Legislature(2017 - 2018)CAPITOL 106

04/27/2017 03:00 PM HEALTH & SOCIAL SERVICES

Note: the audio and video recordings are distinct records and are obtained from different sources. As such there may be key differences between the two. The audio recordings are captured by our records offices as the official record of the meeting and will have more accurate timestamps. Use the icons to switch between them.

Download Mp3. <- Right click and save file as
Download Video part 1. <- Right click and save file as

* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
-- Delayed to 10 Minutes Following Session --
+ Bills Previously Heard/Scheduled TELECONFERENCED
*+ HB 234 EXTEND ALASKA HEALTH CARE COMMISSION TELECONFERENCED
Heard & Held
*+ HB 236 EXTEND SENIOR BENEFITS PAYMENT PROGRAM TELECONFERENCED
Heard & Held
                     ALASKA STATE LEGISLATURE                                                                                 
       HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                    
                          April 27, 2017                                                                                        
                            3:48 p.m.                                                                                           
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Ivy Spohnholz, Chair                                                                                             
Representative Sam Kito                                                                                                         
Representative Geran Tarr                                                                                                       
Representative Jennifer Johnston                                                                                                
Representative Colleen Sullivan-Leonard                                                                                         
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Representative Bryce Edgmon, Vice Chair                                                                                         
Representative David Eastman                                                                                                    
                                                                                                                                
Representative Matt Claman (alternate)                                                                                          
Representative Dan Saddler (alternate)                                                                                          
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
HOUSE BILL NO. 234                                                                                                              
"An Act extending the termination date of the Alaska Health Care                                                                
Commission; and providing for an effective date."                                                                               
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
HOUSE BILL NO. 236                                                                                                              
"An Act extending the Alaska senior benefits payment program."                                                                  
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: HB 234                                                                                                                  
SHORT TITLE: EXTEND ALASKA HEALTH CARE COMMISSION                                                                               
SPONSOR(s): REPRESENTATIVE(s) GUTTENBERG                                                                                        
                                                                                                                                
04/16/17       (H)       READ THE FIRST TIME - REFERRALS                                                                        
04/16/17       (H)       HSS, FIN                                                                                               
04/25/17       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
04/25/17       (H)       -- MEETING CANCELED --                                                                                 
04/27/17       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
BILL: HB 236                                                                                                                  
SHORT TITLE: EXTEND SENIOR BENEFITS PAYMENT PROGRAM                                                                             
SPONSOR(s): REPRESENTATIVE(s) KAWASAKI                                                                                          
                                                                                                                                
04/17/17       (H)       READ THE FIRST TIME - REFERRALS                                                                        
04/17/17       (H)       HSS, FIN                                                                                               
04/25/17       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
04/25/17       (H)       -- MEETING CANCELED --                                                                                 
04/27/17       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
REPRESENTATIVE DAVID GUTTENBERG                                                                                                 
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented HB 234 as the sponsor of the                                                                   
bill.                                                                                                                           
                                                                                                                                
KRISTIN CURTIS                                                                                                                  
Legislative Auditor                                                                                                             
Legislative Audit Division                                                                                                      
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified during discussion of HB 234.                                                                   
                                                                                                                                
DEBORAH ERICKSON, Project Coordinator                                                                                           
Office of the Commissioner                                                                                                      
Department of Health and Social Services                                                                                        
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified during discussion of HB 234.                                                                   
                                                                                                                                
JEANNIE MONK, Vice President                                                                                                    
Alaska State Hospital and Nursing Home Association (ASHNHA)                                                                     
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of HB 234.                                                                          
                                                                                                                                
MERCEDES COLBERT, Staff                                                                                                         
Representative Scott Kawasaki                                                                                                   
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented HB 236 on behalf of the bill                                                                   
sponsor, Representative Kawasaki.                                                                                               
                                                                                                                                
REPRESENTATIVE SCOTT KAWASAKI                                                                                                   
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Answered questions about HB 236, as the                                                                  
sponsor of the bill.                                                                                                            
                                                                                                                                
MONICA WINDOM, Director                                                                                                         
Director's Office                                                                                                               
Division of Public Assistance                                                                                                   
Department of Health and Social Services (DHSS)                                                                                 
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Responded to  questions during discussion of                                                             
HB 236.                                                                                                                         
                                                                                                                                
KEN HELANDER, Advocacy Director                                                                                                 
AARP                                                                                                                            
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of HB 236.                                                                          
                                                                                                                                
DAVID BLACKETER, Chair                                                                                                          
Alaska Commission on Aging                                                                                                      
Kodiak, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in support of HB 236.                                                                          
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
3:48:15 PM                                                                                                                    
                                                                                                                                
CHAIR IVY SPOHNHOLZ  called the House Health  and Social Services                                                             
Standing   Committee    meeting   to    order   at    3:48   p.m.                                                               
Representatives Spohnholz, Kito,  Sullivan-Leonard, and Tarr were                                                               
present at  the call to  order.  Representative  Johnston arrived                                                               
as the meeting  was in progress. [Due  to technical difficulties,                                                               
the first ten minutes of the recording is at a very low volume.]                                                                
                                                                                                                                
3:49:06 PM                                                                                                                    
                                                                                                                                
           HB 234-EXTEND ALASKA HEALTH CARE COMMISSION                                                                      
                                                                                                                                
CHAIR SPOHNHOLZ announced that the  first order of business would                                                               
be HOUSE BILL NO. 234, "An  Act extending the termination date of                                                               
the  Alaska   Health  Care  Commission;  and   providing  for  an                                                               
effective date."                                                                                                                
                                                                                                                                
