Legislature(2013 - 2014)CAPITOL 106

03/25/2014 03:00 PM HEALTH & SOCIAL SERVICES


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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
*+ HB 374 STATEWIDE IMMUNIZATION PROGRAM TELECONFERENCED
Scheduled But Not Heard
+ SB 169 IMMUNIZATION PROGRAM; VACCINE ASSESSMENTS TELECONFERENCED
Heard & Held
<Companion Bill to HB 374>
*+ HB 376 EXTEND ALASKA HEALTH CARE COMMISSION TELECONFERENCED
Moved Out of Committee
*+ HB 360 REGULATION OF SMOKING TELECONFERENCED
Heard & Held
*+ HCR 21 CHILD ABUSE PREVENTION MONTH TELECONFERENCED
Moved Out of Committee
+ Bills Previously Heard/Scheduled TELECONFERENCED
                    ALASKA STATE LEGISLATURE                                                                                  
      HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                     
                         March 25, 2014                                                                                         
                           3:03 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Pete Higgins, Chair                                                                                              
Representative Wes Keller, Vice Chair                                                                                           
Representative Benjamin Nageak                                                                                                  
Representative Lance Pruitt                                                                                                     
Representative Lora Reinbold                                                                                                    
Representative Paul Seaton                                                                                                      
Representative Geran Tarr (via teleconference)                                                                                  
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
All members present                                                                                                             
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
HOUSE BILL NO. 376                                                                                                              
"An Act extending the termination  date of the Alaska Health Care                                                               
Commission; and providing for an effective date."                                                                               
                                                                                                                                
     - MOVED HB 376 OUT OF COMMITTEE                                                                                            
                                                                                                                                
HOUSE CONCURRENT RESOLUTION NO. 21                                                                                              
Proclaiming April 2014 as Child Abuse Prevention Month.                                                                         
                                                                                                                                
     - MOVED HCR 21 OUT OF COMMITTEE                                                                                            
                                                                                                                                
HOUSE BILL NO. 360                                                                                                              
"An Act  prohibiting smoking in certain  locations; and providing                                                               
for an effective date."                                                                                                         
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
COMMITTEE SUBSTITUTE FOR SENATE BILL NO. 169(FIN)                                                                               
"An  Act establishing  in  the Department  of  Health and  Social                                                               
Services a  statewide immunization program and  the State Vaccine                                                               
Assessment  Council;  creating   a  vaccine  assessment  account;                                                               
requiring  a  vaccine  assessment from  assessable  entities  and                                                               
other program participants  for statewide immunization purchases;                                                               
repealing  the temporary  child and  adult immunization  program;                                                               
and providing for an effective date."                                                                                           
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
HOUSE BILL NO. 374                                                                                                              
"An  Act establishing  in  the Department  of  Health and  Social                                                               
Services a  statewide immunization program and  the State Vaccine                                                               
Assessment  Council;  creating   a  vaccine  assessment  account;                                                               
requiring  a  vaccine  assessment from  assessable  entities  and                                                               
other program participants  for statewide immunization purchases;                                                               
repealing  the temporary  child and  adult immunization  program;                                                               
and providing for an effective date."                                                                                           
                                                                                                                                
     - SCHEDULED BUT NOT HEARD                                                                                                  
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: HB 376                                                                                                                  
SHORT TITLE: EXTEND ALASKA HEALTH CARE COMMISSION                                                                               
SPONSOR(s): HEALTH & SOCIAL SERVICES                                                                                            
                                                                                                                                
03/14/14       (H)       READ THE FIRST TIME - REFERRALS                                                                        
03/14/14       (H)       HSS, FIN                                                                                               
03/25/14       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
BILL: HCR 21                                                                                                                  
SHORT TITLE: CHILD ABUSE PREVENTION MONTH                                                                                       
SPONSOR(s): TARR                                                                                                                
                                                                                                                                
02/26/14       (H)       READ THE FIRST TIME - REFERRALS                                                                        
02/26/14       (H)       HSS                                                                                                    
03/25/14       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
BILL: HB 360                                                                                                                  
SHORT TITLE: REGULATION OF SMOKING                                                                                              
SPONSOR(s): HOLMES                                                                                                              
                                                                                                                                
02/26/14       (H)       READ THE FIRST TIME - REFERRALS                                                                        
02/26/14       (H)       HSS, JUD                                                                                               
03/25/14       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
BILL: SB 169                                                                                                                  
SHORT TITLE: IMMUNIZATION PROGRAM; VACCINE ASSESSMENTS                                                                          
SPONSOR(s): GIESSEL                                                                                                             
                                                                                                                                
02/10/14       (S)       READ THE FIRST TIME - REFERRALS                                                                        
02/10/14       (S)       HSS                                                                                                    
02/21/14       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
02/21/14       (S)       Heard & Held                                                                                           
02/21/14       (S)       MINUTE(HSS)                                                                                            
02/24/14       (S)       HSS RPT CS  4DP   NEW TITLE                                                                            
02/24/14       (S)       DP: STEDMAN, MICCICHE, MEYER, ELLIS                                                                    
02/24/14       (S)       FIN REFERRAL ADDED AFTER HSS                                                                           
02/24/14       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
02/24/14       (S)       Moved CSSB 169(HSS) Out of Committee                                                                   
02/24/14       (S)       MINUTE(HSS)                                                                                            
03/03/14       (S)       FIN AT 5:00 PM SENATE FINANCE 532                                                                      
03/03/14       (S)       Scheduled But Not Heard                                                                                
03/05/14       (S)       FIN AT 5:00 PM SENATE FINANCE 532                                                                      
03/05/14       (S)       Moved CSSB 169(FIN) Out of Committee                                                                   
03/05/14       (S)       MINUTE(FIN)                                                                                            
03/07/14       (S)       FIN RPT CS  5DP   NEW TITLE                                                                            
03/07/14       (S)       DP: MEYER, KELLY, BISHOP, DUNLEAVY,                                                                    
                         OLSON                                                                                                  
03/21/14       (S)       TRANSMITTED TO (H)                                                                                     
03/21/14       (S)       VERSION: CSSB 169(FIN)                                                                                 
03/24/14       (H)       READ THE FIRST TIME - REFERRALS                                                                        
03/24/14       (H)       HSS, FIN                                                                                               
03/25/14       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
THOMAS STUDLER, Staff                                                                                                           
Representative Pete Higgins                                                                                                     
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented HB 376 for the sponsor of the                                                                  
bill, Representative Pete Higgins.                                                                                              
                                                                                                                                
WARD HURLBURT, M.D., Chief Medical Officer/Director                                                                             
Division of Public Health                                                                                                       
Central Office                                                                                                                  
Department of Health and Social Services                                                                                        
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Answered questions during the discussion of                                                              
HB 376.                                                                                                                         
                                                                                                                                
DEBORAH ERICKSON, Executive Director                                                                                            
Alaska Health Care Commission                                                                                                   
Office of the Commissioner                                                                                                      
Department of Health and Social Services                                                                                        
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified during discussion of HB 376.                                                                   
                                                                                                                                
KRISTIN CURTIS                                                                                                                  
Legislative Auditor                                                                                                             
Division of Legislative Audit                                                                                                   
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified during discussion of HB 376.                                                                   
                                                                                                                                
REPRESENTATIVE LINDSEY HOLMES                                                                                                   
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Introduced HB 360 as the sponsor of the                                                                  
bill.                                                                                                                           
                                                                                                                                
ROBERT ERVINE, Staff                                                                                                            
Representative Lindsey Holmes                                                                                                   
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Discussed HB 360 on behalf of the sponsor                                                                
of the bill, Representative Holmes.                                                                                             
                                                                                                                                
JANET KINCAID, Business Owner                                                                                                   
Palmer, Alaska                                                                                                                  
POSITION STATEMENT:  Stated her support for HB 360.                                                                           
                                                                                                                                
CARMEN LUNDE                                                                                                                    
Kodiak Cabaret, Hotel, Restaurant, & Retailers Association                                                                      
Kodiak, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in opposition to HB 360.                                                                       
                                                                                                                                
LARRY HACKENMILLER, Member                                                                                                      
Alaska Cabaret, Hotel, Restaurant, & Retailers Association                                                                      
Fairbanks, Alaska                                                                                                               
POSITION STATEMENT:  Testified during discussion of HB 360.                                                                   
                                                                                                                                
MARK MILITELLO, Owner                                                                                                           
Sumo Vapor                                                                                                                      
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified during discussion of HB 360.                                                                   
                                                                                                                                
DANIEL LYNCH                                                                                                                    
Soldotna, Alaska                                                                                                                
POSITION STATEMENT:  Testified in opposition to HB 360.                                                                       
                                                                                                                                
ANGELA CARROLL, Owner                                                                                                           
Glacier Vapors                                                                                                                  
Palmer, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in opposition to HB 360.                                                                       
                                                                                                                                
DALE FOX, President & CEO                                                                                                       
Alaska Cabaret, Hotel, Restaurant, & Retailers Association                                                                      
(CHARR)                                                                                                                         
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in opposition to HB 360.                                                                       
                                                                                                                                
BETTY MACTAVISH                                                                                                                 
Kodiak, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in support of HB 360.                                                                          
                                                                                                                                
MATT WAGNER                                                                                                                     
Bad Boy Vapors Alaska, LLC                                                                                                      
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in opposition to HB 360.                                                                       
                                                                                                                                
SEAN DASILVA                                                                                                                    
Bad Boy Vapors Alaska, LLC                                                                                                      
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in opposition to HB 360.                                                                       
                                                                                                                                
