Legislature(2019 - 2020)DAVIS 106
03/17/2020 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| Confirmation Hearing(s): State Medical Board | |
| HB267 | |
| HB255 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| *+ | HB 267 | TELECONFERENCED | |
| *+ | HB 255 | TELECONFERENCED | |
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 17, 2020
3:22 p.m.
MEMBERS PRESENT
Representative Tiffany Zulkosky, Chair
Representative Ivy Spohnholz, Vice Chair
Representative Matt Claman
Representative Harriet Drummond
Representative Geran Tarr
Representative Sharon Jackson (via teleconference)
MEMBERS ABSENT
Representative Lance Pruitt
COMMITTEE CALENDAR
CONFIRMATION HEARING(S):
State Medical Board
Christopher Gay - Anchorage
Sarah Bigelow Hood - Anchorage
David Boswell - Fairbanks
- CONFIRMATION(S) ADVANCED
HOUSE BILL NO. 267
"An Act relating to short-term health care insurance; and
providing for an effective date."
- HEARD & HELD
HOUSE BILL NO. 255
"An Act relating to a waiver of work requirements or time limits
in the food stamp program; and providing for an effective date."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: HB 267
SHORT TITLE: SHORT-TERM HEALTH CARE INSURANCE
SPONSOR(s): REPRESENTATIVE(s) ZULKOSKY
02/21/20 (H) READ THE FIRST TIME - REFERRALS
02/21/20 (H) HSS, L&C
03/17/20 (H) HSS AT 3:00 PM DAVIS 106
BILL: HB 255
SHORT TITLE: FOOD STAMPS; WORK REQS; TIME LIMITS
SPONSOR(s): REPRESENTATIVE(s) JOSEPHSON
02/19/20 (H) READ THE FIRST TIME - REFERRALS
02/19/20 (H) HSS
03/17/20 (H) HSS AT 3:00 PM DAVIS 106
WITNESS REGISTER
CHRISTOPHER GAY, M.D., Appointee
State Medical Board
Anchorage, Alaska
POSITION STATEMENT: Testified as appointee to the State Medical
Board.
SARAH BIGELOW HOOD, Appointee
State Medical Board
Anchorage, Alaska
POSITION STATEMENT: Testified as appointee to the State Medical
Board.
JULIA BUSCHMANN, Staff
Representative Tiffany Zulkosky
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented the committee substitute (CS) for
HB 267, Version S, on behalf of Representative Zulkosky, prime
sponsor, with the use of a PowerPoint presentation.
SARAH LUECK, Policy Analyst
Center on Budget and Policy Priorities
Washington, D.C.
POSITION STATEMENT: Testified and answered questions during the
hearing on HB 267.
LORI WING-HEIER, Director
Anchorage Office
Division of Insurance
Department of Commerce, Community and Economic Development
(DCCED)
Anchorage, Alaska
POSITION STATEMENT: Answered questions during hearing on HB
267.
ELISE SORUM-BIRK, Staff
Representative Andy Josephson
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented HB 255 on behalf of
Representative Josephson, prime sponsor, with the use of a
PowerPoint presentation.
SHAWNDA O'BRIEN, Director
Division of Public Assistance (DPA)
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Answered questions during the hearing on HB
255.
REPRESENTATIVE ANDY JOSEPHSON
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Provided information and answered questions
during the hearing on HB 255, as prime sponsor.
CARA DURR, Director of Public Engagement
Food Bank of Alaska
Anchorage, Alaska
POSITION STATEMENT: Testified during hearing on HB 255.
ED BOLEN, Senior Policy Analyst
Center on Budget and Policy Priorities
Washington, D.C.
POSITION STATEMENT: Testified and answered questions during
hearing on HB 255.
ACTION NARRATIVE
3:22:26 PM
CHAIR TIFFANY ZULKOSKY called the House Health and Social
Services Standing Committee meeting to order at 3:22 p.m.
Representatives Zulkosky, Spohnholz, Tarr, and Drummond were
present at the call to order. Representative Claman arrived and
Representative Jackson joined (via teleconference) as the
meeting was in progress.
^CONFIRMATION HEARING(S): State Medical Board
CONFIRMATION HEARING(S): State Medical Board
3:22:57 PM
CHAIR ZULKOSKY announced that the first order of business would
be confirmation hearings for appointment to the State Medical
Board.
3:23:31 PM
CHRISTOPHER GAY, M.D., Appointee, State Medical Board, relayed
that he founded the Alaska Center for Pain Relief; with its
primary focus to help patients manage pain and minimize reliance
on opioids. He maintained his interest in serving on the State
Medical Board was to be involved in drafting regulations related
to opioid education for providers who were prescribing opioids,
to assist in drafting regulations for prescription monitoring,
and to review cases regarding opioid prescriptions. He offered
his interest stemmed from wanting to ensure the providers who
treated his family were the best and would not be a danger to
society. He expressed his belief he would bring a useful and
unique prospective to the board given his background and
specialty in interventional pain management; many of the cases
that came up regarding licensing were related to opioid
management; and the regulations for licensing in the state were
also related to opioid management. He has practiced in several
other states and, therefore, brought diversity to the board.
3:25:29 PM
REPRESENTATIVE SPOHNHOLZ asked why he moved from Virginia to
Alaska.
DR. GAY shared one of his mentors had moved to Alaska. He said
he worked for one of the largest pain practices in the country;
the larger it got the less control he had over his ability to
practice the way he wanted. He stated he was attracted to
Alaska due to the change of pace, the people, and the practice
opportunities.
3:26:43 PM
REPRESENTATIVE SPOHNHOLZ asked about his interest in managing
pain and minimizing the use of opioids. She asked for a
description of the evidence-based strategies he used to help his
patients manage pain and how use of the strategies would inform
his work on the State Medical Board.
DR. GAY replied "balance" was the key to the management of pain;
no one treatment could effectively treat pain, but a combination
of treatments. He mentioned working with other specialties -
physical therapy, chiropractic treatment, acupuncture, and
biofeedback. He said what he added to the equation were his
interventions in trying to address the underlying issue causing
the pain or limiting mobility and function. He maintained
relying too heavily on one modality - specifically opioids -
often caused the most issues; when opioids were combined with
the other modalities, patients' use of opioids may be reduced or
eliminated. Some patients were motivated not to be on opioids,
and some may never have relied on opioids. His goal was to keep
them off opioids and keep them functional without them. He
stated his goal [for serving on the board] was to ensure the
state's guidelines were not too onerous; the prescription
monitoring program was reviewed by patients and physicians; and
information was used to make informed decisions about
appropriate therapies.
3:28:48 PM
CHAIR ZULKOSKY stated the State Medical Board had a statewide
reach and by statute, as many geographical areas as possible
were represented on the board with diversity in backgrounds.
She asked about his familiarity with rural communities off
Alaska's road system and the health care organizations within
those communities.
DR. GAY recognized that rural communities had many challenges -
one being access to care. He said unfortunately that challenge
caused some physicians to rely heavily on one modality versus
another. He stated his practice had investigated and tried
telehealth. He maintained it was more challenging for the
providers in the community when the specialties were lacking.
He offered the state had led the way in telehealth going back
ten years; trained providers in the community worked under the
supervision of remote providers to deliver care. He asserted
the State Medical Board's role was to ensure statutes and
guidelines included the situation in rural communities.
CHAIR ZULKOSKY relayed most of the hub communities had
sophisticated tribal health facilities providing a comprehensive
scope of health services. She asked what his relationship was
with providers serving in the hub community hospital settings.
