                                                                                                     
                                                                                                                                
3:09:17 PM                                                                                                                    
                                                                                                                                
SUE WRIGHT,  Staff to Representative Mike  Chenault, Alaska State                                                               
Legislature,  presented  HJR  10   on  behalf  of  Representative                                                               
Chenault,  sponsor.    She  explained  that  the  proposed  joint                                                               
resolution was crafted  to urge the U.S. Congress  to take action                                                               
to  prevent  the  reduction of  the  Federal  Medical  Assistance                                                               
Percentage   (FMAP)   for   Alaskans   from   a   57.58   percent                                                               
federal/42.42 percent state match to  an even 50:50 even split on                                                               
October  1,  2005.    She said,  "This  resolution  outlines  the                                                               
environmental  and  demographic  reasons  health  care  costs  in                                                               
Alaska are  so high  and substantiates that  it is  reasonable to                                                               
maintain a  rate at 57.58  percent instead  of a reduction  to 50                                                               
percent."                                                                                                                       
                                                                                                                                
3:10:26 PM                                                                                                                    
                                                                                                                                
JOEL GILBERTSON,  Commissioner, Alaska  Department of  Health and                                                               
Social  Services, explained  that HJR  10 has  a parallel  in the                                                               
Senate side, which is SJR 6.  He said:                                                                                          
                                                                                                                                
     What  this   gets  towards  is  a   resolution  by  the                                                                    
     legislature  finding  a  lot of  cost  drivers  in  the                                                                    
     Alaska  health care  system.    And also  acknowledging                                                                    
     that, absent  some congressional action, on  October 1,                                                                    
     2005,  ... we  will  see a  sizeable  reduction in  the                                                                    
     federal  support for  our health  care  system in  this                                                                    
     state.     ...      It's  quite   concerning  to   this                                                                    
     administration and to  health care providers generally.                                                                    
     And    what   this    resolution   expresses    is   an                                                                    
     acknowledgement  of this  challenge  and this  problem,                                                                    
     and urges Congress  and the presidential administration                                                                    
     to focus on passing  legislation this session that will                                                                    
     hold  Alaska harmless  and  will  preserve our  current                                                                    
     Medicaid match rate.                                                                                                       
                                                                                                                                
3:11:43 PM                                                                                                                    
                                                                                                                                
COMMISSIONER GILBERTSON continued:                                                                                              
                                                                                                                                
     To give  you a little  background: we run  this program                                                                    
     called Medicaid ... which, for  the State of Alaska, is                                                                    
     serving  almost 130,000  Alaskans.   And in  our FY  06                                                                    
     [fiscal year 2006] budget, for  the first time ever, it                                                                    
     actually   creeps   above   $1   billion   in   program                                                                    
     operations.   It's a  billion-dollar program,  but it's                                                                    
     not  wholly  financed  by  the  state.    The  Medicaid                                                                    
     program, when  established in 1965, was  established as                                                                    
     a  partnership  between  the  states  and  the  federal                                                                    
     government to  provide ... health care  services to low                                                                    
     income  and  needy  populations.   Many  people  become                                                                    
     eligible  because  of  other assistance  benefits  they                                                                    
     have access  to, such  as being  disabled and  being on                                                                    
     [Supplemental Security  Income (SSI)].   But regardless                                                                    
     of  how  you  got  on the  program,  there  is  federal                                                                    
     support to finance that  person's health care services.                                                                    
     ...   How  much  of your  ...  Medicaid program  that's                                                                    
     going  to  be financed  by  the  federal government  is                                                                    
     based  on   a  pretty  rough  formula   that  tries  to                                                                    
     calculate [if  the state  is rich or  poor].   And this                                                                    
     formula  is called  the FMAP,  or  the Federal  Medical                                                                    
     Assistance   Percentage,  and   it's  a   really  rough                                                                    
     formula.  It  looks at a state's per  capita income and                                                                    
     then  compares  it  to the  national  average  for  per                                                                    
     capita  income, and  benchmark[s]  states according  to                                                                    
     that  continuum of  incomes.   The  richest states  are                                                                    
     required  to bear  a greater  burden of  their Medicaid                                                                    
     costs.   The poorest states, and  overwhelmingly that's                                                                    
     always  been  Mississippi,  ...  receives  the  highest                                                                    
     amount of federal support.                                                                                                 
                                                                                                                                
3:13:33 PM                                                                                                                    
                                                                                                                                
COMMISSIONER GILBERTSON continued:                                                                                              
                                                                                                                                
     The  least you  can receive  in federal  support is  50                                                                    
     percent,  and historically  Alaska was  a 50:50  state,                                                                    
     meaning that when that claim  for Medicaid went through                                                                    
     the system ... the state  [paid 50 percent of the claim                                                                    
     and the federal government would  pay 50 percent of the                                                                    
     claim].   What  that formula  failed to  acknowledge is                                                                    
     that,   while  our   per   capita   incomes  might   be                                                                    
     incrementally higher in Alaska,  our cost of delivering                                                                    
     that care is exponentially higher.   And when you start                                                                    
     looking at the  cost of living, the  cost of delivering                                                                    
     supplies,  the  labor  costs, the  construction  costs,                                                                    
     [and] the geographic  challenges around transportation,                                                                    
     ...  it  is  very  expensive  to  deliver  health  care                                                                    
     services in this state.   We spend almost $10 million a                                                                    
     year just  on Medicaid transportation  for nonemergency                                                                    
     cases, just  bringing people into  more urban  areas to                                                                    
     receive services....                                                                                                       
                                                                                                                                