SENATOR CATHY GIESSEL                                                                                                           
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented SB 169 as the sponsor of the                                                                   
bill.                                                                                                                           
                                                                                                                                
ROSALYN SINGLETON, MD                                                                                                           
Alaska Native Tribal Health Consortium (ANTHC) Immunization                                                                     
Program                                                                                                                         
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of SB 169 and                                                                       
presented a PowerPoint titled "Alaska - What have vaccines done                                                                 
for you?"                                                                                                                       
                                                                                                                                
JILL LEWIS, Deputy Director - Juneau                                                                                            
Central Office                                                                                                                  
Division of Public Health                                                                                                       
Department of Health and Social Services                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified and answered questions during                                                                  
discussion of SB 169.                                                                                                           
                                                                                                                                
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
3:03:58 PM                                                                                                                    
                                                                                                                                
CHAIR PETE  HIGGINS called the  House Health and  Social Services                                                             
Standing   Committee    meeting   to    order   at    3:03   p.m.                                                               
Representatives  Higgins,  Keller,   Seaton,  and  Reinbold  were                                                               
present at  the call to  order.  Representatives  Nageak, Pruitt,                                                               
and  Tarr (via  teleconference)  arrived as  the  meeting was  in                                                               
progress.                                                                                                                       
                                                                                                                                
          HB 376-EXTEND ALASKA HEALTH CARE COMMISSION                                                                       
                                                                                                                                
3:04:53 PM                                                                                                                    
                                                                                                                                
CHAIR HIGGINS  announced that the  first order of  business would                                                               
be HOUSE BILL NO. 376, "An  Act extending the termination date of                                                               
the  Alaska   Health  Care  Commission;  and   providing  for  an                                                               
effective date."                                                                                                                
                                                                                                                                
3:05:22 PM                                                                                                                    
                                                                                                                                
THOMAS STUDLER, Staff, Representative  Pete Higgins, Alaska State                                                               
Legislature, paraphrased from the sponsor statement, which read:                                                                
                                                                                                                                
     HB 376 extends the sunset of the Alaska Health Care                                                                        
     Commission until June 30, 2017.  The Legislative                                                                           
     Auditor has concluded that the Alaska Health Care                                                                          
     Commission is serving the public's interest and should                                                                     
     continue its statutory obligation.                                                                                         
                                                                                                                                
     The legislature established the Commission under AS                                                                        
     18.09.010 in 2010 to recommend policies to improve                                                                         
     quality, affordability and access to health care, and                                                                      
     to identify strategies for improving the health of all                                                                     
     Alaskans.  Seats representative of various health care                                                                     
     stakeholders are designated in statute, and voting                                                                         
     members are appointed by the Governor.  Sen. Coghill                                                                       
     and Rep. Keller currently represent the legislature as                                                                     
     ex-officio members of the Commission.                                                                                      
                                                                                                                                
     The Commission's approach has been to study current                                                                        
     conditions of Alaska's health care market, and design                                                                      
     market-based strategies and policy recommendations                                                                         
     that enhance the consumer's role in health and health                                                                      
     care.  The Commission submits an annual report                                                                             
     including policy recommendations to the Governor and                                                                       
     the legislature on January 15 each year.  A summary of                                                                     
     the core strategies and policies recommended by the                                                                        
     Commission to-date is attached.                                                                                            
                                                                                                                                
     In its short tenure the Commission has developed a                                                                         
     strategic framework including a time-specific vision                                                                       
     with measurable objectives; conducted numerous studies                                                                     
     to increase knowledge and understanding of current                                                                         
     problems in the health care system, designed a                                                                             
     comprehensive body of specific, relevant and                                                                               
     measurable market-based policy recommendations for                                                                         
     improving health care cost and quality; and created a                                                                      
     template for and is facilitating development of an                                                                         
     executive branch action plan for implementing                                                                              
     Commission policy recommendations.  The Commission has                                                                     
     also coordinated with and provided consultation to                                                                         
     private sector employer groups on health care system                                                                       
     concerns.                                                                                                                  
                                                                                                                                
     Excessive health  care costs  and medical  inflation in                                                                    
     Alaska threaten  the sustainability of the  health care                                                                    
     system and create  a burden on families  and public and                                                                    
     private  employers.    Continuation of  the  Commission                                                                    
     would promote  accountability and evaluation  of public                                                                    
     program implementation through  finalization of a state                                                                    
     agency   plan   to  implement   recommended   policies,                                                                    
     increase transparency  in the  health care  system, and                                                                    
     provide continuing  consultation and  coordination with                                                                    
     private  sector employers  in support  of their  health                                                                    
     care value improvement strategies.                                                                                         
                                                                                                                                
     The Commission has consistently  proven to be efficient                                                                    
     and effective  in its progress  to develop  a strategic                                                                    
     framework  for improving  statewide health  care and  I                                                                    
     ask for your support in the passage of this bill.                                                                          
                                                                                                                                
3:07:02 PM                                                                                                                    
                                                                                                                                
WARD HURLBURT,  MD, Chief  Medical Officer/Director,  Division of                                                               
Public Health,  Central Office, Department  of Health  and Social                                                               
Services, said  that the Alaska  Health Care Commission  had been                                                               
initially established  by then Governor Sarah  Palin by executive                                                               
order,  and  later  established  in   law  by  the  Alaska  State                                                               
Legislature.  The Commission was  "charged with looking at health                                                               
care delivery in Alaska  related to accessibility, affordability,                                                               
quality, prevention,  and so on."   He stated that  the committee                                                               
had  reviewed the  various aspects  of the  health care  delivery                                                               
system; however,  the dominant focus  was for the cost  of health                                                               
care,  and what  opportunities there  were to  mitigate the  high                                                               
cost.   He  reported  that  about 18  percent  of gross  domestic                                                               
product was  spent for health  care in the United  States, almost                                                               
$3  trillion annually,  whereas  the rest  of the  industrialized                                                               
world spends about half to two-thirds  of this amount in terms of                                                               
both gross domestic  product and dollar equivalents.   He pointed                                                               
out  that Norway  and Switzerland  were the  next most  expensive                                                               
countries,  spending about  two thirds  the amount  of the  U.S.,                                                               
even with  longer life expectancies  and lower  infant mortality.                                                               
In the past twenty years,  comparable health care spending by the                                                               
U.S. to  Norway and Switzerland  in percentage of  gross domestic                                                               
product would have  saved the U.S. about $15  trillion, an amount                                                               
equivalent  to  the current  national  debt.   He  reported  that                                                               
Alaska  spends  about 20  -  21  percent  of its  gross  domestic                                                               
product for health  care.  He relayed that the  average salary of                                                               
teachers in the  Anchorage School District had  increased about 1                                                               
percent annually, over  inflation, in the last  30 years, whereas                                                               
the cost of health care  insurance had increased about 15 percent                                                               
each year above  inflation.  This was a challenge  for the Alaska                                                               
State  Legislature.   He  noted  that  the Milliman  Company  had                                                               
compared the  charges for medical  services by various  payers in                                                               
Alaska  with those  charges in  Washington, Oregon,  Idaho, North                                                               
Dakota,  Wyoming, and  Hawaii, and  that Alaska  was much  higher                                                               
than the  other states.   He said that  an all payer  claims data                                                               
base had been studied by  another contractor, which would provide                                                               
information  for  health service  charges  and  quality data  for                                                               
outcomes.   He noted  that 12  states had  this process,  with 18                                                               
others  considering it.   He  pointed  out that  the Health  Care                                                               
Commission  was working  with other  health  care entities,  both                                                               
public and  private sectors.  He  offered as an example  that the                                                               
Human  Resources directors  from the  large for-profit  companies                                                               
had  included  the  cost  of health  care  during  discussion  of                                                               
expansion plans.   He  noted that  the Legislative  Audit process                                                               
had focused on DHSS developing  a health plan, and the department                                                               
had  taken those  policy recommendations  to the  Legislature and                                                               
the governor for guidelines to the  formation of a health plan to                                                               
benefit Alaskans.  He offered his  belief that all the members of                                                               
the Health Commission believed that  its work benefited the state                                                               
and its  citizens.   He requested a  determination of  value from                                                               
the Alaska State Legislature.                                                                                                   
                                                                                                                                
CHAIR HIGGINS asked if there  had been implementation and savings                                                               
for the state from the  recommendations of the Alaska Health Care                                                               
Commission.                                                                                                                     
                                                                                                                                
DR.  HURLBURT  offered  his  belief   that  there  were  results;                                                               
however,  if  the Alaska  State  Legislature  did not  see  those                                                               
results, he would question his  own assessment.  He declared that                                                               
this was  a critical decision  for the  legislature, particularly                                                               
in light  of the  necessity for fiscal  conservation.   He opined                                                               
that, in terms  of value, the response from  larger employers was                                                               
that the  information had  helped to  contain health  care costs.                                                               
He said  that anecdotal reports  indicated that  this information                                                               
was helpful in negotiating rates  to ensure a level playing field                                                               
between payers and  providers for fair levels  of compensation to                                                               
support  a  health  care  industry which  was  sensitive  to  the                                                               
adverse effects of  high costs.  He compared these  high costs to                                                               
a tax.                                                                                                                          
                                                                                                                                
CHAIR HIGGINS questioned  whether the work of  the commission was                                                               
saving the state money and providing the necessary services.                                                                    
                                                                                                                                
