Legislature(2019 - 2020)DAVIS 106

03/17/2020 03:00 PM HEALTH & SOCIAL SERVICES

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

Document Name Date/Time Subjects
HB 255 Sponsor Statement 3.3.20.pdf HHSS 3/17/2020 3:00:00 PM
HB 255
HB 255 Sectional Analysis 3.3.20.pdf HHSS 3/17/2020 3:00:00 PM
HB 255
HB 255 version A.PDF HHSS 3/17/2020 3:00:00 PM
HB 255
HB 255 Fiscal Note HSS.pdf HHSS 3/17/2020 3:00:00 PM
HB 255
HB 255 Supporting Documents.pdf HHSS 3/17/2020 3:00:00 PM
HB 255
HB 267 ver.S Work Draft.pdf HHSS 3/17/2020 3:00:00 PM
HB 267
HB 267 ver.S Sponsor Statement.pdf HHSS 3/17/2020 3:00:00 PM
HB 267
HB 267 ver.S Sectional Analysis.pdf HHSS 3/17/2020 3:00:00 PM
HB 267
HB 267 Summary of Changes Version U to Version S.pdf HHSS 3/17/2020 3:00:00 PM
HB 267
HB 267 Fiscal Note DCCED.pdf HHSS 3/17/2020 3:00:00 PM
HB 267
HB 267 Handout_Patient Implications Brief.pdf HHSS 3/17/2020 3:00:00 PM
HB 267
HB 267 Handout_State STLD Policies.pdf HHSS 3/17/2020 3:00:00 PM
HB 267
HB 267 Handout_STLD Plans Offered in Alaska.pdf HHSS 3/17/2020 3:00:00 PM
HB 267
Christopher Gay Resume_Redacted.pdf HHSS 3/17/2020 3:00:00 PM
Governor's Appointees to State Medical Board
State Medical Board Sarah Bidelow Hood.pdf HHSS 3/17/2020 3:00:00 PM
Governor's Appointees to State Medical Board
HB 255 PPT.pdf HHSS 3/17/2020 3:00:00 PM
HB 255
HB 267 ver.S PowerPoint.pdf HHSS 3/17/2020 3:00:00 PM
HB 267
HB 255 Supporting Document- CBPP Factsheet on Workers 3.17.20.pdf HHSS 3/17/2020 3:00:00 PM
HB 255