DR. GAY answered he had not had any connections with them; he
would like to explore doing so; he suggested the possibility of
informing providers about the services that could be available
to rural residents.
3:32:04 PM
CHAIR ZULKOSKY relayed the committee had heard testimony from
young leaders - in Anchorage, Juneau, and Fairbanks - in support
of making medically accurate age-appropriate sexual education
accessible to Alaska students. She asked for his prospective as
a provider on making such information available to Alaska
students.
DR. GAY answered, "It would of course depend on a certain number
of things." He posed the questions: Who is making the
guidelines? What is age-appropriate? What is being taught?
Are religious preferences and cultural sensitivity being
followed? He said that the answer was not an easy one, but in
select situations in which all these issues are considered, he
would be potentially supportive.
CHAIR ZULKOSKY asked Dr. Gay to define ethical, unprofessional,
or dishonorable conduct of medical providers, particularly as it
related to women's or reproductive health.
DR. GAY replied the first definition would be to respect the
wishes of the women. He offered Alaska limited government
interference into daily life activities; therefore, regarding
reproductive health, it would be an individual decision for
women to determine what happened to their bodies. He said there
were many experts on the subject, and if the board had to craft
regulations on the issue, he would want to hear opinions from
all sides and perspectives.
3:34:43 PM
SARAH BIGELOW HOOD, Appointee, State Medical Board, relayed that
she was born and raised in Juneau, was married with two
children, and currently worked in family medicine. She stated
she applied to be on the State Medical Board so she could work
with other providers to ensure Alaska residents were being cared
for by competent providers. She reviewed her professional and
volunteer experience: 10 years with the Alaska Academy of
Physician Assistants (AKAPA); 10 years as the Alaska
representative to the American Academy of Physician Assistants
(AAPA); and 17 years' practice in family medicine and pain
management. She stated with her history in the medical field,
she had a strong understanding of the collaborative role of the
physician assistant (PA) in the medical field. She said prior
to entering the medical field, she worked for the State of
Alaska for about 12 years in human resources and labor
relations. During that time, she developed a strong
understanding of investigations and reviewing facts leading to
accurate and fair conclusions. She offered her combined work
history would be an asset to the State Medical Board.
3:36:23 PM
REPRESENTATIVE SPOHNHOLZ asked Ms. Hood why she wanted to serve
on the State Medical Board.
MS. HOOD shared she had followed board activity over the past 10
years and felt there was a lack of communication regarding
issues seen in the medical community and how to prevent or
correct certain practices. She maintained with her experience
and background she could bridge the gap and ensure that PAs
served in a capacity that was best-fitting and most appropriate
for the medical community.
REPRESENTATIVE SPOHNHOLZ asked for more detail on the issues and
communication gaps that the appointee wished to address.
MS. HOOD offered one issue was the Prescription Drug Monitoring
Program (PDMP) database; she was supportive of the database; she
believed use of the database by providers should be required to
ensure prescribing was done appropriately. With the current
opioid crisis, the database should be more tightly monitored and
used to protect patients.
REPRESENTATIVE SPOHNHOLZ agreed with that sentiment. She asked
for clarification of Ms. Hood's testimony that there was a lack
of communication.
MS. HOOD answered in the past ten years, a PA school was opened
in Anchorage; there were about 24 graduates annually. She
communicated with the graduates as a preceptor. She maintained
when asked, many students had a lack of understanding of the PA
board, the PA community, the State Medical Board, the role of
PAs, MDs, and advanced practice registered nurses (APRNs) in the
community and their affect on the public. She maintained if the
students were educated earlier in their careers, they would
carry an understanding forward throughout their careers with
more benefit to patients.
REPRESENTATIVE SPOHNHOLZ shared she worked at the University of
Alaska Anchorage (UAA) College of Health when the PA program
began in Alaska. She mentioned it was well established and
successful in graduating PAs.
3:39:59 PM
CHAIR ZULKOSKY asked Ms. Hood about her familiarity with rural
communities off Alaska's road system and the health systems that
provided services to those communities.
MS. HOOD replied she grew up in Juneau and had spent 30 years in
that community, which is off the road system. She shared
experiences her family had with two children with difficult
medical conditions and limited access to health care. Currently
in Anchorage she worked with patients coming from remote sites
through the Disability During Unemployment (DDU) program or to
the pain clinic where she works. She maintained there were many
challenges - not just regarding access to care but regarding
access to knowledge for providers in remote sites. She worked
in journal clubs - both with her job and on the side - to try to
disseminate information on latest treatments, medications, and
informational websites. She said patients needing follow-up
care were limited due to the expense of travel, lack of funding
for travel, and family situations.
CHAIR ZULKOSKY asked what experience Ms. Hood had with
licensures of applicants, disciplinary sanctions, and license
renewals as they related to rural health care system providers.
MS. HOOD responded she worked in the [Bartlett Regional Hospital
(BRH)] emergency department in Juneau and on the Kenai
Peninsula. She has coordinated the annual PA conference and,
therefore, has been in contact with many PAs throughout the
state. She relayed she has brought questions from PAs at remote
sites to the "state board" to be addressed. She said she was
also the contact regarding pain management; she educated
providers on the appropriate prescription of opioids. She was
the contact for access to the [Alaska] Academy of PAs as well.
CHAIR ZULKOSKY asked Ms. Hood to define ethical, unprofessional,
or dishonorable conduct of medical providers, particularly as it
related to women's or reproductive health.
MS. HOOD answered respect of women's wishes was top priority.
She expressed that her responsibility was to abide by the oath
[of medical providers] to do no harm, to inform patients of all
options regardless of personal belief, and to ensure safety.
3:43:52 PM
CHAIR ZULKOSKY opened public testimony on the State Medical
Board confirmation hearing. After ascertaining that there was
no one who wished to testify, she closed public testimony.
3:44:16 PM
The committee took a brief at-ease.
3:44:41 PM
CHAIR ZULKOSKY moved to advance the confirmations of Christopher
Gay, Sarah Bigelow Hood, and David Boswell, appointees to the
State Medical Board, to a joint session of the House and Senate
for consideration. [The confirmation hearing for Mr. Boswell
was held during the House Health and Social Services Standing
Committee meeting of March 12, 2020.] There being no objection,
the confirmations were advanced.
CHAIR ZULKOSKY moved to advance the confirmations of Anita
Halterman and Rhonda Boyles, appointees to the Alaska State
Mental Health Trust Authority Board of Trustees, to a joint
session of the House and Senate for consideration. [The
confirmation hearings for Ms. Halterman and Ms. Boyles were held
during the House Health and Social Services Standing Committee
meeting of March 12, 2020.] There being no objection, the
confirmations were advanced.
CHAIR ZULKOSKY reminded members signing the reports regarding
appointments to boards and commissions in no way reflected
individual members' approval or disapproval of the appointees,
and the nominations were merely forwarded to the full
legislature for confirmation or rejection.
3:45:32 PM
The committee took an at-ease from 3:45 p.m. to 3:48 p.m.
[Chair Zulkosky passed the gavel to Vice Chair Spohnholz.]
HB 267-SHORT-TERM HEALTH CARE INSURANCE
3:48:20 PM
VICE CHAIR SPOHNHOLZ announced that the next order of business
would be HOUSE BILL NO. 267, "An Act relating to short-term
health care insurance; and providing for an effective date."