3:18:24 PM                                                                                                                    
                                                                                                                                
DEBORAH   ERICKSON,  Executive   Director,  Alaska   Health  Care                                                               
Commission, Office of the Commissioner,  Department of Health and                                                               
Social Services,  addressed the  $500,000 fiscal  note, [Included                                                               
in members'  packets] which had  been proposed in  the governor's                                                               
budget,  as it  reflected  the  ongoing costs  for  the next  few                                                               
years.   She explained  that $335,000 was  paid from  the general                                                               
fund  and  the  remaining  $165,000 from  federal  funds  to  the                                                               
department.  She  reported that this budget  supported two staff,                                                               
travel  for  the  14  commission   members,  and  the  occasional                                                               
facility cost  to host a  meeting with  the private sector.   She                                                               
noted  that  some of  the  budget  was for  professional  service                                                               
contracts for  special studies  on which  the commission  did not                                                               
have  expertise or  capacity.    She offered  an  example of  the                                                               
actuarial  study  comparing   pricing  and  reimbursement  levels                                                               
between  payers in  Alaska, to  better  understand cost  shifting                                                               
between  private  insurance  and  Medicaid, as  well  as  a  cost                                                               
comparison between  Alaska and other  states in our region.   She                                                               
reported that currently  there was a contract  with the Institute                                                               
for Social and  Economic Research (ISER) and  Department of Labor                                                               
&  Workforce   Development  to   survey  private   sector  health                                                               
insurance,  concerns,  and  employee   wellness  programs.    She                                                               
pointed out that there had been  studies related to the impact of                                                               
the  Affordable Care  and Patient  Protection  Act, including  an                                                               
employer survey  to capture information regarding  the actions of                                                               
Alaska  employers both  before and  after  implementation of  the                                                               
individual   mandate,  for   use  as   a  baseline   with  future                                                               
assessments.                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON referred to  the report on "Core Strategies                                                               
for Health  Care Transformation"  [Included in  members' packets]                                                               
and asked how  the commission reached its first  goal of ensuring                                                               
that the best available evidence was used for making decisions.                                                                 
                                                                                                                                
MS.  ERICKSON  replied that  a  series  of more  specific  policy                                                               
recommendations related to  that strategy was an  appendix to the                                                               
commission's 2013  report.   She relayed  that ensuring  the best                                                               
available evidence  was used  for making  decisions was  the most                                                               
important, although  it was more  difficult to implement  and had                                                               
longer  term  implications.    She  offered  an  example  of  the                                                               
learning sessions with the private  medical community in order to                                                               
critically  appraise  medical  literature for  identification  of                                                               
biases  during  reporting  of  studies.    She  said  there  were                                                               
additional techniques  for incorporating evidence  into insurance                                                               
designs,  which were  being discussed  for  employee and  retiree                                                               
health plans.   She noted that the commission  had also presented                                                               
a specific recommendation to the Workers' Compensation Board.                                                                   
                                                                                                                                
REPRESENTATIVE  SEATON asked  that the  upcoming report  show the                                                               
strategy and what was being done to accomplish the strategy.                                                                    
                                                                                                                                
MS.  ERICKSON  directed  attention   to  the  recommendations  by                                                               
Division of  Legislative Audit, which stated  that the commission                                                               
was meeting its  intent, although it was necessary  for an actual                                                               
plan  for implementation  of  the strategies.    She stated  that                                                               
there had  been meetings with  the directors from  state agencies                                                               
that had  a lead role in  health care services.   She referred to                                                               
an appendix  in the 2013 report  that detailed the plan  for each                                                               
agency to implement the recommendations by the commission.                                                                      
                                                                                                                                
3:26:44 PM                                                                                                                    
                                                                                                                                
KRISTIN  CURTIS,  Legislative  Auditor, Division  of  Legislative                                                               
Audit, Alaska State Legislature,  explained that her division had                                                               
conducted a sunset audit of  the commission to decide whether the                                                               
commission   served  the   public   interest   and  whether   its                                                               
termination date should  be extended.  She referred  to the audit                                                               
report  [Included  in  members'   packets].    She  offered  some                                                               
background  on  the  commission and  the  expectations  from  the                                                               
legislature.  The commission had  been started by executive order                                                               
in 2008,  with the  legislature intending  for the  commission to                                                               
achieve  health  reforms  through development  of  the  statewide                                                               
health plan;  however, the original  commission did  not consider                                                               
itself responsible  for the  development of a  plan, and  the new                                                               
commission,  established  in  statute  in  2010,  had  agreed  to                                                               
continue  the  approach  by  the   prior  commission.    The  new                                                               
commission collected  information from  various cost  studies and                                                               
developed high  level policy recommendations,  while establishing                                                               
general  priorities which  evolved  into  a strategic  framework.                                                               
She  directed  attention  to  Appendix  A  of  the  audit  report                                                               
[Included in members' packets].   She declared that the audit had                                                               
concluded that  the commission  was serving  the interest  of the                                                               
public, but  improvements in  the development  of a  state health                                                               
plan  were necessary  to justify  its continued  existence.   She                                                               
stated that the  legislature had intended the  commission to work                                                               
in  conjunction with  Department  of Health  and Social  Services                                                               
(DHSS) to  create a  comprehensive health  plan; however,  as the                                                               
commission   had  not   collaborated  with   DHSS,  Division   of                                                               
Legislative  Audit recommended  only  a three  year extension  in                                                               
order  to  develop  a  plan.     The  audit  concluded  that  the                                                               
commission  was  active,  although   there  was  concern  by  the                                                               
division that the framework lacked  any actionable components for                                                               
effective implementation  and did  not identify  specific actions                                                               
to be taken,  a timeframe for completion,  the person responsible                                                               
for taking  action, a definition  for a successful outcome,  or a                                                               
means to  specifically monitor and  measure progress.   Without a                                                               
statewide  health plan,  the actions  of the  commission may  not                                                               
effectively  impact  health  care  in Alaska.    She  recommended                                                               
coordination with the DHSS commissioner  to identify the role and                                                               
responsibility of each agency and  then pursue development of the                                                               
health  plan.   The audit  also recommended  improvement for  the                                                               
public  noticing of  meetings and  assurance that  annual reports                                                               
include all statutorily required elements.                                                                                      
                                                                                                                                
REPRESENTATIVE  KELLER clarified  that  he was  a  member of  the                                                               
commission,  although  he  did   not  perceive  any  conflict  of                                                               
interest  and he  had no  economic connection.   He  acknowledged                                                               
that he  was biased and  very positive  in general terms  for the                                                               
commission.  He  declared that there was a challenge  to keep the                                                               
health care  system in  Alaska from entering  a crisis,  and that                                                               
everyone on  the commission  had agreed on  the necessity  to cut                                                               
the  costs.    He  opined  that  it  would  get  better,  as  the                                                               
commission had  identified significant issues, including  a focus                                                               
on preventive care.                                                                                                             
                                                                                                                                
3:31:56 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON referenced the  plan mentioned in the audit                                                               
report, and asked  if the commission agreed with  the findings by                                                               
the  Division   of  Legislative  Audit  to   develop  a  specific                                                               
actionable plan as a primary goal of the commission.                                                                            
                                                                                                                                
REPRESENTATIVE KELLER  replied that  this had  been the  focus of                                                               
the previous commission meeting.                                                                                                
                                                                                                                                
CHAIR HIGGINS offered  his agreement that the  commission had the                                                               
potential to be  really beneficial to Alaska,  and he recommended                                                               
that it be allowed more time.                                                                                                   
                                                                                                                                
3:33:07 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KELLER  moved  to  report  HB  376,  version  28-                                                               
LS1604\A, out  of committee  with individual  recommendations and                                                               
the accompanying fiscal notes.   There being no objection, HB 376                                                               
was  moved from  the House  Health and  Social Services  Standing                                                               
Committee.                                                                                                                      
                                                                                                                                
3:33:40 PM                                                                                                                    
                                                                                                                                
The committee took an at-ease from 3:33 p.m. to 3:35 p.m.                                                                       
                                                                                                                                
              HCR 21-CHILD ABUSE PREVENTION MONTH                                                                           
                                                                                                                                
3:35:40 PM                                                                                                                    
                                                                                                                                
CHAIR HIGGINS announced that the  next order of business would be                                                               
HOUSE  CONCURRENT RESOLUTION  NO. 21,  Proclaiming April  2014 as                                                               
Child Abuse Prevention Month.                                                                                                   
                                                                                                                                
3:36:13 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR, via teleconference,  testified in support of                                                               
HCR  21,  as  the  sponsor  of the  resolution.    She  expressed                                                               
recognition of April  as Child Abuse Awareness  Month, and stated                                                               
that it would help raise the  profile of this and similar issues,                                                               
in order to  "break the silence."  She directed  attention to the                                                               
numbers for child  abuse incidences in the  resolution, which had                                                               
been gathered from the DHSS  monthly on-line reports [Included in                                                               
members'  packets].    She stated  that  this  resolution  joined                                                               
others in support across the United  States, and she pointed to a                                                               
chronology for  the national effort  toward recognition  of Child                                                               
Abuse  Awareness  going  back  to   1974  [Included  in  members'                                                               
packets].   She  expressed her  desire to  share this  resolution                                                               
with agencies and organizations that  worked on these issues, and                                                               
with legislators to  share with their constituents.   She offered                                                               
examples of some planned events.                                                                                                
                                                                                                                                
CHAIR HIGGINS expressed his support for the proposed resolution.                                                                
                                                                                                                                
3:40:25 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KELLER  moved  to  report  HCR  21,  Version  28-                                                               
LS1522\U, out  of committee  with individual  recommendations and                                                               
the accompanying  zero fiscal notes.   There being  no objection,                                                               
HCR  21 was  moved  from  the House  Health  and Social  Services                                                               
Standing Committee.                                                                                                             
                                                                                                                                
3:41:00 PM                                                                                                                    
                                                                                                                                
The committee took a brief at-ease.                                                                                             
                                                                                                                                