3:14:46 PM                                                                                                                    
                                                                                                                                
COMMISSIONER GILBERTSON continued:                                                                                              
                                                                                                                                
     [There are] a lot of  cost drivers.  We're dealing with                                                                    
     a  state that,  ...  in  land mass  size,  has no  peer                                                                    
     amongst other  states.  For these  various reasons, ...                                                                    
     Congress twice - once in 1997  and once again in 2000 -                                                                    
     passed  legislation  to temporarily  increase  Alaska's                                                                    
     Medicaid  match  rate.   It  was  historically a  50:50                                                                    
     state,  then U.S.  Senator Frank  Murkowski ...  passed                                                                    
     legislation  ... to  increase  Alaska's Medicaid  match                                                                    
     rate to  59.8 [percent]  ...; it increased  the federal                                                                    
     share by 9.8  points, and in real  dollars that brought                                                                    
     in  about $100  million of  additional support  for our                                                                    
     health care system for three  years.  When that sunset,                                                                    
     he passed  another piece of  legislation to  extend and                                                                    
     to increase the subsidy ....   And this time it was not                                                                    
     set at  a fixed amount; it  was a formula change.   The                                                                    
     net  effect  was [that]  it  decreased  our per  capita                                                                    
     income going into the formula  by about 5 percent.  But                                                                    
     in real  dollars, it increased our  Medicaid match rate                                                                    
     to about  ... 61 percent  federal.   ...  And  that has                                                                    
     slowly evolved down  as per capita income  in the State                                                                    
     of Alaska has increased over  the last couple of years.                                                                    
     And right now, in the  last year of that five-year rate                                                                    
     adjustment,  we're getting  about 57.5  percent federal                                                                    
     financing for a Medicaid claim.                                                                                            
                                                                                                                                
3:16:27 PM                                                                                                                    
                                                                                                                                
     What has that  meant to the State of  Alaska over those                                                                    
     five  years?   It's  meant  about  $300-350 million  of                                                                    
     additional  federal  funds  that  have  come  into  our                                                                    
     health care  system through  this adjustment  over that                                                                    
     time period.                                                                                                               
                                                                                                                                
     ...  This last  adjustment was  a five-year  adjustment                                                                    
     for  the State  of  Alaska; it  sunsets  on October  1,                                                                    
     2005.   And ...  I believe  the department  provided to                                                                    
     the committee a  set of charts and  documents [a 6-page                                                                    
     handout  included in  the  committee  packet, with  the                                                                    
     first page labeled, "Impact of  FMAP Reduction on State                                                                    
     Match"], ...  which sort of  explains what is  the long                                                                    
     term  fiscal impact  to the  State  of Alaska's  health                                                                    
     care system  - absent change.   And that change  can be                                                                    
     about one thing:  ...  legislation passed by the United                                                                    
     States  Congress to  extend the  adjustment, [to]  hold                                                                    
     harmless  the State  of Alaska,  or [to]  come up  with                                                                    
     some other methodology that  acknowledges the high cost                                                                    
     of delivering care in this state.                                                                                          
                                                                                                                                
3:16:51 PM                                                                                                                    
                                                                                                                                
     Absent that  change, October 1,  2005, which  ... would                                                                    
     run for three quarters of  our fiscal year of 2006, the                                                                    
     impact  would  be the  loss  of  about $53  million  in                                                                    
     federal  support to  the state's  Medicaid program  and                                                                    
     our  health   care  system  generally.     Once  that's                                                                    
     annualized in the first state  fiscal year, 2007, where                                                                    
     it  runs for  a  full  12 months,  the  impact will  be                                                                    
     roughly $73  million.  And  what you see in  the charts                                                                    
     we provided is that over the  next 10 years the loss of                                                                    
     this  federal adjustment  that was  passed by  Congress                                                                    
     five  years ago  would be  almost a  billion dollars  -                                                                    
     $914  million dollars  over  the next  ten  years -  of                                                                    
     support that's providing services across the state.                                                                        
                                                                                                                                
3:17:48 PM                                                                                                                    
                                                                                                                                
     While this is money that  comes through the state, this                                                                    
     money does  not stay  within the  state; this  money is                                                                    
     used to pay providers.   These are the dollars that are                                                                    
     paying   for   everything   from   wheel   chairs   and                                                                    
     prosthetics, to  seniors and  skilled nursing  care, to                                                                    
     home  and   community-based  services,   personal  care                                                                    
     attendant services,  acute care services,  services for                                                                    
     chronic disease,  for children, for youth,  and for the                                                                    
     seniors of  this state.   These are resources  that are                                                                    
     going out right now  to support infrastructure, ongoing                                                                    
     operations  and maintenance,  and personal  services of                                                                    
     facilities all throughout  the state.  And  who is hurt                                                                    
     the  most, I  think, is  largely rural  Alaska, because                                                                    
     rural  Alaska disproportionately  relies upon  Medicaid                                                                    
     as its primary source of payment ... and revenue.                                                                          
                                                                                                                                