REPRESENTATIVE  DAVID   GUTTENBERG,  Alaska   State  Legislature,                                                               
paraphrased  from the  Sponsor  Statement  [Included in  members'                                                               
packets] which read as follows [original punctuation provided]:                                                                 
                                                                                                                                
     The   Alaska   Health   Care   Commission   was   first                                                                    
     established by Governor Palm on  December 4, 2008 under                                                                    
     Administrative  Order #246.  In  2010, the  legislature                                                                    
     passed  SB 172,  establishing  the  Alaska Health  Care                                                                    
     Commission  in Statute.  The  legislature's intent  was                                                                    
     that the Commission would be  a permanent instrument to                                                                    
     address the need  for health care reform  in our state.                                                                    
     The  Commission worked  to  identify opportunities,  as                                                                    
     well  as a  broad  set of  strategies,  to improve  the                                                                    
     quality, accessibility and  availability of health care                                                                    
     for  all citizens  of the  State. These  strategies and                                                                    
     recommendations  can  be   found  in  the  Commission's                                                                    
     reports that were issued annually from 2009-20 14.                                                                         
                                                                                                                                
     In 2015 the Commission  was defunded. Alaska's need for                                                                    
     health  care reform  remains one  of the  most critical                                                                    
     challenges we  face. At $10  billion in  total spending                                                                    
     annually25%   of which  is  administered  by the  state                                                                    
     government   health care  is  one  of Alaska's  largest                                                                    
     consumer product  industries. When this  enormous scale                                                                    
     is considered  in conjunction with  the fact  that that                                                                    
     the state  government is the  largest single  payer for                                                                    
     those  services,   there  is   a  clear  need   for  an                                                                    
     instrument that  identifies the  costs and  benefits of                                                                    
     the health  care system, and identifies  strategies for                                                                    
     ensuring sustainability  therein. Extending  the Alaska                                                                    
     Health Care  Commission will give  the state a  tool to                                                                    
     address this crucial priority.                                                                                             
                                                                                                                                
REPRESENTATIVE  GUTTENBERG added  that  the proposed  bill had  a                                                               
zero-fiscal  note.     He  said  that  the   Alaska  Health  Care                                                               
Commission,  when  funded,  had done  considerable  things,  even                                                               
though, he opined, it did not  have as large a perspective on the                                                               
state health care.  He  acknowledged that the commission did make                                                               
considerable recommendations,  even though  these recommendations                                                               
were all too  often put on the  shelf and never read.   He stated                                                               
that  the   commission  was   a  tool   for  the   Department  of                                                               
Administration and  Department of  Health and Social  Services to                                                               
"have the  ability to respond in  a cohesive way" to  any changes                                                               
in the health care environment.                                                                                                 
                                                                                                                                
REPRESENTATIVE  SULLIVAN-LEONARD shared  her background  with the                                                               
commission  and  asked about  the  report  recommendation to  not                                                               
further this specific commission, which  was based on a challenge                                                               
for the development of a statewide health plan.                                                                                 
                                                                                                                                
REPRESENTATIVE GUTTENBERG replied that  the audit had stated that                                                               
the commission  was not  operating in  the state's  best interest                                                               
although it  was not being  funded and  was not functioning.   He                                                               
offered  his belief  that there  had been  consideration for  the                                                               
overall "larger picture  that the state should be  doing.  Should                                                               
it be looking  at the entire, to build a  comprehensive plan from                                                               
the  top  down."    He  stated  that  the  commission  did  offer                                                               
considerable  recommendations.   He noted  that although  some of                                                               
the commission  members felt more  should be done, the  focus had                                                               
been narrowed.   He expressed his agreement with  the audit which                                                               
reported that an entire picture  of the state should be reviewed.                                                               
He  pointed  to  the  vastness  of  all  the  components  of  the                                                               
Department of  Health and Social  Services and  acknowledged that                                                               
he did not  know how to develop the entire  picture even as there                                                               
was a lot to do.                                                                                                                
                                                                                                                                
REPRESENTATIVE   GUTTENBERG   pointed   to   the   work   already                                                               
accomplished, and the current  recommendations, noting that there                                                               
was still so much to be addressed by the legislature.                                                                           
                                                                                                                                
CHAIR SPOHNHOLZ asked if he  had considered "revisiting the scope                                                               
of  the  commission's  work"  along with  the  extension  of  the                                                               
termination date.                                                                                                               
                                                                                                                                
REPRESENTATIVE  GUTTENBERG  opined  that the  current  scope  was                                                               
quite  broad, noting  that there  was only  one person  currently                                                               
designated to the commission, the  Chief Medical Officer from the                                                               
Department of Health and Social Services.                                                                                       
                                                                                                                                
CHAIR SPOHNHOLZ asked  how the work could be  accomplished with a                                                               
zero-fiscal note.                                                                                                               
                                                                                                                                
REPRESENTATIVE GUTTENBERG  explained that this would  only affect                                                               
travel, so, until there were  anticipated costs, there would be a                                                               
zero-fiscal note.  If something  was only being extended, without                                                               
any changes, then there would not be a fiscal note.                                                                             
                                                                                                                                
REPRESENTATIVE JOHNSTON asked when the commission had stopped.                                                                  
                                                                                                                                
REPRESENTATIVE GUTTENBERG,  in response, said that  the technical                                                               
answer would be at the  last election, as the membership changed.                                                               
He pointed out that the  commission had not actually lapsed, even                                                               
though it had  not been functioning due to a  lack of funding and                                                               
a meeting had  not been called. He added that  there were not any                                                               
required meetings or functions.                                                                                                 
                                                                                                                                