                  HB 360-REGULATION OF SMOKING                                                                              
                                                                                                                                
3:42:22 PM                                                                                                                    
                                                                                                                                
CHAIR HIGGINS announced that the  next order of business would be                                                               
HOUSE  BILL  NO. 360,  "An  Act  prohibiting smoking  in  certain                                                               
locations; and providing for an effective date."                                                                                
                                                                                                                                
REPRESENTATIVE  KELLER  moved  to adopt  the  proposed  committee                                                               
substitute  (CS)  CSHB   360,  labeled  28-LS1336\U,  Strasbaugh,                                                               
3/21/14, as the working draft.   There being no objection, it was                                                               
so ordered.                                                                                                                     
                                                                                                                                
3:42:39 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   LINDSEY   HOLMES,  Alaska   State   Legislature,                                                               
declared  that the  proposed bill  was also  called "the  take it                                                               
outside bill."   She  explained that it  was designed  to protect                                                               
people  in their  own workplaces  from having  to breathe  second                                                               
hand smoke.   She stated that there was now  more knowledge about                                                               
the  effects from  second hand  smoke and  she offered  anecdotes                                                               
about  past experiences  with second  hand smoke.   She  reported                                                               
that  second  hand smoke  killed  an  estimated 50,000  Americans                                                               
every year  from lung cancer  and heart disease, and  the Surgeon                                                               
General  had reported  that even  brief exposure  to second  hand                                                               
smoke  could  have  immediate  adverse  effects  on  the  cardio-                                                               
vascular system.   This  same report  estimated that  second hand                                                               
smoke caused  about $5.6 billion  in loss  productivity annually.                                                               
An  analysis from  the Institute  of Medicine  in 2009  concluded                                                               
that smoke free  workplace laws helped reduce  heart attacks from                                                               
6 -  47 percent.   She noted that stroke  had also been  added to                                                               
the list  as caused by exposure  to second hand smoke.   She said                                                               
that approximately  half of  the jobs in  Alaska were  covered by                                                               
smoke  free workplace  laws.   She  reported that  more than  400                                                               
businesses in  Alaska had signed  resolutions supporting  a state                                                               
wide  smoke  free  indoor workplace  law  [Included  in  members'                                                               
packets],  noting  that the  Alaska  Supreme  Court had  recently                                                               
recognized that the government did  have a legitimate interest in                                                               
protecting citizens from "the  well-established dangers of second                                                               
hand  tobacco smoke."    She  reported that  more  than 30  other                                                               
states already had similar laws.                                                                                                
                                                                                                                                
CHAIR HIGGINS  asked if the decision  by work places to  be smoke                                                               
free was voluntary.                                                                                                             
                                                                                                                                
REPRESENTATIVE HOLMES replied that  some were voluntary, although                                                               
many were in  areas of the state that had  local, smoke free work                                                               
place laws.  She pointed  out that, in many unincorporated areas,                                                               
local  government  did  not  have   the  power  to  impose  these                                                               
ordinances.                                                                                                                     
                                                                                                                                
CHAIR HIGGINS asked how the proposed bill would be enforced.                                                                    
                                                                                                                                
REPRESENTATIVE  HOLMES  replied  that  "it's  fairly  well  self-                                                               
policing" and there had been very little need for enforcement.                                                                  
                                                                                                                                
3:47:37 PM                                                                                                                    
                                                                                                                                
ROBERT  ERVINE,  Staff,  Representative  Lindsey  Holmes,  Alaska                                                               
State  Legislature, explained  that smoking  laws in  Alaska were                                                               
under  the purview  of Department  of Environmental  Conservation                                                               
(DEC) although a  goal of the proposed bill was  to shift this to                                                               
Department  of Health  and Social  Services (DHSS).   This  would                                                               
allow an employee  to make a complaint if there  was a violation.                                                               
He  referred  to  the Sectional  Summary  [Included  in  members'                                                               
packets].   He explained that  Section 1, paragraph  (1), created                                                               
new smoking laws  to prohibit smoking in,  among others, enclosed                                                               
areas within  places of employment,  public places,  schools, and                                                               
transportation facilities.   Describing paragraph (2),  he stated                                                               
that it applied  to, among others, outdoor  arenas, stadiums, and                                                               
areas of public schools.  Moving  on to subsection (b), he listed                                                               
the   three  exemptions   to  include   private  clubs,   private                                                               
residences  except  hotels  or motels,  and  vessels  engaged  in                                                               
commercial or  sport fishing  activities.   The next  section, AS                                                               
18.35.331, required  employers, owners, and operators  to post no                                                               
smoking  signs  within  places  or  vehicles  where  smoking  was                                                               
prohibited.                                                                                                                     
                                                                                                                                
REPRESENTATIVE SEATON asked for  identification of the referenced                                                               
page and line.                                                                                                                  
                                                                                                                                
REPRESENTATIVE KELLER stated that this was on page 3, line 3.                                                                   
                                                                                                                                
MR. ERVINE directed attention to  page 3, line 23, which required                                                               
the commissioner of  DHSS to develop and  maintain procedures for                                                               
processing reports of  violations.  He observed that  it would be                                                               
necessary for further  clarification that this was  not "a gotcha                                                               
task  force as  enforcement."   He moved  on to  page 3,  line 31                                                               
through page 4,  line 13, which established the  fine amounts for                                                               
violations.   He noted that,  although these regulations  did not                                                               
fall  under the  purview of  DHSS, DEC  did not  have enforcement                                                               
capabilities  for the  current smoking  law either.   This  would                                                               
shift  the enforcement  to DHSS,  and "hopefully  give them  some                                                               
measure of teeth to enforce this."                                                                                              
                                                                                                                                
REPRESENTATIVE SEATON directed  attention to page 3,  line 6, and                                                               
asked about a task force.                                                                                                       
                                                                                                                                
MR. ERVINE stated that a task force was not being established.                                                                  
                                                                                                                                
REPRESENTATIVE HOLMES  said that  the goal was  for clarification                                                               
that the  intent for  the proposed  bill was not  to be  "a sting                                                               
operation," or a "big enforcement  effort."  She offered that her                                                               
intent  was for  this to  be "complaint  driven only,  and fairly                                                               
limited in scope," and not for "a big enforcement effort."                                                                      
                                                                                                                                
CHAIR HIGGINS said that the proposed bill would be held over.                                                                   
                                                                                                                                
MR.  ERVINE directed  attention back  to AS  18.35.344(c) through                                                               
(e),  page 3,  line 31  through page  4, line  13, which  allowed                                                               
peace officers,  or an employee  designated by  the commissioner,                                                               
to  issue  citations  for  violations  of the  new  law.    These                                                               
violations  could   be  reported   by  a  person   observing  the                                                               
violation.   He stated that it  went on to discuss  ticketing and                                                               
bail for violations.                                                                                                            
                                                                                                                                
3:54:47 PM                                                                                                                    
                                                                                                                                
MR. ERVINE directed  attention to AS 18.35.351, page  5, lines 30                                                               
- 31,  and page 6, lines  1 - 9, which  required the Commissioner                                                               
of DHSS "to administer and enforce  the provisions of the new law                                                               
and adopt regulations  as needed."  He referred  to AS 18.35.356,                                                               
page 6, lines 10 - 19,  which required the [DHSS] commissioner to                                                               
provide ongoing access to the  public about the law, including an                                                               
electronically    published   brochure    explaining   the    new                                                               
requirements for employers,  property owners, property operators,                                                               
and the public.   He said this was an  important component of the                                                               
proposed  bill,  as  it  focused  on  public  education  and  not                                                               
enforcement.                                                                                                                    
                                                                                                                                
MR.  ERVINE moved  on to  AS 18.35.357,  page 6,  lines 20  - 27,                                                               
noting that this  was an important protection  for employees from                                                               
retaliation by an  employer.  He said that AS  18.35.359, page 6,                                                               
lines  28  -  31,  and  page   7,  line  1,  established  that  a                                                               
municipality  may adopt  and enforce  local laws  that were  more                                                               
stringent  that  the  proposed  bill.     He  explained  that  AS                                                               
18.35.366, page 7,  lines 3 - 31  and page 8, lines 1  - 14, were                                                               
the definitions provided  for business, commissioner, department,                                                               
e-cigarette,  employee,  employer,  enclosed  area,  health  care                                                               
facility, private  club, place of  employment, public  place, and                                                               
smoking.                                                                                                                        
                                                                                                                                
MR. ERVINE referred to page 8,  lines 15 - 16, which repealed the                                                               
listed existing statutes.                                                                                                       
                                                                                                                                
CHAIR HIGGINS asked about the authority to issue citations.                                                                     
                                                                                                                                
MR. ERVINE  replied that the  proposed bill would  designate that                                                               
authority.                                                                                                                      
                                                                                                                                
REPRESENTATIVE  KELLER asked  for clarification  that the  person                                                               
issuing the citation had to see the offense committed.                                                                          
                                                                                                                                
MR. ERVINE referred to page 4, lines 21 - 23.                                                                                   
                                                                                                                                
REPRESENTATIVE KELLER asked  if the criteria for  a citation were                                                               
for the complainant to witness the offense.                                                                                     
                                                                                                                                
MR. ERVINE replied that either  a peace officer or the designated                                                               
department person could issue the citation.                                                                                     
                                                                                                                                
REPRESENTATIVE KELLER asked for more clarification.                                                                             
                                                                                                                                
REPRESENTATIVE HOLMES  offered her  understanding that  the peace                                                               
officer  must  witness  the  offense,  but  that  the  designated                                                               
department person did not have to witness it.                                                                                   
                                                                                                                                