3:19:06 PM                                                                                                                    
                                                                                                                                
     These  challenges are  real;  the  fiscal challenge  is                                                                    
     real.    What  this   resolution  expresses  is  ...  a                                                                    
     summation of  the cost drivers in  Alaska's health care                                                                    
     system.  The reason why  the formula currently does not                                                                    
     serve  Alaska very  well ...  [is] that  the underlying                                                                    
     formula  is fundamentally  flawed; it  simply does  not                                                                    
     acknowledge the high cost of  delivering care in rural,                                                                    
     remote frontier  states.  And through  resolution, [it]                                                                    
     urges Congress  and the federal administration  to pass                                                                    
     legislation  this year  to fix  this funding  challenge                                                                    
     and  to  continue  the  federal  support  for  Alaska's                                                                    
     Medicaid program as it is doing in the current year.                                                                       
                                                                                                                                
3:19:34 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON asked if the fix would be temporary.                                                                               
                                                                                                                                
3:19:44 PM                                                                                                                    
                                                                                                                                
COMMISSIONER   GILBERTSON  answered   that  that's   largely  the                                                               
discretion of the  language drafters.  He  stated from experience                                                               
that the  most recent  adjustment for  the state  was set  with a                                                               
five-year sunset, because  that was the amount of  money that was                                                               
available in  the budget at  the time.   He said he  thinks there                                                               
will be a lot of competing factors.   He said in the grand scheme                                                               
of Medicaid "this  is very small."  He  offered his understanding                                                               
that over the  10 years, Medicare/Medicaid will  be spending $2.6                                                               
trillion.  Notwithstanding that, he  stated, "In the grand scheme                                                               
of  the  programs  themselves  it's very  large  when  you  start                                                               
talking about a state our size and with our population base."                                                                   
                                                                                                                                
COMMISSIONER  GILBERTSON said  some states  will be  seeing their                                                               
federal support increase  next year, while others  will be seeing                                                               
it decrease.   He explained that  is due to an  annual adjustment                                                               
that  looks at  a  rolling average  of per  capita  incomes.   He                                                               
reported that Alaska  is the most negatively affected  state at a                                                               
7.5-point drop.  The second-most  affected state is Wyoming, with                                                               
a   3-point  drop.      The  magnitude   of   Alaska's  drop   is                                                               
unprecedented.   He concluded, "It's  going to be a  challenge to                                                               
get this  passed; I  think it's something  that Congress  can do,                                                               
and we're  certainly working with  our delegation to try  and get                                                               
this passed  this year.   But will it be  sunset again?   I think                                                               
parts of  that will  be budgetary concerns  that will  drive that                                                               
decision."                                                                                                                      
                                                                                                                                
3:21:28 PM                                                                                                                    
                                                                                                                                
CHAIR  WILSON asked  if Commissioner  Gilbertson thinks  that the                                                               
delegation needs  the resolution  "to give them  a little  bit of                                                               
backup when they ask for it."                                                                                                   
                                                                                                                                
3:21:39 PM                                                                                                                    
                                                                                                                                
COMMISSIONER  GILBERTSON   responded  that  he   thinks  Alaska's                                                               
delegation  is  keenly  aware  of  the  challenge  and  has  been                                                               
generally  supportive of  the  state's health  care  system.   He                                                               
continued:                                                                                                                      
                                                                                                                                
     This  has  been  passed  twice  by  the  United  States                                                                    
     Congress;  it's been  passed twice  by the  U.S. Senate                                                                    
     unanimously.  I think  it's been generally acknowledged                                                                    
     that this  is a challenge  facing the state, and  it is                                                                    
     in need of  additional assistance.  I'm  sure we're all                                                                    
     aware ...  federal employees receive  a cost  of living                                                                    
     adjustment for  the state.   Many federal  programs are                                                                    
     adjusted.   This  is  one that  should  be adjusted  as                                                                    
     well.                                                                                                                      
                                                                                                                                
COMMISSIONER   GILBERTSON  said   he  thinks   even  though   the                                                               
delegation  is  aware  of  [the   need  for  adjustment],  it  is                                                               
important for all  affected parties to share  their concerns with                                                               
the delegation.                                                                                                                 
                                                                                                                                
3:22:32 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON  asked Commissioner Gilbertson  to describe                                                               
the difference between Title 21 and Title 19.                                                                                   
                                                                                                                                
3:22:46 PM                                                                                                                    
                                                                                                                                
COMMISSIONER  GILBERTSON  explained  that there  is  a  different                                                               
match rate for  different populations.  He  directed attention to                                                               
[the first page  of the previously mentioned  6-page handout] and                                                               
noted  that [the  chart at  the  far-right of  the page,  titled,                                                               
"Announced FMAP*"]  shows a  57.58 percent  match in  fiscal year                                                               
2005 (FY  05) [under Title  XIX FMAP]  and a 70.31  percent match                                                               
the  same year  [under  Title  XXI FMAP].    He  said the  former                                                               
reflects  the  general  Medicaid  population,  while  the  latter                                                               
reflects  the  enhanced  federal medical  assistance  percentage,                                                               
including  the  state children's  programs,  such  as Denali  Kid                                                               
Care.   He added, "We also  were able to get  that enhanced match                                                               
rate  for   our  breast  and   cervical  cancer   program,  under                                                               
Medicaid."   He noted that there  is a third category  for Alaska                                                               
Natives who  receive services through Native  operated facilities                                                               
at 100 percent  federal reimbursement.  That is  not expressed on                                                               
the chart.                                                                                                                      
                                                                                                                                