REPRESENTATIVE  JOHNSTON  expressed  her  confusion,  reiterating                                                               
that there  was not a fiscal  note because there had  not been an                                                               
increase  in  cost  because  there had  not  been  a  functioning                                                               
commission.    She asked  if,  currently,  there was  any  amount                                                               
budgeted for this commission.                                                                                                   
                                                                                                                                
REPRESENTATIVE GUTTENBERG,  in response, offered his  belief that                                                               
the  state   responsibility  to  the  commission   had  been  for                                                               
staffing, and that the only  costs were for teleconferencing.  He                                                               
said  that until  a meeting  was anticipated,  there was  not any                                                               
anticipated cost.                                                                                                               
                                                                                                                                
CHAIR  SPOHNHOLZ suggested  that  this was  an  issue whereby  to                                                               
ensure that  the commission had  the funding it needed,  it would                                                               
need a directive.                                                                                                               
                                                                                                                                
4:00:16 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR  offered her  belief that the  commission had                                                               
completed all the work originally recommended.                                                                                  
                                                                                                                                
4:01:46 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  GUTTENBERG  opined   that  the  recommended  work                                                               
extended back  beyond that last  commission report and  there had                                                               
been  many  recommendations  put   forward  while  few  had  been                                                               
completed.   He said that the  previous budgets from FY13  - FY15                                                               
had been $350  - $450,000.  He stated that  the commissioners had                                                               
asked that  the commission be renewed.   He noted that  the zero-                                                               
fiscal note had been presented by the commission office.                                                                        
                                                                                                                                
CHAIR SPOHNHOLZ  surmised that although  the commission  had work                                                               
to be done, they had stopped acting due to a lack of funds.                                                                     
                                                                                                                                
4:03:13 PM                                                                                                                    
                                                                                                                                
KRISTIN CURTIS, Legislative  Auditor, Legislative Audit Division,                                                               
Alaska State  Legislature, explained  that there were  two audits                                                               
in the meeting packets, dated 2013  and 2016.  She explained that                                                               
the  purpose of  a sunset  [clause]  was to  determine whether  a                                                               
board  or  commission  was  serving  the  public's  interest  and                                                               
whether it  should be  extended.  She  directed attention  to the                                                               
2013 audit  [Included in member's  packets] and stated  that this                                                               
was the  first time  the commission had  been subject  to sunset,                                                               
and background  had been  included in the  report.   She reported                                                               
that the  Alaska Health  Care Commission was  created as  a means                                                               
for  health care  reform and  was  first established  in 2008  by                                                               
administrative order.  She added  that it was then established in                                                               
statute in 2010.  She  reported that the legislature had intended                                                               
for the commission  to achieve reform through  the development of                                                               
a  statewide health  plan, which  was to  be based  on education,                                                               
sustainability,     management     efficiency,    health     care                                                               
effectiveness,  public private  partnerships, research,  personal                                                               
responsibility and  individual choice.  The  original commission,                                                               
in  2008,  had stated  that  it  was  not its  responsibility  to                                                               
develop  a plan,  but  instead, the  commission  had focused  its                                                               
efforts on specific policy recommendations.   When the commission                                                               
was re-established in statute in  2010, the members had agreed to                                                               
continue the  prior commission's  work and  had adopted  the same                                                               
general  approach.   Instead  of  working on  a  state plan,  the                                                               
commission collected  information from  various cost  studies and                                                               
developed  high level  policy  recommendations.   The  commission                                                               
also  established  general priorities  which  did  evolve into  a                                                               
strategic framework,  included as  Appendix 8  of the  2013 audit                                                               
report.   She shared that the  2013 audit had concluded  that the                                                               
commission  was  operating  in the  public's  interest,  although                                                               
improvements in  developing a state  plan were needed  to justify                                                               
its continued existence.  The  commission's statutory purpose was                                                               
to provide  recommendations for and  foster the development  of a                                                               
statewide health  plan to address  the quality  accessibility and                                                               
availability  of health  care for  citizens  of the  state.   The                                                               
legislature intended the commission  to work collaboratively with                                                               
Department   of  Health   and  Social   Services  to   develop  a                                                               
comprehensive   health    plan.      Although    various   policy                                                               
recommendations  were developed,  the audit  had determined  that                                                               
the  commission  and  the  department  had  not  collaborated  to                                                               
develop the plan.   The audit recommended to  limit the extension                                                               
to  three  years  and  discussed  this  recommendation  with  the                                                               
Commissioner of Department of Health  and Social Services and the                                                               
Alaska Health Care  Commission.  The audit  report concluded that                                                               
the commission  was active,  and the report  was positive  in its                                                               
review  for all  the activities  accomplished by  the commission.                                                               
She  shared  that  several  studies had  been  conducted  by  the                                                               
commission, and  a foundation for a  plan had been created.   She                                                               
directed  attention to  Appendix A,  the strategic  framework for                                                               
the plan,  which, she declared, lacked  actionable components for                                                               
implementation and  did not specify  actions to be taken,  a time                                                               
frame  for  completion,  the definition  of  what  constituted  a                                                               
successful  outcome  and  how  that would  be  measured,  or  the                                                               
organization  responsible for  taking the  action.   She reported                                                               
that it was determined that  the activities of the commission may                                                               
not effectively  impact health care  in Alaska.  She  stated that                                                               
the  lack  of a  plan  was  caused  by some  ambiguous  statutes,                                                               
outlying  responsibilities, and  a lack  of coordination  between                                                               
Department  of Health  and Social  Services  and the  commission.                                                               
She directed attention  to the 2013 audit, page  35, which listed                                                               
the  departmental response  to the  audit.   She shared  that the                                                               
main  recommendation was  for  the commission  to  work with  the                                                               
commissioner  of  Department of  Health  and  Social Services  to                                                               
identify  and  define the  responsibilities  and  roles and  then                                                               
pursue development of the plan  accordingly.  Directing attention                                                               
back  to page  35, she  noted that  the department  had partially                                                               
concurred with that recommendation.   They had suggested that the                                                               
framework had not  received enough credit as a  plan, even though                                                               
it  had  offered many  recommendations  and  had  made a  lot  of                                                               
progress.   She  added  that the  commissioner  of Department  of                                                               
Health  and  Social  Services  had  written  in  support  of  the                                                               
recommendation, offering to  provide a memo to  the commission to                                                               
delineate its  responsibilities and  then actively work  with the                                                               
commission to make this actionable  plan.  The commissioner would                                                               
also direct the  department to collaborate on  the development of                                                               
a   measurable  action   plan  to   implement  the   commission's                                                               
significant  policy  recommendations.    After  this  report  was                                                               
issued, the House  Finance Committee Sub Committee  on Health and                                                               
Social Services held  a hearing on October 22,  in Fairbanks, and                                                               
the  commissioner of  Department  of Health  and Social  Services                                                               
responded to the report.                                                                                                        
                                                                                                                                