3:48:26 PM
REPRESENTATIVE DRUMMOND moved to adopt the committee substitute
(CS) for HB 267, Version 31-LS1521\S, Marx, 3/10/20, as the
working document.
VICE CHAIR SPOHNHOLZ objected for discussion purposes.
3:48:50 PM
REPRESENTATIVE ZULKOSKY, as prime sponsor of HB 267, introduced
the CS for HB 267, Version S, as follows:
This legislation seeks to enact consumer protections
for Alaskans insured by short-term limited duration
(STLD) health insurance plans. This bill, from our
perspective, is narrow and seeks to remedy the lack of
protections in Alaska related to short-term health
insurance. In the last two years, many states have
enacted similar protections for consumers. This
legislation seeks to bring similar standards to Alaska
and ensure that Alaskans are no longer put at undue
risk for significant financial hardship posed by these
plans.
REPRESENTATIVE ZULKOSKY added that Version S reflected changes
suggested by the Division of Insurance, [Department of Commerce,
Community & Economic Development (DCCED)]. The proposed
legislation had a zero fiscal note offering the opportunity to
protect consumers at no cost to the State of Alaska.
3:50:32 PM
JULIA BUSCHMANN, Staff, Representative Tiffany Zulkosky, Alaska
State Legislature, on behalf of Representative Zulkosky, prime
sponsor of HB 267, presented Version S, with the use of a
PowerPoint presentation. She began with slide 2, entitled
"Short-Term Limited Duration Health Insurance," which read:
? Intended to fill a temporary gap in health coverage.
? Prior to October 2018, STLD plans were
permitted for a maximum of 90 days.
? STLD plans offer lower premiums and are
advertised as an affordable alternative to plans
that, while more expensive, offer comprehensive
essential coverage.
? The fine print: These plans do not meet federal
qualifications for minimum essential coverage.
? They do not provide coverage for the Essential
Health Benefits, the 10 categories of health care
that federal law deems essential.
? They are able to charge more for those with
pre-existing conditions.
? They can deny an individual's enrollment in a
health plan due to their health status, age,
gender, or other factors that may affect the
purchaser's use of insurance.
MS. BUSCHMANN added that STLD plans, also referred to as "short-
term plans" or "short-term insurance," were defined by the
federal government as insurance coverage with an expiration date
of less than 12 months - a definition in place for nearly 20
years. In 2016, STLDs were redefined as lasting up to 90 days
with no renewals. She said Alaska statutes currently lacked
consumer protections for individuals with short-term plans;
short-term insurance was not required by statute to cover
services that were otherwise mandated by health insurance, such
as infant hearing screening, telemedicine, diabetes equipment,
mammograms, and screenings for colorectal, prostate, and
cervical cancers. The plans could exclude coverage for entire
categories of benefits, charge higher premiums based on health
status, exclude coverage for preexisting conditions, and impose
annual limits. They had significantly higher out-of-pocket
cost-sharing than other plans available on the individual
market. She concluded that while the plans were sold as
individual health coverage, they very often did not cover
consumers.
3:52:37 PM
MS. BUSCHMANN turned to slide 3, entitled "Federal Rule-Making
Finalized in October 2018," which read:
? The final rule amended the definition of short-term
limited duration insurance:
? Lengthening plan duration to 364 days
? Increasing renewal options to permit a total
coverage period of 36 months
? Possible impacts noted in the federal rule:
? "Reduced access to some services and providers
for some consumers who switch from available
individual market plans and possibly reduced
choice for individuals remaining in the
individual market risk pools."
? "Potential increase in out-of-pocket costs for
some consumers, possibly leading to financial
hardship."
? "Potential increase in uncompensated care by
hospitals."
MS. BUSCHMANN referred to the graph on slide 4, entitled
"Estimated Costs Between Plans six months following
diagnosis," to point out the high out-of-pocket costs to the
consumer associated with the new rule. The estimates on the
graph showed the differences in costs between Affordable Care
Act (ACA) [the U.S. comprehensive health care reform law enacted
in March 2010], compliant plans, and STLD plans. She explained
that the graph demonstrated the possible cost for an individual
with a six-month plan, the possible cost for an individual with
a three-month plan including costs from loss of coverage, and
the risk of allowing plans that did not cover preexisting
conditions. If an individual's three-month plan ended and was
renewed while the person still required [medical] treatment,
short-term plans could exclude coverage for services associated
with a condition through medical underwriting. She gave an
example: If the individual's preexisting condition was high
blood pressure, and the person had a stroke as a result, the
insurer could refuse to pay for any treatment related to the
stroke, even if at the time the person had short-term insurance.
3:54:15 PM
MS. BUSCHMANN moved on to slide 5, entitled "Prevalence of State
Regulations January 2020," which illustrated by way of a map
that 32 states and the District of Columbia had regulated the
STLD plans: in 8 states STLD plans were banned or precluded
based on longstanding requirements; some states had chosen to
limit plan duration to 90 days or six months; other states had
opted for a full year including renewals. She referred to the
handout in the committee packet entitled "Duration and renewals
of 2019 Short Term Medical plans by state," for greater detail
on state policies. She relayed that on slide 5, states were
categorized by permitted length of plan duration, but she
suggested that there were other policy areas in which states
could enact consumer protections.
MS. BUSCHMANN referred to slide 6, entitled "State-level
policies that have since been enacted," which read:
? Limit initial plan duration
? Limit number of renewals
? Limit maximum duration
? Limited availability
? Coverage for pre-existing conditions
? Some states have opted to require coverage for pre-
existing conditions only upon plan renewal
? Coverage for essential health benefits
? Required notice to the consumer specifying that STLD
plans do not qualify as providing minimum essential
coverage
MS. BUSCHMANN relayed that it was possible to limit the
availability of the plans: some states didn't allow them to be
purchased during the open enrollment period - the period when
people could purchase plans on the federal marketplace - or
during an individual special enrollment period; Maine required
that short-term plans be purchased in person, and there were no
short-term plans being sold in Maine currently.
MS. BUSCHMANN continued by saying states had required short-term
plans covered certain services: Indiana required short-term
plans cover emergency services; the District of Columbia
requires that plans cover services sought in the prior 12
months, if related to a preexisting condition. Some states
require that the insurer provide a notice to the consumer
relaying that it might medically underwrite the policy and not
cover certain services that do not qualify as minimum essential
coverage.
3:56:07 PM
MS. BUSCHMANN turned to slide 7, entitled "Features of HB 267,"
which read:
? Defined Duration: The initial term may not be more
than 90 days, which conforms with the duration of STLD
plans currently sold in Alaska.
? Limited Renewal: An individual can renew an STLD
plan once.
? Required Coverage for Essential Health Benefits and
Pre-Existing Conditions: A plan must cover the ten
essential health benefits and services related to a
pre-existing condition.
? Limited Availability: STLD plans may only be sold
outside of the federal marketplace's open enrollment
period or an individual's special enrollment period.
MS. BUSCHMANN added that the provision under the last bullet on
the slide is important because it required that a person would
not be purchasing inherently temporary insurance - a short-term
plan - when he/she had the opportunity to purchase longer-term
insurance that provides comprehensive coverage.
MS. BUSCHMANN moved on to slide 8, entitled "Summary of Changes
for Proposed CS HB 267," which read in part:
? Limited Renewal: An individual can renew an STLD
plan twice.
? Required Coverage for Emergency Services: A plan
must, at a minimum, cover ambulatory, emergency,
hospitalization, and laboratory services.
? Protections for Pre-Existing Conditions: A plan must
provide coverage for services associated with pre-
existing conditions if an individual renews their
plan.