3:23:57 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON  asked if the 100  percent match population                                                               
would be affected by the reduction.                                                                                             
                                                                                                                                
3:24:08 PM                                                                                                                    
                                                                                                                                
COMMISSIONER GILBERTSON said it's  important to remember that the                                                               
reduction is not  felt by the provider, but is  felt initially by                                                               
the state.   The real impact to the providers  is felt the second                                                               
year when  the legislature,  as the  appropriator, has  to factor                                                               
into  a new  budget decision  that "it's  going to  cost you  $72                                                               
million  in additional  funding to  do  the same  thing you  were                                                               
doing the previous year."   The challenge created then is whether                                                               
to offset  that loss with  the general fund or  proposing program                                                               
reductions, or a  combination of the two.  He  said, "When that's                                                               
converted, the providers will feel  that downstream, because that                                                               
could  be reductions  in optional  services, ...  rates, [and/or]                                                               
... eligibility."   He reiterated  that the more  rural providers                                                               
will be  more affected by  that, because  they disproportionately                                                               
rely upon Medicaid as one of their key sources of funding.                                                                      
                                                                                                                                
3:25:05 PM                                                                                                                    
                                                                                                                                
COMMISSIONER GILBERTSON continued as follows:                                                                                   
                                                                                                                                
      When the claim is submitted by our provider, we pay                                                                       
       that provider.  We then turn to our federal sister                                                                       
     agency -  Centers for Medicare/Medicaid Services  - and                                                                    
     we submit proof  of that payment, and then  we claim it                                                                    
     and request  payment back  from the  federal government                                                                    
     for their share of that claim.                                                                                             
                                                                                                                                
3:25:39 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON  reiterated that  he wants to  know whether                                                               
the population with the 100  percent match would be unaffected by                                                               
the reduction and would still remain at 100 percent.                                                                            
                                                                                                                                
3:25:52 PM                                                                                                                    
                                                                                                                                
COMMISSIONER  GILBERTSON  answered  yes.     He  noted  that's  a                                                               
sizeable claim volume in the system.   He added, "So, the numbers                                                               
that  you're seeing,  in terms  of impact,  to some  extent [are]                                                               
actually more  drastic, because it's  that impact over  a smaller                                                               
percentage of the overall Medicaid slice."                                                                                      
                                                                                                                                
3:26:14 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON asked if many services  will have to be cut "if this                                                               
doesn't happen."                                                                                                                
                                                                                                                                
3:26:29 PM                                                                                                                    
                                                                                                                                
COMMISSIONER GILBERTSON responded that  the governor's budget for                                                               
FY 06 assumes that the President  and Congress will pass and sign                                                               
legislation  this year  that will  hold harmless  Alaska and  not                                                               
implement  this reduction.    If there  is no  change  in law  by                                                               
October 1, 2005, the administration  will submit "a supplemental"                                                               
to the legislature in FY 06  to offset the loss in federal funds.                                                               
It will be  up to the legislature to decide  at that time whether                                                               
to  fully fund  the supplemental  request or  not to  and instead                                                               
propose changes to the program, "or some other reduction."                                                                      
                                                                                                                                
3:27:36 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON asked, "What happens  if the legislature didn't okay                                                               
that?  How would all this get paid then if it's past tense?"                                                                    
                                                                                                                                
3:27:56 PM                                                                                                                    
                                                                                                                                
COMMISSIONER GILBERTSON  said there is an  acknowledged challenge                                                               
if the hold harmless provision is  not passed by Congress.  If it                                                               
is  six-seven  months into  a  fiscal  year and  the  legislature                                                               
chooses not to  fund the entire amount of  the supplemental, that                                                               
would  put   tremendous  pressure  upon  the   agency  to  reduce                                                               
expenditures  in the  remaining  months of  the  fiscal year  "to                                                               
bring in  line expenditures with  authorization."  He  offered an                                                               
example.                                                                                                                        
                                                                                                                                
3:29:39 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON  moved to  report HJR  10 out  of committee                                                               
with  individual  recommendations  and  the  accompanying  fiscal                                                               
notes.   There being no objection,  HJR 10 was reported  from the                                                               
House Health, Education and Social Services Standing Committee.                                                                 
                                                                                                                                
3:29:47 PM                                                                                                                    
                                                                                                                                
^CONFIRMATION HEARING(S)                                                                                                        
                                                                                                                                
^University of Alaska Board of Regents                                                                                        
                                                                                                                                
3:30:14 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON  announced the next  order of business would  be the                                                               
confirmation hearing  for appointees to the  University of Alaska                                                               
Board of Regents.                                                                                                               
                                                                                                                                
3:30:59 PM                                                                                                                    
                                                                                                                                
CARL  MARRS,  Appointee to  the  University  of Alaska  Board  of                                                               
Regents,  told the  committee  that  he was  born  and raised  in                                                               
Seldovia, Alaska,  went to school  in Kodiak, Alaska,  joined the                                                               
Marine Corps,  and worked as  a commercial fisherman.   Beginning                                                               
September  1973, he  worked for  Cook Inlet  Region, Incorporated                                                               
(CIRI) in a  lot of different capacities,  including as president                                                               
and CEO for  the last eight years until his  retirement from CIRI                                                               
at the end of [2004].                                                                                                           
                                                                                                                                