4:08:58 PM                                                                                                                    
                                                                                                                                
MS.  CURTIS reiterated  the comments  by the  commissioner, which                                                               
she read:                                                                                                                       
                                                                                                                                
     Where I have struggled  with the health care commission                                                                    
     is that the  recommendations that come out  of them are                                                                    
     not  useful.   I don't  say that  in a  negative sense.                                                                    
     It's  been at  the  50,000-foot level  and  if you  are                                                                    
     going to affect change in  health care for Alaskans, it                                                                    
     can't  be  at  the  50,000-foot level,  it  has  to  be                                                                    
     focused.   It  can't be,  "We  have to  reform the  way                                                                    
     payments are to  be made." That doesn't help  me.  It's                                                                    
     getting to  the specifics.   They are now  beginning to                                                                    
     dive  down   into  the  specifics  and   I  think  that                                                                    
     continued  involvement   with  them  will  lead   to  a                                                                    
     meaningful plan  going forward.   Medicaid needs  to be                                                                    
     part of that.   Medicaid is a big part  of your budget,                                                                    
     as well as  a big part of  my budget.  It's  how to get                                                                    
     to that,  how to narrow the  focus, how to do  a better                                                                    
     job.                                                                                                                       
                                                                                                                                
MS.  CURTIS directed  attention  to the  sunset  audit report  in                                                               
2016, and  reported that initially,  after this meeting  with the                                                               
commissioner in  Fairbanks, there  was momentum as  the committee                                                               
met  and discussed  a  shift  of focus  to  move  an action  plan                                                               
forward.  However,  as this initial momentum  dwindled, there was                                                               
no  significant progress  in the  development of  a plan  and the                                                               
commission was de-funded  on July 1, 2015, for FY16.   She shared                                                               
that  the  commission  had  been   part  of  the  budget  of  the                                                               
commissioner  of Department  of  Health and  Social Services,  so                                                               
that all the funding came through the regular budget cycle.                                                                     
                                                                                                                                
4:10:44 PM                                                                                                                    
                                                                                                                                
MS.  CURTIS  moved  on  to  page   22  of  the  2016  audit,  the                                                               
departmental  response to  the most  recent recommendation.   She                                                               
reported that  the audit conclusion  had been, as  the commission                                                               
was not  operating in the  public's interest and not  meeting its                                                               
statutory  purpose  to   develop  a  plan,  to   not  extend  the                                                               
commission.   She  shared that  Department of  Health and  Social                                                               
Services did  not agree  with this  conclusion and  had expressed                                                               
its disagreement that the legislature  had intended for an action                                                               
plan.  She added that the  department stated that they had agreed                                                               
to the prior audit, and they  were not in agreement with the need                                                               
for  an  actionable  plan.   She  stated  reaffirmation  for  the                                                               
recommendation  that  the commission  was  not  serving a  public                                                               
interest by  ensuring that  its good  work somehow  translated to                                                               
change.                                                                                                                         
                                                                                                                                
4:12:05 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SULLIVAN-LEONARD mused  that this  commission had                                                               
been formed  over many years,  utilizing a lot of  "time, energy,                                                               
and talent."   She opined  that although it was  unfortunate that                                                               
there was a recommendation to  not move forward, if something was                                                               
not working it should not be  funded.  She asked for any specific                                                               
reasons  to  this  loss  of  direction,  and  if  there  was  any                                                               
possibility for moving forward utilizing the accrued knowledge.                                                                 
                                                                                                                                
MS. CURTIS  offered her  belief that the  commission had  done "a                                                               
lot of excellent work and a  foundation has been laid."  She said                                                               
that it was necessary  to take it to the next  level to use those                                                               
recommendations for  change.  She  pointed out  that Commissioner                                                               
Streur [Department  of Health  and Social  Services] had  taken a                                                               
lot of  the accountability  during the  last audit  upon himself,                                                               
and that he  was "on-board" for helping  the department implement                                                               
those  recommendations.   She noted  that there  had also  been a                                                               
change in the administration.   She shared that during the budget                                                               
process, there  was a lot  of frustration from the  House Finance                                                               
Committee with  activities of  the commission.   She  offered her                                                               
belief that as the foundation  had been laid, continuation of the                                                               
commission was a possibility.  She  pointed out that there was an                                                               
ambiguity  in the  statute and  a lack  of clarity  for what  the                                                               
commission should be doing going  forward, all of which needed to                                                               
be clarified should the commission continue.                                                                                    
                                                                                                                                