3:57:30 PM
VICE CHAIR SPOHNHOLZ referred to the third bullet on the slide
and asked what the reasoning was for that provision.
3:57:56 PM
REPRESENTATIVE ZULKOSKY explained Director [Lori] Wing-Heier,
[Division of Insurance, DCCED] had relayed some Alaskans
reported they lost [health insurance] coverage or had high
medical bills, because at the end of 90 days, their policies had
to be underwritten; any new medical conditions identified in the
initial 90-day window were excluded from coverage. For example,
an Alaskan had a leg injury during the initial 90-day period;
when the individual had surgery on the leg during a different
90-day period, he/she was told it was a preexisting condition
and the cost would not be reimbursed. The consumer was then
responsible for the entirety of the coverage being denied.
MS. BUSCHMANN continued with slide 8, which read in part:
? Increase in the Cost-Sharing Provision: A plan can
allow up to $10,000 for self-only coverage and up to
$19,500 for family coverage.
MS. BUSCHMANN explained that the cost-sharing was increased to
reflect that lower premium plans tend to have higher cost-
sharing.
3:59:15 PM
REPRESENTATIVE ZULKOSKY drew the committee's attention to the
handout in the committee packet describing the STLD plans
offered in Alaska.
MS. BUSCHMANN reported there were two insurance companies
allowed to issue plans in Alaska - Moda Health and Independence
American Insurance Company (IAIC). The plans on the handout
were those of IAIC.
3:59:47 PM
REPRESENTATIVE ZULKOSKY referred to the plans on the handout -
offered in Juneau, Bethel, and Anchorage. She pointed out the
disparity between the premiums for a female and those for a
male, even though pre-natal care and prescriptions drugs were
not covered. She relayed that a female paying for a STLD plan
is paying $132 per month for the least expensive option, or just
over $1,500 per year; the deductible is $10,000; the coinsurance
rate is 50 percent after the deductible is paid. She said,
"Essentially while this is being marketed and sold in Alaska as
being a health care coverage option, it's essentially not really
covering Alaskans who are paying several thousand dollars a year
to receive this coverage." She stated that with the
understanding that there are Alaskans who may experience a gap
in insurance coverage and need a short-term plan until they
could purchase more comprehensive coverage, the intent of the
proposed legislation was to put parameters around these plans to
ensure Alaskans are not exposed to an undue cost burden.
4:01:51 PM
VICE CHAIR SPOHNHOLZ asked why the insurance cost more for
women, considering the typical additional coverages for women
like reproductive health care were not covered under the plans.
4:02:27 PM
SARAH LUECK, Policy Analyst, Center on Budget and Policy
Priorities, offered her belief that younger women tended to seek
more health care. She acknowledged that without maternity
coverage and prescription drug coverage, it was difficult to
understand the disparity between women and men regarding cost.
She said the higher rates for women reflected practices of the
private insurance market before ACA and opined that the short-
term plans adopted these practices because they can do so.
VICE CHAIR SPOHNHOLZ asserted any woman would maintain the
reason young women use health care more than men is because they
are using birth control to prevent pregnancies or because they
are pregnant; therefore, if those services are not covered, it
makes no sense that health care would cost more.
4:04:20 PM
MS. LUECK relayed that having observed the changes in the short-
term plans and the development of the market over the past
couple years as the federal rules have changed, she has heard of
situations in which people have been harmed under these plans -
with expensive claims not covered. She explained the consumer
may understand the plan was not as good as private individual
market insurance; however, the surprises for the consumer were
not just with benefits not being covered, but with the
preexisting exclusions, for which the insurers had a great deal
of latitude. There have been cases in which claims were not
covered due to some health condition in the person's past that
is not readily recognized by the person to be associated with
the present claim. The result is a "bait-and-switch" situation
for the consumer in which the person has an expensive and
unexpected catastrophic incident occur and discovers that the
"catastrophic" insurance does not cover it.
MS. LUECK offered that the data available from the National
Association of Insurance Commissioners (NAIC) shows that many of
the plans are popular nationwide; they have a medical loss ratio
(MLR) of about 40-50 percent. The MLR is a measure of the
percentage of the premiums that a health plan spends on medical
claims. In the regular individual insurance market, there is a
requirement for insurers not only to cover essential health
benefits (EHB) and preexisting conditions, and to rate men and
women the same, but to spend a minimum portion of the money
collected from consumers on actual medical care - 80 percent.
The short-term market insurers are not under the 80 percent
requirement and, therefore, spend much less.
MS. LUECK concluded, "People may feel, when they buy a short-
term plan, that they're getting a good deal or that it's better
than nothing." If they are healthy and young, they may be able
to find a plan that costs a few hundred dollars per month;
however, it may be too much of an expense for the protection
they are getting and the risk of financial harm.
4:08:19 PM
VICE CHAIR SPOHNHOLZ asked for clarification of MLR. She
expressed her understanding that it is the amount of funds paid
as premium that are used to pay for care.
MS. LUECK answered, "Exactly." She explained that it is the
portion of the premiums of the entire group of consumers that is
used for medical care. She stated that the rest of the money is
used by the insurer for overhead, administrative costs, chief
executive officer (CEO) salary, and profit. She further stated
that in the regular individual insurance market, the companies
were required to spend 80 percent of the premiums on medical
care and quality improvement; the remaining 20 percent could be
used for overhead, CEO salary, and profit. She maintained that
this requirement incentivized companies to not price the
insurance plans too high.
MS. LUECK continued by describing the short-term plans - without
the 80 percent requirement: Administrative costs were not
limited as much. Short-term plans permitted underwriting, which
the regular individual insurance market did not permit.
Underwriting is an expensive service; it involves looking into
the medical records of a consumer, examining medical histories,
speaking with physicians, and determining if the consumer was
honest and fully disclosed medical conditions upon application.
She said that medical underwriting involved a broker and broker
commission. The result is that the short-term plans are much
more expensive than the ACA plans.
4:11:03 PM
REPRESENTATIVE ZULKOSKY confirmed for Vice Chair Spohnholz that
Moda and IAIC are the two insurance companies that offered the
short-term plans, and Moda is just now getting into the market.
She relayed there was an interest among insurance companies to
expand into the short-term insurance market in Alaska, which is
why it was important to establish consumer protections.
VICE CHAIR SPOHNHOLZ asked whether the proposed legislation
provided a limit for the MLR.
REPRESENTATIVE ZULKOSKY answered that there is not currently an
MLR [limit]; however, there is precedence in other states and
would be considered for Alaska.
4:12:28 PM
VICE CHAIR SPOHNHOLZ asked for comment on the proper role of the
short-term plan and the array of options for health care in
Alaska.
LORI WING-HEIER, Director, Anchorage Office, Division of
Insurance, Department of Commerce, Community and Economic
Development (DCCED), answered short-term plans did not offer
very good coverage. She maintained there was a need for short-
term plans in the event of a "gap" in coverage. She pointed out
that currently many people were suddenly without jobs due to
COVID-19 [a novel coronavirus disease]. She mentioned the U.S.
Consolidated Omnibus Reconciliation Act (COBRA) was an option
for some people but is extremely expensive. She offered other
reasons for suddenly losing health insurance - a divorce or the
death of a spouse. She maintained that the short-term plan
provided a stopgap measure until a person could determine
his/her next step - employee benefits, the individual insurance
market, [U.S. Centers for Medicare and Medicaid Services (CMS),
U.S. Department of Health and Social Services (HSS)] health
insurance programs ("Medicaid") and ("Medicare"), or something
else.