3:31:47 PM                                                                                                                    
                                                                                                                                
MR.  MARRS,  in  response  to   a  question  from  Chair  Wilson,                                                               
confirmed that  he is  a new appointee.   Furthermore,  he shared                                                               
the reasons for his interest in  the position.  He said education                                                               
has always been  a top priority.  Even during  his time with CIRI                                                               
he spent a  lot of time on programs for  children and helped fund                                                               
the  CIRI  Foundation  for  Education,  which  presently  has  an                                                               
endowment of approximately $48 million.   He revealed that he has                                                               
served for the  past five years on the  Alaska Pacific University                                                               
Board.  He said he thinks he  can be helpful to the university in                                                               
philanthropic  ways.     He  mentioned  his   concerns  regarding                                                               
fisheries,  artic research,  and research  in general  and stated                                                               
that he  thinks the university  can be one  of the finest  in the                                                               
world in  terms of  research and  he would like  to help  mold it                                                               
that way.                                                                                                                       
                                                                                                                                
3:32:55 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  CISSNA  noted  that  the  University  of  Alaska,                                                               
Anchorage has "the  applied health ... for the state  ... for all                                                               
of the large  medical facilities," and there is  a desperate need                                                               
for advanced degrees  to be given on that campus  "because of its                                                               
large  applied  health presence."    She  mentioned expansion  of                                                               
alternative health.   She indicated  that [the  university] could                                                               
be the  hub of "distance delivery  center."  She asked  Mr. Marrs                                                               
if he has considered those issues and would address them.                                                                       
                                                                                                                                
3:34:12 PM                                                                                                                    
                                                                                                                                
MR. MARRS  stated that  he's spent an  inordinate amount  of time                                                               
working  with and  helping set  up  the SouthCentral  Foundation,                                                               
which  is  "the health  arm  for  Cook  Inlet region  in  Central                                                               
Alaska."   He said there has  been an explosive growth  in health                                                               
care  in the  Anchorage area.    Both [the  University of  Alaska                                                               
Anchorage  (UAA)] and  [Alaska Pacific  University (APU)]  play a                                                               
key  role  in   that.    He  said  APU  has   focused  on  health                                                               
administrative programs and  has a Masters program  in that area,                                                               
while  UAA is  focusing  on research  and nursing.    He said  he                                                               
thinks there  is so much more  that the university could  do, but                                                               
it all  equates to trying to  get the funding to  make it happen.                                                               
He said he thinks it's an area  that he has some knowledge in, by                                                               
virtue of  his work  getting the  SouthCentral Foundation  set up                                                               
and headed  in the right  direction, and also because  of working                                                               
with the federal government to  get federal dollars to help those                                                               
issues.                                                                                                                         
                                                                                                                                
3:36:20 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON said he is  pleased to see someone from his                                                               
district  nominated  for  this  position.    He  said  there  are                                                               
basically  three  concentrated   campuses,  in  Fairbanks  (UAF),                                                               
Anchorage  (UAA), and  Juneau  (UAS), as  well  as the  dispersed                                                               
regional campuses.   He asked  Mr. Marrs to share  his evaluation                                                               
of those systems and whether he  has strong support for the rural                                                               
campuses  across  the state  or  would  like to  concentrate  the                                                               
elements into the three main campuses.                                                                                          
                                                                                                                                
3:37:10 PM                                                                                                                    
                                                                                                                                
MR. MARRS said  he needs to learn more about  those campuses, but                                                               
said he  thinks they bring  value to  the university system.   He                                                               
suggested that  with today's  technology there  ought to  be some                                                               
cost efficiencies built  in to the system.  He  stated his belief                                                               
that having a campus in  areas that have populations is necessary                                                               
for education.   He mentioned  timber, fishing, and tourism.   He                                                               
said  the university  ought to  be  able to  help communities  in                                                               
those areas through research to make  the state a better place in                                                               
which to  work and live.   He said  he thinks the  university has                                                               
the capability and  the technology to "make those  kind of things                                                               
happen."   He noted, "We're one  of the only universities  in the                                                               
country that has a ... super computer."                                                                                         
                                                                                                                                
3:39:05 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE ANDERSON thanked Mr. Marrs  for his service to the                                                               
state,  in terms  of his  philanthropy and  business and  private                                                               
sector experience.  He said  he thinks that will "complement your                                                               
public sector  analysis as  you help ...  secure funding  for the                                                               
university."    He added,  "I  think  we'll  have a  really  good                                                               
advocate in Carl."                                                                                                              
                                                                                                                                
3:40:14 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON  moved to advance the  confirmation of Carl                                                               
Marrs to the joint session of  the House and Senate.  There being                                                               
no objection, the  confirmation of Carl Marrs to  the position of                                                               
Board of Regents was advanced.                                                                                                  
                                                                                                                                