3:59:14 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  PRUITT, asking  for clarification  that a  person                                                               
designated  by the  commissioner could  issue a  citation without                                                               
having to see the offense,  announced that this "could be opening                                                               
ourselves up" and declared "that's a slippery slope."                                                                           
                                                                                                                                
MR.   ERVINE   explained  that   the   intention   was  for   the                                                               
commissioner, or the designated person,  to follow up on a report                                                               
with a  letter, instead  of an  actual citation.   He  offered to                                                               
provide clarification in the proposed bill.                                                                                     
                                                                                                                                
REPRESENTATIVE   PRUITT    stated   his   recognition    for   an                                                               
indeterminate  fiscal  note,  as  it "could  be  huge  if  you're                                                               
talking about having  enough people out there for  all the little                                                               
situations."                                                                                                                    
                                                                                                                                
REPRESENTATIVE HOLMES said  that this was not the  intent for the                                                               
proposed   bill,   and   they   would  continue   to   work   for                                                               
clarification.                                                                                                                  
                                                                                                                                
REPRESENTATIVE  SEATON referred  to page  4, lines  16 -  17, and                                                               
stated that  a violation of AS  18.35.301 had to be  committed in                                                               
the presence of the officer,  although a citation could be issued                                                               
for a  violation of  AS 18.35.331  or AS  18.35.357 that  did not                                                               
occur in the presence of the officer.                                                                                           
                                                                                                                                
REPRESENTATIVE SEATON,  referring to page  5, line 27,  asked for                                                               
clarification and the intent that  a commissioner may bring civil                                                               
action to enjoin a violation of these statutes.                                                                                 
                                                                                                                                
REPRESENTATIVE  HOLMES replied  that this  would be  a result  of                                                               
non-compliance with the law.                                                                                                    
                                                                                                                                
REPRESENTATIVE  SEATON asked  if this  could result  from a  $100                                                               
violation in Superior Court.                                                                                                    
                                                                                                                                
REPRESENTATIVE  HOLMES explained  that enjoining  the action  was                                                               
similar to a temporary restraining  order after non-compliance to                                                               
repeated complaints.                                                                                                            
                                                                                                                                
MR.  ERVINE  pointed  out  that  the  fines  and  the  injunction                                                               
sections were  modeled from existing  law.  He  discussed Section                                                               
3, page 8, lines 17 -  20, which was uncodified law and clarified                                                               
that  the new  provisions of  the bill  applied to  violations or                                                               
failure  to comply  that occur  on or  after the  effective date.                                                               
Section  4,  page 8,  lines  21  -  26,  was uncodified  law  and                                                               
permitted  Department  of Health  and  Social  Services to  adopt                                                               
regulations  to implement  Section 1  of the  proposed bill.   He                                                               
noted  that any  regulations  could not  take  effect before  the                                                               
effective date.   He  concluded with  Sections 5  and 6,  page 8,                                                               
lines 27 and 28, which set  the effective date of October 1, 2014                                                               
for the bill, although Section 4 would take effect immediately.                                                                 
                                                                                                                                
4:05:32 PM                                                                                                                    
                                                                                                                                
MR. ERVINE paraphrased  from the Summary of  Changes [Included in                                                               
members'   packets]  and   stated   that  there   was  a   slight                                                               
modification of  the bill title.   He directed attention  to page                                                               
1,  line 8,  and said  that  the proposed  areas for  prohibiting                                                               
smoking had been split to  just include enclosed areas, with page                                                               
2, line  15, now including  enclosed areas  and the grounds.   On                                                               
page 2, line 1, "health care  facility" was deleted from the list                                                               
in  subsection (a)(1)(D).    On page  2,  lines 11  -  12, a  new                                                               
subparagraph  (H)  specified that  smoking  was  only allowed  in                                                               
vehicles  driven by  an owner/operator,  and not  in any  vehicle                                                               
used as  a place of  employment.  On page  3, line 1,  "or adult"                                                               
was inserted after  "children" to clarify that  the exemption was                                                               
for  private residences,  and did  not include  a location  where                                                               
adult care  was provided on a  fee for service basis.   Moving on                                                               
to page 3,  lines 13 - 17, he described  that subsections (b) and                                                               
(c)  were  combined and  rewritten  to  place responsibility  for                                                               
posting  signage that  smoking was  prohibited on  the person  in                                                               
charge of  the building.   On page 3,  lines 21 -  22, subsection                                                               
(d) was rewritten to require  the Department of Health and Social                                                               
Services to provide the required signs  in this section.  On page                                                               
3, AS 18.35.331, subsection (f) was  deleted, and on page 6, line                                                               
29,  "or  a political  subdivision  of  the state"  was  deleted.                                                               
Finally,  on  page  7,  lines  9 -  12,  the  definition  of  "e-                                                               
cigarette" was amended to include  a broader range of e-cigarette                                                               
products that  produce a vapor  for inhalation, even  though this                                                               
vapor  may  not be  nicotine,  but  could contain  other  harmful                                                               
toxins.                                                                                                                         
                                                                                                                                
4:08:47 PM                                                                                                                    
                                                                                                                                
The committee took an at-ease from 4:08 p.m. to 4:10 p.m.                                                                       
                                                                                                                                
4:10:23 PM                                                                                                                    
                                                                                                                                
CHAIR HIGGINS  said that  the proposed bill  would be  held over,                                                               
and he opened public testimony.                                                                                                 
                                                                                                                                
4:11:22 PM                                                                                                                    
                                                                                                                                
JANET  KINCAID, Business  Owner,  reported that  there  was a  no                                                               
smoking  ordinance in  Palmer with  almost universal  support and                                                               
that it had been very good for business and health.                                                                             
                                                                                                                                
CARMEN  LUNDE, Kodiak  Cabaret,  Hotel,  Restaurant, &  Retailers                                                               
Association (CHARR),  stated that government  intervention needed                                                               
to stop.   She declared  that the  proposed bill was  targeted at                                                               
bars,  as  there  was  no  longer smoking  in  the  other  places                                                               
described  in the  proposed  bill.   She  said  that Kodiak  used                                                               
common sense  for its  smoking issues and  allowed a  free choice                                                               
for  individuals.   She opined  that no  government at  any level                                                               
should have the right to dictate  how a business owner chooses to                                                               
run their business.   She declared that citizens  should have the                                                               
right to make their own choices.                                                                                                
                                                                                                                                
LARRY HACKENMILLER, member, Alaska  Cabaret, Hotel, Restaurant, &                                                               
Retailers  Association, stated  that the  Fairbanks City  Council                                                               
had decided that there was  sufficient choice and had decided not                                                               
to  implement  any   widespread  ban.    He   declared  that  the                                                               
statistics  for death  from  second hand  smoke  had not  changed                                                               
since initial  testimonies, and  he opined  that this  would have                                                               
declined  as there  were now  fewer smokers.   He  questioned the                                                               
hazards included  with smoking.  He  said that there was  not any                                                               
science  to support  harm  from e-cigarettes.    He compared  the                                                               
toxins,  chemicals,  and  carcinogens emitted  from  e-cigarettes                                                               
with  those from  candles,  declaring  them to  be  similar.   He                                                               
pointed out that candles were  not included in the proposed bill.                                                               
He stated  that, as 95  percent of restaurants in  Fairbanks were                                                               
non-smoking by  choice, the proposed  bill was not  necessary and                                                               
only  "makes  criminals   out  of  people"  and   "beefs  up  the                                                               
government  payroll  beyond  what's   necessary  and  it  doesn't                                                               
address  [the] real  issue."   He  referenced  the building  code                                                               
requirement for air exchanges, which  did not mention second hand                                                               
smoke, and he  said "well, this bull about,  well, the employee's                                                               
safety, it's a matter of preference  and an employee may not like                                                               
the  smell of  smoke or  whatever, but  it's still..  again, when                                                               
they keep  telling you that  we have a  right to smoke  free air,                                                               
well, that's  true, but  you also  have a  right to  smoke filled                                                               
air.   Those rights exist for  everybody."  He declared  that, as                                                               
the discussion  was for second hand  smoke, he had not  found any                                                               
research that "shows a miniscule exposure" was a health issue.                                                                  
                                                                                                                                
4:17:09 PM                                                                                                                    
                                                                                                                                
MARK MILITELLO, owner,  Sumo Vapor, said that, although  he was a                                                               
non-smoker, he did  not agree with a comparison  of cigarettes to                                                               
e-cigarettes.  He said he had  not yet been shown that anyone had                                                               
died from exposure  to e-cigarettes.  He offered  his belief that                                                               
e-cigarettes  should  be  compared   to  the  nicotine  patch  or                                                               
nicotine gum.   He stated that he was the  owner of an electronic                                                               
cigarette store,  and he opined  that e-cigarettes should  not be                                                               
included in the proposed bill.                                                                                                  
                                                                                                                                
DANIEL LYNCH  said that  he had  been a  smoker for  forty years,                                                               
although he  recognized that  it was  "a bad  habit."   He stated                                                               
that "a  few do-gooders want to  make me a criminal  for having a                                                               
bad  legal habit."    He  pointed out  that  he voluntarily  paid                                                               
substantial taxes  on his  cigarette purchases.   He  stated that                                                               
cigarette smoke was healthier than  tailpipe exhaust.  He relayed                                                               
that all  of his previous employers  had the freedom to  make and                                                               
enforce their  own policies on  work place  activities, including                                                               
smoking, and that these policies worked well.                                                                                   
                                                                                                                                