VICE CHAIR SPOHNHOLZ offered her understanding that in the
regular insurance market, Alaska managed the MLR; she asked
whether there were other states that managed the MLR
proportions.
MS. WING-HEIER answered that the MLR [of 80 percent] was a
provision of ACA; all states in that market must comply. She
mentioned that in August 2019, Primera [Blue Cross] sent checks
to its consumers, because it had not met the 80 percent MLR and,
therefore, was required to refund the money. She added that all
insurers must do the same under the ACA for the individual and
small group markets.
VICE CHAIR SPOHNHOLZ asked whether any states had limited the
MLR on short-term limited plans.
MS. WING-HEIER replied, "Not that I'm aware of." She offered to
provide that information.
REPRESENTATIVE ZULKOSKY offered to provide a document to
committee members showing all state-level actions on STLD plans
in a side-by-side comparison. She said there were MLR
restrictions in the following states: Delaware at 60 percent;
Kansas at 60 percent; Maine at 50 percent; North Dakota at 55
percent; and Vermont at 80 percent.
VICE CHAIR SPOHNHOLZ expressed that it was troubling that 50
percent of a person's premium for a short-term plan was not
being spent on health care; a 50 percent profit on health care
was excessive. She mentioned the rate differentials between
women and men were concerning, as the plans did not cover
reproductive health care. She asked for comment on that issue.
4:17:02 PM
MS. WING-HEIER replied that she shared that concern; however,
the actuarial data indicated that young women are more expensive
in terms of health care.
VICE CHAIR SPOHNHOLZ asked whether the expense difference is due
to health care providers giving young women an annual exam and
inoculations.
MS. WING-HEIER said that could very well be.
VICE CHAIR SPOHNHOLZ related an anecdote: She saw her health
care provider more frequently than her husband because she was
responsible for the reproductive health care for her family.
With an annual exam, she received inoculations and preventative
care; but to save money, her husband did not.
4:18:20 PM
REPRESENTATIVE TARR asked whether establishing an MLR
restriction would create an administrative burden.
MS. WING-HEIER said it would for plans that are underwritten.
She described the increased administrative burden: There are no
questions about preexisting conditions on an ACA plan
application, but there are on the short-term plan applications.
For processing claims, the short-term plan application would be
reviewed more thoroughly to determine whether there was a
preexisting condition that disqualified the claim.
4:19:44 PM
The committee took a brief at-ease.
[Vice Chair Spohnholz returned the gavel to Chair Zulkosky.]
4:19:54 PM
REPRESENTATIVE SPOHNHOLZ removed her objection to Version S.
There being no further objection, Version S was adopted as the
working document.
CHAIR ZULKOSKY indicated that HB 267 would be held over.
HB 255-FOOD STAMPS; WORK REQS; TIME LIMITS
4:21:11 PM
CHAIR ZULKOSKY announced that the final order of business would
be HOUSE BILL NO. 255, "An Act relating to a waiver of work
requirements or time limits in the food stamp program; and
providing for an effective date."
The committee took a brief at-ease.
4:21:32 PM
ELISE SORUM-BIRK, Staff, Representative Andy Josephson, Alaska
State Legislature, on behalf of Representative Josephson, prime
sponsor of HB 255, relayed the proposed legislation would
address Supplemental Nutrition Assistance Program (SNAP) waivers
for able-bodied adults without dependents - specifically time-
limit waivers. She turned to slide 1, entitled "Goals of HB
255," which read:
? Ensure that Alaska is seeking the broadest waiver
possible under federal law
? Ensure that Alaska is approving the broadest waiver
possible under law
? Ensuring that vulnerable Alaskans have the food they
need to be healthy
4:23:07 PM
MS. SORUM-BIRK moved on to slide 2, entitled "What is SNAP ABAWD
work requirement," which read:
Under the Supplemental Nutrition Assistance Program
(SNAP), also known as food stamps, Able Bodied Adults
Without Dependents (ABAWD) are required to meet
specific work requirement of 80 hours per month to
qualify for benefits.
There is a 3-month time limit per 3 years on benefits
if the work requirement isn't met.
MS. SORUM-BIRK explained that SNAP stands for Supplemental
Nutrition Assistance Program and is also known as "food stamps."
She said that ABAWD stands for Able Bodied Adult Without
Dependents; it is someone between 18 and 49 years old who is
healthy and capable of working according to federal law.
MS. SORUM-BIRK referred to slide 3, entitled "Waivers SNAP ABAWD
Time Limits to Work Requirements," which read:
Since the time limits enactment in 1996 states have
been able to apply for waivers in areas of low work
availability
Additionally states can exempt up to 12% of caseload
who are ineligible for benefits (extending time limit
1 additional month)
Alaska and Guam lost statewide waivers between 4th
quarter of 2019 and 1st quarter of 2020
4:24:38 PM
MS. SORUM-BIRK continued with slide 4, entitled "CBPP- History
of ABAWD Waivers from 1998 to 2019." The graphic on the slide
was published by the Center for Budget Policies and Priorities
(CBPP) and can be found on its website. The slide demonstrated
the history of states acquiring waivers from 1998 through 2019.
She pointed out from the graph that during that period, Alaska
was mostly without any waivers. She mentioned that Alaska has
consistently qualified for a statewide waiver due to its
challenges in employment.
4:25:31 PM
MS. SORUM-BIRK turned to slide 5, entitled "Why has Alaska
always qualified?" which read:
Consistently High Unemployment
? Alaska has consistently met unemployment
requirements under the previous federal rule
? Most areas of Alaska can still meet federal
requirements under the new rule
Lack of Traditional Job Opportunities
? Rural communities with less cash economy
? Highly seasonal workforce in many sectors of the
economy
4:26:19 PM
REPRESENTATIVE SPOHNHOLZ asked for a description of the rule
recently enacted by the [President Donald J.] Trump
administration.
MS. SORUM-BIRK stated the new rule changed the unemployment
requirements that a state could use [to qualify for a waiver].
It set the unemployment rate at 10 percent or higher, or for
alternate waivers, a base of 6 percent or 20 percent above the
national average unemployment rate, whichever is greater. She
said that in Alaska, most of the state met the 6-percent
requirement. She offered that Alaska has transitioned to the
new rule; however, the new rule is not effective until April
[2020], and as of [March 13, 2020], implementation of the rule
has been temporarily halted under a nationwide injunction
[issued by the U.S. District Court for the District of
Columbia].
MS. SORUM-BIRK moved on to slide 6, entitled "Which States might
be Impacted Most?" which shows the results of an analysis by
[Wolfram] Mathematica depicting the states that would be most
impacted by the new U.S. Department of Agriculture (USDA) SNAP
waiver rule. She pointed out that Alaska would be among the
most impacted states with 53-77 percent of ABAWD SNAP
participants affected by the new waiver rule.
4:28:37 PM
MS. SORUM-BIRK moved on to slide 7, entitled "ABAWD Waiver
Timeline for Alaska," to provide clarification on the history of
the waiver and actions on the national level. In 1964, the Food
Stamp Program was codified in federal law. Many changes
occurred to the program between 1964 and 1996. In 1996, the
ABAWD work requirement became part of federal law with the
passage of the Personal Responsibility and Work Opportunity
Reconciliation Act (PRWORA). In 2008, the Food Stamp Program
was renamed the Supplemental Nutrition Assistance Program, or
SNAP. In 2010 the American Recovery and Reinvestment Act (ARRA)
waived SNAP work requirements nationally and broadened the
eligibility for all states to receive waivers. Between 2010 and
2016, the waivers were suspended nationwide.