3:40:46 PM                                                                                                                    
                                                                                                                                
JEFF  STASER, Appointee  to  the University  of  Alaska Board  of                                                               
Regents,  noted that  his  grandfather was  in  the Sixth  Alaska                                                               
Territorial Legislature and his parents  met at the University of                                                               
Alaska Fairbanks campus.   He related that  he enlisted, attended                                                               
West Point  Academy, and served  a military career, ending  up in                                                               
Washington D.C. as the assistant  director of civil works for the                                                               
corps of  engineers.  After  that, he  was asked to  join Senator                                                               
Ted Stevens'  staff from 1994-1999.   In 1999, the  senator asked                                                               
him to  serve in  Alaska as  the federal  co-chair of  the Denali                                                               
Commission.   Mr. Staser  noted that,  while working  for Senator                                                               
Stevens, he was the associate  staff from the senator's office on                                                               
the  Senate Commerce  Subcommittee  for  Science and  Technology.                                                               
Since coming back  to the state, he has worked  at the University                                                               
of Alaska, Anchorage (UAA) as  the Business School advisory board                                                               
member and Engineering  School advisory board member,  as well as                                                               
serving  on  the  statewide [Experimental  Program  to  Stimulate                                                               
Competitive Research  (EPSCoR)].   Mr. Staser  said he  is deeply                                                               
rooted  in  the  state  and  university  system  and  sees  "some                                                               
wonderful,  unfolding opportunities  to  engage [the]  university                                                               
with federal help with some of  the issues that are looming large                                                               
right here in front of us in the very near future."                                                                             
                                                                                                                                
3:43:14 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE CISSNA noted that she  is a student and meets with                                                               
many  students  who have  expressed  concern  about the  lack  of                                                               
advanced degree programs  in advanced health fields.   The result                                                               
is that  those students don't have  the incentive to stay  at the                                                               
university and  go Outside  more often than  not.   She indicated                                                               
that  there   is  not   much  opportunity   to  work   in  health                                                               
institutions right  next to the university.   She says this  is a                                                               
problem that needs to be  addressed.  She said, "The concentrated                                                               
health center there does offer  an opportunity that appears to me                                                               
not being  taken advantage of.   Have you  thought of any  way to                                                               
deal with that?"                                                                                                                
                                                                                                                                
3:45:05 PM                                                                                                                    
                                                                                                                                
MR. STASER replied that the  more he learns about the university,                                                               
the more  he realizes how  much at  risk that institution  is for                                                               
losing  its  accreditation  and   capacity  to  do  research  and                                                               
development.   He said it's  difficult to recruit Ph.D.s  to come                                                               
to  Alaska   with  their  families,   and  without   those  Ph.D.                                                               
instructors,  the  university  not  only loses  out  on  research                                                               
opportunities, but the  classroom suffers.  He  suggested that if                                                               
the university  cannot import instructors  with Ph.D.s,  it ought                                                               
to "grow" its own.  He offered further details.                                                                                 
                                                                                                                                
3:46:29 PM                                                                                                                    
                                                                                                                                
MR.  STASER said  the multiple-disciplinary  aspects  of a  full-                                                               
fledged  Ph.D. program  are  huge.   He  said  the  boards he  is                                                               
involved  with have  been working  hard  to get  programs on  the                                                               
campuses  that promote  having graduate  level programs,  so that                                                               
people can get degrees and stay in Alaska.                                                                                      
                                                                                                                                
3:47:08 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON said he thinks  Mr. Staser's involvement in                                                               
nonprofit organizations is beneficial.   He restated the question                                                               
he asked  of Mr. Marrs  regarding the main campuses  and regional                                                               
sites.                                                                                                                          
                                                                                                                                
3:47:57 PM                                                                                                                    
                                                                                                                                
MR. STASER responded that as he  travels around the state, he has                                                               
seen many rural  communities and regional hubs.   He said, "We're                                                               
all  working in  the connected  world  through the  Internet.   I                                                               
think  one of  our  greatest natural  resources  is the  untapped                                                               
mental capacity  of our rural folks."   He opined that  if people                                                               
are not given access to  education, "they'll never figure out how                                                               
to pay  for and  sustain their  families and  their communities."                                                               
He said the main universities and  the regional areas are all one                                                               
economic engine, connected more so than ever.  He continued:                                                                    
                                                                                                                                
     We're at a  threshold.  We either recognize  how to tap                                                                    
     into  our ability  to innovate,  our ability  to think,                                                                    
     our ability to  work together, or we don't.   And if we                                                                    
     can't do  it effectively in a  sustainable basis, who's                                                                    
     going to  do it  for us?   I  mean, shame  on us  if we                                                                    
     don't figure out  how to get the optimum  mix of access                                                                    
     to high  ..., good  ..., and sustainable  education, so                                                                    
     that we  can afford the  university that we've got.   I                                                                    
     think  we can  get there,  but  it's going  to take  an                                                                    
     awful  lot of  teamwork  - a  lot  of realization  that                                                                    
     we're all  in this  together, and we  may have  to read                                                                    
     just some of the  opportunities versus constraints that                                                                    
     we're working  with.   One of  the things  I've learned                                                                    
     already  through  the  university is  how  complex  our                                                                    
     university system  is, and ...  we need to take  a look                                                                    
     at that.                                                                                                                   
                                                                                                                                
3:50:15 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SEATON expressed  that  many  are concerned  that                                                               
funding will  be concentrated  at the  main campuses  and drained                                                               
from the  regional campuses.   He indicated that he  doesn't want                                                               
total reliance on  a connection to the rural  centers through the                                                               
Internet.                                                                                                                       
                                                                                                                                