ANGELA  CARROLL, Owner,  Glacier  Vapors, said  that  she was  an                                                               
owner of  a vapor e-cigarette shop,  and that she was  opposed to                                                               
the  language including  electronic  cigarettes  in the  proposed                                                               
bill.  She  offered her belief that a business  owner should make                                                               
the decision to  allow vaping or smoking  in their establishment.                                                               
She  stated  that  e-cigarettes   should  not  be  included  with                                                               
cigarettes.   She  reported that  she had  been a  smoker for  37                                                               
years,  and  that  e-cigarettes   had  dramatically  lowered  her                                                               
nicotine intake.   She offered her belief that  the proposed bill                                                               
would  close  down  most  e-cigarette stores.    She  pointed  to                                                               
studies which  indicated that  vaping was  far less  harmful than                                                               
cigarettes, and  she asked for  an educated vote on  the proposed                                                               
bill, and  an exclusion  of e-cigarettes in  the language  of the                                                               
proposed bill.                                                                                                                  
                                                                                                                                
4:24:41 PM                                                                                                                    
                                                                                                                                
DALE FOX, President  & CEO, Alaska Cabaret,  Hotel, Restaurant, &                                                               
Retailers Association (CHARR), declared  that the "ban on smoking                                                               
is a ban on  bars."  He said that almost every  place on the list                                                               
was  already excluded  from smoking,  and  that most  communities                                                               
offered a  number of  choices for bars  and businesses  to visit.                                                               
He   said  that   CHARR  members   were  really   frightened,  as                                                               
significant losses of revenue were  reported after a smoking ban.                                                               
His observations were  that smoking bans had led to  a 30 percent                                                               
decrease in  revenue.  He stated  that there should be  a freedom                                                               
of choice  for smoking or non-smoking.   He said that  many CHARR                                                               
members were  angry, as local  votes had allowed  the maintenance                                                               
of both smoking and non-smoking  establishments.  He stated that,                                                               
if legislators  believed in smaller  government and the  right of                                                               
self-determination  by  local  government,  there  would  not  be                                                               
support of the proposed bill.                                                                                                   
                                                                                                                                
BETTY  MACTAVISH  commended  the committee  for  considering  the                                                               
proposed bill.   She reported  that only half of  Alaskan workers                                                               
were protected  by smoke free  workplace laws, and that  one non-                                                               
smoker died  from second hand  smoke for every nine  smokers "who                                                               
died  from their  addiction."   Her extended  exposure to  second                                                               
hand smoke had resulted in her  diagnosis as "having the lungs of                                                               
a smoker."   She stated that the science was  clear that exposure                                                               
to tobacco  smoke kills.   She addressed e-cigarettes  and second                                                               
hand aerosol, and stated that  this was not harmless water vapor,                                                               
as stated by  the tobacco industry.  She noted  that research had                                                               
just begun for the health  effects of e-cigarettes.  She reported                                                               
that  second  hand  e-cigarette aerosol  contained  nicotine  and                                                               
ultra-fine  particles,  concentrated  at levels  higher  than  in                                                               
conventional   tobacco   cigarette   smoke,   which   exacerbated                                                               
respiratory  ailments.   She  listed some  of  the compounds  and                                                               
metals known to be in  second hand e-cigarette aerosol, including                                                               
chromium,  nickel,  tin, benzene,  acetone,  and  glycerol.   She                                                               
shared  that  three  other states  had  already  protected  their                                                               
workers from  second hand aerosol  exposure from  e-cigarettes in                                                               
the work place by passing strong work place laws.                                                                               
                                                                                                                                
4:29:13 PM                                                                                                                    
                                                                                                                                
CHAIR HIGGINS stated that public testimony would be kept open.                                                                  
                                                                                                                                
4:29:32 PM                                                                                                                    
                                                                                                                                
The committee took a brief at-ease.                                                                                             
                                                                                                                                
4:30:47 PM                                                                                                                    
                                                                                                                                
MATT WAGNER,  Bad Boy Vapors  Alaska, LLC, stated  his opposition                                                               
to the proposed bill.   He expressed his agreement for consistent                                                               
regulation  of  smoking  in Alaska  and  the  detrimental  health                                                               
effects  to both  users and  those  in proximity  to second  hand                                                               
smoke.   He stated,  however, that  inclusion of  e-cigarettes in                                                               
the proposed  bill was a  mistake.   He declared "smoking  is not                                                               
vaping and vaping  is not smoking."  He explained  that there was                                                               
not  any  combustion from  use  of  e-cigarettes, and  therefore,                                                               
there were  no dangerous by-products.   He directed  attention to                                                               
studies which  indicated that the  second hand effects  of vaping                                                               
were  extremely negligible.   He  shared his  excitement for  the                                                               
success of  people who  had "quit  smoking paper  cigarettes with                                                               
the help  of electronic cigarettes."   He declared that  these e-                                                               
cigarettes were an  effective alternative, and that  they did not                                                               
put  anyone  at  risk  for  inhaling  the  toxic  by-products  of                                                               
smoking.   He  declared opposition  to the  proposed bill,  as it                                                               
would  no  longer be  possible  to  demonstrate the  benefits  of                                                               
vaping.                                                                                                                         
                                                                                                                                
SEAN  DASILVA,  Bad  Boy  Vapors Alaska,  LLC,  shared  that  the                                                               
aforementioned  technical   research  had   been  from   a  study                                                               
conducted almost  six years  prior, when  the industry  was still                                                               
extremely primitive.   He acknowledged that  the e-cigarettes and                                                               
the "e-juice"  were then  coming from China,  and that  there had                                                               
not been any  regulation.  He stated expectations for  the FDA to                                                               
regulate and  certify the "e-juice."   He pointed to  two studies                                                               
that  reported no  meaningful risk  from second  hand vapor.   He                                                               
asked  that  the  committee  gather   all  the  facts  to  better                                                               
understand  that  policy in  HB  360  for e-cigarettes  was  mis-                                                               
guided.                                                                                                                         
                                                                                                                                
[HB 360 was held over]                                                                                                          
                                                                                                                                
4:34:14 PM                                                                                                                    
                                                                                                                                
The committee took a brief at-ease.                                                                                             
                                                                                                                                
        SB 169-IMMUNIZATION PROGRAM; VACCINE ASSESSMENTS                                                                    
                                                                                                                                
4:35:14 PM                                                                                                                    
                                                                                                                                
CHAIR HIGGINS announced that the  next order of business would be                                                               
CS  FOR SENATE  BILL NO.  169(FIN), "An  Act establishing  in the                                                               
Department   of   Health   and  Social   Services   a   statewide                                                               
immunization program  and the  State Vaccine  Assessment Council;                                                               
creating  a  vaccine  assessment  account;  requiring  a  vaccine                                                               
assessment   from   assessable   entities   and   other   program                                                               
participants for statewide  immunization purchases; repealing the                                                               
temporary  child and  adult immunization  program; and  providing                                                               
for an effective date."                                                                                                         
                                                                                                                                
4:35:38 PM                                                                                                                    
                                                                                                                                
SENATOR  CATHY GIESSEL,  Alaska  State  Legislature, referred  to                                                               
earlier  testimony  regarding  HB   376,  for  extension  of  the                                                               
termination  date for  the Alaska  Health Care  Commission.   She                                                               
noted that the  commission reviewed the high cost  of health care                                                               
in Alaska,  and, as revenue  was declining  in the state,  it was                                                               
necessary to be very attentive to  the budget.  She declared that                                                               
"vaccines reduce  the cost  of health  care," and  that it  was a                                                               
recommendation  of  the  Alaska  Health  Care  Commission.    She                                                               
reported  that  SB  169   created  a  private/public  partnership                                                               
between the insurance companies  and self-insured groups with the                                                               
State of Alaska to address  vaccine costs through a state vaccine                                                               
assessment  council,  which  would  oversee  a  reinstatement  of                                                               
universal  vaccines in  Alaska through  the Department  of Health                                                               
and Social  Services (DHSS).   She reflected  on the  concerns of                                                               
health  care in  Alaska by  Senator  Ted Stevens,  and shared  an                                                               
anecdote  about the  generous funding  for  vaccines he  secured.                                                               
She  reminded  the committee  about  the  earlier high  rates  of                                                               
polio, as  well as Hepatitis  A & B,  and pointed out  that, with                                                               
vaccines, these had  almost been eradicated.  She  noted that the                                                               
last outbreak of measles in  Alaska, in 2000, had been introduced                                                               
by a  young unvaccinated child  arriving from South  Korea, which                                                               
resulted in  the understanding  for a need  of a  second measles,                                                               
mumps,  and  rubella  vaccine.    She  reported  that  there  was                                                               
currently an outbreak of chicken  pox in the Kenai/Soldotna area,                                                               
which was dangerous  for adult men, pregnant  women, and infants.                                                               
She  declared  that vaccines  could  prevent  chicken pox.    She                                                               
pointed out  that earlier  federal funding  of $4.3  million each                                                               
year to Alaska for vaccines was  now only $700,000.  She reported                                                               
on  a bill  that  had  been introduced  in  2012  as a  temporary                                                               
solution, Senate Bill  140, which had passed  unanimously in both                                                               
the House  and the Senate  to use  $4.3 million of  state funding                                                               
for three  years of  vaccines.   During this  time, the  DHSS had                                                               
been directed  to find a  funding solution other than  the state,                                                               
resulting in proposed  SB 169.  The proposed bill  would create a                                                               
council, page  2, line 19 through  page [4], line 8,  which would                                                               
operate  under  DHSS and  its  staff.    She explained  that  the                                                               
council would determine assessments  for the insurance companies,                                                               
and  then  use  that  money  to  buy  low  cost  vaccines  to  be                                                               
distributed   around  the   state.     She   allowed  that   this                                                               
public/private  partnership was  working  in  nine other  states,                                                               
resulting in substantial savings.   She referred to 24 letters of                                                               
support  [Included in  members' packets],  including a  letter of                                                               
support from Premera Blue Cross.                                                                                                
                                                                                                                                