4:14:26 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  JOHNSTON  asked  about the  overlap  between  the                                                               
Alaska  Health Care  Authority and  this  commission, the  Alaska                                                               
Health Care Commission.                                                                                                         
                                                                                                                                
4:14:57 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  GUTTENBERG, in  response,  said  that the  Alaska                                                               
Health Care  Commission was intended  to design an  overall state                                                               
health care plan;  whereas, the Alaska Health  Care Authority was                                                               
designed to bring  all the state and public  entities together to                                                               
figure a  way to coordinate  efforts for efficiencies of  pay and                                                               
larger pooling  for prescription drugs for  health care coverage.                                                               
He declared that  there was a significant  difference between the                                                               
two groups.                                                                                                                     
                                                                                                                                
4:16:18 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  JOHNSTON  asked  whether  this  included  overall                                                               
health efficiencies or was it just in purchasing power.                                                                         
                                                                                                                                
REPRESENTATIVE  GUTTENBERG opined  that "theoretically  one would                                                               
get you  the other."   He  explained that it  was not  an overall                                                               
health  care  plan, but  a  plan  to  better define  and  deliver                                                               
services.                                                                                                                       
                                                                                                                                
4:17:08 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SULLIVAN-LEONARD said  that  although she  valued                                                               
the work to  date, she failed to  see a plan in place  for how to                                                               
move forward.   She asked  if the  sponsor would consider  a one-                                                               
year  extension for  the commission,  in order  to return  with a                                                               
clear plan.                                                                                                                     
                                                                                                                                
4:18:00 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GUTTENBERG stated that  the department could speak                                                               
for  themselves  for  their  capability and  their  intent.    He                                                               
expressed   support  for   the  extension   as,  otherwise,   the                                                               
commission would need to be recreated.                                                                                          
                                                                                                                                
4:18:47 PM                                                                                                                    
                                                                                                                                
DEBORAH   ERICKSON,   Project    Coordinator,   Office   of   the                                                               
Commissioner, Department  of Health and Social  Services, offered                                                               
some background, noting that she  had been the Executive Director                                                               
of  the Alaska  Health Care  Commission  during the  time it  was                                                               
funded  and   active.    She  acknowledged   the  importance  for                                                               
maintaining  the  "ability to  bring  the  statute back  at  some                                                               
point."   She reported  that the  administration did  support the                                                               
proposed  bill,  and she  directed  attention  to the  letter  of                                                               
support   from  Commissioner   Davidson  [Included   in  members'                                                               
packets],  pointing  out that  Ms.  Davidson  had served  on  the                                                               
commission as the representative from the tribal health system.                                                                 
She shared  that the commission  had been established  through an                                                               
administrative order by former  Governor Palin, and subsequently,                                                               
the  legislature had  established  the commission  in statute  in                                                               
2010.  She stated that  there were 11 voting members representing                                                               
various  stakeholders,   all  of  whom  were   appointed  by  the                                                               
governor.  She added that  there were also three ex-officio seats                                                               
on the commission,  one each for the Office of  the Governor, the                                                               
House of  Representatives, and  the Senate.   She noted  that the                                                               
commission was first established  when the Patient Protection and                                                               
Affordable Care  Act (PPACA) had  just been passed, and  that the                                                               
commission  was most  likely  the  only body  in  the state  that                                                               
conducted  an analysis  of the  impact  of the  PPACA in  Alaska.                                                               
Subsequently,  in  each  following  year,  the  commission  would                                                               
report to the legislature on  the status of implementation of the                                                               
PPACA.  She reported that  the original vision for the commission                                                               
had been for improvement of health  and health care in the state,                                                               
with three  measurable directives  and eight core  strategies for                                                               
transforming the  health care system,  which included:   increase                                                               
price and quality transparency, pay  for value and move away from                                                               
fee  for  service  payment  structure,   increase  the  focus  on                                                               
prevention,  and engage  employers  to improve  health plans  and                                                               
employee  wellness.   She  reported that  within  the eight  core                                                               
strategies,   there   were   more   than   75   specific   policy                                                               
recommendations,   although  these   did  not   delve  into   the                                                               
operational  details for  implementation.   She  added that  each                                                               
year there was  a new study of  the current system to  add to the                                                               
body of knowledge.                                                                                                              
                                                                                                                                
4:26:13 PM                                                                                                                    
                                                                                                                                
MS.  ERICKSON reported  that the  commission had  contracted with                                                               
the Institute  of Social  and Economic Research  (ISER) to  do an                                                               
economic analysis  of health care  spending and health  care cost                                                               
drivers,  as well  as an  ISER  survey of  Alaskan employers  and                                                               
their health  benefit practices.   She added that  the commission                                                               
had  also  contracted  with  an actuarial  firm  for  a  detailed                                                               
actuarial   study  of   the  differences   between  pricing   and                                                               
reimbursement  for health  care  services in  Alaska compared  to                                                               
other states in the region.   She pointed out that the results of                                                               
these  studies were  still  requested.   She  mentioned that  the                                                               
commission did  produce an annual  report, as well  as testifying                                                               
to numerous committees and individual legislators.                                                                              
                                                                                                                                