MS. SORUM-BIRK relayed that in 2016, the time limits were
reinstated. In 2018, an overhaul of the SNAP program was put
forward in the U.S. Agriculture and Nutrition Act of 2018, or
the "Farm Bill," but the proposed tightening measures were
rejected by the U.S. Congress. Despite rejection of the
measures, the Trump administration put forward a new rule in
February 2019 revising the conditions under which USDA would be
able to waive ABAWD time limits. It also limited how states
could choose metrics and define geographical areas. It was
under this rule that the 10 percent and 6 percent were first
discussed. Attorneys general from around the nation and a group
of U.S. Senators wrote letters in opposition to the rule.
MS. SORUM-BIRK continued by saying that in October 2019, the
[Governor Mike] Dunleavy administration began implementing the
new rule at the state level using the 10 percent metric. In
December 2019, the Trump Administration rule was finalized and
set to go into effect in April 2020. In January 2020 once the
rule was finalized, a coalition of states and New York City sued
the Trump administration over the new rule. Just a few days ago
[U.S. District Court Judge Beryl Howell] blocked the rule
temporarily; he cited the pandemic in the opinion.
4:32:49 PM
CHAIR ZULKOSKY asked how [the new rule] impacted Alaskans.
MS. SORUM-BIRK said that it is estimated that 6,917 vulnerable
Alaskans who participated in the SNAP program have lost SNAP
benefits due to the rule change. They are individuals who were
in the ABAWD category and lived in geographic areas that no
longer qualified for the waiver. She referred to the handout in
the committee packet, entitled "SNAP Helps 1 in 11 Workers in
Alaska Put Food on the Table," and pointed out that about one-
third of the Alaskans who were dependent on SNAP worked in the
service industry. Those individuals were already at high risk -
with little job security and difficulty meeting the 20-hour-a-
week minimum for working.
4:34:37 PM
CHAIR ZULKOSKY asked what the geographic spread was for the
nearly 7,000 Alaskans who had lost SNAP benefits under the new
rule.
4:35:10 PM
SHAWNDA O'BRIEN, Director, Division of Public Assistance (DPA),
Department of Health and Social Services (DHSS), relayed the
areas of the state included in the waiver effective October 2019
were the Bethel Census Area, Bristol Bay Borough, Denali
Borough, Haines Borough, Hoonah-Angoon Census Area, Kusilvak,
Lake and Peninsula Borough, Nome Census Area, Northwest Arctic
Borough, Petersburg Borough, Prince of Wales-Hyder Census Area,
Southeast Fairbanks Census Area, Skagway Municipality, Valdez-
Cordova Census Area, Wrangell City and Borough, Yakutat City and
Borough, and Yukon-Koyukuk Census Area. The total number of
individuals [affected by the waiver] for all those locations is
approximately 2,000; the data was constantly changing because
the population of people being served significantly fluctuated
each month. At any point in time that number might change
depending upon when the data was collected, the population
included in the data search, and whatever additional information
the individuals provided to the division to further exempt them
from being considered ABAWD. At the time the waiver went into
effect in October 2019, the division calculated about 7,500
individuals to be ABAWD.
CHAIR ZULKOSKY asked Ms. O'Brien to provide the committee with
the comprehensive list of communities currently waived and the
numbers cited.
MS. O'BRIEN agreed and offered to share information on the
waiver for which the division has asked permission to be
effective April 1. She also offered to provide the committee
with the department's plan in terms of the COVID-19 [a novel
coronavirus disease] response; it involved language to exempt
all participants of the SNAP program from work requirements due
to significant job losses in many communities.
4:38:34 PM
REPRESENTATIVE TARR asked for clarification as to the number of
individuals affected by the rule change.
MS. O'BRIEN responded that when the data was queried in October,
about 7,500 individuals were identified and notified that they
would be required to participate in ABAWD work-related
requirements. She reiterated that the numbers changed monthly.
REPRESENTATIVE TARR asked for clarification on the "2,000"
number Ms. O'Brien cited and clarification on the "boroughs"
versus "census areas" in the listing of areas of the state.
MS. O'BRIEN replied that about 2,000 individuals were not
required to participate [in the new rule] due to the waiver;
without the October waiver exempting those areas of the state,
there would have been about 2,000 more individuals added to the
7,500. The waiver effective April 1 would have exempted another
900 individuals.
MS. O'BRIEN stated she was not able to explain the terminology
or differentiate between census areas and boroughs; it was
determined by the census process within the U.S. Bureau of Labor
Statistics (BLS) [U.S. Department of Labor (USDOL)].
4:41:48 PM
REPRESENTATIVE TARR asked for confirmation of her understanding:
the October 1 deadline prompted notices sent to 7,500 people who
would be required to participate; that number would have been
9,500; however, 2,000 were identified as not being required to
participate; another waiver was requested for April 1, which
would exempt an additional 900; therefore, 900 would be
subtracted from 7,500.
MS. O'BRIEN answered, "Correct."
4:42:30 PM
REPRESENTATIVE SPOHNHOLZ asked for confirmation that in October
2019, 7,500 ABAWD were notified that they would be required to
work and potentially not eligible for SNAP.
MS. O'BRIEN concurred.
REPRESENTATIVE SPOHNHOLZ asked how many people were no longer
eligible for SNAP benefits in November.
MS. O'BRIEN answered that as a result of the ABAWD
implementation, none. She explained that November would have
been the first month of the three months of benefits in a 36-
month time frame; individuals would not have lost benefits until
January.
REPRESENTATIVE SPOHNHOLZ asked how many of the 7,500 were
eligible for SNAP in January.
MS. O'BRIEN stated that she would ask staff to query the data to
determine the number of individuals who lost benefits as a
result of the rule change; she added some individuals closed
cases for other reasons.
4:45:09 PM
CHAIR ZULKOSKY referred to the March 2020 injunction citing
COVID-19 concerns and asked for the effective date of the
decision.
MS. SORUM-BIRK offered her belief that the decision did not
apply retroactively but from the point of the decision forward.
She offered to confirm that information for the committee.
REPRESENTATIVE SPOHNHOLZ asked Ms. O'Brien to provide the total
number of SNAP-eligible people in every month of the calendar
years 2019 and 2020.
MS. O'BRIEN agreed to provide that information.
4:47:10 PM
MS. SORUM-BIRK clarified that "6,917" was the estimate put forth
by the Dunleavy administration in August 2019 to quantify the
number of SNAP recipients who would be required to meet the work
requirements under the new rule starting in October. The
information came from the Anchorage Daily News article [August
12, 2019] included in the committee packet.
MS. SORUM-BIRK continued with the PowerPoint presentation, slide
8, entitled "COVID-19 and SNAP," which read:
? Economic uncertainty is increasing dramatically
? Many low wage jobs will be hit hardest (for example-
roughly 1/3 of SNAP recipients in Alaska work in the
service industry)
? Forcing needy families to go to crowded food
pantries or soup kitchens would increase spread of the
virus
MS. SORUM-BIRK added that the intent of HB 255 was to make it as
easy as possible for people to receive SNAP benefits when they
needed food. She reiterated the federal judge cited COVID-19 as
one of the reasons for blocking the federal rule.