4:43:38 PM                                                                                                                    
                                                                                                                                
ROSALYN  SINGLETON, MD,  Alaska Native  Tribal Health  Consortium                                                               
(ANTHC)  Immunization   Program,  stated  her  support   for  the                                                               
proposed  bill  to  improve  access  to  vaccines  for  Alaskans,                                                               
streamline  distribution, and  reduce  the administrative  burden                                                               
for providers, and she directed  attention to a PowerPoint titled                                                               
"Alaska  - What  have vaccines  done  for you."  She referred  to                                                               
slide  2, "Vaccination:  an ounce  of prevention  saves a  ton of                                                               
lives,"   which  offered   a  brief   summary  of   the  dramatic                                                               
improvement  in disease  control because  of universal  access to                                                               
vaccines  in  Alaska.   She  moved  on  to  slide 3,  "Vaccine  -                                                               
Preventable  Disease  Success,  Alaska,"   and  stated  that  Hib                                                               
meningitis,  measles, and  Hepatitis  A  outbreaks had  virtually                                                               
disappeared.    She pointed  out  that  measles were  most  often                                                               
brought in from  other countries, and in Alaska, this  was only a                                                               
plane  flight away.    She  declared that  it  was imperative  to                                                               
maintain  a high  rate of  vaccination  in children  in order  to                                                               
control  the  disease.    She discussed  slide  4,  "Polio,"  and                                                               
explained  that it  attacked the  nervous system,  causing muscle                                                               
weakness, paralysis, or  death.  She reported that  the last case                                                               
of polio  in the United States  had been in 1979,  although polio                                                               
was  still endemic  in  other parts  of the  world  and could  be                                                               
brought  into   the  country.     She  moved   on  to   slide  5,                                                               
"Diphtheria,"  and shared  an anecdote  of an  epidemic in  Nome,                                                               
which was  today highlighted by  the Iditarod Race.   She relayed                                                               
that  diphtheria was  also  a disease  of the  past  in the  U.S.                                                               
because of  vaccines.  Discussing slide  7, Hepatitis A and  B in                                                               
Alaska," she relayed that there  had been almost total control of                                                               
Hepatitis A  in Alaska since the  vaccine.  She pointed  to slide                                                               
6,  "Hib disease,"  and explained  that  it had  decreased.   She                                                               
concluded with  slide 8,  "Measles," and  stated that  Alaska had                                                               
not  had measles  since 2000.   She  emphasized that  since 2009,                                                               
providers had fronted  the cost of vaccine  for insured patients,                                                               
while separately  stocking private and state  purchased vaccines.                                                               
She relayed  that SB 169  would re-establish universal  access to                                                               
vaccines  through the  self-sustaining,  cost effective  private-                                                               
public partnership.                                                                                                             
                                                                                                                                
REPRESENTATIVE  REINBOLD  opined  that this  was  leveraging  the                                                               
state's buying power  to reduce the cost and  increase access for                                                               
vaccines.   She  asked if  there  were any  adverse reactions  or                                                               
concerns for vaccinations and immunizations on a larger scale.                                                                  
                                                                                                                                
DR. SINGLETON replied that all  vaccines could have adverse side-                                                               
effects.   She  stated that  vaccines  were the  most tested  and                                                               
regulated health care  benefit that we have.  She  said there was                                                               
not  any evidence  for significant  side effects  from the  newer                                                               
vaccines, as they  had been extensively tested  with post vaccine                                                               
testing and evaluation.                                                                                                         
                                                                                                                                
4:50:50 PM                                                                                                                    
                                                                                                                                
DR.  SINGLETON, in  response to  Representative Reinbold,  stated                                                               
that there was  not any link between vaccines and  autism.  There                                                               
had been a 1998 paper published  in Britain, based on research of                                                               
12 children, claiming  a link between vaccines  and autism, which                                                               
had  ultimately been  found  to  be fraudulent.    The paper  was                                                               
disavowed by  the British Medical  Journal, and the data  had not                                                               
been replicated  in subsequent studies.   She declared  that this                                                               
report had  sparked unwarranted concerns,  and she  expressed her                                                               
confidence  that there  was  not any  link  between vaccines  and                                                               
autism.                                                                                                                         
                                                                                                                                
REPRESENTATIVE REINBOLD  said that  the proposed bill  could have                                                               
"a long term, very positive effect on our state budget."                                                                        
                                                                                                                                
CHAIR  HIGGINS   expressed  his  agreement  with   evidence  that                                                               
vaccines were  good.  He  declared that the proposed  bill raised                                                               
the question  for how  to pay  for this.   He stated  his concern                                                               
with third  party payers and  Tricare making these payments.   He                                                               
stated that he wanted to make the program work.                                                                                 
                                                                                                                                
CHAIR HIGGINS  asked for more  information about the  third party                                                               
payer, specifically  Tricare, as the  focus of the  proposed bill                                                               
was for adult  immunizations.  He stated that  federal money paid                                                               
for child  immunizations.   He opined that  the "donut  hole" was                                                               
for adult immunizations, as Medicare  did not offer coverage.  He                                                               
asked how the proposed program would  work for adults.  He stated                                                               
that only  one other state  included adults in  vaccine coverage.                                                               
He  offered his  belief that  Vermont most  closely mirrored  the                                                               
proposed bill.                                                                                                                  
                                                                                                                                
4:56:14 PM                                                                                                                    
                                                                                                                                
JILL LEWIS,  Deputy Director -  Juneau, Central  Office, Division                                                               
of  Public  Health, Department  of  Health  and Social  Services,                                                               
expressed agreement  that Vermont had included  adult vaccines in                                                               
its universal  program since  2009.   She declared  that, without                                                               
the proposed  bill, when the  temporary funding for  vaccines was                                                               
depleted at  the end of  2015, the state  would not have  a state                                                               
supply  for all  children.   She  clarified that  the only  state                                                               
supplied vaccine would be for  the 50 percent of children covered                                                               
by a federal  program, Vaccines for Children.   She reported that                                                               
this  would  only  include   Medicaid,  Alaska  Native,  American                                                               
Indian,  and uninsured  children.   She stated  that anyone  with                                                               
private  pay  insurance  would not  receive  any  state  supplied                                                               
vaccine, as the burden would be  on the providers to purchase and                                                               
pay up front  for vaccines, and then seek  reimbursement from the                                                               
payers.  She  explained that there was no safety  net program for                                                               
adults, and each payer would need  to be assessed funding for its                                                               
patients.  She  noted that Tricare had not  participated and paid                                                               
the  reimbursement  in  other  states.   She  reported  that  the                                                               
proposed  bill had  reviewed  the programs  in  other states  and                                                               
decided  that, should  Tricare not  participate,  then the  state                                                               
would not supply  the vaccine and other payers would  not have to                                                               
pay, so the  providers would continue to purchase  the vaccine on                                                               
the open market and continue  to seek reimbursement from Tricare,                                                               
as was  the current practice.   She said that the  provider could                                                               
continue to  purchase vaccines  privately when  there was  not an                                                               
accessible payer.                                                                                                               
                                                                                                                                
REPRESENTATIVE  NAGEAK asked  that  the vaccine  for shingles  be                                                               
made available for people.                                                                                                      
                                                                                                                                
REPRESENTATIVE  KELLER reflected  that the  proposed bill  was "a                                                               
big issue  and lots of  pitfalls in it."   He requested  that the                                                               
questions  be  answered  before  the  bill  was  moved  from  the                                                               
committee,  that any  unintended consequences  be addressed,  and                                                               
that the costs be closely reviewed.                                                                                             
                                                                                                                                
CHAIR HIGGINS said that [SB 169] would be held over.                                                                            
                                                                                                                                
5:03:15 PM                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no  further business before the  committee, the House                                                               
Health  and  Social  Services   Standing  Committee  meeting  was                                                               
adjourned at 5:03 p.m.                                                                                                          

