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