4:27:55 PM                                                                                                                    
                                                                                                                                
MS. ERICKSON  directed attention  to the  fiscal note  and stated                                                               
that the  commission had ended  when the legislature  removed the                                                               
funding  after  the  last   election,  even  though  Commissioner                                                               
Davidson  [Department  of  Health   and  Social  Services]  still                                                               
actively supported  the work of  the commission.  She  noted that                                                               
deep  budget cuts  were impacting  direct services  to individual                                                               
Alaskans.    She  declared  that  both  the  department  and  the                                                               
administration did support  the proposed bill, with  an intent to                                                               
maintain the  commission statutory  authority.  Then,  should the                                                               
governor or the legislature deem  it necessary to re-activate the                                                               
commission, this could  be done quickly.  She  offered her belief                                                               
that as  the department  could not  support re-activation  of the                                                               
commission without  funding appropriated by the  legislature, the                                                               
department had  filed the zero-fiscal note  with an understanding                                                               
"to keep the commission on the books."                                                                                          
                                                                                                                                
4:30:45 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SULLIVAN-LEONARD asked  about a one-year extension                                                               
for the commission,  to allow for a clear established  plan to be                                                               
developed  for presentation  to the  legislature.   She suggested                                                               
that there  was a disconnect  between setting the policy  and the                                                               
planning aspect.                                                                                                                
                                                                                                                                
4:31:42 PM                                                                                                                    
                                                                                                                                
MS.  ERICKSON replied  that without  funding,  the Department  of                                                               
Health  and Social  Services did  not have  the resources  to put                                                               
that plan  together.  She  expressed her concern  that currently,                                                               
as there  were no members of  the commission, it would  take time                                                               
to recruit  appointments for  the new members.   She  pointed out                                                               
that it  had been more  than two  years since the  commission had                                                               
met,  and  it would  be  necessary  to  review the  prior  policy                                                               
recommendations  and  move  toward  development of  these.    She                                                               
opined  that one  year  would  not be  an  adequate  time to  re-                                                               
activate the  commission, and  that the  department would  not be                                                               
prepared to  re-activate unless the  legislature was  prepared to                                                               
fund  it  through  a  fiscal  note.    She  suggested  that  more                                                               
legislative  intent with  specific directions  to the  commission                                                               
would be helpful.                                                                                                               
                                                                                                                                
4:35:08 PM                                                                                                                    
                                                                                                                                
MS.  CURTIS  explained that  the  Division  of Legislative  Audit                                                               
conducted the sunset audit the  year before termination, hence, a                                                               
two-year extension would  be the minimum as  a one-year extension                                                               
would  mean the  audit would  have to  be performed  immediately,                                                               
which was not logistically possible.                                                                                            
                                                                                                                                
CHAIR SPOHNHOLZ asked if there  had ever been a similar extension                                                               
of authority for a commission without funding.                                                                                  
                                                                                                                                
REPRESENTATIVE GUTTENBERG replied that he did not remember any.                                                                 
                                                                                                                                
CHAIR  SPOHNHOLZ   reflected  that  there  were   several  highly                                                               
divergent paths for either a  re-envisioning of the commission to                                                               
better serve  the current needs,  or for  just keeping it  on the                                                               
books. She  pointed out that  the health  care budget was  a huge                                                               
driver in the  state economy, that "health care costs  are out of                                                               
control"  even though  costs alone  was  not the  solution.   She                                                               
added  that  individual  behaviors  and  quality  were  necessary                                                               
components.   She  stated that  she  was not  surprised that  the                                                               
commission  was not  able to  meet its  charges.   She questioned                                                               
whether thoughtful strategies for  addressing all the health care                                                               
issues should  be found for  the longer  term or should  there be                                                               
immediate  re-envisioning while  the  state  was addressing  huge                                                               
fiscal challenges.                                                                                                              
                                                                                                                                
4:37:55 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GUTTENBERG  suggested that the committee  read the                                                               
commission  reports  for the  core  strategies  from 2013,  which                                                               
included:    use  best available  evidence  in  decision  making,                                                               
increase  price  efficiency  and  transparency,  pay  for  value,                                                               
engage  employees in  approved health  care  plans and  wellness,                                                               
enhance  quality  and efficiencies  of  care  on the  front  end,                                                               
increase dignity and  quality of care for  serious and terminally                                                               
ill patients, build a foundation  of sustainable health care, and                                                               
focus  on prevention.  He emphasized  that  a lot  had been  done                                                               
prior.   He said that a  one-year extension was not  feasible and                                                               
that without funding, nothing would be accomplished.                                                                            
                                                                                                                                
4:40:14 PM                                                                                                                    
                                                                                                                                
JEANNIE MONK,  Vice President, Alaska State  Hospital and Nursing                                                               
Home Association  (ASHNHA) stated that ASHNHA  supported proposed                                                               
HB  234  and  the  effort   to  extend  the  Alaska  Health  Care                                                               
Commission.   She reported  that the  purpose of  the commission,                                                               
according  to   the  statute,  was  very   high  level:  "provide                                                               
recommendations for  and foster the development  of the statewide                                                               
plan  to  address  quality, accessibility,  and  availability  of                                                               
health care for  all citizens."  She noted that  the Alaska State                                                               
Hospital  and Nursing  Home  Association was  one  of the  voting                                                               
members on the past commissions,  and she offered her belief that                                                               
there was  value for  maintaining the  commission in  statute and                                                               
having it  available as a  policy tool.   She stated  support for                                                               
the comments related to re-envisioning  the commission.  Although                                                               
the Alaska  State Hospital and  Nursing Home Association  did not                                                               
always agree with  the positions taken by the  commission or with                                                               
all the  topics chosen  for study, it  supported the  process and                                                               
the  discussions whereby  the stakeholders  could come  together.                                                               
She declared that there was  potential for the commission to play                                                               
a role in the future development  of health care policy, and that                                                               
an extension of the sunset date  may make it possible to use this                                                               
structure without having to recreate the commission.                                                                            
                                                                                                                                