3:51:01 PM                                                                                                                    
                                                                                                                                
MR. STASER  said he agrees.   He said a  person can't get  a good                                                               
education "just through the Internet."   He stated the importance                                                               
of lab  work and hands-on  experience.  He concluded,  "There's a                                                               
lot of things that could be  done better in our rural communities                                                               
with the proper balance of resources and access."                                                                               
                                                                                                                                
3:51:42 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON  moved to advance the  confirmation of Jeff                                                               
Staser  to the  joint session  of the  House and  Senate.   There                                                               
being  no  objection, the  confirmation  of  Jeff Staser  to  the                                                               
position of Board of Regents was advanced.                                                                                      
                                                                                                                                
3:52:18 PM                                                                                                                    
                                                                                                                                
ROBERT MARTIN,  Appointee to  the University  of Alaska  Board of                                                               
Regents, told  the committee that he  was born and raised  in the                                                               
rural village  of Kake and graduated  high school in Juneau.   He                                                               
attended  a technical  school  in  Kansas run  by  the Bureau  of                                                               
Indian  Affairs,  and  worked  several   years  for  the  Federal                                                               
Aviation  Administration  (FAA)  as   a  radar  technician.    He                                                               
attended the University of Alaska  Fairbanks (UAF), graduating in                                                               
1969, at  which point  he served  in the U.S.  Army.   During his                                                               
service in the Army, he helped  build the road to Prudhoe Bay for                                                               
the Alaska Pipeline.   Since then he has worked  primarily in the                                                               
electric  utility and  road building  industries, primarily  with                                                               
the  then Department  of Highways  [currently  the Department  of                                                               
Transportation &  Public Facilities].   Currently, he  is working                                                               
as the regional transportation engineer  for the Bureau of Indian                                                               
Affairs, with responsibility  for transportation needs throughout                                                               
rural Alaska.                                                                                                                   
                                                                                                                                
3:53:59 PM                                                                                                                    
                                                                                                                                
MR. MARTIN stated he is interested  in serving on the board for a                                                               
number  of   reasons.    First,  after   receiving  an  excellent                                                               
engineering education  from UAF, he  said, serving on  the Alaska                                                               
Board of  Regents would be a  way to repay the  university system                                                               
for that  education.  Second,  he said  a huge benefit  is having                                                               
"served my career  in Alaska with people I went  to school with."                                                               
He offered further details.                                                                                                     
                                                                                                                                
3:55:09 PM                                                                                                                    
                                                                                                                                
MR.  MARTIN  described rural  Alaska  as  an untapped  workhorse.                                                               
Currently,  he said,  the state  is  facing a  labor shortage  so                                                               
severe that  within a few  years, it will become  overwhelming if                                                               
nothing  is  done.    He  said rural  residents  have  a  problem                                                               
adapting  to  an  urban  lifestyle while  going  to  school,  but                                                               
offered  his belief  that rural  citizens and  those who  need to                                                               
hire new engineers or business majors  - for example - could help                                                               
each other.                                                                                                                     
                                                                                                                                
3:56:13 PM                                                                                                                    
                                                                                                                                
MR. MARTIN  said he was  fortunate to have  grown up in  a family                                                               
with a  grandfather and  uncle who  both graduated  from college.                                                               
The former  was a  territorial legislator  and the  latter served                                                               
his career  as a  certified public accountant  (CPA).   He added,                                                               
"That's not something  that's available to most rural  kids.  So,                                                               
they  grow up  without  someone that  ... would  ...  be good  at                                                               
things that  they value.   That  sort of leaves  out many  of the                                                               
teachers, because the teachers aren't  skilled at the things that                                                               
are valued  in the Bush."   He indicated that [by  serving on the                                                               
Alaska  Board of  Regents]  he  could be  a  role  model for  the                                                               
children in rural Alaska.                                                                                                       
                                                                                                                                
CHAIR WILSON  agreed that having  a family member with  a college                                                               
education can have a big impact on a person's life.                                                                             
                                                                                                                                
3:58:01 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE CISSNA  noted that the  top employer in  Alaska is                                                               
in  the field  of health  care.   She said  it's a  profession in                                                               
which  people can  work  within a  variety of  job  ranges.   She                                                               
stressed the  importance of  having a  health component  at every                                                               
university,  and asked  Mr. Martin  if  he has  given the  matter                                                               
thought.                                                                                                                        
                                                                                                                                
3:59:59 PM                                                                                                                    
                                                                                                                                
MR.  MARTIN admitted  that health  care is  not a  matter he  has                                                               
spent much  time thinking about.   Notwithstanding that,  he said                                                               
that  as the  Baby Boomers  age, the  demand on  the health  care                                                               
system  increases.    He  noted  that many  of  the  health  care                                                               
professionals  and  technicians go  out  of  state to  get  their                                                               
education, and he  indicated that that is an issue  that could be                                                               
addressed.   He reported that  at the last [University  of Alaska                                                               
Board of Regents] meeting, the  board approved the addition of an                                                               
x-ray technician  program in the  University of  Alaska Southeast                                                               
(UAS).                                                                                                                          
                                                                                                                                
4:01:44 PM                                                                                                                    
                                                                                                                                
CHAIR  WILSON stated  that by  2010  Alaska will  need 4,000  new                                                               
registered  nurses   (RNs).    Two  years   ago,  the  university                                                               
graduated only 200  RNs.  She predicted that,  within five years,                                                               
there will  be the  beginning of  a crisis in  health care.   She                                                               
said the problem is nationwide.                                                                                                 
                                                                                                                                