4:48:50 PM
MS. SORUM-BIRK reviewed slide 9, entitled "Sectional Analysis,"
which read:
Section 1: Amends AS 47.25.975 to add a new subsection
outlining requirements that DHSS:
Must request, accept, and attempt to renew or extend
federal waivers relating to work requirements and time
limits for ABAWDs to the maximum extent allowed under
federal law in all geographical areas of the state.
Must implement ABAWD waivers approved by the federal
government to the maximum allowable extent outlined in
each waiver.
May not create more stringent work requirements or
time limits for ABAWDs than those outlined in an
accepted waiver.
Section 2: Adds a new section to the uncodified law of
the State of Alaska requiring that DHSS promptly apply
to the federal government for a waiver if the
department determines that the waiver is necessary to
implement the policy changes outlined in Section 1 of
this Act.
Section 3 and Section 4: Relate to the conditional
effective date of this Act.
4:50:42 PM
REPRESENTATIVE ANDY JOSEPHSON, Alaska State Legislature, as
prime sponsor of HB 255, shared that the issue was brought to
his attention by the Alaska Food Coalition, and he recognized
the need for the legislature to set a different path through
legislation. He maintained that the position of the Dunleavy
administration regarding SNAP benefit waivers was more stringent
than that of the Trump administration; the governor's policy was
to not seek any possible waiver. Even before COVID-19, Alaska
was the 50th state in employment. He maintained that Alaska
should seek every opportunity to receive waivers as allowed. He
acknowledged the philosophical viewpoint of the Dunleavy
administration - the belief that not receiving SNAP benefits
would force people into seeking employment. He asserted that
the difficulty was that often the employment was seasonal and
inadequate. Many of the recipients were service workers who,
even though employed, still needed the assistance because they
did not get paid enough. He stated there was a class of workers
who were most vulnerable; businesses were closing in response to
the COVID-19 pandemic; and those workers cannot telework. He
emphasized the proposed legislation was timely; it was
consistent with the [HCR 17] focus on need [passed in the House
on 3/17/20]; and it was critical.
REPRESENTATIVE JOSEPHSON referred to the state's opportunity to
identify the most favorable period for waiver; that is, the
months with the highest rate of unemployment. He suggested that
the administration did not advocate for SNAP beneficiaries in
that way. He said that the communities of Anchorage and the
Matanuska-Susitna Valley (Mat-Su) were the ones that stood to
benefit from the proposed legislation. He offered his belief
that it should be the policy of the state to seek the waivers
available. Other state policies reflected a similar approach.
He quoted U.S. Senator Mitt Romney: "While expansions of paid
leave, unemployment insurance, and SNAP benefits are crucial,
the check will help fill the gaps for Americans that may not
quickly navigate different government options."
4:56:10 PM
CHAIR ZULKOSKY opened invited testimony during the hearing on HB
255.
4:56:29 PM
CARA DURR, Director of Public Engagement, Food Bank of Alaska,
relayed that staff at the Food Bank of Alaska understand what a
critical role SNAP plays in fighting hunger in Alaska. For
every meal provided by the Feeding America national network of
food banks, SNAP provided nine meals. Her organization was
concerned with any policy that restricted access to SNAP, such
as is the case with time limits. When people lose SNAP, they
turned to the already burdened food bank network; the food banks
try but cannot fill that gap. The Food Bank of Alaska supports
the goal of helping low income Alaskans who can find work and
keep a job; however, restrictions on access to SNAP is not an
effective way to attain that goal; it is instead a punitive work
requirement. Studies have shown that existing mandatory work
requirements in SNAP and other programs, such as Temporary
Assistance to Needy Families (TANF), are ineffective. She said
that TANF work requirements - in place since 1996 - have yielded
little or no long-term positive impacts on employment or
earnings.
MS. DURR continued by saying that most people who received SNAP
benefits and can work, do work. In many ways SNAP supports
work; when people have their basic needs met, they are better
prepared for the workforce. Time spent visiting food pantries
is time that could be spent looking for work or working. She
offered that many SNAP recipients are working in low-wage jobs
with unpredictable hours. For people whose hours are reduced,
who get sick, or who have a sick child, SNAP benefits are at
risk. She maintained that many people who are subject to the
new rule who are not working are not unemployed by choice. Many
of those subject to the additional work requirements struggled
to find work even when the job market was healthy. Lack of job
skills, living in a rural area with few or no jobs, undiagnosed
health conditions or disabilities are few of the reasons that
individuals may not work. She said that being deemed "able-
bodied" does not mean job-ready, and cutting a vulnerable person
off food assistance does not make them any more employable.
MS. DURR relayed that while there are allowed individual
exemptions - such as having a disability, being medically unfit
for work, or receiving unemployment benefits - and the state has
a low bar for meeting them, the recipients need to understand
enough about the rule to request the exemptions.
MS. DURR stated that at the Alaska Food Bank, staff have
received calls from individuals who have lost benefits; in most
cases the individuals were very confused about the policy and
why they had lost benefits. The confusion is not unique to
Alaska and is not a reflection on the work of DPA but is due to
the complexity of the rule.
MS. DURR offered that currently there are Alaskans who have lost
SNAP due to the new rule who, instead of being able to buy a
small amount of emergency grocery supplies, are now going to
crowded food pantries and soup kitchens to get food. As more
Alaskans lose jobs and directives to stay home increase, it is
not reasonable to expect someone to find a job currently.
Alaska needs to plan for the possibility that the [COVID-19]
situation will intensify, which may force closures of the food
distribution centers. She said that while no one could have
predicted the current situation, clearly Alaska needs to ensure
that SNAP can easily respond to disasters of this sort. Without
policy change, those who have lost benefits would be unable to
requalify for SNAP; many workers who have lost hours or jobs may
only qualify for a short time. She maintained SNAP will be an
incredibly important resource to the many Alaskans who are
struggling from the economic fallout from COVID-19 in the short-
and long-term. She expressed her hope the program could be made
accessible to everyone who needed it. She said she is confident
the state will seek a variety of ways to expand access to SNAP
in consideration of COVID-19. The situation underscored the
need to maintain SNAP flexibility at all times.
MS. DURR noted in conclusion that SNAP benefits are 100 percent
federally funded; every $1 spent in SNAP generated $1.70 in
local economic activity; SNAP injected nearly $200 million in
federal dollars into Alaska's economy. She said, "Let's
maximize access to this important program by seeking all
available waivers from the time limit, which will benefit
struggling Alaskans and our state economy."
5:01:50 PM
REPRESENTATIVE SPOHNHOLZ referred to people coming in to DPA for
interviews and application processing, which could present a
concern regarding transmission of COVID-19 for clients and
employees. She asked what processes the division will adopt to
ensure that people can get access to benefits without increased
risk of spreading COVID-19.
5:02:41 PM
MS. O'BRIEN replied that as many agencies are, the division had
been working hard to balance the need to protect staff and
clients with the delivery of services. She stated that it was
especially challenging for DPA: because of the number of
homeless individuals who have no other means of communicating
with the division, the office cannot close its lobbies or
restrict access. She described solutions that DPA is
implementing to limit the need for people to visit the office:
working with federal partners to use telephonic interview
options and asking for permission to extend certification
deadlines. For example, DPA is seeking for approval to extend
SNAP certifications for a period of six months for March, April,
May, and June benefits. She said that staff will reassess as
operations progress. She offered that TANF, Adult Public
Assistance (APA), Senior Benefits, and [U.S. Centers for
Medicare and Medicaid Services (CMS), U.S. Department of Health
and Social Services (HSS)] health insurance program ("Medicaid")
will be aligned as much as possible to minimize the impact to
clients and staff. She added that she anticipated an increase
in the number of individuals coming to the division for
assistance as a result of job loss and other issues. She
mentioned that changes were occurring rapidly and guidance from
federal partners was coming to the division hourly. She
concluded that together with federal partners, the division was
acting as quickly and as thoughtfully as possible to meet the
needs of all Alaskans.