REPRESENTATIVE JOHNSTON  asked if  this commission had  offered a                                                               
forum  for  major health  issues  that  had not  been  previously                                                               
available.                                                                                                                      
                                                                                                                                
MS. MONK replied  that it was a forum to  bring together multiple                                                               
sectors of the health care industry for discussion.                                                                             
                                                                                                                                
REPRESENTATIVE JOHNSTON  asked if  this forum was  more conducive                                                               
when trying to meet the same goals for improving health care.                                                                   
                                                                                                                                
MS. MONK replied  that the environment was  very different today,                                                               
as six years ago there  had been very little statewide discussion                                                               
about  health  care, costs,  and  services.    Now, there  was  a                                                               
tremendous amount of  discussion, which she opined  was driven by                                                               
fiscal issues.   She  offered her  belief that  the focus  of the                                                               
health care commission could be  different today.  In response to                                                               
Representative   Johnston,  she   said  that   the  health   care                                                               
commission focused  on the entire  health care system,  where the                                                               
health care authority had a much more limited scope.                                                                            
                                                                                                                                
4:45:22 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ announced that HB 234 would be held over.                                                                       
                                                                                                                                
          HB 236-EXTEND SENIOR BENEFITS PAYMENT PROGRAM                                                                     
                                                                                                                                
4:45:37 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ announced that the final order of business would                                                                
be HOUSE BILL NO. 236, "An Act extending the Alaska senior                                                                      
benefits payment program."                                                                                                      
                                                                                                                                
4:46:34 PM                                                                                                                    
                                                                                                                                
MERCEDES  COLBERT, Staff,  Representative Scott  Kawasaki, Alaska                                                               
State  Legislature,  paraphrased   from  the  Sponsors  Statement                                                               
[included in  members' packets] which  read as  follows [original                                                               
punctuation provided]:                                                                                                          
                                                                                                                                
     House  Bill  236  would   extend  the  Senior  Benefits                                                                    
     Program sunset  clause to  2022, ensuring  another four                                                                    
     years of support for low  income seniors across Alaska.                                                                    
     Without action, the program would end in 2018.                                                                             
                                                                                                                                
     The   Senior  Benefits   Program  protects   low-income                                                                    
     seniors by  providing them with modest  cash assistance                                                                    
     to pay  for expenses  like food,  heating, electricity,                                                                    
     transportation and prescription medication.                                                                                
                                                                                                                                
     The  program  was  established in  2007  and  currently                                                                    
     provides assistance  to nearly 12,000 Alaskans  ages 65                                                                    
     and older with incomes at  75 percent, 100 percent, and                                                                    
     175 percent  of the  federal poverty  level. Assistance                                                                    
     ranges from  $47 to $250  a month for  eligible seniors                                                                    
     depending on  income and the size  of the appropriation                                                                    
     from the Alaska State  Legislature. The Senior Benefits                                                                    
     Program is  a successor  to the Longevity  Bonus, which                                                                    
     was created in 1972.                                                                                                       
                                                                                                                                
     This important program protects  seniors who have spent                                                                    
     a lifetime building  this state. It lends  a small hand                                                                    
     to low-income seniors who need  assistance to help make                                                                    
     ends   meet.  Terminating   this   program  would   put                                                                    
     thousands of  seniors at risk  for losing means  to buy                                                                    
     essential  items necessary  for  maintaining a  healthy                                                                    
     lifestyle.                                                                                                                 
                                                                                                                                
4:49:00 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SULLIVAN-LEONARD asked if there was a different                                                                  
process for new applicants to this benefit.                                                                                     
                                                                                                                                
REPRESENTATIVE   SCOTT   KAWASAKI,  Alaska   State   Legislature,                                                               
acknowledged that the number of  beneficiaries was not static, as                                                               
people moved,  died, or  decided they did  not want  the benefit.                                                               
He said  the same amount had  been budgeted for the  last several                                                               
years, about  $20 million.   He said that sometimes  the payments                                                               
would  take  a  different  effect   relative  to  the  number  of                                                               
recipients.                                                                                                                     
                                                                                                                                
4:50:46 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SULLIVAN-LEONARD  asked if anyone could  apply and                                                               
whether there was an open enrollment period.                                                                                    
                                                                                                                                
4:51:42 PM                                                                                                                    
                                                                                                                                
MONICA WINDOM,  Director, Director's  Office, Division  of Public                                                               
Assistance,  Department of  Health  and  Social Services  (DHSS),                                                               
said that  an individual could  apply at  any time and  there was                                                               
not a specific enrollment period.                                                                                               
                                                                                                                                
4:52:34 PM                                                                                                                    
                                                                                                                                
KEN  HELANDER, Advocacy  Director, AARP,  stated support  for the                                                               
continuation  of the  senior benefit  program, pointing  out that                                                               
the program would sunset next year  if not extended.  He reported                                                               
that his  office had  received many calls  from seniors  who were                                                               
dependent on  the benefit from  this program.  He  explained that                                                               
these  people  were not  able  to  supplement their  already  low                                                               
incomes  with a  part  time  job, and  "really  have very  little                                                               
capacity  to cut  expenses by  being more  frugal."   He declared                                                               
that these were  "people who are living on the  edge ... and they                                                               
were struggling  in independent situations,  not wanting  to have                                                               
to  leave home,  have to  go  into a  higher level  of care  that                                                               
ultimately  will cost  the  state  a great  deal  more money  per                                                               
person than these small benefits do."   He reported that the AARP                                                               
policy  was that  state resources  should  go, even  in times  of                                                               
scarcity, to the people who  were most vulnerable and most needy.                                                               
He added  that this program was  part of the safety  net that the                                                               
community depended upon.                                                                                                        
                                                                                                                                