4:03:00 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON  said Mr. Martin covered  the importance of                                                               
rural campuses in  his remarks.  He told Mr.  Martin that he also                                                               
graduated in 1969 from UAF.                                                                                                     
                                                                                                                                
4:03:29 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  GARDNER  moved  to advance  the  confirmation  of                                                               
Robert  Martin to  the joint  session  of the  House and  Senate.                                                               
There being  no objection, the  confirmation of Robert  Martin to                                                               
the position of Board of Regents was advanced.                                                                                  
                                                                                                                                
^Professional Teaching Practices Commission                                                                                   
                                                                                                                                
4:04:01 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON announced that the  final order of business would be                                                               
the  confirmation hearing  for an  appointee to  the Professional                                                               
Teaching Practices Commission.                                                                                                  
                                                                                                                                
4:04:36 PM                                                                                                                    
                                                                                                                                
KAREN MACKLIN,  Appointee to the Professional  Teaching Practices                                                               
Commission  (PTPC), told  the committee  that she  came with  her                                                               
family  to Alaska  in 1967  as a  senior in  high school.   After                                                               
graduating from high  school, she spent several  years working in                                                               
the  private sector  and owned  businesses in  the Anchorage  and                                                               
Girdwood area.   She received  her BEd in  [Elementary] Education                                                               
from  the University  of Alaska,  Anchorage (UAA)  in 1985.   She                                                               
said  she has  taught both  regular and  special education,  pre-                                                               
school  to college  level, for  approximately  20 years  - 14  of                                                               
those years  in Alaska.   She noted that  she holds a  Masters of                                                               
Special  Education from  UAA.    Ms. Macklin  said  she has  been                                                               
active  in  NEA-Alaska  and  its local  chapters,  and  has  been                                                               
involved  with  her  local  school  districts  in  a  variety  of                                                               
capacities.                                                                                                                     
                                                                                                                                
4:05:50 PM                                                                                                                    
                                                                                                                                
MS. MACKLIN stated her biggest  reason for wanting to participate                                                               
with PTPC  is:   "I like  the idea  that we  have the  ability to                                                               
police our  own profession;  that we  have the  responsibility to                                                               
uphold the [professionalism] of educators."   She said she thinks                                                               
the  ethics  that have  been  outlined  in  the Alaska  Code  are                                                               
important.  Ms. Macklin said she  is confident that she holds the                                                               
respect of  her colleagues.  She  said in Sitka there  has been a                                                               
new awareness of what the PTPC  does and what the ethics actually                                                               
mean.   She said  she is interested  in learning  more, including                                                               
the legal vocabulary  and processes used by the  commission.  She                                                               
stated  that  she has  enjoyed  the  sessions  in which  she  has                                                               
participated and has  found the team to be  professional and open                                                               
to  discussion   on  tough  issues  regarding   certification  of                                                               
teachers.  She revealed, "It's  my first somewhat political arena                                                               
... to be involved in, and I've been enjoying it so far."                                                                       
                                                                                                                                
4:07:25 PM                                                                                                                    
                                                                                                                                
MS. MACKLIN reminded  Representative Wilson that she  had met her                                                               
last  year  when   she  brought  a  group  of   students  in  for                                                               
"transition fair" from Sitka.  She offered further details.                                                                     
                                                                                                                                
4:08:40 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GARDNER  noted that Ms. Macklin  had been involved                                                               
in  [fetal  alcohol syndrome  (FAS)  and  fetal alcohol  spectrum                                                               
disorders (FASD)] coursework  and said she's sure  Ms. Macklin is                                                               
aware that  "it's a huge problem  for this state."   She asked if                                                               
Ms. Macklin  has any suggestions  for things that should  be done                                                               
in  Alaska for  FAS/FASD children  that are  not currently  being                                                               
done.                                                                                                                           
                                                                                                                                
4:09:18 PM                                                                                                                    
                                                                                                                                
MS. MACKLIN  responded that  she would  like to  say there  is an                                                               
easy answer  to prevent  FAS and  [fetal alcohol  effects (FAE)].                                                               
She mentioned that there is a  related clinic in Sitka, but it is                                                               
difficult to get  a diagnosis, because the  mother doesn't always                                                               
want to admit that she  was drinking or abusing substances during                                                               
her pregnancy.   Notwithstanding  that, she  stated she  thinks a                                                               
lot of the symptoms of FAS/FAE  can be worked with whether or not                                                               
the  student  "has  that  label."   She  said  the  state  offers                                                               
education on  the subject  and she can't  think of  anything else                                                               
that can be done but offer more education.                                                                                      
                                                                                                                                
4:11:03 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON moved to advance  the confirmation of Karen                                                               
Macklin to  the joint  session of  the House  and Senate.   There                                                               
being  no objection,  the confirmation  of Karen  Macklin to  the                                                               
position of  the Professional  Teaching Practices  Commission was                                                               
advanced.                                                                                                                       
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no further business before the committee, the House                                                                 
Health, Education and Social Services Standing Committee meeting                                                                
was adjourned at 4:12:30 PM.                                                                                                  

Document Name Date/Time Subjects