5:05:42 PM
REPRESENTATIVE SPOHNHOLZ asked about the possibility of
increasing the use of online applications and using technology
to increase access and reduce in-person contact.
MS. O'BRIEN answered that there is an online application for
Medicaid through "myAlaska.gov" or through the federally
facilitated marketplace; application for other benefits cannot
be submitted online; however, applications can be accessed
online, printed out, and submitted through scanning the
application and emailing it to the office or dropping it off.
She added that the division is seeking to get permission to
accept telephone signatures so that individuals may be assisted
over the telephone while at home. She maintained that the
division is looking for ways to accept documentation outside of
normal practices.
5:08:11 PM
REPRESENTATIVE SPOHNHOLZ stated she was surprised online
applications were not possible for public assistance benefits.
She offered having that capability would save time and money, as
well as be useful for both clients and employees.
MS. O'BRIEN responded that the division has been exploring the
possibility of an online application with vendors. In Alaska,
most of the programs can be applied for in one application; the
division has reached out to other states that have successfully
made available an online application. She stated that
technology is a challenge in Alaska due to its information
technology (IT) resources; the division has other IT needs and
must prioritize use of those resources. She said that the
online application is a priority, but the division must engage
with several external stakeholders to accomplish it.
5:09:46 PM
REPRESENTATIVE TARR commented that procedures involving printing
an application and then scanning and emailing it presented a
very limiting option for many people who did not have Internet,
a printer, and/or a scanner. She said that someone could take a
photograph of the application with a smartphone, [a multi-
purpose mobile telephone with internet access], but not everyone
had smartphones. She asked that the division consider other
ways for receiving applications so that these people do not
"slip through the cracks." She maintained that she has been in
hundreds of homes in her district that do not have these
devices.
REPRESENTATIVE TARR asked whether Ms. O'Brien's mention of
"permission to accept telephone signatures" refers to permission
from the individual applicant, permission from the state, or
permission from the federal government.
MS. O'BRIEN responded that for the Medicaid program, the
division had permission to accept telephonic signatures; but for
programs like SNAP, the division did not have federal permission
to accept telephonic signatures. She maintained the division
was working with its federal partners, and the federal partners
had been responsive and cooperative in helping DPA address its
challenges. She acknowledged that Alaska had rural challenges,
as well as challenges regarding individuals who did not have the
capability to print or access the internet. She offered that
DPA could mail applications to individuals, and it is working on
options for taking information over the telephone. She
mentioned that staffing is a concern as well, and the division
is trying to dedicate resources appropriately for stability.
5:12:52 PM
CHAIR ZULKOSKY asked for comment on the new federal rule and why
Alaska's use of the 10 percent unemployment rate [as the
requirement for a waiver] is more restrictive.
5:13:13 PM
ED BOLEN, Senior Policy Analyst, Center on Budget and Policy
Priorities, responded that the proposed legislation would give
Alaska an important guide for addressing access to food
assistance for very poor unemployed workers. He said SNAP was
historically the second most effective response to worsening
economic circumstances; unemployment insurance offered the
quickest response. He relayed that Secretary of Treasury [Steve
Mnuchin] just expressed his concern that the unemployment rate
may spike to 20 percent. "The current policy in Alaska - where
the state would only request waivers of this time limit for ...
ABAWDs ... if unemployment is over 10 percent - means that
because there is this look-back period that was mentioned, the
state would essentially identify areas where unemployment was
over 10 percent for at least 12 months." He offered that by the
time that happened, the recession would have almost passed.
Almost every other state, without the restriction of a 10
percent requirement of unemployment before requesting waivers,
would be able to identify areas where unemployment spikes
quickly and at lower rates. He said, "If their unemployment
rate is currently 6 percent and then it spikes up, that's a lot
of low-income workers losing jobs." States would be able to
identify areas in which they could request waivers and ensure
that people have access to food while they were looking for
work. He opined that HB 255 would address what could be a
sudden and worsening impact on low-income people in service
industry jobs who would likely be affected.
5:15:56 PM
REPRESENTATIVE DRUMMOND echoed the comments regarding the access
of low-income individuals to computers. She mentioned that the
libraries are closed in Anchorage; many services are provided in
libraries, such as the social worker stationed at the library to
answer questions from homeless people. She offered that not
only do people lack the equipment necessary to submit an
application, but many lack the sophistication to fill out a form
on a smartphone; that is, if one has a smartphone and the form
can be filled out on a smartphone.
5:17:55 PM
REPRESENTATIVE JOSEPHSON encouraged the committee to advance HB
255 as soon as possible. He offered that it would be widely
supported and, unfortunately, has become especially important.
5:18:22 PM
CHAIR ZULKOSKY indicated that HB 255 would be held over.
5:18:52 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 5:19 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 255 Sponsor Statement 3.3.20.pdf |
HHSS 3/17/2020 3:00:00 PM |
HB 255 |
| HB 255 Sectional Analysis 3.3.20.pdf |
HHSS 3/17/2020 3:00:00 PM |
HB 255 |
| HB 255 version A.PDF |
HHSS 3/17/2020 3:00:00 PM |
HB 255 |
| HB 255 Fiscal Note HSS.pdf |
HHSS 3/17/2020 3:00:00 PM |
HB 255 |
| HB 255 Supporting Documents.pdf |
HHSS 3/17/2020 3:00:00 PM |
HB 255 |
| HB 267 ver.S Work Draft.pdf |
HHSS 3/17/2020 3:00:00 PM |
HB 267 |
| HB 267 ver.S Sponsor Statement.pdf |
HHSS 3/17/2020 3:00:00 PM |
HB 267 |
| HB 267 ver.S Sectional Analysis.pdf |
HHSS 3/17/2020 3:00:00 PM |
HB 267 |
| HB 267 Summary of Changes Version U to Version S.pdf |
HHSS 3/17/2020 3:00:00 PM |
HB 267 |
| HB 267 Fiscal Note DCCED.pdf |
HHSS 3/17/2020 3:00:00 PM |
HB 267 |
| HB 267 Handout_Patient Implications Brief.pdf |
HHSS 3/17/2020 3:00:00 PM |
HB 267 |
| HB 267 Handout_State STLD Policies.pdf |
HHSS 3/17/2020 3:00:00 PM |
HB 267 |
| HB 267 Handout_STLD Plans Offered in Alaska.pdf |
HHSS 3/17/2020 3:00:00 PM |
HB 267 |
| Christopher Gay Resume_Redacted.pdf |
HHSS 3/17/2020 3:00:00 PM |
Governor's Appointees to State Medical Board |
| State Medical Board Sarah Bidelow Hood.pdf |
HHSS 3/17/2020 3:00:00 PM |
Governor's Appointees to State Medical Board |
| HB 255 PPT.pdf |
HHSS 3/17/2020 3:00:00 PM |
HB 255 |
| HB 267 ver.S PowerPoint.pdf |
HHSS 3/17/2020 3:00:00 PM |
HB 267 |
| HB 255 Supporting Document- CBPP Factsheet on Workers 3.17.20.pdf |
HHSS 3/17/2020 3:00:00 PM |
HB 255 |