4:55:27 PM                                                                                                                    
                                                                                                                                
DAVID  BLACKETER, Chair,  Alaska Commission  on Aging,  said that                                                               
all the previous comments and testimony  had "been right on."  He                                                               
declared support  for proposed  HB 236.   He  shared some  of his                                                               
personal  expenses and  difficulties  to make  ends meet,  adding                                                               
that there was "very little  cushion" for life spending and minor                                                               
emergencies.   He pointed  out that low  income people  in Alaska                                                               
were similar to the state,  both had reduced income and increased                                                               
bills.    He acknowledged  that  there  was belt  tightening  but                                                               
emphasized that  "we're down to  the end of  the belt."   He said                                                               
that  this help  was  very  much needed,  and  he strongly  urged                                                               
passage of proposed HB 236.                                                                                                     
                                                                                                                                
4:58:43 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ announced that HB 236 would be held over.                                                                       
                                                                                                                                
4:59:18 PM                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no  further business before the  committee, the House                                                               
Health  and  Social  Services   Standing  Committee  meeting  was                                                               
adjourned at 4:59 p.m.                                                                                                          

Document Name Date/Time Subjects
HB234 Supporting Document Chapter 18.09 Health Care Commission Statute.pdf HHSS 4/25/2017 3:00:00 PM
HHSS 4/27/2017 3:00:00 PM
HHSS 5/4/2017 3:00:00 PM
HB 234
HB234 Supporting Document-AHCC Annual Report 2014.pdf HHSS 4/25/2017 3:00:00 PM
HHSS 4/27/2017 3:00:00 PM
HHSS 5/4/2017 3:00:00 PM
HB 234
HB234 Supporting Document-AHCC-Audit 2013.pdf HHSS 4/25/2017 3:00:00 PM
HHSS 4/27/2017 3:00:00 PM
HHSS 5/4/2017 3:00:00 PM
HB 234
HB234 Supporting Document-AHCC-Final-Report-Audit 2017.pdf HHSS 4/25/2017 3:00:00 PM
HHSS 4/27/2017 3:00:00 PM
HHSS 5/4/2017 3:00:00 PM
HB 234
HB 234 ver A 4.17.17.pdf HHSS 4/25/2017 3:00:00 PM
HHSS 4/27/2017 3:00:00 PM
HHSS 5/4/2017 3:00:00 PM
HB 234
HB234 Sponsor Statement 4.17.17.pdf HHSS 4/25/2017 3:00:00 PM
HHSS 4/27/2017 3:00:00 PM
HHSS 5/4/2017 3:00:00 PM
HB 234
HB234 Fiscal Note DHSS--DSS 4.25.17.pdf HHSS 4/25/2017 3:00:00 PM
HHSS 4/27/2017 3:00:00 PM
HHSS 5/4/2017 3:00:00 PM
HB 234
HB234 Supporting Document-Support Letter 4.24.17.pdf HHSS 4/25/2017 3:00:00 PM
HHSS 4/27/2017 3:00:00 PM
HHSS 5/4/2017 3:00:00 PM
HB 234
HB234 Supporting Document Office of the Governor_ Administrative Order 246.pdf HHSS 4/25/2017 3:00:00 PM
HHSS 4/27/2017 3:00:00 PM
HHSS 5/4/2017 3:00:00 PM
HB 234
HB 236 ver A.PDF HHSS 4/25/2017 3:00:00 PM
HHSS 4/27/2017 3:00:00 PM
HHSS 5/4/2017 3:00:00 PM
HHSS 9/28/2017 2:00:00 PM
HHSS 2/6/2018 3:00:00 PM
HB 236
HB236 Sponsor Statement.pdf HHSS 4/25/2017 3:00:00 PM
HHSS 4/27/2017 3:00:00 PM
HHSS 5/4/2017 3:00:00 PM
HHSS 2/6/2018 3:00:00 PM
HB 236
HB236 Supporting Documents AARP Letter Support.pdf HHSS 4/25/2017 3:00:00 PM
HHSS 4/27/2017 3:00:00 PM
HHSS 5/4/2017 3:00:00 PM
HHSS 9/28/2017 2:00:00 PM
HHSS 2/6/2018 3:00:00 PM
HB 236
HB236 Supporting Documents Alaska Commission on Aging.pdf HHSS 4/25/2017 3:00:00 PM
HHSS 4/27/2017 3:00:00 PM
HHSS 5/4/2017 3:00:00 PM
HHSS 9/28/2017 2:00:00 PM
HHSS 2/6/2018 3:00:00 PM
HB 236
HB236 Supporting Documents Arneson Support Letter.pdf HHSS 4/25/2017 3:00:00 PM
HHSS 4/27/2017 3:00:00 PM
HHSS 5/4/2017 3:00:00 PM
HHSS 9/28/2017 2:00:00 PM
HHSS 2/6/2018 3:00:00 PM
HB 236
HB236 Supporting Documents Senior Benefits Program Fact Sheet.PDF HHSS 4/25/2017 3:00:00 PM
HHSS 4/27/2017 3:00:00 PM
HHSS 5/4/2017 3:00:00 PM
HHSS 2/6/2018 3:00:00 PM
HB 236