Document Name Date/Time Subjects
SB169 Sponsor Statement FIN.pdf HHSS 3/25/2014 3:00:00 PM
SB 169
SB0169-1-2-022414-DHS-Y.PDF HHSS 3/25/2014 3:00:00 PM
SB 169
SB0169-2-2-022414-DHS-Y.PDF HHSS 3/25/2014 3:00:00 PM
SB 169
SB0169-3-3-022414-DHS-Y.PDF HHSS 3/25/2014 3:00:00 PM
SB 169
SB0169-4-2-022414-CED-N.PDF HHSS 3/25/2014 3:00:00 PM
SB 169
SB0169-5-2-022414-ADM-Y.PDF HHSS 3/25/2014 3:00:00 PM
SB 169
SB0169-6-2-030714-DHS-Y.PDF HHSS 3/25/2014 3:00:00 PM
SB 169
SB0169-7-3-030714-DHS-Y.PDF HHSS 3/25/2014 3:00:00 PM
SB 169
SB0169-8-2-030714-DHS-Y.PDF HHSS 3/25/2014 3:00:00 PM
SB 169
SB169 Vaccines In AK short vsn (2).pptx HHSS 3/25/2014 3:00:00 PM
SB 169
SB169FlowChart_7Mar2014.pdf HHSS 3/25/2014 3:00:00 PM
SB 169
SB169PayerPyramid_7Mar2014.pdf HHSS 3/25/2014 3:00:00 PM
SB 169
SB 169 Support Letters.pdf HHSS 3/25/2014 3:00:00 PM
SB 169
SB 169 Support Emails.pdf HHSS 3/25/2014 3:00:00 PM
SB 169
SB 169 Support Dr. Harvey.pdf HHSS 3/25/2014 3:00:00 PM
SB 169
SB 169 Support Dr Lamm NH.pdf HHSS 3/25/2014 3:00:00 PM
SB 169
SB 169 Sectional Analsis vsn I.pdf HHSS 3/25/2014 3:00:00 PM
SB 169
SB 169 Historic vaccine photo.pdf HHSS 3/25/2014 3:00:00 PM
SB 169
SB 169 FN Vaccine Assmt Acct.pdf HHSS 3/25/2014 3:00:00 PM
SB 169
SB 169 FN Medicaid Svs.pdf HHSS 3/25/2014 3:00:00 PM
SB 169
SB 169 FN Fund Capitalization.pdf HHSS 3/25/2014 3:00:00 PM
SB 169
SB 169 FN Epidemiology.pdf HHSS 3/25/2014 3:00:00 PM
SB 169
SB 169 FN DCCED Insurance.pdf HHSS 3/25/2014 3:00:00 PM
SB 169
SB 169 FN Admin.pdf HHSS 3/25/2014 3:00:00 PM
SB 169
2014_03_19 WA Letter from Dr. Harvey in support of AK S B _169_FINAL.pdf HHSS 3/25/2014 3:00:00 PM
SB 169 FAQs vsn I.pdf HHSS 3/25/2014 3:00:00 PM
SB 169
SB0169 Version I.PDF HHSS 3/25/2014 3:00:00 PM
SB 169
HB0374A.PDF HHSS 3/25/2014 3:00:00 PM
HB 374
HB0376A.PDF HHSS 3/25/2014 3:00:00 PM
HB 376
HB 376 Sponsors Statement.pdf HHSS 3/25/2014 3:00:00 PM
HB 376
HB 360 Version A.pdf HHSS 3/25/2014 3:00:00 PM
HB 360
HB 360 Sponsor Statement.pdf HHSS 3/25/2014 3:00:00 PM
HB 360
HB 360-CA A Cancer Journal for Clinicians.pdf HHSS 3/25/2014 3:00:00 PM
HB 360
HB 360 Smoke-Free Indoor Workplaces Supporters as of 3-5-14.pdf HHSS 3/25/2014 3:00:00 PM
HB 360
HB 360- Borough Smoke Free Law.pdf HHSS 3/25/2014 3:00:00 PM
HB 360
HB 360- Alaska Smoke-Free Indoor Workplaces Summary from Coalition.pdf HHSS 3/25/2014 3:00:00 PM
HB 360
HB 360- acscan-smoke-free-laws-report-summary.pdf HHSS 3/25/2014 3:00:00 PM
HB 360
HCR21 ver U.PDF HHSS 3/25/2014 3:00:00 PM
HCR21 Sponsor Statement.pdf HHSS 3/25/2014 3:00:00 PM
HCR21 Supporting Documents-Safehorizon stats.pdf HHSS 3/25/2014 3:00:00 PM
HCR21 Supporting Documents-US DHHS Webpage.pdf HHSS 3/25/2014 3:00:00 PM
HB 360 Opposed 2.PDF HHSS 3/25/2014 3:00:00 PM
HB 360
HB Opposed 3.PDF HHSS 3/25/2014 3:00:00 PM
HB 360 Opposed 4.PDF HHSS 3/25/2014 3:00:00 PM
HB 360
HB 360 Opposed 5.PDF HHSS 3/25/2014 3:00:00 PM
HB 360
HB 360 Opposed 6.PDF HHSS 3/25/2014 3:00:00 PM
HB 360
HB 360 Opposed 7.PDF HHSS 3/25/2014 3:00:00 PM
HB 360
HB 360 Opposed 8.PDF HHSS 3/25/2014 3:00:00 PM
HB 360
HB 360 Opposed 9.PDF HHSS 3/25/2014 3:00:00 PM
HB 360
HB 360 Opposed 10.PDF HHSS 3/25/2014 3:00:00 PM
HB 360
HB 360 Opposed 11.PDF HHSS 3/25/2014 3:00:00 PM
HB 360
HB 360 Opposed 12.PDF HHSS 3/25/2014 3:00:00 PM
HB 360
HB 360 Opposed 13.PDF HHSS 3/25/2014 3:00:00 PM
HB 360
HB 360 Opposed 14.PDF HHSS 3/25/2014 3:00:00 PM
HB 360
HB374-DCCED-DOI-03-21-14.pdf HHSS 3/25/2014 3:00:00 PM
HB 374
HB374-DHSS-EPI-03-21-14.pdf HHSS 3/25/2014 3:00:00 PM
HB 374
HB374-DHSS-HCMS-03-21-14.pdf HHSS 3/25/2014 3:00:00 PM
HB 374
HB374-DHSS-VAA-03-21-14.pdf HHSS 3/25/2014 3:00:00 PM
HB 374
HB374-DOA-HPA-03-21-14.pdf HHSS 3/25/2014 3:00:00 PM
HB 374
HB376-DHSS-CO-03-20-14.pdf HHSS 3/25/2014 3:00:00 PM
HB 376
HB 360 Opposed 10.PDF HHSS 3/25/2014 3:00:00 PM
HB 360
HB360-DEC-FSS-03-21-14.pdf HHSS 3/25/2014 3:00:00 PM
HB 360
HB360-DHSS-CO-03-21-14.pdf HHSS 3/25/2014 3:00:00 PM
HB 360
HB360-DOT-IASO-3-21-14.pdf HHSS 3/25/2014 3:00:00 PM
HB 360
HB360-DOT-MVO-3-21-14.pdf HHSS 3/25/2014 3:00:00 PM
HB 360
HB360-DOT-SEF-3-21-14.pdf HHSS 3/25/2014 3:00:00 PM
HB 360
HB360-DOT-TMS-3-21-14.pdf HHSS 3/25/2014 3:00:00 PM
HB 360
HB360-DOA-PUR-03-21-14.pdf HHSS 3/25/2014 3:00:00 PM
HB 360
HB 360 Draft CS.pdf HHSS 3/25/2014 3:00:00 PM
HB 360
HB 360-Electronic Cigarette and Secondhand Aerosol (FS-39) 2014-02-181.pdf HHSS 3/25/2014 3:00:00 PM
HB 360
HB 360- NYT Article.pdf HHSS 3/25/2014 3:00:00 PM
HB 360
HB 360-Electronic Cigarette and Secondhand Aerosol (FS-39) 2014-02-181.pdf HHSS 3/25/2014 3:00:00 PM
HB 360
HCR21 Supporting Document-National Timeline.pdf HHSS 3/25/2014 3:00:00 PM
HCR21 Supporting Document-Maltreatment Data Website.pdf HHSS 3/25/2014 3:00:00 PM
HCR21 Supporting Document-Dec2013 Foster Placement.pdf HHSS 3/25/2014 3:00:00 PM
HCR21 Supporting Document-Dec2013 Allegations Substantiated.pdf HHSS 3/25/2014 3:00:00 PM
HCR21 Supporting Document-Dec2013 Allegations Received.pdf HHSS 3/25/2014 3:00:00 PM
HB 360 Sectional Summary.pdf HHSS 3/25/2014 3:00:00 PM
HB 360
HB 360 Summary of Changes 3.pdf HHSS 3/25/2014 3:00:00 PM
HB 360
HB 376 2013AnnualReportFINAL.pdf HHSS 3/25/2014 3:00:00 PM
HB 376
HB 360 Support.PDF HHSS 3/25/2014 3:00:00 PM
HB 360
HB 360- ATCA E-Cigarette Statement for Committee Hearing 3-25-14.pdf HHSS 3/25/2014 3:00:00 PM
HB 360
HB 360 Letter of Support 1.pdf HHSS 3/25/2014 3:00:00 PM
HB 360
HB 360 Letter of Support 2.pdf HHSS 3/25/2014 3:00:00 PM
HB 360
HB 360 Letter of Support 3.pdf HHSS 3/25/2014 3:00:00 PM
HB 360
HB 360 Letter of Support 4.pdf HHSS 3/25/2014 3:00:00 PM
HB 360
HB 360 E-cig Or. Ct CA edit.pdf HHSS 3/25/2014 3:00:00 PM
HB 360
HB 360 17 sug gen.pdf HHSS 3/25/2014 3:00:00 PM
HB 360
HB 360 AMA E-Cig v tobacco.pdf HHSS 3/25/2014 3:00:00 PM
HB 360
HB 360 comment to CA similar bill.pdf HHSS 3/25/2014 3:00:00 PM
HB 360
HB 360 e- cig NY Times edit.pdf HHSS 3/25/2014 3:00:00 PM
HB 360
HB 360 E-Cig Juneau emp.pdf HHSS 3/25/2014 3:00:00 PM
HB 360
HB 360 fm pres Am Lung Assoc.pdf HHSS 3/25/2014 3:00:00 PM
HB 360
HB 360 Wash Times edit.pdf HHSS 3/25/2014 3:00:00 PM
HB 360
HB 360 Letter of Support 5.pdf HHSS 3/25/2014 3:00:00 PM
HB 360
HB 376 Resolutions 3 25 2014.pdf HHSS 3/25/2014 3:00:00 PM
HB 376
SB 169 Support Premera.pdf HHSS 3/25/2014 3:00:00 PM
SB 169
HB 376 AHCC audit rpt-2013.pdf HHSS 3/25/2014 3:00:00 PM
HB 376
HB 360 Technical report 3 25 2014.PDF HHSS 3/25/2014 3:00:00 PM
HB 360
HB 360 Research article informa healthcare 302502014.PDF HHSS 3/25/2014 3:00:00 PM
HB 360